Optimism Linked to Improved Survival With Coronary Artery Disease

March 1, 2011— -- Can a smile a day keep your heart feeling okay? Some researchers say it might.

A new study released Monday adds to growing evidence that having a positive attitude can help you live longer.

Researchers looked at nearly 3,000 patients who underwent hospital treatment for heart disease and found that those who had the highest expectations of a full recovery had a higher chance of living longer than those who were pessimistic about their chance of recovery.

"Patients differ widely in terms of their psychological reactions to major illnesses such as coronary heart disease," Barefoot and colleagues wrote in the Archives of Internal Medicine.

And many experts say there's good reason to believe that your attitude can shape your outcome.

Dr. Steven E. Nissen, department chair of cardiovascular medicine at the Cleveland Clinic, who was not involved in the study, said patients "with a 'positive' attitude may simply be healthier than patients with a negative attitude. In fact, their 'attitude' may reflect their health status."

Study researchers also noted that those who are generally optimistic about their health are more likely to follow treatment recommendations.

"One of those factors might [also] be that cardiovascular providers give better care to patients with a positive outlook-perhaps spending more time with them or being more conscientious," Dr. James Kirkpatrick, assistant professor of medicine at the University of Pennsylvania in Philadelphia, who was not involved in the study.

On the other hand, those who are pessimistic about their health may experience stress that could trigger additional heart problems, researchers said.

The nearly 3,000 patients enrolled were followed for 15 years. One year after their hospital stay, they were asked to fill out a survey that would help researchers learn more about their attitude. The group of patients with a better perspective on their health had a lived nearly 20 percent longer than those who seemed pessimistic. Optimistic patients also lived a more active lifestyle than the pessimists.

Previous studies looking at other potentially fatal diseases including cancer suggest that a positive outlook can affect not only your quality of life, but also whether you survive longer.

"The degrees of evidence observed in these studies suggest that optimism is a powerful 'drug' that compares favorably with highly effective medical therapies," Dr. Robert Gramling and Dr. Ronald Epstein of the University of Rochester in New York wrote in an accompanying editorial.

But while many experts agreed that counseling a patient is an important part of patient care, some say just assessing their patient's attitude won't quite change their prognosis on a condition like heart disease.

[Many doctors] have been sued for not giving an accurate outlook and for this reason may even trend toward the negative," said Dr. Howard Weintraub, clinical director at the center for prevention of cardiovascular disease at NYU Langone Medical Center. "I think the issue is that we as doctors would love to be sources of optimism but if a problem occurs it may be interpreted as not giving fair disclosure and then we have to deal with the consequences."

Still, experts say patients should add a positive attitude to the list of things to do to manage their condition.

"It is important for doctors to elicit optimism from their patients by giving them a realistic idea of their disease and the benefits of medications and procedures that we may prescribe or perform that also improve outcome," said Dr. Nieca Goldberg, director of the women's heart program at NYU Langone Medical Center.

"I always tell my patients that, yes, they have heart disease, but with a collaborative effort we can get them back on their feet and not only live longer but have a better quality of life," she said.