Current Cardiology Reports

, 18:106 | Cite as

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications

  • Nancy L. SinEmail author
Psychological Aspects of Cardiovascular Diseases (A Steptoe, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Psychological Aspects of Cardiovascular Diseases


Positive psychological aspects of well-being—including positive emotions, optimism, and life satisfaction—are increasingly considered to have protective roles for cardiovascular disease (CVD) and longevity. A rapidly-growing body of literature has linked positive well-being with better cardiovascular health, lower incidence of CVD in healthy populations, and reduced risk of adverse outcomes in patients with existing CVD. This review first examines evidence on the associations of positive well-being with CVD and mortality, focusing on recent epidemiological research as well as inconsistent findings. Next, an overview is provided of putative biological, behavioral, and stress-buffering mechanisms that may underlie the relationship between positive well-being and cardiovascular health. Key areas for future inquiry are discussed, in addition to emerging developments that capitalize on technological and methodological advancements. Promising initial results from randomized controlled trials suggest that efforts to target positive well-being may serve as valuable components of broader CVD management programs.


Positive affect Well-being Optimism Cardiovascular disease Mortality Health behaviors 



Nancy L. Sin was supported by National Institute on Aging grant F32AG048698.

Compliance with Ethical Standards

Conflict of Interest

Nancy L. Sin declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Chida Y, Steptoe A. The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. J Am Coll Cardiol. 2009;53:936–46.PubMedCrossRefGoogle Scholar
  2. 2.
    Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010;56:38–46.PubMedCrossRefGoogle Scholar
  3. 3.
    Whooley MA, Wong JM. Depression and cardiovascular disorders. Annu Rev Clin Psychol. 2013;9:327–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med. 2008;70:741–56.PubMedCrossRefGoogle Scholar
  5. 5.
    Pressman SD, Cohen S. Does Positive Affect Influence Health? Psychol Bull. 2005;131:925–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Boehm JK, Kubzansky LD. The heart’s content: the association between positive psychological well-being and cardiovascular health. Psychol Bull. 2012;138:655–91.PubMedCrossRefGoogle Scholar
  7. 7.••
    DuBois CM, Lopez OV, Beale EE, Healy BC, Boehm JK, Huffman JC. Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: a systematic review. Int J Cardiol. 2015;195:265–80. This is a systematic review of prospective studies linking positive well-being with subsequent health outcomes in CVD patients. Meta-analytic results suggest that positive well-being may protect against risks for rehospitalizations and mortality.Google Scholar
  8. 8.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics—2016 Update: a report from the American Heart Association. Circulation. 2016;133:e38–360.PubMedCrossRefGoogle Scholar
  9. 9.
    Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Horn LV, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation. 2010;121:586–613.PubMedCrossRefGoogle Scholar
  10. 10.
    DuBois CM, Beach SR, Kashdan TB, Nyer MB, Park ER, Celano CM, et al. Positive psychological attributes and cardiac outcomes: associations, mechanisms, and interventions. Psychosomatics. 2012;53:303–18.PubMedCrossRefGoogle Scholar
  11. 11.•
    Sin NL, Moskowitz JT, Whooley MA. Positive affect and health behaviors across 5 years in patients with coronary heart disease: the Heart and Soul Study. Psychosom Med. 2015;77:1058–66. This is the perhaps the only longitudinal study linking positive well-being with a range of health behaviors in patients with CHD. Positive affect predicted physical activity, medication adherence, good sleep quality, and non-smoking 5 years later, and changes in positive affect co-occurred with changes in health behaviors.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Ryff CD, Singer B. The contours of positive human health. Psychol Inq. 1998;9:1–28.CrossRefGoogle Scholar
  13. 13.
    Ryan RM, Deci EL. On happiness and human potentials: a review of research on hedonic and eudaimonic well-being. Annu Rev Psychol. 2001;52:141–66.PubMedCrossRefGoogle Scholar
  14. 14.
    Diener E, Suh EM, Lucas RE, Smith HL. Subjective well-being: three decades of progress. Psychol Bull. 1999;125:276–302.CrossRefGoogle Scholar
  15. 15.
    Barth J, Schneider S, von Känel R. Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosom Med. 2010;72:229–38.PubMedCrossRefGoogle Scholar
  16. 16.
