Association of Optimism With Cardiovascular Events and All-Cause Mortality: A Systematic Review and Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 31560385 · doi:10.1001/jamanetworkopen.2019.12200
What was done
A systematic review and meta-analysis following MOOSE guidelines searched PubMed, Scopus, and PsycINFO through July 2, 2019, for cohort studies investigating optimism and cardiovascular events or all-cause mortality. Cardiovascular events were defined as a composite of fatal cardiovascular mortality, nonfatal myocardial infarction, stroke, and/or new-onset angina. Adjusted effect estimates from 15 cohort studies (229,391 participants; mean follow-up 13.8 years, range 2–40 years) were pooled using the Hartung-Knapp-Sidik-Jonkman random-effects model.
What was found
Ten studies reported on cardiovascular events and nine on all-cause mortality. On pooled analysis, optimism was significantly associated with a decreased risk of cardiovascular events (relative risk [RR], 0.65; 95% CI, 0.51–0.78; P < .001; I² = 87.4%) and a decreased risk of all-cause mortality (RR, 0.86; 95% CI, 0.80–0.92; P < .001; I² = 73.2%). Subgroup analyses by assessment method, follow-up duration, sex, and adjustment for depression and other confounders showed consistent associations.
Why it matters
This review pools large, long-term prospective cohorts to establish a consistent association between an optimistic mindset and lower rates of adverse cardiovascular events and premature death.
Limits
All included studies are observational cohorts, so residual confounding cannot be ruled out and causality cannot be established. Statistical heterogeneity was high across cardiovascular event analyses (I² = 87.4%) and moderate for mortality (I² = 73.2%). Specific measurement tools and definitions of optimism varied across included cohorts.
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