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Association of Optimism With Cardiovascular Events and All-Cause Mortality: A Systematic Review and Meta-analysis  

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Original Investigation 
September 27, 2019

Association of Optimism With Cardiovascular Events and All-Cause MortalityA Systematic Review and Meta-analysis

JAMA Netw Open. 2019;2(9):e1912200. doi:10.1001/jamanetworkopen.2019.12200
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Key Points Español  中文 (Chinese)

Question  Is a mindset of optimism associated with a lower risk of cardiovascular events and all-cause mortality?

Findings  In this meta-analysis of 15 studies including 229 391 individuals, optimism was associated with a lower risk of cardiovascular events and pessimism was associated with a higher risk of cardiovascular events; the pooled association was similar to that of other well-established cardiac risk factors.

Meaning  The findings suggest that a mindset of optimism is associated with lower cardiovascular risk and that promotion of optimism and reduction in pessimism may be important for preventive health.



Importance  Optimism and pessimism can be easily measured and are potentially modifiable mindsets that may be associated with cardiovascular risk and all-cause mortality.

Objective  To conduct a meta-analysis and systematic review of the association between optimism and risk for future cardiovascular events and all-cause mortality.

Data Sources and Study Selection  PubMed, Scopus, and PsycINFO electronic databases were systematically searched from inception through July 2, 2019, to identify all cohort studies investigating the association between optimism and pessimism and cardiovascular events and/or all-cause mortality by using the following Medical Subject Heading terms: optimismoptimistic explanatory stylepessimismoutcomesendpointmortalitydeathcardiovascular eventsstrokecoronary artery diseasecoronary heart diseaseischemic heart disease, and cardiovascular disease.

Data Extraction and Synthesis  Data were screened and extracted independently by 2 investigators (A.R. and C.B.). Adjusted effect estimates were used, and pooled analysis was performed using the Hartung-Knapp-Sidik-Jonkman random-effects model. Sensitivity and subgroup analyses were performed to assess the robustness of the findings. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed.

Main Outcomes and Measures  Cardiovascular events included a composite of fatal cardiovascular mortality, nonfatal myocardial infarction, stroke, and/or new-onset angina. All-cause mortality was assessed as a separate outcome.

Results  The search yielded 15 studies comprising 229 391 participants of which 10 studies reported data on cardiovascular events and 9 studies reported data on all-cause mortality. The mean follow-up period was 13.8 years (range, 2-40 years). On pooled analysis, optimism was significantly associated with a decreased risk of cardiovascular events (relative risk, 0.65; 95% CI, 0.51-0.78; P < .001), with high heterogeneity in the analysis (I2 = 87.4%). Similarly, optimism was significantly associated with a lower risk of all-cause mortality (relative risk, 0.86; 95% CI, 0.80-0.92; P < .001), with moderate heterogeneity (I2 = 73.2%). Subgroup analyses by methods for assessment, follow-up duration, sex, and adjustment for depression and other potential confounders yielded similar results.

Conclusions and Relevance  The findings suggest that optimism is associated with a lower risk of cardiovascular events and all-cause mortality. Future studies should seek to better define the biobehavioral mechanisms underlying this association and evaluate the potential benefit of interventions designed to promote optimism or reduce pessimism.





Extensive evidence has demonstrated an association between negative emotions, social factors, and certain chronic stress conditions and adverse cardiac outcomes.1 Less well studied has been the potential association between positive and negative mindsets and cardiac risk. Such research is of interest because mind-sets are potentially modifiable, thus making them a novel relevant target for clinical intervention. One such mindset is an individual’s level of optimism, commonly defined as the tendency to think that good things will happen in the future.2 Empirical studies have long indicated that more optimistic individuals are more likely to succeed at work and in school, sports, politics, relationships, and other forms of life endeavors.3,4 A more recent study also reported positive associations between optimism and a range of favorable physical health outcomes.5 Nevertheless, the assessment of optimism and pessimism in cardiac medical practice is uncommon. In 2001, Kubzansky and colleagues6 reported the first study, to our knowledge, to find an association between higher optimism and a lower risk for specific cardiac outcomes, including angina, myocardial infarction, and cardiac death. They showed effects of optimism beyond those of depression or other forms of psychological distress, a critical finding because a concern about such findings is that they simply reflect the absence of depression rather than active effects of optimism. Since then, similar findings have been described in other studies,7-20 and most studies considered depression or distress as a potential confounder. To consider these findings more systematically, we conducted a meta-analysis of studies that have assessed the association between optimism and pessimism and adverse cardiac outcomes. Our goals were to evaluate the magnitude of this association, the consistency of results among reported studies, the influence of potential confounders, and the quality of the reported literature.




