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Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative

Originally published10 Aug 2009Circulation. 2009;120:656–662

Abstract

Background— Trait optimism (positive future expectations) and cynical, hostile attitudes toward others have not been studied together in relation to incident coronary heart disease (CHD) and mortality in postmenopausal women.

Methods and Results— Participants were 97 253 women (89 259 white, 7994 black) from the Women’s Health Initiative who were free of cancer and cardiovascular disease at study entry. Optimism was assessed by the Life Orientation Test–Revised and cynical hostility by the cynicism subscale of the Cook Medley Questionnaire. Cox proportional hazard models produced adjusted hazard ratios (AHRs) for incident CHD (myocardial infarction, angina, percutaneous coronary angioplasty, or coronary artery bypass surgery) and total mortality (CHD, cardiovascular disease, or cancer related) over ≈8 years. Optimists (top versus bottom quartile [“pessimists”]) had lower age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46 versus 63). The most cynical, hostile women (top versus bottom quartile) had higher rates of CHD (56 versus 44) and total mortality (63 versus 46). Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83 to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality (AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in blacks). Effects of optimism and cynical hostility were independent.

Conclusions— Optimism and cynical hostility are independently associated with important health outcomes in black and white women. Future research should examine whether interventions designed to change attitudes would lead to altered risk.

Footnotes

Correspondence to Hilary A Tindle, MD, MPH, 230 McKee Place, Suite 600, Pittsburgh, PA 15213. E-mail

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circulationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & Wilkins
CLINICAL PERSPECTIVE25082009

Over time, practicing clinicians often become intimately familiar with aspects of their patients’ personalities, including optimistic or cynical, hostile psychological attitudes. Optimism and cynical hostility also appear to be independent risk factors for important health outcomes, including mortality. Optimism and cynical hostility may affect the risks of physical disease via 2 main pathways: (1) Directly, by altering activation of the autonomic nervous system, hypothalamic-pituitary axis, or other stress-response systems, which may in turn speed up the process of diseases such as atherosclerosis; and (2) indirectly, by influencing health behaviors such as smoking, eating patterns/obesity, and adherence to treatment regimens. In this sample, the magnitude of the effects of optimism and cynical hostility was less than but similar to the effect of hypertension for total mortality. The fact that these psychological factors are potentially modifiable increases their clinical relevance, especially when clinicians consider populations at higher risk, such as blacks.

The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA. 108.827642/DC1.

Guest Editor for this article was Richard F. Gillum, MD, MS.

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