    Boehm JK, Peterson C, Kivimaki M, Kubzansky L. A prospective study of positive psychological well-being and coronary heart disease. Health Psychol. 2011;30:259–67.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Boehm JK, Peterson C, Kivimaki M, Kubzansky LD. Heart health when life is satisfying: evidence from the Whitehall II cohort study. Eur Heart J. 2011;32:2672–7.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Kim ES, Smith J, Kubzansky LD. Prospective study of the association between dispositional optimism and incident heart failure. Circ Heart Fail. 2014;7:394–400.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced incidence of stroke in older adults: The Health and Retirement Study. J Psychosom Res. 2013;74:427–32.PubMedCrossRefGoogle Scholar
  20. 20.
    Lambiase MJ, Kubzansky LD, Thurston RC. Positive psychological health and stroke risk: the benefits of emotional vitality. Health Psychol. 2015;34:1043–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Davidson KW, Mostofsky E, Whang W. Don’t worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey. Eur Heart J. 2010;31:1065–70.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Kim ES, Sun JK, Park N, Kubzansky LD, Peterson C. Purpose in life and reduced risk of myocardial infarction among older US adults with coronary heart disease: a two-year follow-up. J Behav Med. 2013;36:124–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Denollet J, Pedersen SS, Daemen J, De Jaegere P, Serruys PW, Van Domburg RT. Reduced positive affect (anhedonia) predicts major clinical events following implantation of coronary-artery stents. J Intern Med. 2008;263:203–11.PubMedCrossRefGoogle Scholar
  24. 24.
    Tindle H, Belnap BH, Houck PR, Mazumdar S, Scheier MF, Matthews KA, et al. Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery. Psychosom Med. 2012;74:200–7.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Huffman JC, Beale EE, Celano CM, Beach SR, Belcher AM, Moore SV, et al. Effects of optimism and gratitude on physical activity, biomarkers, and readmissions after an acute coronary syndrome: The Gratitude Research in Acute Coronary Events Study. Circ Cardiovasc Qual Outcomes. 2016;9:55–63.PubMedCrossRefGoogle Scholar
  26. 26.
    Ronaldson A, Molloy GJ, Wikman A, Poole L, Kaski J-C, Steptoe A. Optimism and recovery after acute coronary syndrome: a clinical cohort study. Psychosom Med. 2015;77:311–8.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Steptoe A, Wardle J. Positive affect measured using ecological momentary assessment and survival in older men and women. Proc Natl Acad Sci. 2011;108:18244–8.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.•
    Boehm JK, Winning A, Segerstrom S, Kubzansky LD. Variability Modifies Life Satisfaction’s Association With Mortality Risk in Older Adults. Psychol Sci. 2015;1–8. This large-scale study of Australian adults demonstrated that high variability in life satisfaction from year to year was associated with increased mortality risk. These findings point to the importance of examining dynamic characteristics and changes in positive well-being.Google Scholar
  29. 29.
    Gana K, Broc G, Saada Y, Amieva H, Quintard B. Subjective wellbeing and longevity: findings from a 22-year cohort study. J Psychosom Res. 2016;85:28–34.PubMedCrossRefGoogle Scholar
  30. 30.
    Wiest M, Schüz B, Webster N, Wurm S. Subjective well-being and mortality revisited: differential effects of cognitive and emotional facets of well-being on mortality. Health Psychol. 2011;30:728–35.PubMedCrossRefGoogle Scholar
  31. 31.
    Wiest M, Schüz B, Wurm S. Life satisfaction and feeling in control: indicators of successful aging predict mortality in old age. J Health Psychol. 2013;18:1199–208.PubMedCrossRefGoogle Scholar
  32. 32.
    Rozanski A. Behavioral cardiology: current advances and future directions. J Am Coll Cardiol. 2014;64:100–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci. 2014;25:1482–6.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Su S, Jimenez MP, Roberts CT, Loucks EB. The role of adverse childhood experiences in cardiovascular disease risk: a review with emphasis on plausible mechanisms. Curr Cardiol Rep. 2015;17:1–10.CrossRefGoogle Scholar
  35. 35.