Data Sources and Searches


For this systematic review and meta-analysis, PubMed, Scopus, and PsycINFO databases were systematically searched for articles published from inception through July 2, 2019, with the following Medical Subject Heading terms: optimism, optimistic explanatory style, pessimism, outcomes, endpoint, mortality, death, cardiovascular events, stroke, coronary artery disease, coronary heart disease, ischemic heart disease, and cardiovascular disease. No language restrictions were imposed for the search. In addition, references from included studies and pertinent review articles were searched to identify other studies meeting selection criteria. The present systematic review and meta-analysis was conducted and reported according to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.21


Study Selection


Two of us (A.R. and C.B.) independently identified articles eligible for review. Articles were selected for inclusion in the meta-analysis if the study evaluated associations of optimism with all-cause mortality and/or cardiovascular events and reported adjusted risk estimates with 95% CIs. Studies of patients with cancer were excluded to avoid confounding secondary to terminal sickness. Articles were identified for further review by performing an initial screen of abstracts, followed by full-text reviews. Only empirical articles were considered. With regard to multiple studies from the same data set, only 1 article was included and was selected based on relevance, clearly defined outcomes, and larger sample size.


Data Extraction and Quality Assessment


Data were independently extracted by 2 of us (A.R. and C.B.) using a standardized protocol and reporting form. Disagreements were resolved by arbitration, and consensus was reached after discussion. The following information was extracted: study characteristics (study name, authors, publication year, country of origin, sample size, study design, and follow-up duration), study sample characteristics (mean age, sex, and major comorbidities), main exposure (method of assessment of optimism or pessimism) and main outcomes (all-cause mortality and/or cardiovascular events). Adjusted relative risks (RRs) or hazard ratios, 95% CIs, and information about the variables used for adjustment in multivariable analysis were abstracted. Study quality was assessed by the Newcastle-Ottawa scale,22 with quality grades assigned based on selection of the study groups, comparability, and assessment of outcomes.


Statistical Analysis


For the present analysis, only adjusted RRs or hazard ratios and 95% CIs reported by individual studies were used, which reflect estimates with the most complete adjustment available for baseline covariates. Because of known clinical and methodologic heterogeneity of studies, effect estimates were pooled using Hartung-Knapp-Sidik-Jonkman random-effects models.23 When studies reported separate RRs for men and women from the same cohort, data were included from both men and women separately in the pooled analysis. Most studies compared multiple categories of optimism (often categorized according to tertiles or quartiles based on score distribution in a particular sample), reporting effect estimates for highest levels of optimism vs lowest reference categories. When effect estimates for optimism and outcomes were reported according to categorical optimism levels and also using optimism as a continuous variable, effect estimates were selected for the highest categorical level of optimism. Studies by Brummett et al,7 Grossardt et al,8 and Mosing et al9 reported effect estimates for pessimism and all-cause mortality, for which we used reciprocal values of RR or hazard ratio to ensure uniform statistical analysis.


All-cause mortality and cardiovascular events were analyzed as separate outcomes. Cardiovascular events predominantly included cardiovascular or coronary heart disease mortality; in 2 studies, the occurrence of nonfatal myocardial infarction and/or new onset angina was also included as cardiovascular events.6,10 Heterogeneity among studies was assessed using Higgins and Thompson I2 statistics. The I2 is the proportion of total variation observed among the studies that are attributable to differences between studies rather than sampling error (chance), with I2 values corresponding to the following levels of heterogeneity: low (<25%), moderate (25%-75%), and high (>75%).24 Reasons for heterogeneity in study results were further explored using subgroup analyses. Subgroup analyses were performed according to assessment method for optimism or pessimism, follow-up duration, sex, geographical location, and determination of whether studies assessed or did not assess the effects of critical potential confounders, including depression, educational level, and health behavior as measured by physical activity. Other health behaviors were not considered because of too few studies reported on them. In addition, there was sufficient data to assess whether findings differed with and without consideration of the educational level as a separate covariate. We also performed a sensitivity analysis to investigate the association of each individual study with the overall meta-analysis results. Publication bias was tested using the Begg correlation test25 and visual inspection of a funnel plot. Publication bias tests could be highly limited because of a smaller number of studies.26 The Duval and Tweedie nonparametric trim-and-fill procedure was used to further assess the possible effect of publication bias in our meta-analysis.27 The Duval and Tweedie trim-and-fill method use an iterative procedure (1000 iterations used in this study) to remove (ie, trim) smaller studies that cause funnel plot asymmetry and thus publication bias, uses the trimmed funnel plot to estimate the true center of the funnel plot, and then replaces the omitted studies and their missing counterparts around the center (ie, fill). A 2-tailed P < .05 was considered to be statistically significant. All analyses were performed using Stata statistical software, version 16 (StataCorp).




Study Characteristics


A flow diagram of the literature search and related screening process is shown in Figure 1. A total of 15 studies6-20 published between November 2001 and January 2017 met our inclusion criteria. Of these, 14 were prospective studies and 1 was a retrospective cohort study.8 Overall characteristics of the included studies, which comprised 229 391 individuals, are summarized in Table 1.


