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Optimism and Cardiovascular Health: Multi-Ethnic Study of
Atherosclerosis (MESA)
Rosalba Hernandez, PhD1, Kiarri N. Kershaw, PhD2, Juned Siddique, DrPH2, Julia K.
Boehm, PhD3, Laura D. Kubzansky, PhD, MPH4, Ana Diez-Roux, MD, PhD, MPH5, Hongyan
Ning, MD2, and Donald M. Lloyd-Jones, MD, ScM2
1School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL
2Dept of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
3Dept of Psychology, Chapman University, Orange, CA
4Dept of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
5School of Public Health, Drexel University, Philadelphia, PA
Abstract
Objectives—We examined the cross-sectional association between optimism and cardiovascular
health (CVH).
Methods—We used data collected from adults aged 52–84 who participated in the Multi-Ethnic
Study of Atherosclerosis (MESA) (n=5,134) during the first follow-up visit (2002–2004).
Multinomial logistic regression was used to examine associations of optimism with ideal and
intermediate CVH (with reference being poor CVH), after adjusting for socio-demographic factors
and psychological ill-being.
Results—Participants in the highest quartile of optimism were more likely to have intermediate
[OR=1.51:95%CI=1.25,1.82] and ideal [OR=1.92:95%CI=1.30,2.85] CVH when compared to the
least optimistic group. Individual CVH metrics of diet, physical activity, BMI, smoking, blood
sugar and total cholesterol contributed to the overall association.
Conclusions—We offer evidence for a cross-sectional association between optimism and CVH.
Keywords
well-being; optimism; cardiovascular health
A recent paradigm shift in cardiovascular epidemiology has occurred from a focus on the
singular examination of cardiovascular disease (CVD) risk factors to assessment and
consideration of factors involved in the maintenance and promotion of overall
Address for Correspondence: Rosalba Hernandez, PhD, University of Illinois at Urbana-Champaign, School of Social Work, 1010
W. Nevada Street, Urbana, IL 61801, Tel: 217-300-1049, Fax: 217-244-5220, rherna17@illinois.edu.
Human Subjects Statement: The Multi-Ethnic Study of Atherosclerosis (MESA) was approved by the institutional review boards at
each of the study sites.
Conflicts of Interest Disclosures: The authors declare that they have no conflict of interest with respect to the data reported herein.
HHS Public Access
Author manuscript
Health Behav Policy Rev. Author manuscript; available in PMC 2016 January 01.
Published in final edited form as:
Health Behav Policy Rev. 2015 January ; 2(1): 62–73. doi:10.14485/HBPR.2.1.6.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
cardiovascular health (CVH).1,2 In its recently published document—Strategic Impact Goal
Through 2020 and Beyond—the American Heart Association (AHA) seeks a 20%
improvement in CVH among all Americans within a 10-year time span, i.e., by the year
2020.2 As defined using AHA standards, CVH is assessed through consideration of seven
metrics categorized as health behaviors (diet, smoking, physical activity, BMI) and health
factors (blood pressure, blood sugar, total cholesterol). Empirical evidence is accumulating
to suggest that favorable CVH profiles are associated with reduced all-cause and cardiac-
related mortality,3 decreased cancer incidence,4 enhanced cognitive functioning,5 and
greater quality of life.
Researchers have long argued for an important relationship between psychological traits and
heart health. Historically, researchers have examined the role of poor psychological
functioning as increasing risk of adverse cardiovascular outcomes (e.g., depression and
anxiety), but more recently positive psychological characteristics such as dispositional
optimism have been considered as possibly conferring protective effects for heart health.
