Men who believe they are at low risk of a heart attack may in fact live longer than those with a more pessimistic outlook, a new study suggests.
Researchers found that of more than 2 800 adults followed for 15 years, men who thought they were at lower-than-average risk of a heart attack were 70 percent less likely than other men to die of heart disease or stroke - even with their objective risks taken into account. This relationship was not seen among women though.
The findings, published in the Annals of Family Medicine, suggest that a dose of optimism may be helpful in controlling heart disease risk. An awareness of one's heart disease risk factors can certainly be a good thing. But problems may arise when people become fearful about their odds of suffering a heart attack, according to lead researcher Dr Robert E. Gramling, of the University of Rochester in New York.
The good and bad of worrying
On one hand, he explained in an interview, you might expect people who believe themselves to be at high risk would be especially careful about their lifestyle habits, and take care to get high blood pressure, high cholesterol and other risk factors under control.
"But emotion becomes part of our decision-making," Gramling said. People who are fearful about their heart risks, he explained, may turn to "coping behaviours" like smoking, overeating or drinking.
In addition, chronic stress itself may have physiologic effects on the cardiovascular system.
Gramling and his colleagues based their findings on interviews with 1 678 women and 1 138 men ages 35 to 75 who had no history of heart disease at the start of the study. During the interviews, participants rated their risk of having a heart attack in the next five years as high, average or low, compared with other people of the same age and sex.
The researchers also calculated each participant's Framingham Risk Score (FRS) - a standard tool doctors use to estimate a patient's risk of having a heart attack in the next 10 years, based on age, sex, blood pressure, cholesterol and smoking habits.
Over the next 15 years, 98 study participants died of coronary heart disease or stroke. In general, Gramling's team found men who, at the outset, described themselves as low risk were less likely than other men to die of cardiovascular disease - even with Framingham scores factored in.
No such relationship was seen among women.
However, Gramling pointed out that the interviews were done in 1990, a time when many people still saw heart disease as a "man's disease". So women in the study - even those who thought they were more likely than other women to have a heart attack - might not have seen heart disease as a major threat.
Affects doctors' communication with patients
Gramling said the findings have implications for the ways in which doctors communicate risks.
"We might want to be careful about the labels we use," he said. "We tend to create a pessimistic bias with the language we use."
For example, the FRS categorises people as "high risk" when their risk factors suggest that they have a 20-percent chance of having a heart attack in the next 10 years.
Instead of telling patients their risk is "high", doctors may do better to specify that the risk is 1-in-5 - which "might be less fear-provoking," Gramling noted, since it also implies a 4-in-5 chance that the patient won't have a heart attack.
"Ideally," he said, "it would be great if people could maintain an optimistic outlook while doing the things they need to lower their risk. That would be the best of both worlds". – (Amy Norton/Reuters Health)
SOURCE: Annals of Family Medicine, July/August 2008.
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