Of the 15 studies, 8 were conducted in the United States,6-8,11,15-17,19 5 in Europe,10,12-14,18 1 in Israel,20 and 1 in Australia.9 Ten studies reported data on cardiovascular events,6,10,11,13-19 and 9 studies reported data on all-cause mortality.7-9,11-13,17,19,20 The mean follow-up period was 13.8 years (range, 2-40 years). With the exceptions of a study that assessed ambulatory patients8 and another that assessed patients who had previous myocardial infarction,20 all studies were performed in community cohorts of different ages. Mean age at baseline assessment ranged from 19 to 93 years. Details regarding how exposures and outcomes were assessed in the included studies are shown in eTable 1 in the Supplement. A variety of scales were used to assess optimism and pessimism. The most frequently used (in 8 of 15 studies) scale was the Life Orientation Test–Revised.28 All studies had a low risk for bias per the Newcastle-Ottawa scale (eTable 2 in the Supplement).


Optimism and Incident Cardiovascular Events


The 10 studies reporting on cardiovascular events included 209 436 participants. On pooled analysis, optimism was significantly associated with reduced risk of cardiovascular events (RR, 0.65; 95% CI, 0.51-0.78; P < .001) (Figure 2). A high heterogeneity was observed in the analysis (I2 = 87.4%). Exclusion of the study by Tindle et al,19 the largest study, did not result in any change in the pooled result (RR, 0.63; 95% CI, 0.48-0.78; P = .001). Visual inspection of the funnel plot showed evidence of publication bias (smaller studies showing no beneficial effects were missing). According to the trim-and-fill method, the association between optimism and cardiovascular events remained significant after imputing 4 possible missing studies (adjusted RR, 0.77; 95% CI, 0.61-0.92; P < .001) (eFigure in the Supplement).


Optimism and All-Cause Mortality


The 9 studies (10 comparisons) reporting on all-cause mortality included 188 599 participants. On pooled analysis, optimism was significantly associated with reduced risk of all-cause mortality (RR, 0.86; 95% CI, 0.80-0.92; P < .001) (Figure 3). Moderate heterogeneity was observed in the analysis (I2 = 73.2%). The exclusion of the study by Tindle et al19 did not result in any change in the pooled result (RR, 0.86; 95% CI, 0.79-0.93; P < .001). Visual inspection of a funnel plot showed evidence of publication bias. According to the trim-and-fill method, the association between optimism and all-cause mortality remained significant after imputing 4 possible missing studies (adjusted RR, 0.90; 95% CI, 0.83-0.97; P < .001) (eFigure in the Supplement).


Subgroup Analysis


Subgroup analysis by method of assessment for optimism, follow-up duration, sex, study location, depression, educational level, socioeconomic status, and exercise or physical activity yielded largely similar results for the associations between optimism and pessimism and the risk for either cardiovascular events or all-cause mortality (Table 2).


Assessment of Linear Trend


Among the 15 studies, optimism and pessimism were assessed solely as a continuous variable in 2 studies.7,9,11 In the other 13 studies, participants were divided into either tertiles or quartiles and a statistical assessment was performed regarding the presence or absence of a significant linear trend between levels of optimism and reduced risk for cardiac events and/or all-cause mortality (eTable 1 in the Supplement). In 12 of 15 studies, a significant linear trend was observed.




A review of the literature has noted associations between a number of psychosocial risk factors, including negative emotions such as depression and anxiety, social factors (eg, loneliness), and certain chronic stress conditions, with cardiovascular disease. Specific mindsets, habitual patterns of thinking which influence individuals’ views and interactions, have also been associated with cardiovascular disease risk. Using the strongest epidemiologic methods available, a growing body of research has investigated whether the mindset of optimism vs pessimism might be associated with cardiovascular disease and has also explored potential mechanisms underlying these associations. Herein, we report the results of a comprehensive systematic review and meta-analysis to assess the association between optimism and pessimism and adverse cardiovascular outcomes.


This meta-analysis consisted of 15 studies6-20 involving 229 391 participants. Ten of the studies assessed the association between optimism and pessimism and adverse cardiovascular outcomes. In 9 of 10 studies,6,10,11,13-19 there was a significantly lower risk of cardiovascular events among individuals with high optimism scores after adjustment for a variety of clinical measures in each study. The overall pooled risk ratio for cardiovascular events among individuals with high optimism levels was 0.65. Among 9 studies,7-9,11-13,17,19,20 optimism was also associated with a reduction in all-cause mortality, but the decrease in risk was more modest, with an overall pooled risk ratio of 0.86. As with cardiovascular events, the results among studies were consistent, with 8 of 9 studies showing a lower risk of all-cause mortality among the most optimistic individuals.


