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A Healthy Dose of Optimism

"The things you think are the disasters in your life are not the disasters really. Almost anything can be turned around: out of every ditch, a path, if you can only see it." Hilary Mantel

Some of us appear to be naturally optimistic, others not so much. Optimists always try to find something to be happy about; pessimists usually have something to worry about, for example, their health. How do these mind states relate to our physical wellbeing and medical outcome?

A number of studies have been carried out by the American Heart Association to answer the following question: is emotional and mental state of people with cardiovascular disease associated with their physical condition and if so, how does it impact their treatment and life expectancy?

A systematic review of prospective studies analysing the relationship between a positive mindset and health-related outcome among patients with coronary heart disease has shown that so-called positive wellbeing helps decrease the level of inflammation and is directly associated with a shorter hospitalisation time and lower mortality in 12 month follow-up.

A recently published Dutch study has found that people who are naturally optimistic were 45% less likely to die of heart disease and other causes than those with high levels of pessimism. The researchers have found that optimistic patients with cardiovascular disease undergoing bypass surgery experienced fewer complications, recovered faster and were in a better shape than the pessimists. All these factors contributed to a lower rate of re-hospitalisation.

Scientists investigated further looking to find if pessimists have perhaps shorter life expectancy because they are more depressed than those who are optimistic.

The link between depression and cardiovascular disease has been well established. A solid medical evidence has shown that certain mental states, like depression, are associated with a significantly higher risk of cardiovascular death. Several well-designed studies have proven that depression can increase a relative risk of having a first heart attack by more than 50%, independently of other risk factors. Moreover, for those who have already been diagnosed with heart disease, depression increases the risk of death about threefold.

People with depression and cardiovascular disease are also more likely to be readmitted to a hospital than those who are at a positive state of mind.

A few studies have shown that positive social attitude described as optimism, hope, gratitude and a general sense of wellbeing translate directly into our cardiovascular health.

After a thorough analysis of basic risk factors like blood pressure, cholesterol, smoking and alcohol consumption, it turned out that even if all these variable above were well controlled, there was still a significant excess of both mortality and morbidity in the pessimistic group compared with the optimists.

Given that these findings are reliable, and optimists have indeed a survival advantage, what mechanisms could explain it? One possibility is that optimists have well-developed resilience and may, therefore, be able to cope better with adversities. In fact, optimism is strongly associated with seeking social support and having better capacity to cope with stress.

There is no medical evidence that pessimism in the absence of clinical depression is a risk factor for developing heart disease. Nevertheless, there is a strong evidence that psychotherapy and serotonin-enhancing antidepressants can enrich our natural personality traits like social engagement, even in people without depression.

Pessimists have constant worries and endless reasons to feel unhappy. If there is anything they should be worried about, is that they may have an undiagnosed, but treatable depression. Although treating depression may not guarantee a longer life expectancy, it will definitely make their life healthier, brighter and more enjoyable.

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