    Hernandez R, Kershaw KN, Siddique J, Boehm JK, Kubzansky LD, Diez-Roux A, et al. Optimism and cardiovascular health: multi-ethnic study of atherosclerosis (MESA). Health Behav Policy Rev. 2015;2:62–73.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Boehm JK, Chen Y, Williams DR, Ryff CD, Kubzansky LD. Subjective well-being and cardiometabolic health: an 8–11 year study of midlife adults. J Psychosom Res. 2016;85:1–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Boehm JK, Williams DR, Rimm EB, Ryff C, Kubzansky LD. Relation between optimism and lipids in midlife. Am J Cardiol. 2013;111:1425–31.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Trudel-Fitzgerald C, Boehm JK, Kivimaki M, Kubzansky LD. Taking the tension out of hypertension: a prospective study of psychological well being and hypertension. J Hypertens. 2014;32:1222–8.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Freak-Poli R, Mirza SS, Franco OH, Ikram MA, Hofman A, Tiemeier H. Positive affect is not associated with incidence of cardiovascular disease: a population-based study of older persons. Prev Med. 2015;74:14–20.PubMedCrossRefGoogle Scholar
  40. 40.•
    Liu B, Floud S, Pirie K, Green J, Peto R, Beral V, et al. Does happiness itself directly affect mortality? The prospective UK Million Women Study. Lancet. 2016;387:874–81. This widely-publicized study found that, after adjustment for self-rated health, happiness was no longer associated with reduced mortality risk.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Nabi H, Kivimaki M, De Vogli R, Marmot MG, Singh-Manoux A. Whitehall II Prospective Cohort Study. Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study. BMJ. 2008;337:a118.PubMedCrossRefGoogle Scholar
  42. 42.
    Ortega FB, Lee D, Sui X, Kubzansky LD, Ruiz JR, Baruth M, et al. Psychological well-being, cardiorespiratory fitness, and long-term survival. Am J Prev Med. 2010;39:440–8.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Stewart JC, Zielke DJ, Hawkins MAW, Williams DR, Carnethon MR, Knox SS, et al. Depressive Symptom Clusters and 5-Year Incidence of Coronary Artery Calcification The Coronary Artery Risk Development in Young Adults Study. Circulation. 2012;126:410–7.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.••
    Hoen PW, Denollet J, de Jonge P, Whooley MA. Positive affect and survival in patients with stable coronary heart disease: findings from the Heart and Soul Study. J Clin Psychiatry. 2013;74:716–22. This study evaluated a range of potential biological and behavioral mediators in the link between positive affect and all-cause mortality among patients with CHD. The association was largely explained by health behaviors, particularly physical activity.PubMedCrossRefGoogle Scholar
  45. 45.
    Hoogwegt MT, Versteeg H, Hansen TB, Thygesen LC, Pedersen SS, Zwisler A-D. Exercise mediates the association between positive affect and 5-year mortality in patients with ischemic heart disease. Circ Cardiovasc Qual Outcomes. 2013;6:559–66.PubMedCrossRefGoogle Scholar
  46. 46.
    Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol. 2000;55:647–54.PubMedCrossRefGoogle Scholar
  47. 47.
    Ong AD. Pathways Linking Positive Emotion and Health in Later Life. Curr Dir Psychol Sci. 2010;19:358–62.CrossRefGoogle Scholar
  48. 48.
    Marsland AL, Pressman S, Cohen S. Positive affect and immune function. Psychoneuroimmunology Ed R Ader. 2007;261–79.Google Scholar
  49. 49.
    Cohen S, Alper CM, Doyle WJ, Treanor JJ, Turner RB. Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus. Psychosom Med. 2006;68:809–15.PubMedCrossRefGoogle Scholar
  50. 50.
    Marsland AL, Cohen S, Rabin BS, Manuck SB. Trait positive affect and antibody response to hepatitis B vaccination. Brain Behav Immun. 2006;20:261–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Deverts DJ, Cohen S, DiLillo VG, Lewis CE, Kiefe C, Whooley M, et al. Depressive symptoms, race, and circulating C-reactive protein: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Psychosom Med. 2010;72:734–41.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Friedman EM, Hayney M, Love GD, Singer BH, Ryff CD. Plasma interleukin-6 and soluble IL-6 receptors are associated with psychological well-being in aging women. Health Psychol. 2007;26:305–13.PubMedCrossRefGoogle Scholar
  53. 53.