Methodologic Differences Among Studies


There was considerable variation in questionnaires used to assess optimism and pessimism. Most studies queried dispositional optimism, with the Life Orientation Test–Revised28 most commonly used (in 8 of 15 studies). Three studies6-8 used an explanatory style measure of optimism derived using items from the Minnesota Multiphasic Personality Inventory, whereas 2 studies10,12 used a single-item measure. Despite this heterogeneity in how optimism was assessed, the lower RR that was associated with optimism was comparable among studies. Studies also varied by length of follow-up. Among the 15 studies, participants were followed for at least 10 years in 8 studies.6-9,12,14,15,20 Significantly lower risk of cardiovascular events and all-cause mortality was observed across studies regardless of follow-up duration.


Assessment of Potentially Confounding Variables


In general, the risk ratios used for this meta-analysis were adjusted for a variety of potentially confounding clinical variables. Most studies adjusted for some if not all major cardiac disease risk factors. Many studies also adjusted for psychological distress to rule out concerns that associations were primarily attributable to the absence of depression, and approximately half of the studies presented estimates also adjusted for educational level and physical activity. Protective effects of optimism were maintained among studies adjusting for these variables. In addition, optimism was associated with comparably reduced risk among studies with a predominance of men vs women and among studies conducted in the United States vs other countries.


Assessment of Outcomes According to the Magnitude of Optimism and Pessimism


Optimism was generally assessed according to continuous scales that used multi-item measures, with associations generally estimated according to tertiles or quartiles of optimism. In the 2 studies assessing optimism and pessimism by a single question, participants were divided into 3 categories based on their responses, with comparisons made between the highest vs lowest categories. Evidence of a dose-response association between level of optimism and decreased clinical risk was present in 12 of 15 studies. In 2 of the 3 studies without evidence of a dose-response association,10,15 the optimism assessment was limited with measures including only 1 or 2 items. The evidence of dose-response associations paralleled similar findings reported for the clinical hazard of cardiovascular outcomes associated with depression, poor social support, and other psychosocial risk factors.1


Comparison With Studies of Optimism and Other Medical Conditions


Our study was the first meta-analysis, to our knowledge, to assess the association between optimism and clinical outcomes. Findings were consistent with studies17,29-31 that have evaluated the association between optimism and other related medical conditions. This includes studies that have shown an association between optimism and the risk of heart failure,29 development of cognitive dysfunction among elderly persons,30 rate of atherosclerotic progression,31 and respiratory disease, infection, and various cancers.17 In addition, a previous meta-analysis found consistent associations between optimism and a reduced likelihood of various other adverse physical health outcomes.5 Combined, these data support the findings of our meta-analysis.




Psychosocial risk factors tend to exert their adverse effects by both indirect behavioral mechanisms and direct physiologic mechanisms.32 Accumulating data suggest that similar mechanisms may be associated with the presence of optimism and pessimism. With respect to behavioral mechanisms, Boehm and colleagues33 conducted a random-effects meta-analysis to examine the association between optimism and 3 cardiac-relevant health behaviors: physical activity, diet, and cigarette smoking. The study33 found a positive association between optimism and better health behaviors, although most evidence was cross-sectional and effect sizes were modest. More recently, however, larger studies34-37 with prospective designs have found significant associations between the measurement of initial optimism and pessimism levels and subsequent health behaviors. For instance, among participants in the Women’s Health Initiative, greater optimism was associated with both better diet quality34 and a greater likelihood of sustaining physical exercise over time.35


Studies have also reported associations between optimism and pessimism and a variety of pathophysiologic mediators of chronic disease, including increased inflammation and impairments in hemostasis and endothelial function38,39; metabolic function40; telomerase activity and telomere length41-43; ambulatory blood pressure44; and hypothalamic-pituitary-adrenocortical function.45-47 Together, these findings suggest a direct association of optimism vs pessimism with physiologic functioning, although the study of individual mediators remains sparse compared with the study of more established psychosocial mediators, such as depression. A prospective study is needed to evaluate whether pessimism is a stronger contributor to pathophysiologic dysfunction (as suggested by some studies38,40,43) than optimism is for providing positive physiologic buffering.


Clinical Significance


Optimism has long been promulgated as a positive attribute for living. The findings of the current meta-analysis suggest that optimism is associated with cardiovascular benefits and that pessimism is associated with cardiovascular risk, with a pooled association that was similar to that for well-established cardiac risk factors. Taken together, the cardiovascular and psychological benefits of optimism make it an attractive new arena for study within the field of behavioral cardiology. The success of this research may require addressing 3 key issues. First, there is a need to define more clearly the central processes that underlie the medical benefits associated with optimism. This should include more study into the physiological processes and health behaviors that may ensue from optimism vs pessimism as well as the study of potential salutogenic mechanisms that may travel with optimism vs pessimism. With respect to the latter, a study48 reported an association of optimism with more effective goal setting, problem-solving, and coping skills, suggesting that these are potential assets related to optimism that could be incorporated into the measurement of optimism and/or form the basis of clinical intervention.