Defined as possessing positive outcome expectancy for future events across life domains,
dispositional optimism appears to be important for CVD-related outcomes given its positive
influence on physiological regulation (e.g., favorable profiles for inflammatory and
hemostatic factors) and promotion of healthy lifestyle choices (e.g., physical activity).6,7
When CVD risk factor and health behavior measures are considered individually in cross-
sectional and prospective observational studies, positive psychological well-being emerges
as a strong predictor for engagement in physical activity,8,9 healthy food consumption,9,10
abstinence from tobacco use,11 and favorable physiological functioning when measuring
blood pressure,12–14 glycosylated hemoglobin,15 triglycerides,13,16,17 and body mass
index.6,10,18,19 Dispositional optimism has been identified as a potential causal factor for
CVD and related outcomes, with evident reduction in risk for coronary heart disease (CHD)
with increasing optimism levels.20,21 Prospective studies indicate that optimism is
associated with a 50% reduction in CVD risk.6 To our knowledge, no study has examined
the association between optimism and the new multicomponent construct of CVH, which
offers a novel multisystem exploration that may support a biobehavioral pathway through
which well-being influences risk for CHD events and mortality (see Figure 1).Consideration
of the new construct of CVH additionally counters the existing scientific discipline that
emphasizes disease states by underscoring that health is not the mere absence of disease and
that exploration of health assets and protective factors is of import. This new paradigm
accentuates primordial prevention instead of disease onset.
Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), a large multi-center
cohort study, we examined the cross-sectional association between optimism and CVH. We
hypothesized that persons with higher optimism levels were more likely to have favorable
CVH profiles independent of socio-demographic factors and psychological ill-being (e.g.,
depressive symptoms). The socio-demographic and mental health factors were identified as
covariates given their potential to confound the main relationship of interest, with final
selection informed by a recently published systematic review documenting important
covariates when considering cardiac health in the context of positive psychological well-
being.22
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METHODS
Study Population and Data Source
MESA is a large multi-center cohort study aiming to conduct an in-depth assessment of
subclinical CVD, with particular emphasis on its progression and associated risk factors.
Details of the MESA recruitment and study protocol have been published previously.
Briefly, original study enrollment occurred from July 2000 to August 2002 across six US
regions (Baltimore City and Baltimore County, Maryland; Chicago, Illinois; Forsyth
County, North Carolina; Los Angeles County, California; New York, New York; and St.
Paul, Minnesota), with inclusion of a total of 6,814 adults between the ages of 45–84. Those
with a previous history of symptomatic/clinical CVD were excluded during baseline
enrollment. A heterogeneous racial/ethnic composition was achieved with distribution as
follows: 38% White, 28% African American, 22% Hispanic/Latino, and 12% Chinese.
Participants have been followed across an 11-year time span, with repeat measures taken at
1.5–2 year intervals. There have been 4 repeat assessments to date. Unless noted otherwise,
this study used data collected during the first follow-up visit (2002–2004). Approval for the
study was obtained through the Institutional Review Boards (IRB) at all participating
academic sites.
Analyses for the current study involved 5,134 adult participants. Of the 6,233 participants
who attended the first follow up visit, we excluded those who were missing data across main
variables of interest, i.e., dispositional optimism (n=56) and participants with incomplete
information needed to categorize the seven CVH metrics (n=980). Participants were
additionally excluded if they reported an incident CVD-related event prior to the first
follow-up visit (n= 63).
Study Measures
Optimism—The Life Orientation Test-Revised (LOT-R) was completed at the first follow-
up visit (2002–2004) and used to assess levels of dispositional optimism. The LOT-R is a 6-
item self-administered questionnaire with possible scores ranging from 6 (least optimistic) to
24 (most optimistic).23,24 The scale includes three positively worded items (e.g., I’m always
optimistic about my future) and three negatively worded items (e.g., I hardly expect things
to go my way) that are rated on a 4-point Likert scale with response options ranging from a
lot like me to not at all like me. Responses for the negatively worded items were reverse-
coded prior to calculation of a composite score, with higher scores indicative of greater
optimism. As optimism is characterized by endorsement and rejection across positively and
negatively worded items, we did not consider the 3-item subscales of the LOT-R, but instead
decided on unidimensional treatment as recommended.25,26 Given the lack of clinically-
based cutoffs for the LOT-R, quartiles were created as this resulted in more equitable
distribution of participants across scores; previous studies using the MESA cohort have
employed use of quartiles.7 Adequate internal consistency for the LOT-R was evident in the
current study with an overall Cronbach alpha of 0.73.
