Pessimism and Heart Disease

The negative impact of pessimism, cynicism and defeatism on health has been researched extensively. It is not a question of IF. The research has been approached in many different ways by many different researchers, and the facts are in: Pessimism is bad for your heart. Pessimism damages your cardiovascular system.

In other words, negativity is a major contributing factor to the number one cause of death in industrialized countries: Heart disease.

Learn more about how fighting pessimism can help prevent heart disease by reading the information below, and then undemoralize yourself. Here are a few summaries of some of the best studies:

In a twelve-year study, those who felt negative emotions frequently were seventy percent more likely to die of a heart attack or a stroke.

In a thirty-year study at John Hopkins on a thousand men, the most easily-upset men were six times more likely to have a stroke and three times more likely to have a heart attack.

In another study, men who had reduced heart function after a heart attack were given psychological tests. The ones who measured high on negative emotions were more than four times more likely to have another heart attack in the next ten years.

At the Mayo Clinic, they studied 380 people who were entering a cardiac rehabilitation program. At the time the study started, 41 of them had anxiety or depression but didn't have any more severe heart disease than the rest of the group. Six months later, the anxious and depressed group were more than twice as likely to be rehospitalized for heart problems.

In another study, half of a group of heart-attack survivors were given the usual medical follow up, the other half met every other week in group therapy where they concentrated on solving troubling personal problems and practicing relaxation techniques. In other words, they worked to reduce the amount of pessimism, cynicism and defeatism by gaining more control in important areas of their lives — more control over their ability to relax and more control over handling negative emotion constructively. They became less helpless, less defeated, and we can guess with a fair degree of certainty, this gave them less pessimism and cynicism.

One year later, the people in the therapy group were much better off than the control group. Their blood pressure and weight had dropped more. Their cholesterol levels had dropped about 37 mg/dl. The control group had only dropped about 5 mg/dl. Blood pressure, cholesterol levels and weight are all risk factors of heart disease.

In another study, researchers hooked up a hundred participants with blood pressure monitors that took a reading every half hour. The most pessimistic people had the highest average blood pressures.

In another study, researchers injected 100 calories worth of triglycerides into healthy, nonsmoking volunteers. Half the people then rested for 40 minutes while their triglyceride level was monitored. The other half were put through 40 minutes of stress. The volunteers had to prepare and give a speech while being videotaped, do some difficult word problems, some motor skills tests, and some timed math problems. Their triglyceride levels were also monitored.

The results were consistent. The ones with the most stress had the highest triglyceride levels. Stress impairs your body's ability to clear the fat out of your blood stream. The reason this is important is that the longer fat circulates, the more likely it will be deposited in the arteries where it contributes to heart disease.

Pessimism causes more stress in your life. Having negative feelings of stress more often harms your cardiovascular system over time.


In a study of 376 young people (aged 18 to 30), those who measured high on hostility and had a cynical view of the world were two and a half times more likely to have some calcium deposits in the arteries leading to the heart than the less hostile and cynical people. Calcium deposits are the early signs of developing heart disease. And the hostile, cynical participants were nine times more likely to have high levels of calcification, which is an indication that fatty plaques were already developing. The link between hostility and calcification held even after they accounted for smoking, blood pressure, and being overweight. Hostile and cynical ways of looking at the world were causing the calcification independently of other factors.

Blair Justice, a psychologist who specializes in how the mind influences the body, says, "Hostile, cynical people…are three times more likely to have a heart attack and six times more likely to die of it."

At one time it was discovered that having a "Type A" personality made you more prone to depression. The Type A personality was defined by a combination of characteristics. But since then, researchers have looked in more depth to find that the key characteristic is hostility, which causes frequent feelings of anger, and that regular input of adrenaline and cortisol and other stress hormones has a cumulative impact on a person's heart. It raises blood pressure. Some of the stress hormones encourage plaque to build up in the arteries. And cortisol contributes to the rise in cholesterol and triglycerides and helps put fat on the abdomen (the worst place, as far as heart health is concerned, to store fat).

Hostility and indeed all negative emotions are caused or made worse by pessimism, cynicism, and defeatism.

Not only does hostility increase blood pressure, but it prolongs high blood pressure. In a study at the University of Michigan, they had participants recall an incident that made them angry, while the researchers monitored their blood pressure. People with generally hostile personalities jacked up their blood pressure the most. No surprise there. But for the hostile people, the diastolic blood pressure remained high for about 80 seconds. The blood pressure of the less hostile people were back to normal in 42 seconds.

Think about this. People with hostile personalities get angry more often. Their blood pressure rises higher and stays high almost twice as long. This has an unhealthy long-term effect on the cardiovascular system.

