Psychological Well-Being and Restorative Biological Processes: HDL-C in Older English Adults

Rationale Psychological well-being is associated with better cardiovascular health, but the underlying mechanisms are unclear. Objective This study investigates one possible mechanism by examining psychological well-being\u27s prospective association with lipid levels, focusing on high-density lipoprotein cholesterol (HDL-C). Methods Participants were 4757 healthy men and women ages ≥50 from the English Longitudinal Study of Ageing with clinical data from three times, three to five years apart. Psychological well-being was assessed at baseline using the Control, Autonomy, Satisfaction, and Pleasure scale; HDL-C, triglycerides, and total cholesterol were assayed from blood samples. Descriptive statistics and linear mixed models were used to examine associations between psychological well-being and lipid levels over time; the latter controlled for confounders and health behaviours. Results In descriptive analyses, HDL-C levels were initially higher in people with greater psychological well-being. Among those who met recommended levels of HDL-C at baseline, fewer individuals with higher versus lower psychological well-being dropped below HDL-C recommendations over time. Mixed models indicated that HDL-C increased over time (β = 0.64; 95% CI = 0.58 to 0.69) and higher baseline psychological well-being was associated with higher baseline HDL-C (β = 0.51; 95% CI = 0.03 to 0.99). A significant well-being by time interaction indicated individuals with higher versus lower well-being exhibited a more rapid rate of increase in HDL-C over follow-up. Higher psychological well-being was also significantly associated with lower triglycerides, but main effects for both HDL-C and triglycerides were attenuated after accounting for health behaviours. Conclusion Higher psychological well-being is associated with healthier HDL-C levels; these effects may compound over time. This protective effect may be partly explained by health behaviours

Longitudinal Associations Between Psychological Well-Being and the Consumption of Fruits and Vegetables

Background: Psychological well-being is associated with longevity and reduced risk of disease, but possible mechanisms are understudied. Health behaviors like eating fruits and vegetables may link psychological well-being with better health; however, most evidence is cross-sectional. Purpose: This study investigated psychological well-being’s longitudinal association with fruit and vegetable consumption across as many as 7 years. Method: Participants were 6,565 older adults from the English Longitudinal Study of Ageing, which includes men and women aged 50 years or older. Psychological well-being was assessed with 17 items from the Control, Autonomy, Satisfaction, Pleasure Scale. Fruit and vegetable consumption was initially assessed during 2006–2007 and then approximately every 2 years through 2012–2013. Covariates included sociodemographic factors, health status, and other health behaviors. Results: Mixed linear models showed that higher baseline levels of psychological well-being were associated with more fruit and vegetable consumption at baseline (β = 0.05, 95% confidence interval [CI] [0.02, 0.08]) and that fruit and vegetable consumption declined across time (β = −0.01, 95% CI [−0.02, −0.004]). Psychological well-being interacted significantly with time such that individuals with higher baseline psychological well-being had slower declines in fruit and vegetable consumption (β = 0.01, 95% CI [0.01, 0.02]). Among individuals who initially met recommendations to consume 5 or more servings of fruits and vegetables (N = 1,719), higher baseline psychological well-being was associated with 11% reduced risk of falling below recommended levels during follow-up (hazard ratio = 0.89, 95% CI [0.83, 0.95]). Conclusions: Findings suggest that psychological well-being may be a precursor to healthy behaviors such as eating a diet rich in fruits and vegetables. (PsycInfo Database Record (c) 2020 APA, all rights reserved

Optimism and Lipid Profiles in Midlife: A 15-Year Study of Black and White Adults