Second, the studies of our meta-analysis were associated with substantial variability in the cut points that were applied to optimism vs pessimism. This variability differs from the use of depression scales, whereby specific diagnostic cut points have been established. For instance, screening for depression, as advocated by the American Heart Association, has been made possible because of the development of widely accepted criteria for defining depression risk based on the 2- and 9-item General Health Questionnaire. A similar consensus in diagnostic criteria could improve future epidemiologic investigations regarding optimism and pessimism and is needed for use as a clinical assessment tool in medical practice. To this end, emerging data suggest that the Life Orientation Test-Revised, as developed by Scheier and colleagues,28 may be a suitable screening tool given its brevity and successful use across many clinical outcomes.


Third, the findings of this meta-analysis appear to support the establishment of interventions that might diminish pessimism and promote optimism among clinical patients. Various studies49-54 have reported that pessimism can be reduced49,50 and optimism can be enhanced through the use of cognitive-behavioral therapy and positive psychological techniques,51-54 making these techniques potentially suitable for use in cardiac rehabilitation programs and other group settings.55 However, further research will need to assess whether optimism that is enhanced or induced through directed prevention or intervention strategies has similar health benefits vs optimism that is naturally occurring. More broadly, the present findings concerning the cardiac benefits of optimism might encourage studies on whether similar benefits can be derived from instilling other positive mindsets (eg, sense of purpose or gratitude) that may be elicited through guided interventions.




Our meta-analysis has several limitations. The cohorts included in this meta-analysis varied widely in age, ranging from teenagers in 1 study7 to nonagenarians in another.12 However, the consistent association of optimism to reduced cardiovascular risk among all age groups could also be considered a strength of our study. Although each study adjusted for important covariates, these covariates varied widely from study to study. Thus, we could not systematically assess the independent effects of various individual clinical covariates, including smoking, diabetes, and hypertension. This variability in covariate adjustment may help to account for the considerable heterogeneity found among studies, which was high for the assessment of cardiovascular outcomes (I2 = 87.4%) and moderate for all-cause mortality (I2 = 73.2%). Lack of uniformity in scales and/or variance in the cut points used within a given scale, particularly the Life Orientation Test-Revised, may have also contributed to this heterogeneity. In addition, the measurement of optimism according to both positively and negatively framed items has led to an ongoing debate as to whether these items separately represent optimism and pessimism as distinct constructs. Although recent research suggests that considering both positively and negatively worded items as indicative of a unitary measure of optimism is most appropriate,56 there was insufficient information to address this issue in our meta-analysis.




The findings suggest that optimism is associated with a lower risk of cardiovascular events and all-cause mortality. Future studies should seek to better define the biobehavioral mechanisms underlying this association and evaluate the potential benefit of interventions designed to promote optimism or reduce pessimism.


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Article Information

Accepted for Publication: August 9, 2019.

Published: September 27, 2019. doi:10.1001/jamanetworkopen.2019.12200

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Rozanski A et al. JAMA Network Open.

Corresponding Author: Alan Rozanski, MD, Department of Cardiology, Mount Sinai St Luke’s Hospital, 1111 Amsterdam Ave, New York, NY 10025 (

Author Contributions: Drs Rozanski and Bavishi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Rozanski, Bavishi, Kubzansky.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Rozanski, Bavishi, Cohen.

Critical revision of the manuscript for important intellectual content: Rozanski, Bavishi, Kubzansky.

Statistical analysis: Rozanski, Bavishi, Kubzansky.

Administrative, technical, or material support: Bavishi.

Supervision: Rozanski.

Conflict of Interest Disclosures: None reported.



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Kim  ES, Smith  J, Kubzansky  LD.  Prospective study of the association between dispositional optimism and incident heart failure.  Circ Heart Fail. 2014;7(3):394-400. doi:10.1161/CIRCHEARTFAILURE.113.000644PubMedGoogle ScholarCrossref

Gawronski  KA, Kim  ES, Langa  KM, Kubzansky  LD.  Dispositional optimism and incidence of cognitive impairment in older adults.  Psychosom Med. 2016;78(7):819-828. doi:10.1097/PSY.0000000000000345PubMedGoogle ScholarCrossref

Matthews  KA, Räikkönen  K, Sutton-Tyrrell  K, Kuller  LH.  Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women.  Psychosom Med. 2004;66(5):640-644. doi:10.1097/01.psy.0000139999.99756.a5PubMedGoogle ScholarCrossref

Rozanski  A.  Behavioral cardiology: current advances and future directions.  J Am Coll Cardiol. 2014;64(1):100-110. doi:10.1016/j.jacc.2014.03.047PubMedGoogle ScholarCrossref

