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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“Thus, overall there is evidence suggesting that general psychological wellbeing and positive affectivity are associated with a reduced risk of IHD [14,16], though results are somewhat inconsistent regarding differences between men and women (possibly due to different study samples, designs, and operationalizations of…”
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The Effect of Positive Management Practices on Firm Profitability – Evidence from Text Mining
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“More recent studies even found that positive emotions are associated with a lower risk of heart disease and lower functional limitations (Davidson et al., 2010; Wiese et al., 2019).”
Background
Association between stress and eating behaviour among Malaysian adolescents prior to examination
Jalaluddin, N. M. S. N. A. M. Y., Aghamohammadi, N., Thangiah, N., Ng, A. K., & Majid, H. A. (2023) · Scientific Reports · doi:10.1038/s41598-023-34699-3 · Cited by 11
Associations between positive emotional well-being and stress-induced myocardial ischemia
Feigal, J. P., Boyle, S. H., Samad, Z. Z., Velazquez, E. J., Wilson, J. L., Becker, R. C., Williams, R. B., Kuhn, C. M., Ortel, T. L., Rogers, J. G., et al. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.11.012 · Cited by 11
Is sleep apnea a potential link between major depressive disorder and cardiovascular disease?
Ehrmann, D. E., Deldin, P. J., & Pitt, B. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.10.106 · Cited by 11
“The link between Major Depressive Disorder (MDD) and Cardiovascular Disease (CVD) is well documented [1].”
Background
The longitudinal association of psychological resources with chronic conditions and the mediating roles of health behaviours and allostatic load
Woo, J., Lehrer, H. M., Whyne, E. Z., & Steinhardt, M. A. (2019) · Psychology and Health · doi:10.1080/08870446.2019.1656205 · Cited by 11
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“The benefits generated by subjective well-being will lead to physical and psychological health [27-30], including reducing the risk of stroke [27, 31] and arousing enthusiasm [32].”
Background
Associations Between Positive and Negative Affect and 12-Month Physical Disorders in a National Sample
Weiser, E. B. (2012) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-011-9277-9 · Cited by 12
“As Davidson et al. (2010) suggested, behavioral activation techniques, which traditionally are applied to the treatment of depression, seem promising in this regard.”
Background
Afecto positivo y negativo como mediador de la relación optimismo y salud: evaluación de un modelo estructural
Vera-Villarroel, P., & Celis-Atenas, K. (2014) · Universitas Psychologica · doi:10.11144/javeriana.upsy13-3.apnm · Cited by 10
Benefit Finding in Cardiac Patients: Relationships with Emotional Well-Being and Resources after Controlling for Physical Functional Impairment
Sanjuán, P., Zamora, C. G., Ruiz, M. Á., Rueda, B., Arranz, H., & Castro, A. (2016) · The Spanish Journal of Psychology · doi:10.1017/sjp.2016.60 · Cited by 10
Contentment Duration Mediates the Associations between Anxious Attachment Style and Psychological Distress
Ng, S. M., & Hou, W. K. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00258 · Cited by 14
“It is also well established that positive emotions are inversely associated with anxiety and depressive symptoms (Headey et al., 1993; Watson et al., 1988; Davidson et al., 2010).”
Background
Does the ability to express different emotions predict different indices of physical health? A skill‐based study of physical symptoms and heart rate variability
Tuck, N. L., Adams, K. S., & Consedine, N. S. (2017) · British Journal of Health Psychology · doi:10.1111/bjhp.12242 · Cited by 11
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Do positive psychosocial factors contribute to the prediction of coronary artery disease? A UK Biobank–based machine learning approach
Hefti, R., Guemghar, S., Battegay, E., Mueller, C. E., Koenig, H. G., Schaefert, R., & Meinlschmidt, G. (2024) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwae237 · Cited by 9
“,16, 17, 20, 23 Similarly to the Swedish”
Unequal Life Chances and Choices: How Subjective Well-Being Metrics Can Inform Benefit-Cost Analysis
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The Polish Regional Labour Market Welfare Indicator And Its Links To Other Well-being Measures
Ręklewski, M., & Ryczkowski, M. (2016) · Comparative Economic Research Central and Eastern Europe · doi:10.1515/cer-2016-0023 · Cited by 9
HUBUNGAN KUALITAS PERNIKAHAN DENGAN KEBAHAGIAAN DAN KEPUASAN HIDUP PRIBADI: STUDI PADA INDIVIDU DENGAN USIA PERNIKAHAN 1-5 TAHUN DI BANDUNG
Kendhawati, L., & Purba, F. D. (2019) · Jurnal Psikologi · doi:10.14710/jp.18.1.106-115 · Cited by 9
Is stressor‐evoked cardiovascular reactivity a pathway linking positive and negative emotionality to preclinical cardiovascular disease risk?
DuPont, C. M., Wright, A. G. C., Manuck, S. B., Muldoon, M. F., Jennings, J. R., & Gianaros, P. J. (2020) · Psychophysiology · doi:10.1111/psyp.13741 · Cited by 10
“In contrast, the majority of studies on positive emotionality and health overwhelmingly control for negative emotionality in their analyses (Brummett et al., 2005; Davidson et al., 2010; Giannelou et al., 2018; Hoen et al., 2013; Jokela et al., 2014).”