    Friedman EM, Hayney MS, Love GD, Urry HL, Rosenkranz MA, Davidson RJ, et al. Social relationships, sleep quality, and interleukin-6 in aging women. Proc Natl Acad Sci U S A. 2005;102:18757–62.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Friedman EM, Ryff CD. Living well with medical comorbidities: a biopsychosocial perspective. J Gerontol B Psychol Sci Soc Sci. 2012;67:535–44.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Stellar JE, John-Henderson N, Anderson CL, Gordon AM, McNeil GD, Keltner D. Positive affect and markers of inflammation: discrete positive emotions predict lower levels of inflammatory cytokines. Emotion. 2015;15:129–33.PubMedCrossRefGoogle Scholar
  56. 56.
    Steptoe A, O’Donnell K, Badrick E, Kumari M, Marmot M. Neuroendocrine and Inflammatory Factors Associated with Positive Affect in Healthy Men and Women The Whitehall II Study. Am J Epidemiol. 2008;167:96–102.PubMedCrossRefGoogle Scholar
  57. 57.
    Sturgeon JA, Arewasikporn A, Okun MA, Davis MC, Ong AD, Zautra AJ. The psychosocial context of financial stress: implications for inflammation and psychological health. Psychosom Med. 2016;78:134–43.PubMedCrossRefGoogle Scholar
  58. 58.
    von Känel R, Mausbach BT, Dimsdale JE, Mills PJ, Patterson TL, Ancoli-Israel S, et al. Ways of coping and biomarkers of an increased atherothrombotic cardiovascular disease risk in elderly individuals. Cardiovasc Psychiatry Neurol. 2012;2012:1–9.CrossRefGoogle Scholar
  59. 59.
    Brouwers C, Mommersteeg PMC, Nyklíček I, Pelle AJ, Westerhuis BLWJJM, Szabó BM, et al. Positive affect dimensions and their association with inflammatory biomarkers in patients with chronic heart failure. Biol Psychol. 2013;92:220–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Prather AA, Marsland AL, Muldoon MF, Manuck SB. Positive affective style covaries with stimulated IL-6 and IL-10 production in a middle-aged community sample. Brain Behav Immun. 2007;21:1033–7.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Pressman SD, Matthews KA, Cohen S, Martire LM, Scheier M, Baum A, et al. Association of enjoyable leisure activities with psychological and physical well-being. Psychosom Med. 2009;71:725–32.Google Scholar
  62. 62.
    Kim S, Ferraro KF. Do Productive Activities Reduce Inflammation in Later Life? Multiple Roles, Frequency of Activities, and C-Reactive Protein. The Gerontologist. 2014;54:830–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Sin NL, Graham-Engeland JE, Almeida DM. Daily positive events and inflammation: findings from the National Study of Daily Experiences. Brain Behav Immun. 2015;43:130–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Hoyt LT, Craske MG, Mineka S, Adam EK. Positive and negative affect and arousal: cross-sectional and longitudinal associations with adolescent cortisol diurnal rhythms. Psychosom Med. 2015;77:392–401.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Miller KG, Wright AGC, Peterson LM, Kamarck TW, Anderson BA, Kirschbaum C, et al. Trait positive and negative emotionality differentially associate with diurnal cortisol activity. Psychoneuroendocrinology. 2016;68:177–85.PubMedCrossRefGoogle Scholar
  66. 66.
    Kumari M, Shipley M, Stafford M, Kivimaki M. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II Study. J Clin Endocrinol Metab. 2011;96:1478–85.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Matthews K, Schwartz J, Cohen S, Seeman T. Diurnal cortisol decline is related to coronary calcification: CARDIA study. Psychosom Med. 2006;68:657–61.PubMedCrossRefGoogle Scholar
  68. 68.
    Steptoe A, Gibson EL, Hamer M, Wardle J. Neuroendocrine and cardiovascular correlates of positive affect measured by ecological momentary assessment and by questionnaire. Psychoneuroendocrinology. 2007;32:56–64.PubMedCrossRefGoogle Scholar
  69. 69.
    Bostock S, Hamer M, Wawrzyniak AJ, Mitchell ES, Steptoe A. Positive emotional style and subjective, cardiovascular and cortisol responses to acute laboratory stress. Psychoneuroendocrinology. 2011;36:1175–83.PubMedCrossRefGoogle Scholar
  70. 70.
    Smyth J, Ockenfels MC, Porter L, Kirschbaum C, Hellhammer DH, Stone AA. Stressors and mood measured on a momentary basis are associated with salivary cortisol secretion. Psychoneuroendocrinology. 1998;23:353–70.PubMedCrossRefGoogle Scholar
  71. 71.