Boehm  JK, Chen  Y, Koga  H, Mathur  MB, Vie  LL, Kubzansky  LD.  Is optimism associated with healthier cardiovascular-related behavior? meta-analyses of 3 health behaviors.  Circ Res. 2018;122(8):1119-1134. doi:10.1161/CIRCRESAHA.117.310828PubMedGoogle ScholarCrossref

Hingle  MD, Wertheim  BC, Tindle  HA,  et al.  Optimism and diet quality in the Women’s Health Initiative.  J Acad Nutr Diet. 2014;114(7):1036-1045. doi:10.1016/j.jand.2013.12.018PubMedGoogle ScholarCrossref

Progovac  AM, Donohue  JM, Matthews  KA,  et al.  Optimism predicts sustained vigorous physical activity in postmenopausal women.  Prev Med Rep. 2017;8:286-293. doi:10.1016/j.pmedr.2017.10.008PubMedGoogle ScholarCrossref

Pänkäläinen  M, Fogelholm  M, Valve  R,  et al.  Pessimism, diet, and the ability to improve dietary habits: a three-year follow-up study among middle-aged and older Finnish men and women.  Nutr J. 2018;17(1):92. doi:10.1186/s12937-018-0400-8PubMedGoogle ScholarCrossref

Trudel-Fitzgerald  C, James  P, Kim  ES, Zevon  ES, Grodstein  F, Kubzansky  LD.  Prospective associations of happiness and optimism with lifestyle over up to two decades.  Prev Med. 2019;126:105754. doi:10.1016/j.ypmed.2019.105754PubMedGoogle Scholar

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Tindle  HA, Duncan  MS, Liu  S,  et al.  Optimism, pessimism, cynical hostility, and biomarkers of metabolic function in the Women’s Health Initiative.  J Diabetes. 2018;10(6):512-523. doi:10.1111/1753-0407.12584PubMedGoogle ScholarCrossref

O’Donovan  A, Lin  J, Tillie  J,  et al.  Pessimism correlates with leukocyte telomere shortness and elevated interleukin-6 in post-menopausal women.  Brain Behav Immun. 2009;23(4):446-449. doi:10.1016/j.bbi.2008.11.006PubMedGoogle ScholarCrossref

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Ikeda  A, Schwartz  J, Peters  JL,  et al.  Pessimistic orientation in relation to telomere length in older men: the VA normative aging study.  Psychoneuroendocrinology. 2014;42:68-76. doi:10.1016/j.psyneuen.2014.01.001PubMedGoogle ScholarCrossref

Räikkönen  K, Matthews  KA, Flory  JD, Owens  JF, Gump  BB.  Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life.  J Pers Soc Psychol. 1999;76(1):104-113. doi:10.1037/0022-3514.76.1.104PubMedGoogle ScholarCrossref

Endrighi  R, Hamer  M, Steptoe  A.  Associations of trait optimism with diurnal neuroendocrine activity, cortisol responses to mental stress, and subjective stress measures in healthy men and women.  Psychosom Med. 2011;73(8):672-678. doi:10.1097/PSY.0b013e31822f9cd7PubMedGoogle ScholarCrossref

Puig-Perez  S, Hackett  RA, Salvador  A, Steptoe  A.  Optimism moderates psychophysiological responses to stress in older people with type 2 diabetes.  Psychophysiology. 2017;54(4):536-543. doi:10.1111/psyp.12806PubMedGoogle ScholarCrossref

Puig-Perez  S, Villada  C, Pulopulos  MM, Almela  M, Hidalgo  V, Salvador  A.  Optimism, and pessimism are related to different components of the stress response in healthy older people.  Int J Psychophysiol. 2015;98(2, pt 1):213-221. doi:10.1016/j.ijpsycho.2015.09.002PubMedGoogle ScholarCrossref

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Seligman  ME, Schulman  P, Tryon  AM.  Group prevention of depression and anxiety symptoms.  Behav Res Ther. 2007;45(6):1111-1126. doi:10.1016/j.brat.2006.09.010PubMedGoogle ScholarCrossref

Meevissen  YM, Peters  ML, Alberts  HJ.  Become more optimistic by imagining the best possible self: effects of a two-week intervention.  J Behav Ther Exp Psychiatry. 2011;42(3):371-378. doi:10.1016/j.jbtep.2011.02.012PubMedGoogle ScholarCrossref

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Huffman  JC, Millstein  RA, Mastromauro  CA,  et al.  A positive psychology intervention for patients with an acute coronary syndrome: treatment development and proof-of-concept trial.  J Happiness Stud. 2016;17(5):1985-2006. doi:10.1007/s10902-015-9681-1PubMedGoogle ScholarCrossref

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Mohammadi  N, Aghayousefi  A, Nikrahan  GR,  et al.  A randomized trial of an optimism training intervention in patients with heart disease.  Gen Hosp Psychiatry. 2018;51:46-53. doi:10.1016/j.genhosppsych.2017.12.004PubMedGoogle ScholarCrossref