And hostility, like all negative emotions, is not on or off. It is a sliding scale. We all feel anger and hostility from time to time. The only thing to realize is that the more we do, the worse it is for the heart. And more importantly, you can do something that will reduce how much anger and hostility you have. It's not difficult and it makes life more enjoyable. Read more about that here.

In another study, researchers found that hostile people are more likely to experience repeated periods of depression, and depression itself is another risk factor for heart disease, which we will get to in a minute. The researchers guess that at least one of the causes of the depression is that hostility makes people less capable of having good relationships with people, and poor social support is a risk factor for depression as well as heart disease.

New studies are coming out all the time, and they all point in the same direction: Negativity is bad for your heart, bad for your health, bad for your relationships, and no fun.

medical treatment

Angioplasty is a treatment for blockages in the arteries. Having an artery blocked can obviously lead to a heart attack, so one treatment is to stick a balloon into the artery and inflate it where the blockage is, to open up the artery.

Studying 298 people who received this treatment, researchers found that the people with the most pessimism, cynicism and defeatism at the time of the treatment were more likely to have problems at a six month follow-up — problems like a heart attack, another angioplasty, bypass surgery, or the heart disease simply getting worse.

One of the researchers, Vicki Helgeson, said, "Patients who scored in the lower third of the index were three times as likely as patients who scored in the upper third of the index to sustain a new coronary event."

Keep in mind, all we're talking about here is the way you habitually think. And what defines healthy thinking from unhealthy thinking is not a mystery, it's not complicated, and it can be improved. Learn how to change your thinking.

In a study with a surprising outcome, known as the Coronary Drug Project, researchers experimented on men who had suffered a heart attack and survived. Some men took a drug called clofibrate, and some got a placebo (a sugar pill with no medicinal value). The surprise was that five years later, the survival rate was almost the same.

But they also found that those who took 80% or more of the pills they were supposed to take had a much better survival rate than those who didn't, regardless of whether they were taking the placebo or the drug.

In other words, it wasn't the drug that made the difference. The study accidentally measured how consistently they took their medicine. In other words, it measured how much pessimism, cynicism, or defeatism they had about the medicine. That's not how the researchers put it, but think about it: If you were taking a medicine and you believed it would help, or at least if you were committed to doing what you could, you would take your medicine. But if you thought your condition was hopeless (pessimism) or if you thought it wouldn't make any difference (cynicism), or if you thought you're a dead man already (defeatism), you would probably be more careless about taking your medicine. Why bother? And it was this factor rather than the content of the pills that predicted how well their hearts recovered from the heart attack.

In another study, researchers looked at data from 31 different medical facilities. Again, the study was on men who'd had a heart attack. Some got a placebo, and some got a real medicine, in this case, propranolol. The propranolol-takers did better than the placebo-takers this time. And yet, there was a similarity to the earlier study: Men who failed to take their medicine 75% of the time or less were twice as likely to die within a year, and they did not have more severe cardiac problems to begin with.

Whether they were taking a placebo or a real medicine, those who were pessimistic or cynical or defeatist enough to neglect to take their medicine were more likely to die.

cortisol and stress

Here's a short course on stress hormones for you brainiacs. First some stimulus in the brain — either an event in the world or a stressful way of thinking, or a combination of the two — causes the hypothalamus to release CRH (corticotropin releasing factor). The CRH tells the pituitary gland to secrete ACTH (adrenocorticotropic hormone) into the bloodstream. ACTH acts directly on the adrenal glands.

You have two adrenal glands, one on top of each kidney. The cortex of the adrenal glands, stimulated by ACTH, releases cortisol, causing the body to break down muscle fibers to release amino acids into the bloodstream. And cortisol also has an anti-inflammatory effect, reducing swelling.

Cortisol is called a stress hormone, but it is necessary for the normal functioning of almost every part of the body. It is only excessive amounts of cortisol, released too often, that create problems. Cortisol has a tremendously wide range of jobs to do, including the regulation of blood pressure.

Your body increases its output of cortisol in response to stress. The stress could be extremes of temperature, illness, physical exertion, trauma, or psychological stress (upset, anxiety, etc.)

Cortisol triggers certain parts of the body to stop burning blood sugar so that more will be available to important organs, such as the brain. Cortisol also releases glucose from storage, mobilizing it for use.

Cortisol makes the body release fatty acids (triglycerides) from fat cells so muscles can use it for fuel. It gears up the body to deal with stressful situations and potential danger.

Once the stressful situation is over, cortisol levels stay high, making you hungry enough to replenish the fuel you have just burned.

A frequent and excessive release of cortisol results in a storage of fat in the abdomen and elevated insulin levels, which is linked to heart attacks, strokes and diabetes.