Cardiovascular Health—Details of the MESA study protocol and assessment methods
have been published elsewhere. Briefly, former and current smoking status was determined
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from self-report. A food frequency questionnaire adapted from the Insulin Resistance
Atherosclerosis Study survey was used to evaluate dietary intake.27 Adapted from the Cross-
Cultural Activity Participation Study, physical activity was subjectively assessed using a
detailed self-report survey instrument.28 BMI (kg/m2) was calculated from staff-ascertained
measures of weight and height. After a 12-hour fast, blood was drawn (~40 ml) to obtain
lipid profiles and fasting glucose values. Congruent across study sites, three systolic and
diastolic blood pressure readings were taken with participants in the seated position; mean
values were obtained by averaging the last two readings.29,30 Self-reported medication use
was also considered when identifying those with pre-existing diabetes mellitus,
hypercholesterolemia, and hypertension. Information on dietary intake was obtained during
the baseline assessment; the remaining CVH metrics were evaluated using data from the first
follow-up visit.
Cardiovascular health was assessed with the following seven metrics: smoking status, diet,
physical activity, body mass index (BMI), fasting plasma glucose, serum cholesterol, and
blood pressure. Each metric was scored and categorized as poor, intermediate, and ideal as
specified by AHA recent recommendations, with consideration of medication use (i.e.,
antihypertensive, lipid-lowering, and hypoglycemic) where appropriate.2 Points were
allocated for each of the seven metrics with scores of 0 (poor), 1 (intermediate) or 2
(ideal)for each health behavior (diet, smoking, physical activity, BMI) and health factor
(blood pressure, blood sugar, total cholesterol). A total CVH score was computed by
summing across metrics to derive a score that could range from 0 to 14, with higher scores
indicative of better cardiovascular health. This composite CVH score was further
categorized into poor (0–7 points), intermediate (8–11 points), and ideal (12–14 points),
which is consistent with previously published classification methods for total CVH.31
Covariates—Covariates included age, sex (i.e., male; or female), race/ethnicity (i.e.,
Caucasian; Chinese-American; African American; or Hispanic), marital status, education,
income, health insurance status (i.e., insured; or not-insured), and psychological ill-being.
Categorical values were created for marital status (i.e., married/living as married/living with
a partner; or other [widowed, divorced, separated, or never married]), education (i.e., less
than high school; high school; some college; bachelor degree; or graduate/professional
degree), and income (i.e., less than $40,000; or ≥ $40,000). All socio-demographic
information was collected using self-report questionnaires completed in person at the first
follow-up assessment (2002–2004). Psychological ill-being was assessed using the Mental
Health Composite Scale of the 12-item Short Form Health Survey (SF-12).32 Scores for
mental health range from 0 to 100, with lower scores indicative of poor mental health.
Physical health was assessed using self-report measures, i.e., Physical Health Composite
Scale of the SF-1232 and inquiry of diagnosed medical conditions of arthritis, liver and
kidney disease.
Statistical Analyses
The continuous composite score for optimism was used to create quartiles across the full
range of the observed distribution. Descriptive characteristics are presented by quartile of
optimism. Group differences in participant characteristics across optimism quartiles were
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examined using an F-test or χ2-test as appropriate. Age-, sex-, and race-adjusted mean
optimism scores were computed for the composite CVH measure and individual metrics
across classification groups (i.e., ideal, intermediate, poor); F-tests were used for
comparison across groups.
The association between optimism and the composite CVH score was examined using
multinomial logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were
estimated for the prevalence of intermediate and ideal CVH (versus poor CVH), across
quartiles of optimism. The lowest quartile of optimism (i.e., the least optimistic) served as
the reference category. Three separate models were constructed. Model 1 was unadjusted.
Model 2 adjusted for age, sex, race/ethnicity, marital status, education, income, and
insurance status. Model 3 additionally adjusted for psychological ill-being. In sensitivity
analyses, multivariate Model 2 was re-examined with additional inclusion of covariates
capturing self-reported measures of physical health, i.e., physical health composite scale of
SF-12 and medical comorbidities of arthritis, liver and kidney disease. Additional sensitivity
analyses employing multinomial logistic regression treated dispositional optimism as a
continuous score ranging from 6 to 24 when modeling its association with composite CVH
categories (poor CVH vs. intermediate or ideal).