Introduction Optimism is associated with better cardiovascular health, yet little is known about the underlying mechanisms and whether protective relationships are consistently observed across diverse groups. This study examines optimism\u27s association with lipid profiles over time and separately among Black and White men and women. Methods Data were from 3,206 middle-aged adults in the Coronary Artery Risk Development in Young Adults study. Optimism was measured in 2000–2001 using the Revised Life Orientation Test. Triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol measurements were obtained at 5-year intervals through 2015–2016. Linear mixed models evaluated relationships between optimism and lipids, adjusting for covariates, including prebaseline lipids. Subgroup differences were examined using interaction terms and stratification. All analyses were conducted in 2020. Results Higher optimism was associated with both lower baseline total cholesterol (β= −2.33, 95% CI= −4.31, −0.36) and low-density lipoprotein cholesterol levels (β= −1.93, 95% CI= −3.65, −0.21) and a more rapid incremental increase in both markers over time (total cholesterol: β=0.09, 95% CI=0.00, 0.18; low-density lipoprotein cholesterol: β=0.09, 95% CI=0.01, 0.16). No associations were apparent with baseline triglycerides, high-density lipoprotein cholesterol, or changes in either lipid over time. Tests for interaction only found evidence of heterogeneous associations with baseline triglyceride levels, but stratified models hinted at stronger protective associations with baseline levels of total cholesterol and low-density lipoprotein cholesterol among White women. Conclusions Optimism may help diverse individuals establish healthy total cholesterol and low-density lipoprotein cholesterol levels before midlife. Although associations were largely consistent across subgroups, stronger associations among White men and White women highlight a need to study optimism\u27s health impact in diverse samples

Psychological Well-being’s Link With Cardiovascular Health in Older Adults

Introduction Favorable cardiovascular health (FCH) is associated with healthy longevity and reduced cardiovascular mortality risk. However, limited work has investigated the distribution of FCH in older age or considered the antecedents of FCH. Based on prior work linking psychological well-being with cardiovascular endpoints, higher psychological well-being was hypothesized to be associated with increased likelihood of maintaining FCH over time. Methods Data were from the English Longitudinal Study of Ageing. The first study wave (2002–2003) included men and women aged ≥50 years. The analytic sample (N=4,925) was restricted to individuals without baseline cardiovascular disease and with clinical data from three follow-ups through 2013. Psychological well-being was assessed with 17 items from the Control, Autonomy, Satisfaction, and Pleasure scale. FCH was defined as being a non-smoker, diabetes-free, and having healthy levels of blood pressure, cholesterol, and BMI (FCH scores ranged from 0–5). Statistical analyses conducted in 2016–2017 used linear mixed models to examine associations between psychological well-being and FCH scores over time. Secondary analyses examined cardiovascular-related mortality. Results Only 1% of participants had achieved complete FCH at study baseline. Adjusting for sociodemographic factors and depression, greater psychological well-being was associated with higher FCH scores across time (β=0.05, 95% CI=0.02, 0.08), but not rate of change in FCH. Psychological well-being was also associated with a 29% reduced risk of cardiovascular-related mortality in multivariable-adjusted models. Conclusions Findings suggest that psychological well-being is associated with having FCH at older ages, and add to knowledge of assets that may increase likelihood of healthy aging

Optimism and Cardiovascular Health: Longitudinal Findings from the CARDIA Study

Objective: Favorable cardiovascular health is associated with greater longevity free of cardiovascular disease. Although the prevalence of cardiovascular health decreases with age, less is known about protective factors that promote and preserve it over time. We investigated whether optimism was associated with better cardiovascular health over a 10-year period. Methods: Participants included 3,188 Black and White men and women from the Coronary Artery Risk Development in Young Adults Study. Self-reported optimism was assessed in 2000 (this study’s baseline) with the revised Life Orientation Test. Favorable cardiovascular health was defined by healthy status on five components of cardiovascular functioning that were repeatedly assessed through 2010 either clinically or via self-report (blood pressure, lipids, body mass index, diabetes, and smoking status). Linear mixed effects models examined whether optimism predicted cardiovascular health over time, adjusting for covariates such as sociodemographic characteristics, health behaviors, health status, and depression diagnosis. Results: In models adjusting for sociodemographic characteristics, optimism was associated with better cardiovascular health across all time points (β=0.08, 95% confidence interval=0.04-0.11, p≤.001), but not with rate of change in cardiovascular health. Findings were similar when adjusting for additional covariates. Optimism did not interact significantly with race (p=0.85), but did with sex such that associations appeared stronger for women than men (p=0.03). Conclusions: Optimism may contribute to establishing future patterns of cardiovascular health in adulthood, but other factors may be more strongly related to how slowly or quickly cardiovascular health deteriorates over time

Positive Emotions and Favorable Cardiovascular Health: A 20-Year Longitudinal Study

