Cited by 334Cardiac Health and Mental HealthCardiovascular Health and Risk FactorsPsychological Well-being and Life Satisfaction

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Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey

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Davidson, K. W., Mostofsky, E., Whang, W.·2010·European Heart Journal

DOI 10.1093/eurheartj/ehp603PMC PMC2862179

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Abstract

AIMS: Positive affect is believed to predict cardiovascular health independent of negative affect. We examined whether higher levels of positive affect are associated with a lower risk of coronary heart disease (CHD) in a large prospective study with 10 years of follow-up. METHODS AND RESULTS: We examined the association between positive affect and cardiovascular events in 1739 adults (862 men and 877 women) in the 1995 Nova Scotia Health Survey. Trained nurses conducted Type A Structured Interviews, and coders rated the degree of outwardly displayed positive affect on a five-point scale. To test that positive affect predicts incident CHD when controlling for depressive symptoms and other negative affects, we used as covariates: Center for Epidemiological Studies Depressive symptoms Scale, the Cook Medley Hostility scale, and the Spielberger Trait Anxiety Inventory. There were 145 (8.3%) acute non-fatal or fatal ischaemic heart disease events during the 14 916 person-years of observation. In a proportional hazards model controlling for age, sex, and cardiovascular risk factors, positive affect predicted CHD (adjusted HR, 0.78; 95% CI 0.63-0.96 per point; P = 0.02), the covariate depressive symptoms continued to predict CHD as had been published previously in the same patients (HR, 1.04; 95% CI 1.01-1.07 per point; P = 0.004) and hostility and anxiety did not (both P > 0.05). CONCLUSION: In this large, population-based study, increased positive affect was protective against 10-year incident CHD, suggesting that preventive strategies may be enhanced not only by reducing depressive symptoms but also by increasing positive affect.

