Kou Minghao, Li Xiang, Ma Hao, Wang Xuan, Heianza Yoriko, Manson JoAnn E, Qi Lu
Department of Epidemiology, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, 70112, USA.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, USA.
Eur J Epidemiol. 2025 Apr 7. doi: 10.1007/s10654-025-01225-w.
Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between life satisfaction and incident CVD, as well as the relative importance of life satisfaction compared to traditional risk factors.
The study included 153,810 participants free of CVD at baseline, with measurements of life satisfaction on general happiness, personal health, family relationships, friendships, and financial situation, followed up until December 31, 2022. Cox proportional hazards models were used to estimate associations between life satisfaction and incident CVD. The relative importance of life satisfaction in predicting CVD was measured by explained R values.
During a median follow-up of 12.9 years, 14,370 incident CVD events occurred, including 10,070 CHD and 2,895 strokes. Individuals with low life satisfaction had an 80% higher risk of CVD compared to those with high life satisfaction (hazard ratio [95% confidence interval], 1.84 [1.63-2.07] for CVD, 1.83 [1.59-2.10] for CHD, and 1.74 [1.31-2.31] for stroke). Life satisfaction was ranked as the fourth-strongest CVD risk factor, following hypertension, race, and income. Low satisfaction with all individual aspects was significantly associated with higher risks of CVD and CHD (P < 0.05), while satisfaction with personal health showing the strongest association.
This study indicates that life satisfaction is robustly associated with incident CVD and may be considered one of the strongest predictors of CVD risk, alongside traditional risk factors. Our findings support the inclusion of life satisfaction in cardiovascular health metrics.
新出现的证据表明心理健康在心血管疾病（CVD）的发生发展中起作用，但支持性数据仍然有限。本研究评估了生活满意度与CVD发病之间的前瞻性关联，以及生活满意度相对于传统危险因素的相对重要性。
该研究纳入了153810名基线时无CVD的参与者，对其在总体幸福感、个人健康、家庭关系、友谊和财务状况方面的生活满意度进行了测量，随访至2022年12月31日。采用Cox比例风险模型估计生活满意度与CVD发病之间的关联。通过解释R值衡量生活满意度在预测CVD中的相对重要性。
在中位随访12.9年期间，发生了14370例CVD事件，包括10070例冠心病和2895例中风。生活满意度低的个体患CVD的风险比生活满意度高的个体高80%（风险比[95%置信区间]，CVD为1.84[1.63 - 2.07]，冠心病为1.83[1.59 - 2.10]，中风为1.74[1.31 - 2.31]）。生活满意度被列为第四大CVD危险因素，仅次于高血压、种族和收入。对所有个体方面的低满意度均与CVD和冠心病的较高风险显著相关（P < 0.05），而对个人健康的满意度显示出最强的关联。
本研究表明生活满意度与CVD发病密切相关，可能被视为CVD风险的最强预测因素之一，与传统危险因素并列。我们的研究结果支持将生活满意度纳入心血管健康指标。