All data analyses were conducted using statistical software (SAS 9.1 for Windows; SAS,
Inc, Cary, North Carolina).
RESULTS
Characteristics of the study sample
Table 1 provides participant characteristics according to level of optimism. The p-values for
overall trend across socio-demographic characteristics are presented by quartile of optimism.
Participants categorized as most optimistic tended to be older and reported more favorable
mental health. Race/ethnicity, income, education and health insurance status differed by
optimism level. A greater proportion of African American and Hispanic/Latino participants
were in the highest optimism quartile as compared with the lowest quartile, while this trend
was reversed for White and Chinese participants. Compared to the least optimistic
participants, greater levels of income and education were reported by those in the highest
optimism quartile. Finally, as compared to the least optimistic, a slightly greater proportion
of uninsured participants were classified as most optimistic.
Association of optimism with cardiovascular health measures
Distribution of the CVH measures by optimism quartile are presented in Table 2. A
significantly higher mean composite CVH score was observed with increasing levels of
optimism, ranging from7.57 among the least optimistic to 8.13 among the most optimistic.
Optimists displayed more favorable CVH profiles with greater likelihood for classification
into intermediate and/or ideal categories across multiple health behaviors and factors.
This finding is supported by Figure 2 which presents the proportion of participants classified
as ideal across the CVH metrics based upon optimism quartile. Although not a completely
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graded response is evident, across most health metrics, a greater proportion of individuals
have an ideal health classification with increasing optimism scores.
Table 3 presents the odds ratios and associated confidence intervals for having intermediate
or ideal CVH according to quartile of optimism, with poor CVH serving as the referent
category. In unadjusted models and when compared to the least optimistic group,
participants in the highest quartile of optimism showed50% higher odds of being in the
intermediate versus poor CVH category (95% CI=1.26, 1.78) and 76% higher odds of being
in the ideal versus poor CVH category(95% CI=1.24, 2.50).These associations were
strengthened after adjustment for socio-demographic factors (Model 2); those in the highest
quartile had 55% higher odds of having intermediate CVH (95% CI=1.29, 1.85) and twice
the odds of having ideal CVH (95% CI=1.45, 3.06). Similar results were observed in the
multivariable adjusted model accounting for ill-being. In sensitivity analyses, adjustment for
self-reported physical health and medical comorbidities mildly attenuated the results, with
documented maintenance of a robust association between optimism and CVH (not shown).
Table 4 presents the association between continuous scores of dispositional optimism and
CVH categories. As before, a three-category modeling scheme was used to examine CVH;
poor [0–7 points] (ref), intermediate (8–11 points), and ideal (12–14 points). In the
multivariable adjusted model, one SD increase in dispositional optimism was associated
with 13% [95% CI = 1.06, 1.21] higher odds of being in intermediate health and 15% [95%
CI = 1.003, 1.32] higher odds for classification into ideal health, when treating poor CVH as
the referent category for the modeling procedure. As before, inclusion of psychological ill-
being as a covariate only slightly attenuated the observed associations. Differences were not
observed for dispositional optimism scores (19.8 vs. 19.9, p = 0.39), but on average, less
favorable CVH profiles were evident for participants with missing values across the main
variables of interest.
DISCUSSION
There was a statistically significant positive cross-sectional association between
dispositional optimism and CVH, with the most optimistic participants exhibiting twice the
odds of having ideal CVH profiles in unadjusted analyses. This association remained
significant even after adjustment for socio-demographic characteristics (i.e., age, sex, race/
ethnicity, marital status, education, income, and insurance status) and psychological ill-
being. Secondary analyses identified the associations of optimism with individual CVH
metrics of diet, physical activity, BMI, smoking, blood sugar and total cholesterol as
contributing to the overall association.
