Positive cardiovascular health isn’t just wellness jargon; it’s a concept that emerged from the intersection of positive psychology and preventive cardiology. It gained recognition in 2021 when the American Heart Association (AHA) acknowledged that psychological factors like optimism and a sense of purpose can lower the risk of cardiovascular disease. Among these factors, there’s one intervention that’s particularly easy to implement: gratitude.
- Brian Leavy, MSc, doctoral researcher in psychology at Maynooth University, Ireland
- Claudia Hackl-Zuccarella, PhD, head of laboratory research at the Clinic for Consultant Psychiatry and Psychosomatics in the University Hospital Zurich, Switzerland
- Jeff Huffman, MD, associate professor of psychiatry at Harvard Medical School and the director of the Cardiac Psychiatry Research Program in the Massachusetts General Hospital
- Stephen Gallagher, PhD, health psychologist and a professor in the psychology department at the University of Limerick, Ireland
Gratitude has been defined differently over the ages—notably, as a virtue by Cicero and a disease by Stalin. Today’s researchers talk about two main types: state gratitude, the feeling of being thankful in specific situations when helped, and trait or dispositional gratitude, which is a person’s general tendency to appreciate the positives in life. What’s great is that both can improve our cardiovascular health. Here’s how.
Dispositional gratitude is linked to lower inflammation and improved endothelial function, both of which are important for cardiovascular health. (The endothelium is the thin membrane that lines our heart and blood vessels.) In one study, patients with asymptomatic heart failure were asked to integrate a gratitude practice into their lives by jotting down three to five things they appreciated every day. This daily habit reduced inflammation in just eight weeks.
Another way that gratitude improves heart health is by buffering against stress, which has both immediate and long-lasting consequences for our hearts. Heart attacks increase in the wake of natural disasters and terrorist attacks, and even within two hours of stressful soccer matches. Chronic, cumulative stress, like work-related stress, is associated with a 40 percent increase in developing cardiovascular disease, according to the AHA.
Recent research by Brian Leavy, MSc, showed that people with high dispositional gratitude were less likely to suffer from a heart attack six years later, and state gratitude improves both cardiovascular reaction and recovery from psychological stress.
One reason that gratitude buffers stress is likely psychosocial, because “people who are more grateful tend to have better-quality friends and relationships,” according to Leavy. This means they have more social support.
Both the World Health Organization and the Centers for Disease Control and Prevention recognize the importance of social relationships. Psychologist Stephen Gallagher, PhD, explains that this is because social relationships are a strong determinant of health that can be even more important than other lifestyle choices like exercise. Loneliness and social isolation have even been reported to be as bad as smoking when it comes to deaths from heart disease.
Gratitude encourages healthy habits
Gratitude is not a substitute for healthy behaviors that reduce cardiovascular risk, like those outlined in the AHA’s recently updated “Life’s Essential 8.” But it can motivate us to adopt those behaviors, according to Harvard psychiatrist Jeff Huffman, MD: “In the context of a heart attack, feeling grateful for one's health, in one's life, and so forth, seems to be associated with taking on healthier behaviors that lead to greater longevity,” he explains. In one of his studies, he found that people with higher state gratitude two weeks after a heart attack also reported six months later that they had taken their medication more reliably, maintained a healthier diet, gotten more exercise, had better health-related quality of life and lower rates of developing depression and anxiety.
Psychologist Claudia Hackl-Zuccarella, PhD, explains that “gratitude is often associated with various positive psychological and behavioral processes, contributing to a virtuous circle of well-being.” When we’re grateful for the good things in life, we’re more likely to invest in that life. “Grateful individuals may be more inclined to engage in health-promoting behaviors, contributing to overall well-being,” she adds.
Can you become more grateful?
Although some people might have a greater dispositional gratitude because it is something they learned growing up, that doesn’t mean you’re doomed if it doesn’t come naturally to you. It’s possible to become more grateful, according to Dr. Gallagher, because “trait gratitude is likely influenced by your social environment; it's not fixed, it's malleable.”
Here are a few ways you can proactively build gratitude into your life:
Keep a gratitude journal
Dr. Hackl-Zuccarella asks her patients to take time every evening to reflect on their day and note down three things that they’re grateful for. “This helps focus more on the positive aspects and end the day with a good feeling,” she says.
Write a gratitude letter to someone else
To go a step further and benefit from more social connection, Dr. Gallagher suggests writing gratitude letters or emails. In this way, you can reflect on good things in your life and become closer to others at the same time.
Follow these prompts
If you find it difficult to find things to be grateful for, the AHA’s suggestions can help:
- Reflect on happiness: What makes you happy? Who or what makes your life easier? Whom do you appreciate?
- Find joy: Where is your favorite place to be? What uplifts you on tough days? Recall a joyful memory that makes you happy.
- Consider personal achievements: Think about something you have accomplished. Reflect on recent achievements. What are you looking forward to?
—reviewed by Jennifer Logan, MD, MPH
- Labarthe, Darwin R et al. “Positive Cardiovascular Health: A Timely Convergence.” Journal of the American College of Cardiology vol. 68,8 (2016): 860-7. doi:10.1016/j.jacc.2016.03.608
- Wang, Xiaoxiao, and Chunli Song. “The impact of gratitude interventions on patients with cardiovascular disease: a systematic review.” Frontiers in psychology vol. 14 1243598. 21 Sep. 2023, doi:10.3389/fpsyg.2023.1243598
- Redwine, Laura S et al. “Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability and Inflammatory Biomarkers in Patients With Stage B Heart Failure.” Psychosomatic medicine vol. 78,6 (2016): 667-76. doi:10.1097/PSY.0000000000000316
- Levine, Glenn N. “Psychological Stress and Heart Disease: Fact or Folklore?.” The American journal of medicine vol. 135,6 (2022): 688-696. doi:10.1016/j.amjmed.2022.01.053
- Wilbert-Lampen, Ute et al. “Cardiovascular events during World Cup soccer.” The New England journal of medicine vol. 358,5 (2008): 475-83. doi:10.1056/NEJMoa0707427
- Leavy, Brian et al. “Heart rate reactivity mediates the relationship between trait gratitude and acute myocardial infarction.” Biological psychology vol. 183 (2023): 108663. doi:10.1016/j.biopsycho.2023.108663
- Leavy, Brian et al. “Gratitude, affect balance, and stress buffering: A growth curve examination of cardiovascular responses to a laboratory stress task.” International journal of psychophysiology : official journal of the International Organization of Psychophysiology vol. 183 (2023): 103-116. doi:10.1016/j.ijpsycho.2022.11.013
- Holt-Lunstad, Julianne et al. “Social relationships and mortality risk: a meta-analytic review.” PLoS medicine vol. 7,7 e1000316. 27 Jul. 2010, doi:10.1371/journal.pmed.1000316
- Millstein, Rachel A et al. “The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome.” General hospital psychiatry vol. 43 (2016): 17-22. doi:10.1016/j.genhosppsych.2016.08.006
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