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BackgroundResult
Reduced positive affect (anhedonia) is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: results from the RESEARCH registry
Damen, N. L., Pelle, A. J. M., Boersma, E. H., Serruys, P. W. J. C., van Domburg, R. T., & Pedersen, S. S. (2012) · European Journal of Preventive Cardiology · doi:10.1177/2047487312436452 · Cited by 41
Money, Age and Happiness: Association of Subjective Wellbeing with Socio-Demographic Variables
Vera-Villarroel, P., Celis-Atenas, K., Pavez, P., Lillo, S., Bello, F., Díaz, N., & Lopez, W. (2012) · Americanae (AECID Library) · doi:10.14349/rlp.v44i2.1039 · Cited by 41
Psychological Well-being’s Link with Cardiovascular Health in Older Adults
Boehm, J. K., Soo, J., Chen, Y., Zevon, E. S., Hernandez, R., Lloyd-Jones, D., & Kubzansky, L. D. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.06.028 · Cited by 37
Return to Work after Percutaneous Coronary Intervention: The Predictive Value of Self-Reported Health Compared to Clinical Measures
Biering, K., Nielsen, T. T., Rasmussen, K., Niemann, T., & Hjøllund, N. H. (2012) · PLoS ONE · doi:10.1371/journal.pone.0049268 · Cited by 38
“Anxiety and depression has previously been found associated with RTW after heart disease [27,36] and recent work has suggested a close relationship between negative emotions/distressed personality and the risk of incident heart disease as well as poor prognosis [37–40].”
Background
Positivity impairment as a broad-based feature of social anxiety.
Gilboa‐Schechtman, E., Shachar, I., & Sahar, Y. (2014) · The Wiley Blackwell Handbook of Social Anxiety Disorder · doi:10.1002/9781118653920.ch19 · Cited by 36
Social integration and pulmonary function in the elderly.
Crittenden, C. N., Pressman, S. D., Cohen, S., Janicki‐Deverts, D., Smith, B. W., & Seeman, T. E. (2014) · Health Psychology · doi:10.1037/hea0000029 · Cited by 37
The crossroads of magic and wellbeing: A review of wellbeing-focused magic programs, empirical studies, and conceivable theories
Bagienski, S., & Kuhn, G. (2019) · International Journal of Wellbeing · doi:10.5502/ijw.v9i2.740 · Cited by 42
Which Aspects of Positive Affect Are Related to Mortality? Results From a General Population Longitudinal Study
Petrie, K. J., Pressman, S. D., Pennebaker, J. W., Øverland, S. N., Tell, G. S., & Sivertsen, B. (2018) · Annals of Behavioral Medicine · doi:10.1093/abm/kax018 · Cited by 39
“There is also strong supporting evidence from the general population and cardiovascular literature that positive affect seems to play a particularly important prognostic role in predicting mortality from coronary heart disease [19, 37, 38].”
Background
Within-person increase in pathological worry predicts future depletion of unique executive functioning domains
Zainal, N. H., & Newman, M. G. (2020) · Psychological Medicine · doi:10.1017/s0033291720000422 · Cited by 38
Complementary Spiritist Therapy: Systematic Review of Scientific Evidence
Lucchetti, G., Lucchetti, A. L. G., Bassi, R. M., & Nobre, M. R. S. (2011) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2011/835945 · Cited by 39
“Furthermore, positive affect was related to fewer cardiovascular events in healthy adults [87] and in patients following percutaneous coronary intervention (PCI) [88] and to lower risk for frailty [89, 90], lower incidence of compromised activities of daily living in the elderly [91], improved performance-based functi…”
Background
Joint exposure to positive affect, life satisfaction, broad depression, and neuroticism and risk of cardiovascular diseases: A prospective cohort study
Sun, Y. B., Zhang, H., Wang, B., Chen, C., Chen, Y., Chen, Y., Xia, F., Tan, X. W., Zhang, J., Li, Q., et al. (2022) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2022.08.007 · Cited by 36
Positive affect, anhedonia, and compliance with self-care in patients with chronic heart failure
Kessing, D., Pelle, A. J. M., Kupper, N. H. M., Szabó, B. M., & Denollet, J. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.08.007 · Cited by 35
“, mood states such as feeling active, joy or cheerful) but preliminary evidence suggests that positive affect may be associated with enhanced cardiovascular health [10–12], healthy lifestyle (e.”
Background
A Neurocomputational Model for Intrinsic Reward
Chew, B., Blain, B., Dolan, R. J., & Rutledge, R. B. (2021) · Journal of Neuroscience · doi:10.1523/jneurosci.0858-20.2021 · Cited by 40
“, 2015) and have a lower risk of disease (Davidson et al., 2010).”
Background
Positive affect is not associated with incidence of cardiovascular disease: A population-based study of older persons
Freak‐Poli, R., Mirza, S. S., Franco, O. H., Ikram, M. A., Albert Hofman, D., & Tiemeier, H. W. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.01.032 · Cited by 32
“, 2001), socioeconomic position (Davidson et al., 2010) and marital status (Davidson et al.”
BackgroundInfluential
Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients
Stewart, J. C., Hawkins, M. A. W., Khambaty, T., Perkins, A. J., & Callahan, C. M. (2016) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000315 · Cited by 32
Observed Hostility and the Risk of Incident Ischemic Heart Disease
Newman, J. D., Davidson, K. W., Shaffer, J. A., Schwartz, J. E., Chaplin, W. F., Kirkland, S., & Shimbo, D. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.04.044 · Cited by 32
“However, the results of prior studies suggest that personality characteristics such as hostility and positive affect are stable over time (21,40).”
InfluentialSelf-citation
Association of dispositional optimism with Life’s Simple 7’s Cardiovascular Health Index: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (SCAS)
Hernandez, R., González, H. M., Tarraf, W., Moskowitz, J. T., Carnethon, M. R., Gallo, L. C., Penedo, F. J., Isasi, C. R., Ruiz, J. M., Arguelles, W., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019434 · Cited by 34
“30 For example, in a large prospective population-based study (n=1739) with 10 years of follow-up, each unit increase in positive emotion resulted in a 22% lower incidence rate of coronary heart disease, independent of demographic factors, traditional risk factors and negative emotion.(31) A 2012 systematic review by…”
Background
Happiness and Sustainability Together at Last! Sustainable Happiness.
O’Brien, C. (2013) · Canadian Journal of Education / Revue canadienne de l éducation · Cited by 31
El Rol Predisponente del Optimismo: Hacia un Modelo Etiológico del Bienestar
Vera-Villarroel, P., Pávez, P., & Silva, J. (2012) · Terapia psicológica · doi:10.4067/s0718-48082012000200008 · Cited by 36
“A pesar de la evidencia señalada anteriormente, según Davidson et al. (2010), existe aún poca información de los mecanismos y variables relacionadas en los procesos de felicidad, optimismo y afectos positivos, como escaso consenso acerca de los mecanismos psicológicos y/o fisiológicos en los…”
Background
vmPFC activation during a stressor predicts positive emotions during stress recovery
Yang, X., Garcia, K. M., Jung, Y., Whitlow, C. T., McRae, K., & Waugh, C. E. (2018) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsy012 · Cited by 36
“In a large Nova Scotian sample, researchers found increased positive emotions protective against 10 year incident coronary heart disease (Davidson et al., 2010).”
Background
Cardiovascular Effects of Acute Positive Emotional Arousal
Lackner, H. K., Weiss, E. M., Hinghofer-Szalkay, H. G., & Papousek, I. (2013) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-013-9235-4 · Cited by 31
Emotional states and future risk of venous thromboembolism
Brækkan, S. K., Hansen-Krone, I. J., Hansen, J., & Enga, K. F. (2012) · Thrombosis and Haemostasis · doi:10.1160/th11-09-0667 · Cited by 32
Atherosclerosis in coronary artery and aorta in a semi-urban population by applying modified American Heart Association classification of atherosclerosis: An autopsy study
Thej, M. J., Kalyani, R., & Kiran, J. (2012) · Journal of Cardiovascular Disease Research · doi:10.4103/0975-3583.102692 · Cited by 30
“[7] Early implementation of anti-atherosclerotic measures can help prevent the development of these raised lesions and future CHD.”
BackgroundInfluential
Is Positive Affect Associated With Survival? A Population-based Study of Elderly Persons
Krijthe, B. P., Walter, S., Newson, R. S., Albert Hofman, D., Hunink, M. G. M., & Tiemeier, H. W. (2011) · American Journal of Epidemiology · doi:10.1093/aje/kwr012 · Cited by 30
Group singing improves both physical and psychological wellbeing in people with and without chronic health conditions: A narrative review
Campbell, Q., Bodkin-Allen, S., & Swain, N. (2021) · Journal of Health Psychology · doi:10.1177/13591053211012778 · Cited by 34
“Physical health and wellness have been shown to have a correlation with mental wellbeing (Boehm et al., 2011; Davidson et al., 2010; Farivar et al., 2007; Okely and Gale, 2016).”
Background
The temporal dynamics of cognitive reappraisal: Cardiovascular consequences of downregulation of negative emotion and upregulation of positive emotion
Pavlov, S. V., Reva, N. V., Валерьевич, Л. К., Tumyalis, A. V., Викторович, К. В., & Aftanas, L. I. (2013) · Psychophysiology · doi:10.1111/psyp.12159 · Cited by 30
Being “in” or “out” of the game: subjective and acoustic reactions to exclusion and popularity in social anxiety
Gilboa‐Schechtman, E., Galili, L., Sahar, Y., & Amir, O. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00147 · Cited by 30
“Relatedly, positive affect experienced in response to social acceptance is likely to strengthen one’s psychological resilience (Fredrickson et al., 2003), to promote physical health (e.g., Davidson et al., 2010; Boehm and Kubzansky, 2012), and to increase longevity (Xu and Roberts, 2010).”
BackgroundInfluential
Positive mental health in schizophrenia and healthy comparison groups: relationships with overall health and biomarkers
Edmonds, E. C., Martin, A. S., Palmer, B. W., Eyler, L. T., Rana, B. K., & Jeste, D. V. (2018) · Aging & Mental Health · doi:10.1080/13607863.2016.1251572 · Cited by 27