No studies have examined whether positive emotions lead to favorable cardiovascular health (CVH) early in the lifespan, before cardiovascular disease is diagnosed. Moreover, the direction of the association has not been thoroughly investigated. Among younger adults, we investigated whether baseline positive emotions were associated with better CVH over 20 years. We also considered whether baseline CVH was associated with subsequent positive emotions during the same period. Participants included 4196 Black and White men and women from the Coronary Artery Risk Development in Young Adults Study. Positive emotions and cardiovascular-related parameters were each assessed in 1990 (this study\u27s baseline), with repeated assessment through 2010. CVH was defined by blood pressure, lipids, body mass index, diabetes, and smoking status. Primary analyses used linear mixed effects models adjusting for potential confounders; secondary analyses stratified by race and sex. Controlling for sociodemographic factors, greater baseline positive emotions were associated with better CVH across time (β = 0.03, 95% confidence interval = 0.007–0.06). However, positive emotions were unrelated to rate of change in CVH across time. Baseline CVH was also associated with greater average positive emotions across time (β = 0.09, 95% confidence interval = 0.02–0.15), but not rate of change. Positive emotions\u27 association with CVH was stronger for women than men, but race did not modify associations. Positive emotions in early to middle adulthood were associated with better CVH across several decades. Baseline CVH was also associated with greater positive emotions during follow-up. Future research may be able to disentangle these relationships by assessing positive emotions and CVH earlier in life

Positive emotions and favorable cardiovascular health: A 20-year longitudinal study

No studies have examined whether positive emotions lead to favorable cardiovascular health (CVH) early in the lifespan, before cardiovascular disease is diagnosed. Moreover, the direction of the association has not been thoroughly investigated. Among younger adults, we investigated whether baseline positive emotions were associated with better CVH over 20 years. We also considered whether baseline CVH was associated with subsequent positive emotions during the same period. Participants included 4196 Black and White men and women from the Coronary Artery Risk Development in Young Adults Study. Positive emotions and cardiovascular-related parameters were each assessed in 1990 (this study's baseline), with repeated assessment through 2010. CVH was defined by blood pressure, lipids, body mass index, diabetes, and smoking status. Primary analyses used linear mixed effects models adjusting for potential confounders; secondary analyses stratified by race and sex. Controlling for sociodemographic factors, greater baseline positive emotions were associated with better CVH across time (β = 0.03, 95% confidence interval = 0.007-0.06). However, positive emotions were unrelated to rate of change in CVH across time. Baseline CVH was also associated with greater average positive emotions across time (β = 0.09, 95% confidence interval = 0.02-0.15), but not rate of change. Positive emotions' association with CVH was stronger for women than men, but race did not modify associations. Positive emotions in early to middle adulthood were associated with better CVH across several decades. Baseline CVH was also associated with greater positive emotions during follow-up. Future research may be able to disentangle these relationships by assessing positive emotions and CVH earlier in life

Midwifery continuity of care versus standard maternity care for women at increased risk of preterm birth : a hybrid implementation–effectiveness, randomised controlled pilot trial in the UK

