Optimism, resilience may guard heart health in Black adults

Optimism, a sense of purpose and feeling in control are a recipe for better heart health among Black adults, even in neighborhoods where heart disease and stroke are more common, a new study shows.

Researchers looked into how psychosocial well-being, or resilience, affected health. They found that in neighborhoods with high rates of people having or dying from heart disease or stroke, Black adults with higher resilience scores had a 12.5% lower rate of cardiovascular disease than those with lower resilience.

Living in a neighborhood with fewer or limited socioeconomic resources is recognized as a social determinant of health, the conditions in which people are born and live that could impact a person's risk of cardiovascular disease.

"Almost everything we know about Black Americans and their health focuses on deficits, yet we really need to begin to identify strengths," one of the study's principal investigators, Tené T. Lewis, said in a news release. He is a clinical psychologist and associate professor of epidemiology at the Rollins School of Public Health at Emory University in Atlanta. "Understanding which strengths matter most for Black Americans – and under which contexts – will allow us to develop the most appropriate and applicable public health interventions for this group."

The study, published Wednesday in the American Heart Association's journal Circulation: Cardiovascular Quality and Outcomes, measured cardiovascular health based on the AHA's Life's Simple 7: smoking status, physical activity, diet, weight, and levels of blood glucose, cholesterol and blood pressure.

Researchers recruited 389 adult volunteers with no prior history of heart disease who self-identified as Black or African American, living in the greater Atlanta region. The study was part of a larger AHA-funded Morehouse-Emory Cardiovascular Center for Health Equity study.

Participants gauged their psychosocial health through multiple questionnaires during in-person interviews. The questions focused on their perceptions of control over their own environment; whether they felt a sense of purpose in life; their level of optimism; and an assessment of coping skills and depressive symptoms. Study participants also received physical examinations and blood analysis, and people with prior heart events or illnesses were excluded.

The psychosocial and physical data were compared to the corresponding neighborhood "resilience" information on rates of heart disease, stroke and related deaths according to the 2010 U.S. Census Tract.

"We assumed that being both high on psychosocial resilience and living in a resilient neighborhood would be the most beneficial for cardiovascular health," Lewis said. "Yet what we found was that psychosocial resilience demonstrated the most robust association regardless of the neighborhood resilience measure."

The study did not assess the neighborhoods' structural characteristics, such as walkability, access to food or environmental factors like air pollution, that also could affect heart health.

"As a result of the heartbreaking consequences of COVID-19 and the inhumanity of George Floyd's death, we are having a national conversation about the ways in which structural and interpersonal racism have shaped Black Americans' lives and deaths," Lewis said. "More studies like this are necessary to fully understand the factors that promote better health for Black Americans."

The study was published alongside an editorial by Dr. Amber E. Johnson and Dr. Jared W. Magnani, assistant professors of medicine in cardiology at the University of Pittsburgh School of Medicine.

The work underscores "the importance of psychosocial support and empowerment for Black patients at risk for developing CVD," they wrote, but the links between resilience and cardiovascular health have yet to be defined.

Resilience techniques can be taught, Johnson and Magnani wrote, but that "requires intentional acknowledgement of the conditions and experiences from which the adversity originated."

But the goal, they said, is to tackle society's larger disparity issues. "We advocate for promoting health equity and social justice first, thereby rendering interventions to bolster resilience unnecessary."

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