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Always look on the bright side of life?

Comment by Thomas Berger, EAPC Exercise, Basic and Translational Research Section

Risk Factors and Prevention

Despite well recognized physiological risk factors (e.g. diabetes, hypertension, smoking,...) there is still lack of awareness for mental causes of coronary heart disease (CHD). Throughout history the heart was always believed as a centre of emotions and mental health. First documented scientific work on this topic was done in the early 20th century by Malzberg et al. who showed an association of involutional depression on cardiovascular mortality. (1) Also data from recent meta-analyses support the strong relationship of mental distress and CHD. (2)

Pänkäläinen et al. studied the impact of optimism and pessimism on CHD mortality. (3) In this GOAL (Good Ageing in Lahti region) study cardiovascular risk factors as well as the optimism and pessimism levels were obtained in 2815 subjects. A revised version of the Life Orientation Test (LOT-R) was used for estimation of optimism and pessimism levels using a two-dimensional approach. Eleven years after inclusion data from 97% of the subjects were available for statistical evaluation. For each individual a general cardiovascular disease risk score was calculated on basis of the Framingham Heart Study. Using a logistic regression model for CHD mortality pessimism was independently associated with the risk of death from CHD. In a sub-analysis the highest quartile of pessimism had a ~2.2-fold higher odds-ratio when compared to the lowest quartile. These effects were independent of sex. Though, optimism alone showed no influence on CHD mortality in this study.

A strength of this study is the long follow-up interval, the sample size and the balanced population regarding gender and age as well as the prospective design. These findings suggest the differentiation between optimism and pessimism as different variables may be helpful in future studies. Moreover, also for primary and secondary prevention these findings stress the importance of structured psychological care of patients at risk for CHD.


Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


1  Mortality amonfg patients with involution melancholia.,Malzberg B., Am J Psych. 1937;93:1231-38

2  Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies.,Yong Gan, Yanhong Gong, Xinyue Tong, Huilian Sun, Yingjie Cong, Xiaoxin Dong, Yunxia Wang, Xing Xu, Xiaoxu Yin, Jian Deng, Liqing Li, Shiyi Cao, Zuxun Lu.,  BMC Psychiatry. 2014; 14: 371.

3  Pessimism and risk of death from coronary heart disease among middle-aged and older Finns: an eleven-year follow-up study. Pänkäläinen M, Kerola T, Kampman O, Kauppi M, Hintikka J., BMC Public Health. 2016 Nov 17;16(1):1124.