Table_1_Examining Optimism, Psychosocial Risks, and Cardiovascular Health Using Life's Simple 7 Metrics in the Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study.DOCX

Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship.
Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk.
Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04–1.16] and 1.05 (95% CI: 0.99–1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98–1.12) and 1.04 (0.97–1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0–1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98–1.03) and 1.01 (0.98–1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics.
Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.

研究背景：已有研究证实，乐观情绪与更佳的心血管健康（cardiovascular health, CVH）呈正相关。然而，目前仍缺乏探讨乐观情绪对心血管健康益处的前瞻性研究，尤其是在存在逆境即社会心理风险因素的情境下。本研究基于「生命简单7项」（Life's Simple 7, LS7）指标，分析乐观情绪与心血管健康结局之间的前瞻性关联，并探究多水平社会心理风险因素是否会对上述关联产生调节作用。

研究方法：本研究采用两项美国队列研究的统一标准化数据集，分析自我报告的乐观情绪与心血管健康状况，这两项队列分别为多民族动脉粥样硬化研究（Multi-Ethnic Study of Atherosclerosis, MESA）与杰克逊心脏研究（Jackson Heart Study, JHS）。针对MESA队列的3520名参与者，我们采用修正泊松回归模型，基于LS7指标估算乐观情绪与心血管健康的关联；针对MESA与JHS队列共计5541名参与者，我们基于4项生物学LS7指标（体质量指数、血压、胆固醇与血糖），分析目标关联。针对所有心血管健康结局，我们评估了社会心理风险因素对效应量的调节作用。

研究结果：在MESA队列参与者中，与乐观情绪水平最低者相比，自我报告高乐观与中乐观者的LS7指标下理想或中等心血管健康的校正风险比（adjusted risk ratio, aRR）分别为1.10[95%置信区间（confidence interval, CI）：1.04~1.16]与1.05（95%CI：0.99~1.11）。在MESA与JHS队列的全部参与者中，基于4项生物学LS7指标的全部理想或中等（相较于无不良指标）心血管健康结局的校正风险比分别为1.05（0.98~1.12）与1.04（0.97~1.11）；而基于该4项生物学LS7指标的心血管低风险（0~1项不良指标）结局的对应校正风险比均为1.01（0.98~1.03）。另有初步证据表明，针对LS7指标结局，邻里匮乏程度可对效应量产生调节作用；针对基于4项生物学LS7指标的理想或中等（无不良指标）结局，慢性应激可对效应量产生调节作用。

研究结论：本研究结果显示，在种族/民族多样化的研究人群中，基于特定LS7指标结局，更高水平的乐观情绪与更佳的心血管健康呈正相关。该关联可被特定社会心理风险因素调节。乐观情绪有望成为心血管健康干预的潜在靶点。然而，仍需开展更多前瞻性研究与干预研究以进一步验证上述结论。