The Role of Psychological Health in Cardiovascular Health: A Racial Comparison

TL;DR

This study explores how psychological health factors like stress and optimism relate to cardiovascular health and how these relationships differ between Black and White adults in the US.

Contribution

The study reveals racial differences in the association between psychological health and cardiovascular health metrics, particularly highlighting stronger positive psychological health in Black individuals.

Findings

Negative psychological health factors like pessimism were linked to worse cardiovascular health scores in Black individuals compared to White individuals.

Positive psychological health factors such as well-being and optimism showed stronger associations in Black individuals than in White individuals.

Racial disparities in cardiovascular health are not primarily explained by differences in psychological health factors.

Abstract

Purpose: Modifiable health factors influence racial disparities in cardiovascular health (CVH), yet the role of psychological health in these disparities remains understudied. This study examines (1) the association between negative and positive psychological health measures and CVH and (2) the racial differences in these associations among US adults. Methods: Aim 1 included adults aged 34–84 from the MIDUS biomarker substudy (n = 1255). Aim 2 included adults aged 28–84 from the MIDUS parent study (N = 4702). Our outcome was CVH, operationalized as the AHA’s Life’s Essential 8 (LE8) total score, behavior, and health factor subscores. Negative psychological health was operationalized as depressive symptoms (CES-D), stress reactivity (from the Multidimensional Personality Questionnaire [MPS]), aggression (from the MPS), pessimism (Life Orientation Test), perceived stress (Perceived Stress Scale), and trait anxiety (Spielberger Trait Anxiety Inventory); positive psychological health was operationalized as psychological well-being (“PWB”; Ryff Well-Being Scale [WBS] and MPS), purpose in life (from the WBS), mindfulness (developed by MIDUS), gratitude (developed by MIDUS), and optimism (Life Orientation Test). Results: In covariate-adjusted models, most negative psychological health factors were negatively associated with LE8 total scores and health behavior subscores. Of those, pessimism was the only factor to demonstrate Black–White differences (Black > White, p < 0.001). Positive psychological health factors were less consistently associated with the LE8 total, health behavior, and health factor subscores in covariate-adjusted models. Of these, PWB (Black > White, p < 0.001), gratitude (Black > White, p < 0.001), and optimism (Black > White, p < 0.001) demonstrated significant differences by race. Conclusions: Black–White differences in LE8 are not largely explained by differences in psychological health.