In an interesting pilot study by Elissa Epel, those who controlled stress with daily meditation or muscle relaxation exercises lost significantly more abdominal fat (the most unhealthy place to store it) than the control group. When you are experiencing anxiety or anger or depression, the cortisol stimulates your abdominal fat cells to soak up and store fat. This is unhealthy if it is done too often.

The fat stored in your belly is worse for your heart health than the fat stored elsewhere in your body. One of the things cortisol does is activates fat-storage enzymes in cells. The fat cells in your middle — the cells behind your abdominal muscles and surrounding your organs — have more receptors for cortisol than do other fat cells in your body.

And several studies have looked at the link between stress and belly fat. The findings all point in the same direction. For example, women were asked to do some stressful tasks over a period of several days. They gave public speeches, did difficult puzzles and arithmetic. The women who said they were stressed out a lot in their everyday life also got stressed out the most during these tests, and they produced more cortisol. They also had the most belly fat.

The way a person thinks about a situation makes that situation more or less stressful. The stress produces cortisol. Cortisol causes the fat cells to store fat, especially in the abdomen, and it all contributes to heart disease. This is one ways the pessimism sucks the life out of us.

Cortisol is produced in excessive amounts by stress. Stress can be increased or decreased by increasing or decreasing your pessimism, cynicism, and defeatism.

Cortisol not only increases abdominal fat storage, it also raises your insulin level, which contributes to heart attacks, diabetes and strokes. Cortisol also raises blood pressure, and raises your cholesterol level.

And just to finish the short coarse on stress hormones, the medulla of your adrenal glands — again, stimulated by ACTH — produce two hormones: epinephrine (what we normally call adrenaline) and norepinephrine (sometimes called noradrenaline). These cause your system to step up its pace: they increase heart rate, breathing rate, blood pressure (by constricting the peripheral blood vessels), blood flow to the muscles, and metabolism.

When your adrenal glands release too much stress hormone regularly, it is bad for your health, bad for your relationships, bad for your long-term ability to effectively do your work, and it feels bad.


Daniel Mark of Duke University asked 1719 heart disease patients whether or not they thought they'd make it. This is a very simple and specific measure of their level of pessimism, cynicism, and defeatism. Some said yes, they think they'll make it. Some said no. The ones who said no were twice as likely to have died within a year as the ones who said yes.

Researchers at Carnegie Mellon University tested 309 people who were scheduled for a bypass surgery. A bypass surgery reroutes blood around a blocked artery. Six months later, those who had the most pessimism, cynicism and defeatism were the most likely to be rehospitalized.

In another study of bypass surgery patients, researchers tested the participants before they left the hospital and then did a follow-up one year later. Those who were depressed in the initial interviews were three times more likely to have another heart problem within a year (chest pain, a heart attack, the need for another cardiac procedure, or heart failure requiring hospitalization.)

Depression has a very strong relation to the deadly triad of pessimism, cynicism and defeatism. Combine those with a setback of any kind and it can produce depression. And depression isn't on or off. It's a sliding scale. That means being even a little depressed has a small effect similar to the large effects of major depression. This is a point of dispute among experts in the field. Some believe that major depression is a distinctly different animal than mild or moderate depression, but Martin Seligman, author of Learned Optimism, who is one of the world's leading experts on depression and also a careful scientist and researcher, makes a very good case that there is no evidence good enough to justify the claim that the two are different.

So in the following descriptions of the effects of depression on the heart, do not discount the effects of even mild depression or everyday kinds of demoralization. The way you think can make a setback either a passing annoyance with relatively little impact or something with much more serious consequences. And since the most important defining characteristic of a depressed person is their pessimistic, cynical and defeated way of thinking, a study about the effects of depression is a study about the deadly triad, make no mistake. We're looking at the lamprey of the mind and what it can do.

In a huge study of 7893 volunteers over a period of ten years, depressed men were seventy percent more likely to develop heart disease than men who were not depressed. None of the volunteers had heart disease at the start of the study. For women, at the same level of depression, they were only twelve percent more likely to develop heart disease. However, when the researchers looked at severely depressed women, they were seventy-eight percent more likely to develop heart disease than women who weren't depressed. And the findings were true even when they factored in other risk factors like weight, blood pressure, smoking, and age.

A researcher at Washington University studied 103 patients with coronary artery disease. Twenty percent of them were depressed. Those depressed few were eight times more likely to develop VT (ventricular tachycardia). This rapid heart rhythm happens most often before a sudden cardiac death.

In another study of 887 people who already had one heart attack, researchers found that the depressed people were three times more likely to have a second heart attack within a year of their first one than those who weren't depressed. Temporary depression is common after a heart attack. But about a third of the people stay depressed. Plenty of research has shown that what makes people remain depressed is their level of pessimism, cynicism and defeatism. Which means what makes people remain depressed is their habitual way of thinking.

