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Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up

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Abstract

This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study—a nationally representative panel study of American adults over the age of 50—were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period. On a six-point purpose in life measure, each unit increase was associated with a multivariate-adjusted odds ratio of 0.73 for myocardial infarction (95% CI, 0.57–0.93, P = .01). The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease.

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References

  • Aalto, A., Heijmans, M., Weinman, J., & Aro, A. R. (2005). Illness perceptions in coronary heart disease: Sociodemographic, illness-related, and psychosocial correlates. Journal of Psychosomatic Research, 58, 393–402. doi:10.1016/j.jpsychores.2005.03.001

    Article  PubMed  Google Scholar 

  • Abbott, R., Ploubidis, G., Huppert, F., Kuh, D., Wadsworth, M., & Croudace, T. (2006). Psychometric evaluation and predictive validity of Ryff’s psychological well-being items in a UK birth cohort sample of women. Health and Quality of Life Outcomes, 4, 76. doi:10.1186/1477-7525-4-76

    Article  PubMed  Google Scholar 

  • Alim, T. N., Feder, A., Graves, R. E., Wang, Y., Weaver, J., & Westphal, M. (2008). Trauma, resilience, and recovery in a high-risk African-American population. American Journal of Psychiatry, 165, 1566–1575. doi:10.1176/appi.ajp.2008.07121939

    Article  PubMed  Google Scholar 

  • Bagley, S. C., White, H., & Golomb, B. A. (2001). Logistic regression in the medical literature: Standards for use and reporting, with particular attention to one medical domain. Journal of Clinical Epidemiology, 54, 979–985. doi:10.1016/S0895-4356(01)00372-9

    Article  PubMed  CAS  Google Scholar 

  • Banks, J., Marmot, M., Oldfield, Z., & Smith, J. P. (2006). Disease and disadvantage in the United States and in England. JAMA, 295, 2037–2045. doi:10.1001/jama.295.17.2037

    Article  PubMed  CAS  Google Scholar 

  • Bergmann, M. M., Byers, T., Freedman, D. S., Mokdad, A. (1998). Validity of self-reported diagnoses leading to hospitalization: A comparison of self-reports with hospital records in a prospective study of American adults. American Journal of Epidemiology, 147, 969–977. Retrieved from http://aje.oxfordjournals.org.

    Google Scholar 

  • Bower, J. E., Kemeny, M. E., Taylor, S. E., & Fahey, J. L. (2003). Finding positive meaning and its association with natural killer cell cytotoxicity among participants in a bereavement-related disclosure intervention. Annals of Behavioral Medicine, 25, 146–155. doi:10.1207/s15324796abm2502

    Article  PubMed  Google Scholar 

  • Boyle, P. A., Barnes, L. L., Buchman, A. S., & Bennett, D. A. (2009). Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic Medicine, 71, 574–579. doi:10.1097/PSY.0b013e3181a5a7c0

    Article  PubMed  Google Scholar 

  • Boyle, P. A., Buchman, A. S., Barnes, L. L., & Bennett, D. A. (2010). Effect of a purpose in life on risk of incident Alzheimer disease and mild cognitive impairment in community-dwelling older persons. Archives of General Psychiatry, 67, 304–310. doi:10.1001/archgenpsychiatry.2009.208

    Article  PubMed  Google Scholar 

  • Bush, T. L., Miller, S. R., Golden, A. L., & Hale, W. E. (1989). Self-report and medical record report agreement of selected medical conditions in the elderly. American Journal of Public Health, 79, 1554–1556. doi:10.2105/ajph.79.11.1554

    Article  PubMed  CAS  Google Scholar 

  • Chida, Y., & Steptoe, A. (2008). Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosomatic Medicine, 70, 741–756. doi:10.1097/PSY.0b013e31818105ba

    Article  PubMed  Google Scholar 

  • Cigolle, C. T., Langa, K. M., Kabeto, M. U., Tian, Z., & Blaum, C. S. (2007). Geriatric conditions and disability: The Health and Retirement Study. Annals of Internal Medicine, 147, 156–164. Retrieved from http://annals.org.

