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Background: Recent research has identified associations between optimism and cardiovascular disease endpoints. However, other resilience factors like shift-and-persist (SP; adapting the self to stress while finding purpose in tough times), spirituality, social support, and life satisfaction have been understudied. We assessed associations among these factors and a lifestyle-based CVD metric (the Fuster BEWAT score (FBS)) and identified the strongest predictor among young adults in Puerto Rico (PR), a population with a high burden of CVD risk factors. Methods: This cross-sectional analysis used data from young adults (18-29y) who underwent survey and clinical assessments (September 2020-September 2023 ) as part of the PR-OUTLOOK study. Those with complete data were included (n=1,721; 61% female). SP was measured with the Chen scale, optimism with the Life Orientation Test-Revised-6 items scale, spirituality with the Daily Spiritual Experiences Scales, social support (from friends, family, and partner) with the Whalen scale, and life satisfaction with one item from the International Social Survey Program. Higher scores in all scales represent greater resilience and all were converted to z-scores. The FBS included blood pressure, exercise, weight, diet, and tobacco. All metrics were dichotomized as ideal (1) or non-ideal (0) and a total FBS was calculated and categorized according to the number of ideal metrics: poor (0-1), intermediate (2-3), and ideal (≥4). The intermediate and ideal groups were grouped for analysis due to small cell size. Logistic regression models assessed the association between each resilience factor and intermediate/ideal FBS (vs. poor) adjusting for socio-demographics, health insurance, and depression symptoms (Model 1), and for all other resilience factors (Model 2). Results: In the sample, 46% had a poor FBS score, 53% had an intermediate score, and 1% achieved an ideal score. In Model 1, a one standard deviation increase in SP was associated with a 21% higher odds of intermediate/ideal FBS (OR=1.21; 95% CI=1.08-1.36), while optimism, life satisfaction, and social support were associated with 17% (OR=1.17; 95% CI=1.05-1.32), 15% (OR=1.15; 95% CI=1.03-1.29), and 12% (OR=1.12; 95% CI=1.01-1.25) higher odds, respectively. Upon adjusting for all resilience factors (Model 2), only SP remained significantly associated with intermediate/ideal FBS (OR=1.17, 95% CI=1.01-1.35). Conclusion: While optimism, life satisfaction, and social support demonstrated initial associations with better FBS scores, SP emerged as the most significant resilience factor predicting FBS. If confirmed with longitudinal studies, SP could be an important target for future studies of CVD prevention interventions.
López‐Cepero et al. (Tue,) studied this question.