Although this is the first study to consider the association between optimism and CVH as
defined by the American Heart Association,2 our results are generally consistent with
evidence derived from studies considering the relationship between dispositional optimism
and single cardiac-related health behaviors and/or factors. Previous cross-sectional and
longitudinal evidence links optimism to more favorable dietary9,10 and physical activity8,9,33
profiles, and reduced likelihood for smoking.6,11,34,35 Reports on the relationship between
optimism and BMI are less consistent.8–10
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These findings notwithstanding, it is worth noting that cross-sectional and longitudinal
studies have yielded somewhat inconsistent findings on the association of dispositional
optimism with metabolic and physiologic measures (e.g., glycated hemoglobin, lipids and
blood pressure).6 Unlike our findings with the MESA cohort, Brody et al.36 did not find an
association between optimism and glycemic control in a sample of 200 African American
adults with type 2 diabetes. Discordant findings may be a consequence of dissimilar study
measures (i.e., fasting glucose in mg/dl vs. HbA1C) and divergent participant samples (i.e.,
diabetic individuals of African American descent vs. a heterogeneous cohort with and
without diabetes). Additionally, the LOT-R scoring rubric used by Brody et al.36 focused on
identifying participants with low levels of optimism and did not consider effects across the
continuum of optimism levels. The relatively small sample (n = 200) of African American
adults with type 2 diabetes may further explain the null findings, particularly if insufficient
power was achieved to detect the association of interest, i.e., low optimism and HbA1C.
Contributing to the current state of knowledge in the area of positive psychological well-
being and glycemic control, the current study, the first to utilize a large (n = 5,134)
heterogeneous adult cohort, documents a robust association between optimism and fasting
glucose levels. This is also applicable in relation to findings on the association between
optimism and lipid levels, as limited and discordant findings are also reported to date.9,13
Longitudinal studies document protective effects of optimism-related measures (i.e., hope,
curiosity, vitality) on incident hypertension across a 1-year time span.12,13 However, several
cross-sectional studies report an inverse association between dispositional optimism and
blood pressure,14 while others document null findings.6,37 Racial/ethnic heterogeneity of the
MESA sample, particularly inclusion of underserved minority populations (i.e., African
Americans and Hispanic/Latinos), may inform our null finding. Raikkonen and Matthews38
found a robust association between optimism and ambulatory blood pressure in a sample of
middle-aged working non-Hispanic Whites, while no such finding was evident in a more
diverse adolescent sample that included African American participants.37 Results for the
MESA cohort are consistent with that reported for racial/ethnic minority adolescents, with
similarities in racial/ethnic composition potentially explaining congruent findings. If racial/
ethnic minorities more frequently experience chronic daily stressors such as racial
discrimination, it is possible that this may obscure the effects of an individual’s life
orientation on single-day assessments of blood pressure, particularly if stressful events serve
to temporarily increase blood pressure.
Future studies will want to consider the mechanism through which dispositional optimism
may influence the metrics used to construct the CVH score, particularly as the difference in
CVH between the least and most optimistic subgroups, i.e., 0.56 points, may be of clinical
significance as it approximates the 1-point difference associated with an 8% reduction in
stroke risk.39 At the population level, even this moderate difference in CVH score translates
into a significant reduction in subsequent deaths. In terms of mechanism, one possibility is
that optimists employ more adaptive coping skills when faced with adversity.40 For
example, optimists are more likely to engage in active problem-focused coping and positive
reinterpretation of stress evoking events, while infrequently employing tactics of denial and
avoidance.41,42 In turn, these positive coping responses have been found to be predictive of
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greater likelihood of engaging in prudent health behaviors—i.e., tobacco avoidance and
moderate alcohol use—and attainment of favorable physical health profiles.40
Although additional work is necessary, our findings offer support—through assessment of
the new construct of CVH—for the hypothesized biobehavioral mechanism through which
optimism favorably impacts CVD-related endpoints. Major CVD risk factors (e.g.,
hypercholesterolemia, hypertension, diabetes, obesity)—considered when deriving the CVH
score—have substantial evidence linking them to progression of subclinical atherosclerosis,
clinical manifestation of CVD, and subsequent CVD-related mortality.43 Thus, the
mechanism whereby psychological well-being influences CVD-related outcomes may well
be both behavioral and biologic in nature, through favorable impact on engagement in
healthy behavior (e.g., high levels of physical activity) and enhanced regulation of metabolic
and cardiovascular functioning (e.g., improved glucose metabolism).44
The present study has multiple strengths. It is the first to examine the association of
dispositional optimism and CVH in a large (n=5,134) ethnically/racially diverse sample of
adults. This allowed for examination of effect modification by race/ethnicity, yielding no
apparent interaction of race/ethnicity with dispositional optimism when regressed upon
CVH metrics. A well-validated instrument was used to assess dispositional optimism and
standardized approaches were used to obtain objective measures of the health factors, i.e.,
blood pressure, blood sugar, and total cholesterol. However, study limitations should be
considered when interpreting findings. Measurement error and misclassification bias are
plausible for dietary intake and physical activity as they were self-reported. As with all
cross-sectional studies, we are unable to make definitive inferences about causality.
