Happiness is key to a healthy heart

An analysis using the UK Biobank dataset shows a robust inverse association between well-being and risk of cardiovascular diseases (CVDs), underpinning the protective effect of higher well-being on the four major CVDs evaluated: coronary heart disease, MI, heart failure (HF), and stroke.

“Emerging evidence suggests a potential protective role of well-being in reducing CVD risk … [As such,] we assessed the well-being of participants using a well-being index derived from baseline questionnaires,” said the researchers. The well-being index is a validated, reliable measure of subjective well-being. [Transl Psychiatry 2022;12:113]

“[Our study showed that the] well-being index longitudinally predicts CVDs … [E]ach 1-SD increase in the well-being index [was] associated with a reduced risk of CVDs,” they said.

In model 1*, a higher well-being index was tied to reduced CVD risk, with hazard ratios (HRs) ranging from 0.79 to 0.86. This inverse association was upheld in models 2* (HRs from 0.81 to 0.88) and 3* (HRs from 0.83 to 0.90). [J Am Heart Assoc 2024;13:e035225]

A sex-based comparison revealed a marginally higher average score in women vs men (0.023 vs −0.029; Wilcoxon p=1.140×10⁻¹⁶). “We observed that happiness, while acting as a protective factor against almost all four CVD outcomes, showed a reduced effect in men. This could be linked to the generally lower baseline levels of happiness in men compared with women,” the researchers explained.

“Sociocultural norms and expectations regarding sex roles might play a significant role here,” they added. Men may be emotionally withdrawn owing to the societal construct depicting men as more impassive than women. [The Gendered Landscape of Suicide: Masculinities, Emotions, and Culture 2019:61–95]

In the latent class analysis that identified four distinct well-being classes (low, moderate-to-high, high, variable satisfaction), higher satisfaction levels generally correlated with lower risk of CVDs than the low-satisfaction group (HRs from 0.44 to 0.56).

Of note, participants in the moderate-to-high-satisfaction group – despite occasionally achieving the ‘extremely happy’ level – did not consistently sustain high satisfaction across all dimensions of well-being. They had higher CVD risks than the high-satisfaction group, who were generally in a ‘very happy’ state across a more balanced range of dimensions. “This finding highlights the importance of a holistic approach to well-being, considering multiple dimensions to assess an individual’s overall state,” the researchers said.

A viable target for CVD prevention

The study cohort comprised 121,317 participants (mean age 56.56 years, 55 percent women). Over a median follow-up period of 11.77 years, various CVD cases were recorded: chronic ischaemic heart disease (n=9,177), MI (n=6,462), stroke (n=5,990), and HF (n=3,323).

“In light of the generally irreversible nature of most CVDs, primary prevention has become a critical approach in maintaining CV and cerebrovascular health,” said the researchers. “The findings underscore the importance of incorporating well-being enhancement strategies into public health initiatives aimed at reducing CVD risk.”

However, some outcomes were self-reported, which might have introduced biases. The predominantly White lineage and participants belonging to more affluent and healthier UK neighbourhoods also limit generalizability of the findings.

Despite the limitations, the large sample size, long follow-up, and several CVD outcomes evaluated may have contributed to the strong inverse relationship between well-being and CVD risk.

“Understanding this relationship could aid in identifying at-risk populations and devising intervention strategies to enhance well-being, potentially reducing the incidence of CV and cerebrovascular diseases,” the researchers concluded.