Emotional Vitality and Incident Coronary Heart Disease

CONTEXT: The potentially toxic effects of psychopathology and poorly regulated emotion on physical health have long been considered, but less work has addressed whether healthy psychological functioning may also benefit physical health. Emotional vitality--characterized by a sense of energy, positive well-being, and effective emotion regulation--has been hypothesized to reduce risk of heart disease, but no studies have examined this relationship. OBJECTIVES: To examine whether emotional vitality is associated with reduced risk of coronary heart disease (CHD). Secondary aims are to consider whether effects are independent of negative emotion and how they may occur. DESIGN: A prospective population-based cohort study. SETTING: National Health and Nutrition Examination Survey I and follow-up studies (a probability sample of US adults). PARTICIPANTS: Six thousand twenty-five men and women aged 25 to 74 years without CHD at baseline, followed up for a mean 15 years after the baseline interview. MAIN OUTCOME MEASURES: Measures of incident CHD were obtained from hospital records and death certificates. During the follow-up period, 1141 cases of incident CHD occurred. RESULTS: At the baseline interview (1971-1975), participants completed the General Well-being Schedule from which we derived a measure of emotional vitality. Compared with individuals with low levels, those reporting high levels of emotional vitality had multivariate-adjusted relative risks of 0.81 (95% confidence interval, 0.69-0.94) for CHD. A dose-response relationship was evident (P < .001). Significant associations were also found for each individual emotional vitality component with CHD, but findings with the overall emotional vitality measure were more reliable. Further analyses suggested that one way in which emotional vitality may influence coronary health is via health behaviors. However, the effect remained significant after controlling for health behaviors and other potential confounders, including depressive symptoms or other psychological problems. CONCLUSION: Emotional vitality may protect against risk of CHD in men and women.