Letter by Lucchetti and Granero Regarding Article, “Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative”
To the Editor:
We would like to make some comments about the article1 “Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative” published on August 25, 2009. First, we would like to congratulate the authors for this impressive work and for choosing to analyze some patient personality traits such as optimism and cynical attitudes.
Medicine is starting to study the relationship between psycho-socio-spiritual aspects and clinical outcomes. This important issue is sometimes neglected by physicians.
However, a doubt emerged from this study. According to the authors, optimists (compared with pessimists) were more likely to attend religious services at least once per week, and optimists (versus pessimists) had a lower hazard of coronary heart disease, coronary heart disease–related mortality, and total mortality. If we remember correctly, previous studies concerning religious attendance2,3 showed an 18% to 22% reduction in mortality for those frequently attending religious services, almost the same result found here.
In this study, no concerns are made about religious attendance and mortality relationship. In addition, the multivariable Cox proportional-hazard models were not adjusted for religious attendance.
If we assume that patients with higher levels of religiousness have more optimism, this optimism could mediate the relationship with mortality. A clear example was the research carried out by Lutgendorf et al4 in 2004 in which interleukin-6 mediated the relationship between religious attendance and mortality.
In other words, we would like to suggest that the authors analyze in the present study the relationship between religious attendance and mortality and include religious attendance in the multivariate model.