Authors: Davidson, K. W., Mostofsky, E., & Whang, W.
Affiliations: Columbia University Irving Medical Center (US)
Corresponding author: Davidson, K. W.
ORCID: Davidson, K. W.
Whang, W.
Venue: European Heart Journal
Publisher: Oxford University Press (OUP)
Published: 2010-02-17
Volume: 31
Issue: 9
Pages: 1065-1070
ISSN: 0195-668X (ISSN-L)
1522-9645
DOI: 10.1093/eurheartj/ehp603
PMC: PMC2862179
OpenAlex: W2168019533
Cited by: 334
References: 44
Citations by year: 2026: 8 · 2025: 15 · 2024: 11 · 2023: 15 · 2022: 22 · 2021: 18 · 2020: 19 · 2019: 24 · 2018: 23 · 2017: 27 · 2016: 31 · 2015: 21 · 2014: 20 · 2013: 21 · 2012: 28
FWCI: 17.78
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: European Heart Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Columbia Academic Commons (Columbia University)
Funders: Heart and Stroke Foundation of Canada
National Institutes of Health (n01hc25197-0-0-0, RR024156)
National Heart, Lung, and Blood Institute (HC25197, R24HL076857, K24HL084034, R01HL080665, K23HL004458, HL088117, HL04458, HL-084034, HL-076857, N01 HC025197, HL-080665, P01HL088117)
National Center for Research Resources (UL1RR024156)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
Keywords: positive affect, coronary artery disease, depressive symptoms, hostility, trait anxiety, cardiovascular risk, ischemic heart disease, emotional well-being, cardiovascular disease prevention
MeSH terms: Adult, Aged, Antidepressive Agents, Anxiety, Coronary Disease, Depressive Disorder, Female, Hostility, Humans, Male, Middle Aged, Nova Scotia, Risk Factors, Incidence, Young Adult

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Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey

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