Trajectories of Psychological Well-Being and Cardiovascular Health in the Women's Health Initiative

Previous studies have demonstrated moderate levels of cardiovascular health (CVH) in the general population, with achievement of healthful behaviors, such as physical activity, being particularly poor. These findings suggest that innovative interventions are needed to bolster CVH among US adults. Novel interventions could consider targeting improvements in psychological well-being (PWB), as PWB can influence CVH through both biological and behavioral pathways. However, more needs to be known regarding how different aspects of PWB change over time and whether sustained, high levels of PWB may improve CVH. Therefore, this dissertation 1) characterized trajectories of PWB among more than 100,000 participants of the Women’s Health Initiative and 2) estimated associations between trajectories of PWB and achievement of CVH, as defined by Life’s Essential 8 (LE8), late in life. We used group-based trajectory modelling to identify trajectories of purpose in life (n=29,717), personal growth (n=12,148), negative affect (n=101,598), and positive affect (n=103,618). Over almost 20 years of follow-up, we found 3 trajectories of purpose in life, 3 trajectories of personal growth, 5 trajectories of negative affect, and 5 trajectories of positive affect. Trajectories of negative and positive affect were more dynamic over time, while trajectories of purpose in life and personal growth were relatively stable. Many contextual factors, including education and income, were significantly associated with trajectories of PWB. Using log-binomial regression, we consistently found that being in the highest trajectories of purpose in life (Risk Ratio 1.64 [1.48, 1.81]), personal growth (1.71 [1.54, 1.90]), and positive affect (1.58 [1.47,1.69]) was associated with high CVH (LE8 > 80), even after adjustment for demographic, social support, and comorbidity factors. Analyses of continuous differences in LE8 scores yielded similar results and showed that trajectories of PWB had a greater impact on the health behaviors than the health factors of LE8. In conclusion, we found evidence of diverse trajectories of PWB in a large sample of postmenopausal women. We observed that maintaining high levels of positive aspects of PWB was associated with better CVH late in life. These findings suggest future works should continue to explore strategies to enhance PWB as a means to promote CVH.