Not to go all The Secret on you, but it looks like optimism really does pay off—and pessimism is, literally, a killer. At least, that's the conclusion one might draw from the results of a study published in the July/August issue of the Annals of Family Medicine. The study, conducted at Brown University, found that men who believed themselves to be low risk for a heart attack were actually one-third less likely to die of one than men who believed themselves to be of average risk.
Sure, you say—because the men who perceived themselves to be of high risk were probably overweight smoking couch potatoes, right? Turns out, not so. These results were found to hold true regardless of the actual risk factors of the men in question. The study followed 2,816 adults between the ages of 35 and 75. The subjects had no history of heart disease. Baseline measures of their health were taken in 1990 to 92, and death records were assimilated through 2005, to yield 15 years of results. Researchers were trying to find out whether pessimism about their risk of heart disease might lead subjects to take up pathological behaviors associated with fear responses, such as elevated stress, increased alcohol consumption, or over-eating.
To begin the study, subjects responded to the following study question: "Compared with persons of your own age and sex, how would you rate your risk of having a heart attack or stroke in the next five years?" It turns out that men were not particularly good at answering this question: Almost half of the men who estimated their risk to be "low" would have "high" or "very high" risk according to medical testing. Yet these men died of heart attacks far less frequently than their more accurately self-aware peers—leading Dr. Robert Gramling, who headed the study while at Brown (he is currently at the University of Rochester), to conclude that, "Clearly, holding optimistic perceptions of risk has its advantages for men."
Women, on the other hand, were much more accurate in rating their own heart disease risk. Yet women who believed themselves to be low risk, the study found, died at the same rate as those who thought they had average risk. Researchers attribute this gap to a difference in public perception. In the 1990s when the study began, Gramling points out, heart disease was almost exclusively associated with men—and only recently has it become a well-known fact that it is also the leading killer of women. Women, therefore, have until now been much less likely to perceive the risk of heart disease for themselves, leading them to have less of a fear response, and fewer fear-driven behaviors. If the study's theory is accurate, one would expect to see the gender gap narrow as public awareness of the risk of heart disease for women improves.
Though the precise role of optimism and pessimism in these outcomes remains to be clarified, Dr. Gramling believes that the results have serious implications for how the medical community goes about trying to change patients' behaviors. "In medical systems, we often have a pessimistic bias," he said. "We use normative language, telling people their risk might be high. Using the Framingham Heart Score places a fair amount of people into the categories of high or very high risk. After the age of 40, 80 percent might be viewed as at high risk." As his study suggests, there may be actually health consequences to passing this kind of pessimism on to patients. While people should presumably not treasure genuinely false perceptions about their own cardiovascular health, Gramling hopes the study might encourage a change in how risk is framed: "I would suggest that fear-based prevention, meaning making changes based on fear, is not as helpful as holding an optimistic view. We should focus on helping make changes easy to do, rather than on making people more fearful."