Background Midwifery continuity of care is the only health system intervention shown to reduce preterm birth (PTB) and improve perinatal survival, but no trial evidence exists for women with identified risk factors for PTB. We aimed to assess feasibility, fidelity, and clinical outcomes of a model of midwifery continuity of care linked with a specialist obstetric clinic for women considered at increased risk for PTB. Methods and findings We conducted a hybrid implementation–effectiveness, randomised, controlled, unblinded, parallel-group pilot trial at an inner-city maternity service in London (UK), in which pregnant women identified at increased risk of PTB were randomly assigned (1:1) to either midwifery continuity of antenatal, intrapartum, and postnatal care (Pilot study Of midwifery Practice in Preterm birth Including women’s Experiences [POPPIE] group) or standard care group (maternity care by different midwives working in designated clinical areas). Pregnant women attending for antenatal care at less than 24 weeks’ gestation were eligible if they fulfilled one or more of the following criteria: previous cervical surgery, cerclage, premature rupture of membranes, PTB, or late miscarriage; previous short cervix or short cervix this pregnancy; or uterine abnormality and/or current smoker of tobacco. Feasibility outcomes included eligibility, recruitment and attrition rates, and fidelity of the model. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth. We analysed by intention to treat. Between 9 May 2017 and 30 September 2018, 334 women were recruited; 169 women were allocated to the POPPIE group and 165 to the standard group. Mean maternal age was 31 years; 32% of the women were from Black, Asian, and ethnic minority groups; 70% were in employment; and 46% had a university degree. Nearly 70% of women lived in areas of social deprivation. More than a quarter of women had at least one pre-existing medical condition and multiple risk factors for PTB. More than 75% of antenatal and postnatal visits were provided by a named/partner midwife, and a midwife from the POPPIE team was present at 80% of births. The incidence of the primary composite outcome showed no statistically significant difference between groups (POPPIE group 83.3% versus standard group 84.7%; risk ratio 0.98 [95% confidence interval (CI) 0.90 to 1.08]; p = 0.742). Infants in the POPPIE group were significantly more likely to have skin-to-skin contact after birth, to have it for a longer time, and to breastfeed immediately after birth and at hospital discharge. There were no differences in other secondary outcomes. The number of serious adverse events was similar in both groups and unrelated to the intervention (POPPIE group 6 versus standard group 5). Limitations of this study included the limited power and the nonmasking of group allocation; however, study assignment was masked to the statistician and researchers who analysed the data. Conclusions In this study, we found that it is feasible to set up and achieve fidelity of a model of midwifery continuity of care linked with specialist obstetric care for women at increased risk of PTB in an inner-city maternity service in London (UK), but there is no impact on most outcomes for this population group. Larger appropriately powered trials are needed, including in other settings, to evaluate the impact of relational continuity and hypothesised mechanisms of effect based on increased trust and engagement, improved care coordination, and earlier referral on disadvantaged communities, including women with complex social factors and social vulnerability. Trial registration We prospectively registered the pilot trial on the UK Clinical Research Network Portfolio Database (ID number: 31951, 24 April 2017). We registered the trial on the International Standard Randomised Controlled Trial Number (ISRCTN) (Number: 37733900, 21 August 2017) and before trial recruitment was completed (30 September 2018) when informed that prospective registration for a pilot trial was also required in a primary clinical trial registry recognised by WHO and the International Committee of Medical Journal Editors (ICMJE). The protocol as registered and published has remained unchanged, and the analysis conforms to the original plan

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

Tumour risks and genotype-phenotype correlations associated with germline variants in succinate dehydrogenase subunit genes SDHB, SDHC and SDHD.

BACKGROUND: Germline pathogenic variants in SDHB/SDHC/SDHD are the most frequent causes of inherited phaeochromocytomas/paragangliomas. Insufficient information regarding penetrance and phenotypic variability hinders optimum management of mutation carriers. We estimate penetrance for symptomatic tumours and elucidate genotype-phenotype correlations in a large cohort of SDHB/SDHC/SDHD mutation carriers. METHODS: A retrospective survey of 1832 individuals referred for genetic testing due to a personal or family history of phaeochromocytoma/paraganglioma. 876 patients (401 previously reported) had a germline mutation in SDHB/SDHC/SDHD (n=673/43/160). Tumour risks were correlated with in silico structural prediction analyses. RESULTS: Tumour risks analysis provided novel penetrance estimates and genotype-phenotype correlations. In addition to tumour type susceptibility differences for individual genes, we confirmed that the SDHD:p.Pro81Leu mutation has a distinct phenotype and identified increased age-related tumour risks with highly destabilising SDHB missense mutations. By Kaplan-Meier analysis, the penetrance (cumulative risk of clinically apparent tumours) in SDHB and (paternally inherited) SDHD mutation-positive non-probands (n=371/67 with detailed clinical information) by age 60 years was 21.8% (95% CI 15.2% to 27.9%) and 43.2% (95% CI 25.4% to 56.7%), respectively. Risk of malignant disease at age 60 years in non-proband SDHB mutation carriers was 4.2%(95% CI 1.1% to 7.2%). With retrospective cohort analysis to adjust for ascertainment, cumulative tumour risks for SDHB mutation carriers at ages 60 years and 80 years were 23.9% (95% CI 20.9% to 27.4%) and 30.6% (95% CI 26.8% to 34.7%). CONCLUSIONS: Overall risks of clinically apparent tumours for SDHB mutation carriers are substantially lower than initially estimated and will improve counselling of affected families. Specific genotype-tumour risk associations provides a basis for novel investigative strategies into succinate dehydrogenase-related mechanisms of tumourigenesis and the development of personalised management for SDHB/SDHC/SDHD mutation carriers