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Optimism and Cardiovascular Events: One Issue to be Considered

      To the Editor:
      We read with great interest the report by Krittanawong et al
      • Krittanawong C
      • Maitra NS
      • Hassan Virk HU
      • et al.
      Association of optimism with cardiovascular events and all-cause mortality: systematic review and meta-analysis.
      regarding the association between the levels of optimism and cardiovascular disease events. Increasing evidence suggests that interventions to improve mental well-being are associated with a multitude of beneficial impacts on cardiovascular diseases.
      • Levine GN
      • Cohen BE
      • Commodore-Mensah Y
      • et al.
      Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association.
      This meta-analysis successfully showed optimism to be associated with a lower risk of cardiovascular events and all-cause mortality.
      However, one essential factor must be considered before translating their findings into clinical practice: Optimism is a nonpermanent mental state, which changes over time. Trait measures assessing optimism, including the Revised Life Orientation Test and 1- to 7-item questionnaires, cannot capture the transitions in the level of optimism,
      • Malouff JM
      • Schutte NS
      Can psychological interventions increase optimism? A meta-analysis.
      and there is no available instrument designed to measure changes over time.
      • Millstein RA
      • Chung WJ
      • Hoeppner BB
      • et al.
      Development of the State Optimism Measure.
      Furthermore, the follow-up periods of studies included in this meta-analysis ranged between 7 and 40 years, and the patients’ level of optimism can fluctuate during the course of follow-up. For example, the levels of optimism were assessed only once or twice in some studies included in this meta-analysis.
      • Kim ES
      • Hagan KA
      • Grodstein F
      • DeMeo DL
      • De Vivo I
      • Kubzansky LD
      Optimism and cause-specific mortality: a prospective cohort study.
      ,
      • Weiss-Faratci N
      • Lurie I
      • Benyamini Y
      • Cohen G
      • Goldbourt U
      • Gerber Y
      Optimism during hospitalization for first acute myocardial infarction and long-term mortality risk: a prospective cohort study.
      With such measurements, whether the patients were optimistic at the time of cardiovascular events is therefore unknown, despite their classification as “optimistic.” When considering the results from this meta-analysis, readers should take into account the possible fluctuation of optimism over time. Future studies on novel methods to accurately comprehend such traits of optimism will be of help to better assess the effect of optimism on various outcomes.

      References

        • Krittanawong C
        • Maitra NS
        • Hassan Virk HU
        • et al.
        Association of optimism with cardiovascular events and all-cause mortality: systematic review and meta-analysis.
        Am J Med. 2022; 135: 856-863.e2
        • Levine GN
        • Cohen BE
        • Commodore-Mensah Y
        • et al.
        Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association.
        Circulation. 2021; 143: e763-e783
        • Malouff JM
        • Schutte NS
        Can psychological interventions increase optimism? A meta-analysis.
        J Posit Pscyhol. 2017; 12: 594-604
        • Millstein RA
        • Chung WJ
        • Hoeppner BB
        • et al.
        Development of the State Optimism Measure.
        Gen Hosp Psychiatry. 2019; 58: 83-93
        • Kim ES
        • Hagan KA
        • Grodstein F
        • DeMeo DL
        • De Vivo I
        • Kubzansky LD
        Optimism and cause-specific mortality: a prospective cohort study.
        Am J Epidemiol. 2017; 185: 21-29
        • Weiss-Faratci N
        • Lurie I
        • Benyamini Y
        • Cohen G
        • Goldbourt U
        • Gerber Y
        Optimism during hospitalization for first acute myocardial infarction and long-term mortality risk: a prospective cohort study.
        Mayo Clin Proc. 2017; 92: 49-56