Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series

Abstract

Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

Keywords: cardiovascular disease; cardiovascular health; health behaviors; optimism; positive psychological well-being.

Central Illustration. Model of the Relation Between Positive Psychological Well-Being and Cardiovascular Health.

This model illustrates the complex direct and indirect relationships linking positive psychological well-being with better CVH via health behaviors, biological function, and psychosocial factors. psychological well-being may also reduce likelihood of experiencing stress or buffer the health-related impact of stress. These relationships are conditional on the social and physical environment and may vary in their nature and implications across the life course. (+ represents direct, positive relationships; - represents indirect, negative relationships.)

Figure 1:. Case Studies of Positive Psychological Well-Being Interventions.

These two case studies illustrate application of psychological well-being interventions in clinical and community/organizational settings, respectively. While these are small in scale, they typify intervention approaches being explored in this arena. (ACS, acute coronary syndrome; AHA, American Heart Association; CVD, cardiovascular disease; CVH, cardiovascular health.)

Figure 2:. Principles and Methods of Positive Psychological Interventions.

These principles are illustrated in two types of settings. Together they may aid the clinician and co-providers to identify previously unrecognized opportunities for improving CVH through approaches unique to each setting. (CVH, cardiovascular health)