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Psychedelic Therapy:

Psychedelic Drug Psilocybin Tamps Down Brain’s Ego Center plus Getting Closer to Nature, One Bite at a Time

Psychedelic Drug Psilocybin Tamps Down Brain’s Ego Center plus Getting Closer to Nature, One Bite at a Time – Dr. Frederick Barrett – Steve Brill – Violet Brill – Perhaps no region of the brain is more fittingly named than the claustrum, taken from the Latin word for -hidden or shut away-. The claustrum is an extremely thin sheet of neurons deep within the cortex, yet it reaches out to every other region of the brain. Its true purpose remains -hidden away- as well, with researchers speculating about many functions. What is known is that this region contains a large number of receptors targeted by psychedelic drugs such as LSD or psilocybin the hallucinogenic chemical found in certain mushrooms. To see what happens in the claustrum when people are on psychedelics, Johns Hopkins Medicine researchers compared the brain scans of people after they took psilocybin with their scans after taking a placebo. PLUS Steve and Violet Brill looks at a forest the same way most people think about a supermarket. Walkthrough a park or wooded area with them and they can show you a number of wild plants that might make for tasty additions to your dinner plate. They would tell you how yellow wood sorrel tastes just like lemonade or how black birch can be used as a minty flavoring for pudding. With the advent of this pandemic, foraging may be more important than ever. Some are including it in their home-schooling curriculum in hopes of arming their children with this almost-forgotten art.

Longevity – Life Extension – Anti-Aging Board



“An ounce of prevention is worth a pound of cure.”



Peptides – a Powerful Piece of the Longevity Puzzle

In this episode of Living Beyond 120, Mark and Dr. Gladden begin by talking about how we need to manifest goals in our minds first in order to make them realities.

Next, they discuss some recent health tests Dr. Gladden participated in, along with the remarkable results regarding his cardiovascular health and age. He talks about his plans for getting in the best shape of his life.

They continue their conversation revisiting the subject of peptides, discussing specific peptides, and the amazing outcomes that Dr. Gladden is seeing in his practice. From better immune function to healing the gut, improved fat burning, and much more, they describe which peptides have had positive health effects on many different conditions. To learn more about peptides, you can visit


The novel coronavirus causing COVID-19 seems to hit some people harder than others, with some people experiencing only mild symptoms and others being hospitalized and requiring ventilation. In this episode, Ted shares the latest research on the coronavirus.

Preventing Cardiovascular Disease – an Interview with Dr. Jeffry Life 

In this episode, we’re featuring a special RAAD Fest discussion from last year between Dr. Gladden and Dr. Jeffry Life, a doctor who has focused his practice on healthy aging and helping patients avoiding heart attacks and strokes. He incorporates the Bale-Doneen Method (learn more in the book Beat the Heart Attack Gene) in his treatment plans, which is about aggressively looking for vascular inflammation that causes heart disease and working to stop it.

They discuss some of the testings that can be done to identify vascular risk factors, which fall outside of the normal insurance-based model of healthcare.

Ketogenic Diet Hacks:

Doing The Perfect Keto Diet: Doing Perfect Keto – Chris Irvin –

Everyone agrees that a low-carb, low-sugar Keto lifestyle reduces inflammation and resets insulin sensitivity. Yet there is still confusion about what to eat too and what not to eat. So much so there are entire books dedicated to the subject. And much of that information in those books become outdated as soon as new research provides insights into which foods and supplements work or don’t work as originally expected. And when it comes to snack foods and sweet treats the water gets even murkier. What if there was a website that was driven by current science and gave you access to everything you needed to do low-carb Keto right? Perfect Keto.

