Health and Socialization

Live Long and Be Positive

A positive outlook goes a long way toward improving survival after a heart attack.

Patients that have coronary heart disease  with positive recovery expectations, expressing their beliefs such as "I can still have strong body and live long" had greater survival in long terms, some researchers reported.

Almost 3,000 of cohort patients undergoing coronary angiography, those who have highest expectations for their outcomes had the best outcomes, Dr. John C. Barefoot, and colleagues from Duke University Medical Center in Durham, N.C.

"Patients differ usually in terms of their emotional reactions to major sicknesses such as coronary heart disease," Bare foot’s group explained online in the Archives of Internal Medicine.

Related: Should I Have an Angiogram?

To search for the specific potential influence of expectations recovery, rather than total optimistic character traits, the investigators enrolled 2,618 patients with clinically significant disease and monitored them for about 16 years.

Expectations of recovery were assessed on the Expectations for Coping Scale, in which patients agreed or disagreed with statements such as "I think I will never recover from my heart problems" and " The condition of my heart will have slight or no effect on my ability to do work."

Patients were stratified into quartiles according to their expectation scores.

After multiple variables adjustment, the rate in the highest quartile of morality — the most enthusiastic group — was 33 per 100 versus 45 per 100, correspondingly, "illustrating a considerable amount of this effect even after taking numerous covariates into account," Barefoot and colleagues observed.

"These observations add to a convincing body of confirmation that endorsing positive expectations for one's future heart health is related with clinically essential aids to cardiovascular outcomes," Dr. Robert Gramling, and Dr. Ronald Epstein, of the University of Rochester in New York, wrote in a commentary associated the study.

"The degrees of sign observed in these studies advise that confidence is an influential 'drug' that compares favorably with exceedingly effective medical therapies," they wrote.

Other experts advised caution, however.

"Like all observational studies, not knowing patient’s characteristics may have contributed to the better outcomes," observed Dr. Steven E. Nissen, of the Cleveland Clinic.

"Patients with a negative' attitude may simply be not healthier than patients with a passitive attitude. In fact, their 'attitude' may reflect their health status," Nissen wrote to MedPage Today and ABC News in an e-mail.

Two "plausible" hypotheses can help explain the study findings, according to Barefoot and colleagues.

First, patients who are positive may use more effective strategies to cope with illness recovery, by addressing the problem and minimizing risk factors.

Second, patients who have negative outlook may experience worse stress that in turn could have dangerous cardiac effects.

Related: How Optimism Helps in the Long Run

Restrictions of the study, according to the investigators, included the possibility of confounders and selection bias.

"These findings maintain for prolonged efforts to appreciate the influence of recovery expectations and the potential aids of attempts to modify them," Barefoot's group concluded.

However, the potential effectiveness of such hard work is uncertain, according to Dr. James Kirkpatrick, of the University of Pennsylvania in Philadelphia.

"Whether a patient's point of view can be changed (or patients can change their outlook) and improve results, and whether there are additional factors which might make these patients do better, is unidentified. One of those factors might be that cardiovascular benefactors give better care to patients with a positive point of view — perhaps spending more time with them or being more conscientious," wrote Kirkpatrick in an email toMedPage Today and ABC News.

"Future studies will need to take this possible mechanism into account," wrote Kirkpatrick.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute on Aging.

One journalist has a patent pending on an allele as a marker of cardiovascular sickness and stress, and is a founder and main stockholder in Williams Life Skills Inc.

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