Researchers have made great strides in developing drugs and technologies to improve heart health, but the key to a healthy ticker may be far simpler.
Positive psychological well-being, which includes things like happiness, life satisfaction and especially optimism, may help protect against heart attacks, stroke and other cardiovascular problems, according to a new scientific review.
"The field of medicine so often focuses on dysfunction and disease," said Julia Boehm, a postdoctoral research fellow at the Harvard School of Public Health and co-author of the new report, published online Tuesday in the journal Psychological Bulletin.
"Health is more than the absence of disease," Boehm continued. "So we looked at the positive side of things -- how optimism and happiness might protect against cardiovascular disease."
To do so, Boehm and her colleagues reviewed more than 200 studies from the last several decades looking at positive psychological well-being and heart health. Similar reviews have focused on the role that "ill-being," or conditions like depression and anxiety, can have on the heart. But the authors say their study is the first to focus specifically on the role that happiness and optimism might play.
"This paper gives us a picture that there is a large amount of association," said Dr. James Kirkpatrick, an assistant professor at the Hospital of the University of Pennsylvania who was not involved with the study. He cautioned that the review does not establish causality and is not a true meta-analysis -- a systematic method of comparing the results of multiple, independent studies -- because the 200 studies were so different in design.
"The question is, what do you do with that?" Kirkpatrick asked.
One goal of the new review is to begin to unpack how well-being and heart health are related.
The evidence suggests that people who are happy and optimistic are more likely to engage in healthy behaviors, like doing physical activity, eating healthy foods and getting enough sleep. It also shows an association between positivity and measurable biological factors, like lower blood pressure and healthier lipid profiles.
But the various studies do not reveal whether happiness or healthy behaviors come first. It could be that happier, more positive people are more likely to engage in healthy behaviors, which in turn improves factors like blood pressure. It could also be that engaging in healthy behaviors and having a better biological profile helps boost psychological well-being.
"Looking at the temporal order of those associations is really important," said Boehm, who hopes to address such issues in future research.
The current evidence, Boehm added, is not at the point at which experts should, or even can, suggest specific strategies to help maintain and enhance psychological well-being among their patients. But she believes it does signal an important area to explore, particularly given the burden of cardiovascular problems in the nation. The Centers for Disease Control and Prevention estimates that heart disease causes one in four deaths in the United States, while someone has a stroke every 40 seconds.
"This opens up an interesting opportunity for cardiologists to begin to look at the things that one could do to improve psychological well-being and to impact global risk," said Dr. Richard Stein, a spokesman for the American Heart Association and professor of cardiology at the New York University School of Medicine.
"The questions now are, 'Are the instruments used to measure [well-being] ready for prime time?" he asked. "And if they are, are there behavioral, cognitive strategies that one could implement?'"