A lot of research has associated severe depression with a greater risk of fatal heart disease. But depression is a sliding scale, and a study by a team of researchers from the Centers for Disease Control and Prevention have discovered that even mild depression harms the heart. They selected 2800 people who had no signs of heart disease, in an age range between 45 and 77. At the beginning of the study, about a fourth of the volunteers had at least mild depression.

Twelve years later, those who were even a little depressed had a significantly higher rate of heart disease. Those who had the most depression in the beginning were twice as likely to have developed heart disease than the undepressed people.

Why? How do feelings of defeat, cynicism, and pessimism harm the heart? There are several different ways. The researchers in the study above (by the Centers for Disease Control and Prevention) point out that having these feelings fairly often can thicken artery walls and promote blood clotting.

In another study, this time of a group of 600 diabetics, the participants were tested every two years for six years. They used the Beck Depression Inventory, a questionnaire, a kind of mood scale, to determine the diabetics' level of depression. Over the period of the study, the participants' scores on the Beck Inventory predicted the development of heart disease better than the measures of blood sugar level.

We're looking at many different studies by many different scientists looking at many different aspects of many different levels of depression over many different levels of severity over many different lengths of time, and all the results point in the same direction: Depression is bad for the heart. And to put it in more practical terms: Pessimism, cynicism, and defeatism are bad for the heart.

Here's another one: Brenda Penninx, a researcher from Wake Forest University started with a group of 2900 volunteers. Some had heart disease and some didn't. She tested them for depression. Four years later, those with severe depression were almost four times more likely to die of heart disease as people who were not depressed, and this ratio held true even for those people who didn't have any heart problems at the beginning of the study. People with only mild depression had fatal heart disease fifty percent higher than the undepressed.

Depression is stressful on the body. Stress produces extra cortisol, and we've already seen what kind of damage that can cause. People who feel more pessimistic or cynical or defeated have also been shown to exercise less and to be less likely to seek medical help for problems (they doubt it would make any difference).

In a separate study, 4493 people over age 65 were followed for six years. None of them had heart disease at the beginning of the study. Using the Depression Scale, the volunteers were tested every year. They were also interviewed and given medical exams.

The Depression Scale is a questionnaire that asks the volunteers to determine how often they behaved or felt a particular way in a given week. The study found out that for every five-unit increase on the depression score, their chance of developing heart disease increased fifteen percent.

Curt Furgerg, a professor of public health science, says that there are several possible ways depression can contribute to heart disease. First, we have evidence that depression increases production of free radicals and fatty acids, and these can harm the blood vessel lining. Also, the stress of depression might increase plaque and blockages in blood vessels. And finally, people who are depressed, even mildly, tend to be more likely to smoke and less likely to exercise.

In another study, this time with 2000 people over a period of ten years, a team of researchers discovered that depression increases the fatality of heart disease and that even healthy people who were once depressed had a greater risk of heart disease down the road.

Let's be very clear on this point: Pessimism, cynicism, and defeatism is not cool, it is not chic, it does not make you superior in any way. It is dangerous. It is deadly. And it is also contagious. It harms your health, it makes you weak, and it is bad for the people around you.

In so many different ways, the deadly triad are bad for your heart. Of course, when a study shows that you have four times greater chance of dying of a heart attack if you get depressed, it doesn't mean if you've been depressed, you will die of a heart attack. Pessimism, cynicism and defeatism are not the only risk factors for heart disease — they only increase the chance. They are not the only factor, but they are major risk factors. This is important enough to be worth doing something about. Not only is the deadly triad bad for your heart, they make life significantly less enjoyable. They're bad for your heart and even bad for your sense of humor.

The researcher, Lee Berk, looked at heart disease patients over the course of a year while they went through a rehabilitation program. The participants were randomly assigned to two groups. Both received the same therapy, but he added one extra exercise for one of the groups: Every day they watched a half hour of a humorous movie of their choice. Those who laughed the most during the movie experienced the least heart-disease symptoms. One of the side effects of pessimism, cynicism and defeatism is that things aren't as funny.

All of this research I've presented here is only a concentrated sampling of the tremendous body of research on how the deadly triad contributes mightily to heart disease. When you encounter people who act as if pessimism or cynicism is good, use this information to disabuse them of the idea. Do it with finesse, but make sure you leave no doubt how supremely foolish is is to continue thinking pessimistically.

Pessimism doesn't just contribute to heart disease. It also weakens your immune system. Read more about that here: Pessimism and Health.

Adam Khan is the author of Antivirus For Your Mind: How to Strengthen Your Persistence and Determination and Feel Good More Often and co-author with Klassy Evans of How to Change the Way You Look at Things (in Plain English). Follow his podcast, The Adam Bomb.

No comments:

Post a Comment