Abstract
BACKGROUND: 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. METHODS: 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(2) values. RESULTS: 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. CONCLUSIONS: 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.