Effects of Optimism and Gratitude on Physical Activity, Biomarkers, and Readmissions After an Acute Coronary Syndrome

Abstract

Background Positive psychological constructs, such as optimism, are associated with beneficial health outcomes. However, no study has separately examined the effects of multiple positive psychological constructs on behavioral, biological, and clinical outcomes after an acute coronary syndrome (ACS). Accordingly, we aimed to investigate associations of baseline optimism and gratitude with subsequent physical activity, prognostic biomarkers, and cardiac rehospitalizations in post-ACS patients. Methods and Results Participants were enrolled during admission for ACS and underwent assessments at baseline (2 weeks post-ACS) and follow-up (6 months later). Associations between baseline positive psychological constructs and subsequent physical activity/biomarkers were analyzed using multivariable linear regression. Associations between baseline positive constructs and 6-month rehospitalizations were assessed via multivariable Cox regression. Overall, 164 participants enrolled and completed the baseline 2-week assessments. Baseline optimism was significantly associated with greater physical activity at 6 months (n=153; β=102.5; 95% confidence interval [13.6-191.5]; p=.024), controlling for baseline activity and sociodemographic, medical, and negative psychological covariates. Baseline optimism was also associated with lower rates of cardiac readmissions at 6 months (N=164), controlling for age, gender, and medical comorbidity (hazard ratio=.92; 95% confidence interval [.86-.98]; p=.006). There were no significant relationships between optimism and biomarkers. Gratitude was minimally associated with post-ACS outcomes. Conclusions Post-ACS optimism, but not gratitude, was prospectively and independently associated with superior physical activity and fewer cardiac readmissions. Whether interventions that target optimism can successfully increase optimism or improve cardiovascular outcomes in post-ACS patients is not yet known, but can be tested in future studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709669.

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“…Our results also suggest that we should consider healthier behaviors (e.g., eating a healthier diet, engaging in more physical activity, etc. )-which are associated with many disease outcomes-not simply as potential confounders, especially in light of past research that showed that optimism is associated with increased physical activity, higher-quality sleep, abstention from cigarette smoking, and consumption of healthier diets (19,42,(46)(47)(48)(49). In the present study, given that assessments of optimism preceded assessments of behavior and that primary associations were somewhat attenuated after inclusion of behavior in the model, our findings might suggest that these behaviors partly serve as a mechanism underlying the observed associations between optimism and mortality (35, 36) (although we recognize that it may be difficult to distinguish well between confounding and intermediate variables and that health behaviors may be both confounding and intermediate variables).…”

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