Specifically, it is possible that individuals are more optimistic because they are healthier.
Longitudinal studies are needed to establish causality and adequately address uncertainties
regarding temporality of the association. Finally, future studies should examine differential
item functioning when using the LOT-R with diverse ethnic/racial subgroups, particularly as
we observed a greater proportion of African American and Hispanic/Latino participants in
the highest optimism quartile as compared with the lowest quartile.
IMPLICATIONS FOR HEALTH BEHAVIOR
The current study found a significant positive association between dispositional optimism
and CVH. This evidence suggests that, primordial-, primary-, and secondary-prevention
strategies through modification of psychological well-being (e.g., optimism) may be a
potential avenue in helping to reach AHA’s goal to increase cardiovascular health by 20%
before 2020. As evidence suggests that 40% of individual variance in happiness—a
hedonistic construct of psychological well-being—is determined by intentional activities
under direct human volition,45–47 current evidence, in conjunction with implementation of
randomized clinical trials will further aid in determining whether successful alteration of
psychological well-being favorably impacts CVH behaviors and factors. Indeed, mutable
psychological factors (e.g., optimism) are evident for which public health interventions may
be of benefit.
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Acknowledgements
This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161,N01-HC-95162, N01-
HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166,N01-HC-95167, N01-HC-95168 and N01-HC-95169
from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-TR-001079 from
NCRR. The authors thank the other investigators, the staff, and the participants of the MESA study for their
valuable contributions. A full list of participating MESA investigators and institutions can be found at http://
www.mesa-nhlbi.org. Rosalba Hernandez was a T32 Post-Doctoral Fellow on NHLBI T32 HL-069771-10
(Daviglus, PI).
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Figure 1.
Theoretical model: Psychological well-being and clinical disease
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Figure 2.
Proportion in Ideal Classification Group across Metrics by Optimism Quartile. P-values for
comparison across groups based on Chi-square tests.
