A Prospective Study of Positive Psychological Well-Being and Coronary Heart Disease
A Prospective Study of Positive Psychological Well-Being and Coronary Heart Disease
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DOI：
10.1037/a0023124
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Kubzansky, Laura
中科院分区：
文献类型：
--
作者：
Boehm, Julia K.;Peterson, Christopher;Kubzansky, Laura
目的：研究表明，积极的心理健康与心血管健康有关。然而，这项研究的大部分样本都是老年人，并没有确定心理健康影响心血管疾病的途径，也没有确定对男性和女性的影响是否相似。这项研究调查了两个方面的幸福感(情绪活力和乐观)与冠心病(CHD)之间的关系，并考虑了潜在的中介因素。方法：1991至1994年间，对白厅H队列中7942名既往无心血管事件的人的幸福感和冠状动脉危险因素进行了评估。事件CHD(致命性CHD，首次非致命性心肌梗死，或首次明确心绞痛)在5人年的随访中被跟踪。结果：积极的心理幸福感与CHD风险降低相关，具有明显的阈值效应。与幸福感水平最低的人相比，幸福感水平最高的人的最小调整风险比为0.74，情绪活力的95%可信区间为[0.55，0.98]，乐观的风险比为0.73，95%可信区间[0.54，0.99]。此外，这种联系对两性来说都很强，在考虑到疾病时，这种联系只被弱化了。无论是与健康相关的行为，还是生物因素，都无法解释这些关联。结论：积极的心理健康与适度但一致的降低冠心病发病风险有关。这种关系在男性和女性中是相当的，在控制了心血管风险因素和疾病后仍保持着这种关系。还需要更多的研究来确定潜在的机制，并调查提高幸福感的干预措施是否可以改善心血管健康。
Objective: Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors. Method: Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall H cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results: Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions: Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health.