Abstract
Objectives. To determine whether optimism and anger modify the association between neighborhood disadvantage and incident cardiovascular disease (CVD) and whether these relationships vary by ethnoracial group. Methods. We drew data from 4326 participants in the Multi-Ethnic Study of Atherosclerosis (MESA: 2000-2019), a cohort of US adults aged 45 to 84 years without baseline CVD. We measured neighborhood disadvantage using the Area Deprivation Index. We assessed optimism and anger (reaction and temperament) by self-report. We used multilevel Cox proportional hazards models to estimate hazard ratios for incident CVD over 19 years of follow-up, adjusting for demographic, behavioral, and clinical factors. Results. A total of 879 incident CVD events occurred. Greater neighborhood disadvantage was associated with higher CVD risk. Tract-level optimism attenuated this association, whereas tract-level anger amplified it. Effects of optimism were stronger among Black participants, whereas anger more strongly exacerbated risk among Hispanic participants. Conclusions. Psychosocial resilience and risk factors modify the impact of neighborhood disadvantage on CVD, with important ethnoracial differences. Public Health Implications. Structural and community-partnered strategies are needed to address ethnoracial differences in how psychosocial factors modify the cardiovascular effects of neighborhood disadvantage. (Am J Public Health. 2026;116(5):711-721. https://doi.org/10.2105/AJPH.2025.308407).