Background
Moxie matters: associations of future orientation with active life expectancy
Laditka, S. B., & Laditka, J. N. (2016) · Aging & Mental Health · doi:10.1080/13607863.2016.1199011 · Cited by 9
“Studies have found that a sense of control over future health is associated with lower rates of coronary heart disease (Davidson et al., 2010; Steptoe & Wardle, 2012) and cardiovascular disease (Boehm & Kubzansky, 2012), and lower mortality (e.”
BackgroundResultInfluential
Exploring the causes, symptoms and health consequences of joint and inverse states of work engagement and burnout
Moodie, S., Dolan, S. L., & Burke, R. (2014) · Management Research The Journal of the Iberoamerican Academy of Management · doi:10.1108/mrjiam-05-2013-0506 · Cited by 14
Recursos psicosociales positivos y salud cardiovascular
Nitsche, M. P., Marcela Bitran, C., Nuria Pedrals, G., Echeverría, G., & Rigotti, A. (2014) · Revista médica de Chile · doi:10.4067/s0034-98872014001000012 · Cited by 9
Impact of Affect on Lung Transplant Candidate Outcomes
Pennington, K. M., Benzo, R. P., Schneekloth, T. D., Budev, M. M., Chandrashekaran, S., Erasmus, D. B., Lease, E. D., Levine, D. J., Thompson, K. L., Stevens, E., et al. (2019) · Progress in Transplantation · doi:10.1177/1526924819892921 · Cited by 9
“Reduced positive affect has also been associated with risk of death or myocardial infarction, while increased positive affect was protective against cardiac events.(26,27) Such findings lend credence to the possible association between affect and mortality in our study.”
Result
Are happy people healthier? An instrumental variable approach using data from Greece
Kyriopoulos, I., Athanasakis, K., & Kyriopoulos, J. E. (2018) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2018-210568 · Cited by 8
Heart and mind: are we closer to disentangling the relationship between emotions and poor prognosis in heart disease?
Pedersen, S. S., Kupper, N. H. M., & van Domburg, R. T. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr156 · Cited by 8
Association of Depressive and Anxiety Symptoms With Risk of Cardiovascular Disease in Middle-Aged and Older Chinese Women
Wang, X., Gao, D., & Zhang, X. (2024) · Asia Pacific Journal of Public Health · doi:10.1177/10105395241237664 · Cited by 7
First definition of Minimal Care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology
Bettinardi, O., Vico, L. D., Pierobon, A., Iannucci, M., Maffezzoni, B., Borghi, S., Ferrari, M., Brazzo, S., Mazza, A., Sommaruga, M., et al. (2015) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2014.55 · Cited by 7
A Bifactor Model of Subjective Well-Being at Personal, Community, and Country Levels: A Case With Three Latin-American Countries
Torres‐Vallejos, J., Juarros‐Basterretxea, J., Oyanedel, J. C., & Sato, M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.641641 · Cited by 7
“, 2009); well-being has been showed to be related to several socially desirable outcomes, such as lower prevalence of mental illness (Lyubomirsky et al., 2005; Pressman and Cohen, 2005; Howell et al., 2007; Davidson et al., 2010; Kushlev et al., 2020), better mental health (Keyes, 2006; Sin and Lyubomirsky, 2009; Wern…”
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How Is Work Ability Shaped in Groups of Shift and Non-Shift Workers? A Comprehensive Approach to Job Resources and Mediation Role of Emotions at Work
Baka, Ł., Ścigała, D. K., Kapica, Ł., Najmiec, A., & Grala, K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18157730 · Cited by 8
“For instance, some researchers showed that positive affect is a predictor of lower blood fat, blood pressure and a healthier body mass index [70], lower risk for heart disease [71] and improved self-rated health [72].”
Background
Happiness and unhappiness have no direct effect on mortality
Barreto, P. D. S., & Rolland, Y. (2015) · The Lancet · doi:10.1016/s0140-6736(15)01222-2 · Cited by 7
Associations of baseline depressed mood and happiness with subsequent well-being in cardiac patients
Craner, J. R., Douglas, K. V., Dierkhising, R., Hathaway, J. C., Goel, K., & Thomas, R. J. (2016) · Social Science & Medicine · doi:10.1016/j.socscimed.2016.12.013 · Cited by 7
“In addition, the results of one study demonstrated that higher positive affect scores based on observer-coded interviews were associated with lower risk for coronary heart disease across a 10-year time period (Davidson et al., 2010).”
Result
Successful aging in community seniors and stroke survivors: current and future strategies
Kamat, R., Depp, C. A., & Jeste, D. V. (2017) · Neurological Research · doi:10.1080/01616412.2017.1322348 · Cited by 7
Associations between affective factors and high-frequency heart rate variability in primary care patients with depression
Shell, A. L., Gonzenbach, V., Sawhney, M., Crawford, C. A., & Stewart, J. C. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.110992 · Cited by 7

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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