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Table 1
Characteristics of the Study Sample According to Quartile of Optimism: MESA (N=5,134)
N=5,134 Optimism Quartile
Least
Optimistic Mid-Low
Optimistic Mid-High
Optimistic Most
Optimistic
Quartile of LOT-R Score (Optimism) I
n=1611 II
n=1522 III
n=1118 IV
n=883 pb
Age, M (SD) 63.5 (10.5) 63.0 (10.1) 63.6 (9.8) 64.2 (10.1) 0.04
Sex
Women, n (%) 872 (54.1) 781 (51.3) 596 (53.3) 476 (53.9) 0.41
Race/Ethnicity, n (%)
Caucasian 670 (41.6) 654 (43.0) 518 (46.3)*297 (33.6)*<0.0001
Chinese-American 199 (12.4) 191 (12.6) 111 (9.9) 95 (10.8)*
African American 368 (22.8) 368 (24.2) 304 (27.2)*244 (27.6)
Hispanic 374 (23.2) 309 (20.3) 185 (16.6) 247 (28.0)
Marital Status
Married/Living as married/Living with a partner 968 (60.2) 954 (62.7) 711 (63.7) 564 (63.9) 0.18
Othera640 (39.8) 568 (37.3) 406 (36.4) 319 (36.1)
Annual Income, n (%)
Less than 40K 852 (52.9) 716 (47.0) 452 (40.4) 423 (47.9) <0.0001
≥ 40K 759 (47.1) 806 (53.0)*666 (59.6)*460 (52.1)*
Education, n (%)
Less than high school 314 (19.5) 209 (13.7) 139 (12.4) 170 (19.3) <0.0001
High school 378 (23.5) 261 (17.2) 145 (13.0) 133 (15.1)
Some college 437 (27.2) 448 (29.4)*326 (29.2)*245 (27.8)
Bachelor degree 240 (14.9) 297 (19.5)*240 (21.5)*159 (18.0)
Graduate or professional degree 239 (14.9) 307 (20.2)*267 (23.9)*176 (19.9)*
Health Insurance Status, n (%)
Has health insurance 1521 (94.4) 1417 (93.1) 1050 (93.9) 801 (90.7)*0.003
Does not have health insurance 90 (5.6) 105 (6.9) 68 (6.1) 82 (9.3)
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N=5,134 Optimism Quartile
Least
Optimistic Mid-Low
Optimistic Mid-High
Optimistic Most
Optimistic
Quartile of LOT-R Score (Optimism) I
n=1611 II
n=1522 III
n=1118 IV
n=883 pb
SF-12 Health Survey, M (SD)
Mental Health Index 48.3 (10.0) 52.7 (7.8) 54.1 (7.3) 55.8 (6.6) <0.0001
aIncludes those reporting being widowed, divorced, separated, or never married.
bP-value examining overall group differences using χ2 or F tests as appropriate.
*Multinomial regression model(s) treating least optimistic as the referent group along with the socio-demographic categories of Hispanic, male, not-insured, less than high school, and income < 40K; used
to examine between-group differences with a p-value < 0.05.
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Table 2
Distribution of Total Cardiovascular health (CVH) and Subcomponents by Quartile of Optimism: MESA (N=5,134)
Optimism Quartile
Least
Optimistic Mid-Low
Optimistic Mid-High
Optimistic Most
Optimistic
Quartile of LOT-R Score
(Optimism) I
n=1611 II
n=1522 III
n=1118 IV
n=883 pb
Total CVH Scorea, M (SD) 7.57 (2.49) 7.96 (2.43) 8.06 (2.41) 8.13 (2.31) <0.0001
CVH, n (%)
Poor 774 (48.1) 637 (41.9) 458 (41.0) 334 (37.8) <0.0001
Intermediate 752 (46.7) 791 (52.0)*569 (50.9)*485 (54.9)*
Ideal 84 (5.2) 94 (6.2) 90 (8.1)*64 (7.3)*
Diet
Poor 731 (45.4) 623 (40.9) 418 (37.4) 309 (35.0) <0.0001
Intermediate 802 (49.8) 807 (53.0)*622 (55.6)*511 (57.9)*
Ideal 78 (4.8) 92 (6.0)*78 (7.0)*63 (7.1)*
Smoking
Poor 217 (13.5) 168 (11.0) 106 (9.5) 73 (8.3) 0.0005
Intermediate 653 (40.5) 671 (44.1)*490 (43.8)*366 (41.5)*
Ideal 741 (46.0) 683 (44.5) 522 (46.7)*444 (50.3)*
Physical Activity
Poor 476 (29.6) 342 (22.5) 238 (21.3) 212 (24.0) <0.0001
Intermediate 300 (18.6) 265 (17.4) 182 (16.3) 154 (17.4)
