Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly dutch men and women

Background: Major depression is known to be related to higher cardiovascular mortality. However, epidemiological data regarding dispositional optimism in relation to mortality are scanty. Objective: To test whether subjects who are optimistic live longer than those who are pessimistic. Design: Our analysis formed part of a prospective population-based cohort study in the Netherlands (Arnhem Elderly Study). Setting: General community. Participants: Elderly subjects aged 65 to 85 years (999 men and women) completed the 30-item validated Dutch Scale of Subjective Well-being for Older Persons, with 5 subscales: health, self-respect, morale, optimism, and contacts. A total of 941 subjects (466 men and 475 women) had complete dispositional optimism data, and these subjects were divided into quartiles. Main Outcome Measure: Number of deaths during the follow-up period. Results: During the follow-up period of 9.1 years (19912001), there were 397 deaths. Compared with subjects with a high level of pessimism, those reporting a high level of optimism had an age- and sex-adjusted hazard ratio of 0.55 (95% confidence interval, 0.42-0.74; upper vs lower quartile) for all-cause mortality. For cardiovascular mortality, the hazard ratio was 0.23 (95% confidence interval, 0.10-0.55) when adjusted for age, sex, chronic disease, education, smoking, alcohol consumption, history of cardiovascular disease or hypertension, body mass index, and total cholesterol level. Protective trend relationships were observed between the level of optimism and all-cause and cardiovascular mortality (P<.001 and P=.001 for trend, respectively). Interaction with sex (P=.04) supported a stronger protective effect of optimism in men than women for all-cause mortality but not for cardiovascular mortality. Conclusions: Our results provide support for a graded and independent protective relationship between dispositional optimism and all-cause mortality in old age. Prevention of cardiovascular mortality accounted for much of the effect.