Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative
Department of Medicine, Division of Preventive and Behavioral Medicine
Medical Subject Headings
African Continental Ancestry Group; Age Distribution; Aged; *Attitude; Comorbidity; *Coronary Disease; European Continental Ancestry Group; Female; Follow-Up Studies; *Hostility; Humans; Incidence; Middle Aged; Multivariate Analysis; Postmenopause; Proportional Hazards Models; Questionnaires; Risk Factors; *Women's Health
Behavior and Behavior Mechanisms | Cardiovascular Diseases | Community Health | Community Health and Preventive Medicine | Public Health | Public Health Education and Promotion | Women's Health
BACKGROUND: Trait optimism (positive future expectations) and cynical, hostile attitudes toward others have not been studied together in relation to incident coronary heart disease (CHD) and mortality in postmenopausal women.
METHODS AND RESULTS: Participants were 97 253 women (89 259 white, 7994 black) from the Women's Health Initiative who were free of cancer and cardiovascular disease at study entry. Optimism was assessed by the Life Orientation Test-Revised and cynical hostility by the cynicism subscale of the Cook Medley Questionnaire. Cox proportional hazard models produced adjusted hazard ratios (AHRs) for incident CHD (myocardial infarction, angina, percutaneous coronary angioplasty, or coronary artery bypass surgery) and total mortality (CHD, cardiovascular disease, or cancer related) over approximately 8 years. Optimists (top versus bottom quartile ["pessimists"]) had lower age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46 versus 63). The most cynical, hostile women (top versus bottom quartile) had higher rates of CHD (56 versus 44) and total mortality (63 versus 46). Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83 to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality (AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in blacks). Effects of optimism and cynical hostility were independent.
CONCLUSIONS: Optimism and cynical hostility are independently associated with important health outcomes in black and white women. Future research should examine whether interventions designed to change attitudes would lead to altered risk.
Tindle, Hilary A.; Chang, Yue-Fang; Kuller, Lewis H.; Manson, JoAnn E.; Robinson, Jennifer G.; Rosal, Milagros C.; Siegle, Greg J.; and Matthews, Karen A., "Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative" (2009). UMass Worcester Prevention Research Center Publications. 13.