Ideal 835 (51.8) 915 (60.1)*698 (62.4)*517 (58.6)*
Body Mass Index
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Optimism Quartile
Least
Optimistic Mid-Low
Optimistic Mid-High
Optimistic Most
Optimistic
Quartile of LOT-R Score
(Optimism) I
n=1611 II
n=1522 III
n=1118 IV
n=883 pb
Poor 560(34.8) 484 (31.8) 331 (29.6) 258 (29.2) 0.02
Intermediate 608 (37.7) 581 (38.2) 471 (42.1) 362 (41.0)
Ideal 443 (27.5) 457 (30.0) 316 (28.3) 263 (29.8)
Blood Pressure
Poor 773 (48.0) 708 (46.5) 560 (50.1) 419 (47.5) 0.62
Intermediate 297 (18.4) 279 (18.3) 205 (18.3) 168 (19.0)
Ideal 541 (33.6) 535 (35.2) 353 (31.6) 296 (33.5)
Blood Sugar
Poor 250 (15.5) 202 (13.3) 135 (12.1) 110 (12.5) 0.04
Intermediate 275 (17.1) 286 (18.8)*177 (15.8) 160 (18.1)
Ideal 1086 (67.4) 1034 (67.9) 806 (72.1)*613 (69.4)*
Total Cholesterol
Poor 494 (30.7) 439 (28.8) 305 (27.3) 218 (24.7) 0.01
Intermediate 425 (26.4) 373 (24.5) 305 (27.3) 262 (29.7)*
Ideal 692 (43.0) 710 (46.7) 508 (45.4) 403 (45.6)*
aContinuous CVH scores range from 0–14 with higher scores representing better CVH.
bP-value examining overall group differences using χ2 or F tests as appropriate.
*Multinomial regression model(s) treating categories of poor CVH and least optimistic as the referent group to examine between-group differences; p < 0.05.
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Table 3
Multivariable Association Between Optimism and Cardiovascular Health (N= 5,128)
Cardiovascular Health
Intermediate vs.
Poor Ideal vs.
Poor
6-item LOT-R
OR (95% CI) OR (95% CI)
M1: Unadjusted
Quartile I—Lowest 1.0 (ref) 1.0 (ref)
Quartile II 1.28 (1.11, 1.48) 1.36 (0.99, 1.86)
Quartile III 1.28 (1.10, 1.50) 1.81 (1.32, 2.49)
Quartile IV—Highest 1.50 (1.26, 1.78) 1.76 (1.24, 2.50)
M2: Minimally Adjusteda
Quartile I—Lowest 1.0 (ref) 1.0 (ref)
Quartile II 1.21 (1.04, 1.40) 1.24 (0.89, 1.73)
Quartile III 1.19 (1.01, 1.41) 1.76 (1.26, 2.48)
Quartile IV—Highest 1.55 (1.29, 1.85) 2.11 (1.45, 3.06)
M3: Multivariable Adjustedb
Quartile I—Lowest 1.0 (ref) 1.0 (ref)
Quartile II 1.19 (1.02, 1.39) 1.18 (0.84, 1.65)
Quartile III 1.17 (0.99, 1.39) 1.64 (1.15, 2.33)
Quartile IV—Highest 1.51 (1.25, 1.82) 1.92 (1.30, 2.85)
Quartiles range from lowest (I) to highest (IV) for the LOT-R measure, with Quartile IV corresponding to the highest levels of optimism for the full
6-item LOT-R measure.
aAdjusted for age, gender, race/ethnicity, marital status, education, income, and insurance status.
bAdjusted for age, gender, race/ethnicity, marital status, education, income, insurance status, and mental health (SF-12).
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Table 4
Odds ratios and 95% confidence intervals (CIs) for the cross-sectional association of one standard deviation
increase in optimism score with cardiovascular health (N= 5,128)
Cardiovascular Health
Intermediate vs. Poor Ideal vs. Poor
6-item LOT-R
OR (95% CI) OR (95% CI)
M1: Unadjusted 1.17 (1.10, 1.24) 1.28 (1.13, 1.44)
M2: Minimally Adjusteda1.14 (1.08, 1.21) 1.21 (1.06, 1.37)
M3: Multivariable Adjustedb1.13 (1.06, 1.21) 1.15 (1.003, 1.32)
aAdjusted for age, gender, race/ethnicity, marital status, education, income, and insurance status.
bAdjusted for age, gender, race/ethnicity, marital status, education, income, insurance status, and mental health (SF-12).
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