    Google Scholar 

  • Clarke, P., Fisher, G., House, J., Smith, J., & Weir, D. (2008). Guide to content of the HRS psychosocial leave-behind participant lifestyle questionnaires: 2004 & 2006. Survey Research Center, Institute for Social Research. Retrieved from http://hrsonline.isr.umich.edu/

  • Eagle, K. A., Ginsburg, G. S., Musunuru, K., Aird, W. C., Balaban, R. S., & Bennett, S. K. (2010). Identifying patients at high risk of a cardiovascular event in the near future: Current status and future directions: Report of a National Heart, Lung, and Blood Institute Working Group. Circulation, 121, 1447–1454. doi:10.1161/circulationaha.109.904029

    Article  PubMed  Google Scholar 

  • Enders, C. K. (2006). A primer on the use of modern missing-data methods in psychosomatic medicine research. Psychosomatic Medicine, 68, 427–436. doi:10.1097/01.psy.0000221275.75056.d8

    Article  PubMed  Google Scholar 

  • Frankl, V. E. (1959). Man’s search for meaning. Boston: Beacon Press.

    Google Scholar 

  • Friedman, E. M., Hayney, M., Love, G. D., Singer, B. H., & Ryff, C. D. (2007). Plasma interleukin-6 and soluble il-6 receptors are associated with psychological well-being in aging women. Health Psychology, 26, 305–313. doi:10.1037/0278-6133.26.3.305

    Article  PubMed  Google Scholar 

  • Giltay, E. J., Kamphuis, M. H., Kalmijn, S., Zitman, F. G., & Kromhout, D. (2006). Dispositional optimism and the risk of cardiovascular death: The Zutphen Elderly Study. Archives of Internal Medicine, 166, 431–436. doi:10.1001/.431

    PubMed  Google Scholar 

  • Glymour, M. M., & Avendano, M. (2009). Can self-reported strokes be used to study stroke incidence and risk factors? Evidence from the Health and Retirement Study. Stroke, 40, 873–879. doi:10.1161/strokeaha.108.529479

    Article  PubMed  Google Scholar 

  • Greenland, S., & Finkle, W. D. (1995). A critical look at methods for handling missing covariates in epidemiologic regression analyses. American Journal of Epidemiology, 142, 1255–1264. Retrieved from http://aje.oxfordjournals.org/

    Google Scholar 

  • Heckbert, S. R., Kooperberg, C., Safford, M. M., Psaty, B. M., Hsia, J., & McTiernan, A. (2004). Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the women’s health initiative. American Journal of Epidemiology, 160, 1152–1158. doi:10.1093/aje/kwh314

    Article  PubMed  Google Scholar 

  • Heron, M., Hoyert, D., Murphy, S., Xu, J., Kochanek, K., & Tejada-Vera, B. (2009). Deaths: final data for 2006. National Vital Statistics Reports, 57, 1–134. Retrieved from http://cdc.gov

  • Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37. doi:10.2307/2955359

    Article  PubMed  CAS  Google Scholar 

  • Ives, D. G., Fitzpatrick, A. L., Bild, D. E., Psaty, B. M., Kuller, L. H., & Crowley, P. M. (1995). Surveillance and ascertainment of cardiovascular events: The Cardiovascular Health Study. Annals of Epidemiology, 5, 278–285. doi:10.1016/1047-2797(94)00093-9

    Article  PubMed  CAS  Google Scholar 

  • Kim, E. S., Park, N., & Peterson, C. (2011). Dispositional optimism protects older adults from stroke: The Health and Retirement Study. Stroke, 42, 2855–2859. doi:10.1161/STROKEAHA.111.613448

    Google Scholar 

  • Kubzansky, L. D., & Kawachi, I. (2000). Going to the heart of the matter: Do negative emotions cause coronary heart disease? Journal of Psychosomatic Research, 48, 323–337. doi:10.1016/s0022-3999(99)00091-4

    Article  PubMed  CAS  Google Scholar 

  • Kubzansky, L. D., Kubzansky, P. E., & Maselko, J. (2004). Optimism and pessimism in the context of health: Bipolar opposites or separate constructs? Personality and Social Psychology Bulletin, 30, 943–956. doi:10.1177/0146167203262086

    Article  PubMed  Google Scholar 

  • Kubzansky, L. D., & Thurston, R. C. (2007). Emotional vitality and incident coronary heart disease: Benefits of healthy psychological functioning. Archives of General Psychiatry, 64, 1393–1401. doi:10.1001/archpsyc.64.12.1393

    Article  PubMed  Google Scholar 

  • Lampe, F., Walker, M., Lennon, L., Whincup, P., & Ebrahim, S. (1999). Validity of a self-reported history of doctor-diagnosed angina. Journal of Clinical Epidemiology, 52, 73–81. doi:10.1016/S0895-4356(98)00146-2

    Article  PubMed  CAS  Google Scholar 

  • Lindfors, P., & Lundberg, U. (2002). Is low cortisol release an indicator of positive health? Stress and Health: Journal of the International Society for the Investigation of Stress, 18, 153–160. doi:10.1002/smi.942

    Article  Google Scholar 

  • Little, R. J. A., & Rubin, D. B. (2002). Statistical analysis with missing data. Hoboken, NJ: Wiley.