    Adam EK, Hawkley LC, Kudielka BM, Cacioppo JT. Day-to-day dynamics of experience–cortisol associations in a population-based sample of older adults. Proc Natl Acad Sci. 2006;103:17058–63.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Jacobs N, Myin-Germeys I, Derom C, Delespaul P, van Os J, Nicolson NA. A momentary assessment study of the relationship between affective and adrenocortical stress responses in daily life. Biol Psychol. 2007;74:60–6.PubMedCrossRefGoogle Scholar
  73. 73.
    Polk DE, Cohen S, Doyle WJ, Skoner DP, Kirschbaum C. State and trait affect as predictors of salivary cortisol in healthy adults. Psychoneuroendocrinology. 2005;30:261–72.PubMedCrossRefGoogle Scholar
  74. 74.
    Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. 2009;34:1423–36.PubMedCrossRefGoogle Scholar
  75. 75.
    Ong AD, Allaire JC. Cardiovascular intraindividual variability in later life: the influence of social connectedness and positive emotions. Psychol Aging. 2005;20:476–85.PubMedCrossRefGoogle Scholar
  76. 76.
    Steptoe A, Wardle J. Positive affect and biological function in everyday life. Neurobiol Aging. 2005;26:108–12.PubMedCrossRefGoogle Scholar
  77. 77.
    Schwerdtfeger AR, Gerteis AKS. The manifold effects of positive affect on heart rate variability in everyday life: distinguishing within-person and between-person associations. Health Psychol. 2014;33(9):1065–73.Google Scholar
  78. 78.•
    Charlson ME, Wells MT, Peterson JC, Boutin-Foster C, Ogedegbe GO, Mancuso CA, et al. Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation. Transl Behav Med. 2014;4:7–17. This paper describes 3 randomized controlled trials in which a positive affect/self-affirmation intervention improved health behaviors among patients with cardiopulmonary disease.PubMedCrossRefGoogle Scholar
  79. 79.
    Rasmussen HN, Wrosch C, Scheier MF, Carver CS. Self-regulation processes and health: the importance of optimism and goal adjustment. J Pers. 2006;74:1721–48.PubMedCrossRefGoogle Scholar
  80. 80.
    Boehm JK, Vie LL, Kubzansky LD. The Promise of Well-Being Interventions for Improving Health Risk Behaviors. Curr Cardiovasc Risk Rep. 2012;6:511–9.CrossRefGoogle Scholar
  81. 81.
    Grant N, Wardle J, Steptoe A. The relationship between life satisfaction and health behavior: a cross-cultural analysis of young adults. Int J Behav Med. 2009;16:259–68.PubMedCrossRefGoogle Scholar
  82. 82.
    Kim ES, Hershner SD, Strecher VJ. Purpose in life and incidence of sleep disturbances. J Behav Med. 2015;38:590–7.PubMedCrossRefGoogle Scholar
  83. 83.
    Nsamenang SA, Hirsch JK. Positive psychological determinants of treatment adherence among primary care patients. Prim Health Care Res Dev. 2015;16:398–406.PubMedCrossRefGoogle Scholar
  84. 84.
    Steptoe A, Wright C, Kunz-Ebrecht SR, Iliffe S. Dispositional optimism and health behaviour in community-dwelling older people: associations with healthy ageing. Br J Health Psychol. 2006;11:71–84.PubMedCrossRefGoogle Scholar
  85. 85.
    Huffman JC, DuBois CM, Mastromauro CA, Moore SV, Suarez L, Park ER. Positive psychological states and health behaviors in acute coronary syndrome patients: a qualitative study. J Health Psychol. Google Scholar
  86. 86.
    Bower JE, Moskowitz JT, Epel E. Is Benefit Finding Good for Your Health? Pathways Linking Positive Life Changes After Stress and Physical Health Outcomes. Curr Dir Psychol Sci. 2009;18:337–41.CrossRefGoogle Scholar
  87. 87.
    Fredrickson BL. What good are positive emotions? Rev Gen Psychol. 1998;2:300–19.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Hobfoll SE. Conservation of resources: a new attempt at conceptualizing stress. Am Psychol. 1989;44:513–24.PubMedCrossRefGoogle Scholar
  89. 89.
