The path to better heart health may start with higher levels of well-being

People with higher levels of well-being are less likely to have cardiovascular issues, and an extensive and detailed look at the connection offers insights as to why.

In a study published Wednesday in the Journal of the American Heart Association, researchers used data from more than 121,000 participants in the UK Biobank, a large health database in the United Kingdom.

The study found that higher levels of well-being are associated with a significantly reduced risk of cardiovascular problems, said senior author Dr. Wen Sun, deputy director of the Stroke Center at the First Affiliated Hospital of the University of Science and Technology of China in Hefei.

The study also linked higher well-being with healthier lifestyles and lower levels of inflammation, suggesting a possible behavioral and biological explanation for how well-being influences physical health.

The UK database includes responses to questions about issues such as friendships, health, finances, general happiness and satisfaction with family. Using that information, the researchers developed an index to measure well-being.

The researchers then looked at who had experienced a stroke, coronary heart disease (when plaque buildup narrows or blocks the heart's arteries), heart attack, or heart failure (when the heart is not pumping as well as it should).

They also examined a long list of healthy lifestyle factors, such as how much a person slept, how often they ate fruit, their television-watching habits and more.

Because increased inflammation has been linked to a higher risk of cardiovascular disease, the researchers also looked at markers for inflammation in the blood and at genetic markers related to well-being.

After analyzing these factors, the researchers found that participants with higher well-being tended to have healthier behaviors. For example, they were less likely to be a current smoker and more likely to be physically active.

People with higher well-being also had lower levels of inflammation, which the researchers said could explain some of the apparent protective effects of well-being.

"While we expected well-being to influence cardiovascular health, the extent to which lifestyle factors like physical activity, diet and smoking mediated this relationship was remarkable," Sun said.

Overall, higher levels of well-being were associated with a significantly reduced risk of cardiovascular disease. In the broadest statistical model, which adjusted for variations in age, sex, ethnicity, high blood pressure, diabetes and more, the risk for heart attack fell 21% and the risk of stroke dropped 14% with each increase in a person's well-being score. In the strictest statistical model, which screened out people with serious illnesses such as cancer and diabetes, the risk of heart attack fell 17%, and the risk of stroke dropped 11% each time the well-being score went up.

Levels of coronary heart disease and heart failure decreased as well.

Because participants in the UK Biobank are predominantly white, the findings might not directly apply to other ethnic or racial groups. "Further studies in diverse populations are necessary to determine if the protective effects of well-being observed in this study hold across different groups," Sun said.

Dr. Julia Boehm, an associate professor of psychology at Chapman University in Orange, California, said the new study's scope, with its large number of participants and multiple layers of analysis, made it unique.

"The findings that higher levels of well-being were associated with lower risk of various cardiovascular disease outcomes were spot-on and very consistent with previous work," said Boehm, whose own research has linked optimism and life satisfaction to improved cardiovascular health. She was not involved in the new study.

The wealth of information in the study made it difficult to zero in on specific connections, she said. Although a "whole host of lifestyle factors and inflammatory markers" were looked at, Boehm said she "didn't see an in-depth analysis of which ones were strongest, which ones were most consistent and, theoretically, which ones would matter most."

That's one potential focus for future research, Boehm said, as is whether a treatment based on well-being could be designed "that is powerful enough and leads to enough sustainable change to actually influence cardiovascular disease down the road. That really remains to be seen."

Sun said the findings could help people understand the "significant" impact that mental and emotional health has on physical health, particularly cardiovascular health. "Engaging in activities that boost well-being, like socializing, exercising and pursuing fulfilling work or hobbies, could be practical steps toward better overall health," he said.

The work also suggests that physicians could consider incorporating well-being assessments into regular health evaluations and should consider mental health a significant factor in cardiovascular risk, Sun said.

"By recognizing the influence of well-being, physicians might recommend and integrate psychological therapies, stress management techniques and lifestyle interventions as part of a holistic approach" to preventing or managing cardiovascular disease, he said. "This approach can help in treating the patient as a whole rather than focusing solely on traditional physical risk factors."

Boehm said that people should remember that cardiovascular disease is complex and caused by multiple factors beyond well-being. But for most people, she said, the takeaway from the new study is clear: "Higher levels of well-being tend to mean lower risk of disease."