Satisfaction With Life Portends Less CVD: UK Biobank Analysis

People who report having a lack of well-being are at higher risk for cardiovascular disease, an analysis of the UK Biobank suggests. The links, researchers say, present a window of opportunity for prevention.

The “robust” inverse association they found suggests “that enhancing well-being may be a viable strategy for CVD prevention,” Jinghui Zhong, MD (The First Affiliated Hospital of the University of Science and Technology of China, Hefei), and colleagues conclude, advocating a “holistic approach” that considers everything from money to relationships.

Senior author Wen Sun, MD, PhD (The First Affiliated Hospital of the University of Science and Technology of China), told TCTMD via email that the results, some of which came from Mendelian randomization analyses, suggest “potential causal relationships that prior studies, often limited by smaller sample sizes and cross-sectional designs, have not definitively shown.” Moreover, their work explored how lifestyle factors and inflammatory markers might mediate the relationships, “providing a clearer picture of the possible biological pathways involved,” he added.

Published in the Journal of the American Heart Association, the new study dovetails with a 2021 scientific statement from the American Heart Association that drew a connection between psychological health and CVD.

Monika M. Safford, MD (Weill Cornell Medicine, New York, NY), commenting on the results for TCTMD, said they speak to the prospect of addressing well-being as a way to make inroads into the residual risk that some patients have despite controlling things like blood pressure and cholesterol levels.

“One of the problems that we have with our healthcare system is that we are so focused on biomarkers, and reducing risks by lowering those biomarkers, that we forget that there are psychosocial aspects that are sometimes more powerful than some of the things that we spend a lot of time and effort on trying to [address],” she said, adding, “There's a quite a bit that we can do to make people feel better that could actually reduce their cardiovascular risk.”

Beyond the topic itself, Safford said the study “is yet again an incredible demonstration of the power of the UK Biobank” to address health questions on such a large scale.

Higher Well-being, Lower CVD Risk

For their cohort analysis, published this week in the Journal of the American Heart Association, Zhong et al looked for links between well-being and the risks of four major CVD types in 121,317 UK Biobank participants (mean age 57; 45% men). Health information was derived from blood tests, electronic health records, and hospital procedure codes.

There were 5,990 strokes, 9,177 cases of chronic ischemic heart disease, 6,462 MIs, and 3,323 cases of heart failure over a median follow-up period of 11.8 years.

The researchers, using responses to baseline questionnaires distributed through the UK Biobank, first developed a well-being index that considered general happiness as well as satisfaction with family, friendships, health, and finance. From this vantage point, they divided the population based on whether the individuals expressed low, variable, moderate-to-high, or high satisfaction at baseline. Compared with those reporting low satisfaction, those with higher levels had progressively lower risks of CVD.

CVD Risks Based on Greater (vs Low) Satisfaction: HR (95% CI)

General happiness and health satisfaction emerged as the most influential drivers of well-being in relation to CVD, Sun said, with family relationships, friendships, and financial situation having a less-pronounced impact.

The individuals with greater well-being tended to have healthier lifestyles in terms of things like body mass index, diet, alcohol intake, smoking, duration of sleep, and time spent watching television. They also tended to have lower levels of inflammatory markers. In Mendelian randomization, these factors partially—but not entirely—mediated the associations between well-being and CVD risk.

Sun said the mediating roles of lifestyle and inflammation were “particularly notable” findings that came as a surprise. “While we expected well-being to influence cardiovascular health, the extent to which lifestyle factors like physical activity, diet, and smoking mediated this relationship was remarkable,” he observed.

The robust associations they found between well-being and CVD, plus some genetic evidence, do suggested causation, but this can’t be definitively proven without further study, Sun said.

Interestingly, while most patterns were consistent by sex, there were some differences.

“Happiness, while acting as a protective factor against almost all of the four CVD outcomes, showed a reduced effect in men,” the paper notes, suggesting that this may be because men on the average tend to report being less happy than women. “Sociocultural norms and expectations regarding sex roles might play a significant role here. Often, societal expectations encourage men to display traits like stoicism and independence, potentially leading to a reluctance in expressing or acknowledging emotional needs, which in turn could adversely impact their overall well-being.”

How to Foster Well-being?

Well-being, of course, is a wide-ranging concept, which begs the question of how best to promote it.

Safford, for her part, suggested techniques like cognitive restructuring, where people are trained to pause when thinking negative thoughts and replace them with a positive alternative.

It’s all about outlook: someone with a chronic illness like heart failure, for example, might be more apt to feel like they’re aging successfully if despite their health challenges, they have social connections, good cognitive function, and enough stamina to get out and about, she explained. “You don't have to be able to run a marathon, but you want to be able to go to a senior center and visit with friends, if that's what you want to do, or go to church on Sunday.”

As for mechanism, Safford agreed inflammation—a risk factor that continues to gain recognition—could play a central role. “I think what’s new here is this relationship between well-being and inflammation,” she said, noting that it’s known that people with comorbidities like obesity and diabetes have signs of increased inflammation. “But the idea that your general mood and well-being also is associated with inflammation is really kind of intriguing.”

The next steps will be developing and validating interventions to promote well-being.

One example, Safford said, is that as part of the CHAMPS National program, researchers are studying ways to improve cardiovascular health in postpartum women. The intervention involves the Life’s Essential 8, but that framework doesn’t include psychosocial factors among its metrics.

So, said Safford, “we're working with doulas who are going to be delivering [our] intervention to women who recently delivered a baby. They were the ones who said, ‘Oh, we need to build in community.’ And so we did that, because they requested it and we wanted the intervention to be acceptable and engaging to people.” It may be that improving a sense of well-being through community translates to better cardiovascular health, she said.

The current results can encourage clinicians to consider “holistic health management” that emphasizes not just physical but psychological well-being in preventive cardiovascular care, Sun advised. “They might discuss with patients how enhancing well-being—through stress management, fostering positive social relationships, and improving lifestyle factors like diet and exercise—could potentially lower their risk of cardiovascular diseases. Clinicians can also use these insights to advocate for integrated care approaches that include psychological and social support components.”

Next up, he said, their group intends to investigate how well-being might mediate brain health and neurological conditions.