    Google Scholar 

  • Maslow, A. H. (1962). Toward a psychology of being. Princeton, N.J.: Van Nostrand.

    Book  Google Scholar 

  • McWilliams, J. M., Meara, E., Zaslavsky, A. M., & Ayanian, J. Z. (2007). Health of previously uninsured adults after acquiring medicare coverage. JAMA, 298, 2886–2894. doi:10.1001/jama.298.24.2886

    Article  PubMed  CAS  Google Scholar 

  • McWilliams, J. M., Zaslavsky, A. M., Meara, E., & Ayanian, J. Z. (2003). Impact of medicare coverage on basic clinical services for previously uninsured adults. JAMA, 29, 757–764. doi:10.1001/jama.290.6.757

    Article  Google Scholar 

  • Okura, Y., Urban, L. H., Mahoney, D. W., Jacobsen, S. J., & Rodeheffer, R. J. (2004). Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57, 1096–1103. doi:10.1016/j.jclinepi.2004.04.005

    Article  PubMed  Google Scholar 

  • Peterson, C. (2006). A primer in positive psychology. New York, NY: Oxford University Press.

    Google Scholar 

  • Peterson, C., & Kim, E. S. (2011). Psychological interventions and coronary heart disease. International Journal of Clinical and Health Psychology, 11(3), 563–575. Retrieved from http://www.aepc.es/ijchp/index.php?coid=English

    Google Scholar 

  • Peterson, C., Seligman, M. E. P., & Vaillant, G. E. (1988). Pessimistic explanatory style is a risk factor for physical illness: A thirty-five-year longitudinal study. Journal of Personality and Social Psychology, 55, 23–27. doi:10.1037//0022-3514.55.1.23

    Article  PubMed  CAS  Google Scholar 

  • Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health? Psychological Bulletin, 131, 925–971. doi:10.1037/0033-2909.131.6.925

    Article  PubMed  Google Scholar 

  • Psaty, B. M., Kuller, L. H., Bild, D., Burke, G. L., Kittner, S. J., Mittelmark, M., et al. (1995). Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study. Annals of Epidemiology, 5, 270–277. doi:10.1016/1047-2797(94)00092-8

    Article  PubMed  CAS  Google Scholar 

  • Rasmussen, H. N., Scheier, M. F., & Greenhouse, J. B. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, 37, 239–256. doi:10.1007/s12160-009-9111-x

    Article  PubMed  Google Scholar 

  • Rossouw, J. E., Lewis, B., & Rifkind, B. M. (1990). The value of lowering cholesterol after myocardial infarction. New England Journal of Medicine, 323, 1112–1119. doi:10.1056/NEJM199010183231606

    Google Scholar 

  • Royston, P. (2009). Multiple imputation of missing values: Further update of ICE, with an emphasis on categorical variables. Stata Journal, 9, 466–477. Retrieved from http://www.stata-journal.com/

  • Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L. (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. Journal of the American College of Cardiology, 45, 637–651. doi:10.1016/j.jacc.2004.12.005

    Article  PubMed  Google Scholar 

  • Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069–1081. doi:10.1037/0022-3514.57.6.1069

    Article  Google Scholar 

  • Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719–727. doi:10.1037/0022-3514.69.4.719

    Article  PubMed  CAS  Google Scholar 

  • Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1–28. doi:10.1207/s15327965pli0901_1

    Article  Google Scholar 

  • Ryff, C. D., Singer, B., & Love, G. D. (2004). Positive health: Connecting well-being with biology. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 359, 1383–1394. doi:10.1098/rstb.2004.1521

    Article  PubMed  Google Scholar 

  • Scheier, M. F., Matthews, K. A., Owens, J. F., Schulz, R., Bridges, M. W., Magovern, S., et al. (1999). Optimism and rehospitalization after coronary artery bypass graft surgery. Archives of Internal Medicine, 159, 829–835. doi:10.1001/archinte.159.8.829