RSS Live Long and Master Aging

  • #203 Health Starts In Your Mouth - Dr Dominik Nischwitz September 21, 2020
    Welcome to the Body Mind Empowerment podcast I’m your host Siim Land and our guest today is Dr Dominik Nischwitz. Dr Dome is a biological dentist and functional medical practitioner in Germany. He’s written the book It's All In Your Mouth and practices biological dentistry in his clinic. Timestamps: What Is Biological Dentistry 01:30 How […]
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  • #202 Birthday Q&A - Hair Health, Fixing Tendonitis, Preventing Neurodegeneration September 17, 2020
    This episode is a live Q&A on Siim's birthday. Timestamps: How to Improve HDL Cholesterol 01:53 Astragalus and Autophagy Boosters 02:55 Hair Health and Growth 04:29 How to Detox Regularly 05:53 Tips for Giving Up Caffeine 09:14 Siim's Current Food Protocol 10:48 Can Autophagy Fight the Virus 14:14 How to Treat Acne and Improve Skin […]
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  • #201 Molecular Hydrogen, Oxidative Stress, and Autophagy - Tyler LeBaron September 14, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Tyler LeBaron. Tyler is the founder and executive director of the Molecular Hydrogen Institute. He’s the world’s leading expert on molecular hydrogen and how it can affect health, aging, and stress resilience. Get Drink HRW Molecular Hydrogen for […]
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  • #200 Optimal Meal Timing and Circadian Rhythms - Siim Land at the Biohacker Summit 2019 September 12, 2020
    In this episode, you can listen to Siim Land's speech at the Biohacker Summit 2019 in Helsinki. It talks about optimal meal timing, circadian rhythms, and intermittent fasting. Click here to watch it on YouTube! Here are the links to the podcast on all platforms Link to the Audio Podcast on iTunes and Stitcher Link to the podcast […]
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  • #199 Why You Need More Magnesium to Manage Stress - Wade Lightheart September 6, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Wade Lightheart. Wade is one of the founders of BiOptimizers, which is a supplement company that fixes digestion. He’s also a Canadian natural bodybuilding champion. We’re going to talk about stress and magnesium. Timestamps: How Wade Reacted to […]
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  • #198 Stronger by Stress Q&A with Teemu Arina August 30, 2020
    In this episode of the Body Mind Empowerment Podcast we talk about my new book Stronger by Stress. It's recorded at the Biohacker Center with Teemu Arina. Timestamps: Introduction Notes 00:48 Siim's Time During the Lockdown 04:04 Hormesis and Antifragility 07:00 How to Lower Chronic Stress 10:35 Break Vicious Cycles of Stress 13:40 Gut Problems […]
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  • #197 Genetics for Weight Loss and Longevity - Joe Cohen August 25, 2020
    Welcome to the Body Mind Empowerment Podcast, I’m your host Siim Land and our guest today is Joe Cohen. Joe is the founder and CEO of Self-Hacked, which is one of the most popular biohacking websites online. He’s also founded SelfDecode, which is a genetics decoding company.   Timestamps: How Joe Started to Research Genetics […]
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  • #196 Neurohacking the Brain and Stress - Dr Greg Kelly August 19, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Dr Gregory Kelly. Dr Greg is a naturopathic physician and former editor of the journal Alternative Medicine Review. He’s also a lead product formulator at Neurohacker Collective. Timestamps: Greg's Background as an ND and the Army 02:10 Neurohacking […]
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  • #195 Continuous Glucose Monitoring for Better Metabolic Health - Kara Collier August 13, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Kara Collier. Kara is the Head of Nutrition at, which is a company that offers commercial continuous glucose monitoring services. Your glucose is one of the best indicators of overall metabolic health and flexibility. I also tried […]
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  • #194 Stoicism and the Art of Happiness - Donald Robertson August 5, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Donald Robertson. Donald is a writer about stoic philosophy and an expert in cognitive behavioral therapy. He’s written several books like How to Think Like a Roman Emperor and Stoicism and the Art of Happiness. Timestamps: How Donald […]
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  • #193 How to Stay Healthy in a City - Tim Gray July 31, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Tim Gray. Tim is an entrepreneur and biohacker from the UK. He’s also the founder of the Health Optimisation Summit in London. We’re going to talk about how to stay healthy and well when living in urban environments […]
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  • #192 Dr Dominic D’Agostino on Using Ketosis for High Stress Environments July 25, 2020
    Welcome to the Body Mind Empowerment podcast I’m your host Siim Land and our guest today is Dr Dominic D’Agostino. Dr Dom has a PhD in neuroscience and physiology. He’s a professor at the University of South Florida and is considered one of the world’s top experts in ketosis, ketogenic diets, fasting, and hyperbaric oxygen […]
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  • #191 Biohacking Focus, Productivity and Performance with Olli Sovijärvi and Teemu Arina July 19, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guests today are Olli Sovijärvi and Teemu Arina. Olli and Teemu run the Biohacker Center in Finland and organize the Biohacker Summit. In this episode we’re going to talk about how to optimize your health and performance at work, especially if […]
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  • #190 How to Swap Out Bad Fats From Your Body with Dave Asprey July 12, 2020
    Welcome to the Body Mind Empowerment Podcast. I’m your host Siim Land and our guest today is Dave Asprey. Dave is the founder of Bulletproof, Truedark, and many other companies. He’s a best-selling author of several books and often called the ’father of biohacking’. Timestamps: Biohacking and Medical Freedom 03:20 Bulletproof Coffee and Structured Water […]
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  • #189 Lower Inflammation and Pain Using PEMF Therapy with Bob Dennis PhD July 6, 2020
    Welcome to the Body Mind Empowerment Podcast I’m your host Siim Land and our guest today is Bob Dennis. Bob has a PhD in Biomedical Engineering. He’s one of the first people to use Pulsed Electromagnetic Frequency (PEMF) therapy in NASA. During the 90s he worked with NASA to build PEMF equipment for astronauts. Bob […]
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