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Psychological well-being linked to better cardiovascular outcomes

Doctors should have patient-centred discussions on how to promote psychological well-being

Louise Prime

Tuesday, 11 September 2018

Patients can achieve better overall cardiovascular outcomes when they maintain positive thoughts and feelings through intervention programmes, according to a new review* published in the Journal of the American College of Cardiology. The authors, led from Northwestern University Feinberg School of Medicine in the US, said psychological well-being influences heart health through biological processes, health behaviours and psychosocial resources.

They considered how social environment, psychological well-being and the effectiveness of intervention strategies can help to strengthen a patient’s outlook, and focused on published research into whether or not psychological well-being is consistently associated with a reduced risk of cardiovascular disease.

For the review, they defined cardiovascular health in two parts: health behaviours (covering healthy diet, physical activity, smoking status and body mass index (BMI); and health factors (including favourable blood pressure, total cholesterol and glucose).

They cited prospective studies that have reported positive associations between optimism and heart disease, including one from 2017 that reported that women with scores in the highest quartile for optimism had a relatively 38% lower risk of mortality from heart disease; and other studies, published since 2012, that reported a lower relative risk of stroke among participants with “perceived higher purpose in life”.

Studies showed that patients with higher scores for optimism were less likely 12 months later to be current smokers; and that high levels of psychological well-being were associated with regular physical activity. Optimistic patients sustained healthier diets by consuming more fruits and vegetables, and less processed meats and sweets, helping them to maintain a healthy BMI.

The review authors said the studies they analysed showed that psychological well-being influenced heart health through biological processes, health behaviours and psychosocial resources.

They commented: “Optimists persevere by using problem-solving and planning strategies to manage stressors. [Whereas if] others are faced with factors out of their control, they begin to shift their goals and use potentially maladaptive coping strategies, which would ultimately result in raising inflammation levels and less favourable overall heart health.”

The reviewers also reported evidence that when patients have a strong network of social support this gives them confidence about their future health and helps them act readily on medical advice, engage in problem solving and take active preventive measures. They noted that a probable link is that favourable social environment, which is known to influence heart disease risk, has also been shown to predict psychological well-being.

The review authors commented that intervention programmes might strengthen psychological well-being. They pointed out that mindfulness programmes have been shown to improve anxiety, quality of life, smoking cessation, healthy eating and more; and that yoga and tai chi, which are often incorporated in mindfulness-based interventions, have improved outcomes in heart failure patients and lowered blood pressure. Furthermore, life purpose programmes for palliative care patients have led to improvements in mental health, distress from physical symptoms and overall well-being.

They concluded: “It may seem challenging to help patients modify psychological well-being in the face of a new medical diagnosis, but these events can represent a ‘teachable moment’. Just having patient-centred discussions surrounding sources of psychological well-being and information about specific activities to promote well-being are a small, but meaningful, part of a patient’s care.”

*Kubzansky LD, Huffman JC, Boehm JK, et al. Positive psychological well-being and cardiovascular disease. Journal of the American College of Cardiology Sep 2018, 72 (12) 1382-1396; DOI: 10.1016/j.jacc.2018.07.042

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