Positive psychological well-being (PPWB), especially optimism, protects against the incidence, and somewhat against the progression, of cardiovascular disease (CVD) through a broad array of mechanisms, according to this extensive literature review.

The relationship between mental and physical health is well-known but more attention has been paid to the impact of negative psychological states, (e.g., depression, anxiety, stress, etc.) on health. Here, the authors note that “the absence of the negative” is not the same as the “presence of the positive.” This qualitative review focuses on the association between CVD and the presence of various measures of PPWB, including optimism, hedonic well-being (generally defined as “happiness”) and eudaimonic well-being (based on elements such as life purpose, growth, acceptance, etc.). The review also looked for evidence of the underlying mechanisms between PPWB and CVD.

Key Findings:

• Evidence indicates that PPWB and CVD are associated, independent of typical factors (e.g., socioeconomic status, smoking, body mass index, cholesterol) and negative psychological states, and based on studies of both patients and healthy populations.
• PPWB appears to protect against both the incidence of CVD and, to a lesser extent, the progression of the disease.
• Optimism seems to be the “most robust” measure of PPWB associated with reducing risks of CVD.
• The mechanisms that link PPWB and CVD seem to include direct, biological pathways; indirect, behavioral pathways; restorative processes, such as sleep and antioxidants; and deteriorative processes, such as inflammation and smoking.

There are significant gaps in the research, including little study of the direction of the association between health behaviors and PPWB, or of how the various types of PPWB impact health. But this review suggests that interventions to protect cardiovascular health are best aimed at “bolstering psychological strengths,” as opposed to repairing deficits.

This study is one in a series supported by the Robert Wood Johnson Foundation’s Pioneer Portfolio to explore Positive Health, an emerging concept that seeks to demonstrate that in addition to health risks, people also have health assets, which can be strengthened to produce a healthier life. These health assets could include biological factors, such as high heart rate variability; subjective factors, such as optimism; and functional factors, such as a stable marriage.