Abstract 5101: Optimism, Hostility and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative
Background - Anger/hostility predicts cardiovascular disease (CVD). Less is known about positive attributes such as trait optimism, which is the expectation that good things will happen, and CVD risk. Optimism and hostility have not been extensively studied in post-menopausal women.
Methods - We analyzed data from 107,356 Women’s Health Initiative participants (98,378 white, 8978 black) free of chronic disease at baseline. Optimism was assessed by the Life Orientation Test-Revised and hostility was assessed by the Cook Medley Questionnaire (cynicism subscale). Chi-square analyses were used to determine the association of optimism and hostility with baseline risk factors, and multivariable Cox proportional hazard models were used to determine whether optimism and hostility independently influenced incident coronary heard disease (CHD, composite endpoint of myocardial infarction, angina, or coronary artery bypass surgery) and total mortality over ~ 8 years of follow up.
Results - Optimists were less likely, and hostile women more likely, to be hypertensive, diabetic, and smokers (p < .0001). Most optimistic (vs. least, or pessimistic) women had reduced age-adjusted rates of incident CHD (41 vs. 57 per 10,000) and total mortality (46 vs. 64 per 10,000). Most (vs. least) hostile women had increased rates of CHD (54 vs. 43 per 10,000) and total mortality (63 vs. 47 per 10,000). Adjusting for age, education, hypertension, diabetes, BMI, smoking, alcohol, and depressive symptoms, optimists (vs. pessimists) had decreased hazard of incident CHD (AHR 0.88, 95% CI [0.81– 0.96]) and of total mortality (AHR 0.84 [0.78 –0.91]). Most hostile women exhibited a higher hazard of death from all causes (AHR 1.19 [1.10 –1.30)] but not incident CHD. Mortality outcomes were pronounced in blacks: AHR (optimists vs. pessimists) 0.69 [0.52– 0.91]; AHR (most vs. least hostile) 1.61 [1.15–2.24]).
Conclusion - High optimism was associated with favorable health outcomes. High hostility was associated with increased risk of all-cause mortality. For mortality, results were more striking in blacks. Further research is needed to understand why and how optimism and hostility relate to CVD in women in order to develop targeted, efficacious interventions to modify these attitudes.