    Zautra AJ, Reich JW, Davis MC, Potter PT, Nicolson NA. The role of stressful events in the relationship between positive and negative affects: evidence from Field and Experimental Studies. J Pers. 2000;68:927–51.PubMedCrossRefGoogle Scholar
  90. 90.
    Aschbacher K, Epel E, Wolkowitz OM, Prather AA, Puterman E, Dhabhar FS. Maintenance of a positive outlook during acute stress protects against pro-inflammatory reactivity and future depressive symptoms. Brain Behav Immun. 2012;26:346–52.PubMedCrossRefGoogle Scholar
  91. 91.
    Steptoe A, Wardle J, Marmot M. Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes. Proc Natl Acad Sci U S A. 2005;102:6508–12.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Fredrickson BL, Mancuso RA, Branigan C, Tugade MM. The undoing effect of positive emotions. Motiv Emot. 2000;24:237–58.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Sin NL, Graham-Engeland JE, Ong AD, Almeida DM. Affective reactivity to daily stressors is associated with elevated inflammation. Health Psychol. 2015;34:1154–65.PubMedCrossRefGoogle Scholar
  94. 94.
    Mroczek DK, Stawski RS, Turiano NA, Chan W, Almeida DM, Neupert SD, et al. Emotional reactivity and mortality: longitudinal findings from the VA Normative Aging Study. J Gerontol B Psychol Sci Soc Sci. 2015;70:398–406.PubMedCrossRefGoogle Scholar
  95. 95.••
    Meyer FA, von Känel R, Saner H, Schmid J-P, Stauber S. Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation. Eur J Prev Cardiol. 2015;22:1247–53. This is one of the only studies to examine the “buffering effect” of positive affect on subsequent health outcomes in patients with CVD. Findings showed that positive affect mitigated the influence of negative affect on CVD-related hospitalizations and all-cause mortality.PubMedCrossRefGoogle Scholar
  96. 96.
    Morozink JA, Friedman EM, Coe CL, Ryff CD. Socioeconomic and psychosocial predictors of interleukin-6 in the MIDUS national sample. Health Psychol. 2010;29:626-35.Google Scholar
  97. 97.
    Zilioli S, Imami L, Slatcher RB. Life satisfaction moderates the impact of socioeconomic status on diurnal cortisol slope. Psychoneuroendocrinology. 2015;60:91–5.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Koopmans TA, Geleijnse JM, Zitman FG, Giltay EJ. Effects of happiness on all-cause mortality during 15 years of follow-up: The Arnhem Elderly Study. J Happiness Stud. 2010;11:113–24.CrossRefGoogle Scholar
  99. 99.
    Kubzansky LD, Thurston RC. Emotional vitality and incident coronary heart disease: benefits of healthy psychological functioning. Arch Gen Psychiatry. 2007;64:1393–401.PubMedCrossRefGoogle Scholar
  100. 100.
    Pressman SD, Cohen S. Positive emotion word use and longevity in famous deceased psychologists. Health Psychol. 2012;31:297–305.PubMedCrossRefGoogle Scholar
  101. 101.
    Abel EL, Kruger ML. Smile intensity in photographs predicts longevity. Psychol Sci. 2010;21:542–4.PubMedCrossRefGoogle Scholar
  102. 102.•
    Eichstaedt JC, Schwartz HA, Kern ML, Park G, Labarthe DR, Merchant RM, et al. Psychological Language on Twitter Predicts County-Level Heart Disease Mortality. Psychol Sci. 2015;26:159–69. This innovative study examined language use in Twitter messages in relation to county-level CHD mortality in the United States. Counties where residents expressed more positive experiences, engagement, and optimism in their Twitter messages had relatively lower rates of CHD mortality.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Kahneman D, Riis J. Living, and thinking about it: two perspectives on life. Sci Well-Being. 2005;285–304.Google Scholar
  104. 104.
    Conner TS, Barrett LF. Trends in ambulatory self-report: the role of momentary experience in psychosomatic medicine. Psychosom Med. 2012;74:327–37.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Cohen S, Doyle WJ, Turner RB, Alper CM, Skoner DP. Emotional style and susceptibility to the common cold. Psychosom Med. 2003;65:652–7.PubMedCrossRefGoogle Scholar
  106. 106.
    Kamarck TW, Schwartz JE, Shiffman S, Muldoon MF, Sutton-Tyrrell K, Janicki DL. Psychosocial stress and cardiovascular risk: what is the role of daily experience? J Pers. 2005;73:1749–74.PubMedCrossRefGoogle Scholar
  107. 107.