    Article  PubMed  CAS  Google Scholar 

  • Seligman, M. E. P. (2008). Positive health. Applied Psychology: An International Review, 57, 3–18. doi:10.1111/j.1464-0597.2008.00351.x

    Article  Google Scholar 

  • Skrabski, Á., Kopp, M., Rózsa, R., Réthelyi, J., & Rahe, R. H. (2005). Life meaning: An important correlate of health in the Hungarian population. International Journal of Behavioral Medicine, 12, 78–85. doi:10.1207/s15327558ijbm1202_5

    Article  PubMed  Google Scholar 

  • Sone, T., Nakaya, N., Ohmori, K., Shimazu, T., Higashiguchi, M., & Kakizaki, M. (2008). Sense of life worth living (Ikigai) and mortality in Japan: Ohsaki study. Psychosomatic Medicine, 70, 709–715. doi:10.1097/PSY.0b013e31817e7e64

    Article  PubMed  Google Scholar 

  • Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80–93. doi:10.1037/0022-0167.53.1.80

    Article  Google Scholar 

  • Steptoe, A., Dockray, S., & Wardle, J. (2009). Positive affect and psychobiological processes relevant to health. Journal of Personality, 77, 1747–1776. doi:10.1111/j.1467-6494.2009.00599.x

    Article  PubMed  Google Scholar 

  • Steptoe, A., O’Donnell, K., Marmot, M., & Wardle, J. (2008). Positive affect, psychological well-being, and good sleep. Journal of Psychosomatic Research, 64, 409–415. doi:10.1016/j.jpsychores.2007.11.008

    Article  PubMed  Google Scholar 

  • Tindle, H. A., Chang, Y.-F., Kuller, L. H., Manson, J. E., Robinson, J. G., & Rosal, M. C. (2009). Optimism, cynical hostility, and incident coronary heart disease and mortality in the women’s health initiative. Circulation, 120, 656–662. doi:10.1161/circulationaha.108.827642

    Article  PubMed  Google Scholar 

  • Udvarhelyi, I. S., Gatsonis, C., Epstein, A. M., Pashos, C. L., Newhouse, J. P., & McNeil, B. J. (1992). Acute myocardial infarction in the medicare population. JAMA, 268, 2530–2536. doi:10.1001/jama.1992.03490180062027

    Article  PubMed  CAS  Google Scholar 

  • Van Belle, G. (2008). Statistical rules of thumb. Hoboken, NJ: Wiley.

    Book  Google Scholar 

  • Voaklander, D., Thommasen, H., & Michalos, A. (2006). The relationship between health survey and medical chart review results in a rural population. Social Indicators Research, 77, 287–305. doi:10.1007/s11205-005-2551-1

    Article  Google Scholar 

  • Wallace, R. B., & Herzog, A. R. (1995). Overview of the health measures in the Health and Retirement Study. Journal of Human Resources, 30, S84–S107. Retrieved from http://www.ssc.wisc.edu/jhr/

  • Whooley, M. A., de Jonge, P., Vittinghoff, E., Otte, C., Moos, R., & Carney, R. M. (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA, 300, 2379–2388. doi:10.1001/jama.2008.711

    Article  PubMed  CAS  Google Scholar 

  • Wood, A. M., & Joseph, S. (2009). The absence of positive psychological (eudemonic) well-being as a risk factor for depression: A ten year cohort study. Journal of Affective Disorders, 122, 213–217. doi:10.1016/j.jad.2009.06.032

    Article  PubMed  Google Scholar 

  • Wulsin, L. R., & Singal, B. M. (2003). Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine, 65, 201–210. doi:10.1097/01.psy.0000058371.50240.e3

    Article  PubMed  Google Scholar 

  • Xu, J., & Roberts, R. E. (2010). The power of positive emotions: It’s a matter of life or death—subjective well-being and longevity over 28 years in a general population. Health Psychology, 29, 9–19. doi:10.1037/a0016767

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Support for this publication is provided by the Robert Wood Johnson Foundation’s Pioneer Portfolio, which supports innovative ideas that may lead to breakthroughs in the future of health and health care. The Pioneer Portfolio funding was administered through a Positive Health grant to the Positive Psychology Center at the University of Pennsylvania, Martin Seligman, director.

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Kim, E.S., Sun, J.K., Park, N. et al. Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up. J Behav Med 36, 124–133 (2013). https://doi.org/10.1007/s10865-012-9406-4

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