    Slavish DC, Graham-Engeland JE, Smyth JM, Engeland CG. Salivary markers of inflammation in response to acute stress. Brain Behav Immun. 2015;44:253–69.PubMedCrossRefGoogle Scholar
  108. 108.
    Samuelsson LB, Hall MH, McLean S, Porter JH, Berkman L, Marino M, et al. Validation of biomarkers of CVD risk from dried blood spots in community-based research: methodologies and study-specific serum equivalencies. Biodemography Soc Biol. 2015;61:285–97.PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Gruber J, Kogan A, Quoidbach J, Mauss IB. Happiness is best kept stable: positive emotion variability is associated with poorer psychological health. Emotion. 2013;13:1–6.PubMedCrossRefGoogle Scholar
  110. 110.
    Ong AD, Exner-Cortens D, Riffin C, Steptoe A, Zautra A, Almeida DM. Linking stable and dynamic features of positive affect to sleep. Ann Behav Med. 2013;46:52–61.PubMedPubMedCentralCrossRefGoogle Scholar
  111. 111.
    Hardy J, Segerstrom SC. Intra-individual variability and psychological flexibility: affect and health in a National US sample. J Res Pers. 2016.Google Scholar
  112. 112.
    Abdel-Khalek AM. Measuring happiness with a single-item scale. Soc Behav Personal. 2006;34:139–50.CrossRefGoogle Scholar
  113. 113.
    Lyubomirsky S, King L, Diener E. The benefits of frequent positive affect: does happiness lead to success? Psychol Bull. 2005;131:803–55.PubMedCrossRefGoogle Scholar
  114. 114.
    Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol. 1994;67:1063–78.PubMedCrossRefGoogle Scholar
  115. 115.
    Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54:1063–70.PubMedCrossRefGoogle Scholar
  116. 116.
    Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger Jr JT, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288:701–9.Google Scholar
  117. 117.
    O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol. 2010;56:692–9.PubMedPubMedCentralCrossRefGoogle Scholar
  118. 118.
    Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA. 2003;289:3106–16.Google Scholar
  119. 119.
    Blumenthal JA, Sherwood A, Babyak MA, Watkins LL, Smith PJ, Hoffman BM, et al. Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. J Am Coll Cardiol. 2012;60:1053–63.PubMedPubMedCentralCrossRefGoogle Scholar
  120. 120.
    Blumenthal JA, Babyak MA, O’Connor C, Keteyian S, Landzberg J, Howlett J, et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA. 2012;308:465–74.Google Scholar
  121. 121.
    Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, et al. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation. 2016;133(14):1341-50.Google Scholar
  122. 122.
    Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health. 2013;13:1–20.CrossRefGoogle Scholar
  123. 123.
    Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J Clin Psychol. 2009;65:467–87.PubMedCrossRefGoogle Scholar
  124. 124.
    Peterson JC, Charlson ME, Hoffman Z, Wells MT, Wong S-C, Hollenberg JP, et al. A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention. Arch Intern Med. 2012;172:329–36.PubMedPubMedCentralCrossRefGoogle Scholar
  125. 125.
    Ogedegbe GO, Boutin-Foster C, Wells MT, Allegrante JP, Isen AM, Jobe JB, et al. A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. Arch Intern Med. 2012;172:322–6.PubMedPubMedCentralCrossRefGoogle Scholar
  126. 126.
    Sanjuán P, Montalbetti T, Pérez-García AM, Bermúdez J, Arranz H, Castro A. A Randomised Trial of a Positive Intervention to Promote Well-Being in Cardiac Patients. Appl Psychol Health Well-Being. 2016;8:64–84.PubMedCrossRefGoogle Scholar
  127. 127.•
    Nikrahan GR, Laferton JA, Asgari K, Kalantari M, Abedi MR, Etesampour A, et al. Effects of positive psychology interventions on risk biomarkers in coronary patients: a Randomized, Wait-List Controlled Pilot Trial. Psychosomatics. 2016;57:359–68. This exploratory trial tested strategies to improve positive well-being in cardiac patients. The study presents initial evidence suggesting that positive psychology interventions may be effective for improving CVD risk biomarkers.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Center for Healthy Aging and the Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkUSA

Personalised recommendations