Association between subjective well-being and the risk of cardiovascular diseases among older adults: evidence from the Chinese longitudinal healthy longevity survey.

Background/objective: Evidence regarding the impact of subjective well-being (SWB) on the incidence of cardiovascular diseases (CVD) among Chinese older adults was limited. This study aimed to ascertain the association between integrated SWB score and the risk of CVD among Chinese older adults.

Methods: A prospective cohort study was designed based on the data from the survey in 2011-2012 and 2014 of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Participants aged over 65 years without CVD at baseline were included in this study. SWB was measured by a scale consisting of 8-item question. The outcome was CVD (heart disease or stroke) that occurred during the observation period. Restricted cubic splines were used to determine the linear relationship between SWB and CVD risk. Hierarchical regression based on modified Poisson regressions was performed to estimate the association between SWB and CVD risk. Subgroup analyses were conducted in mutually exclusive and overlapping subgroups based on healthy lifestyles. Moreover, sensitivity analyses were performed to confirm the robustness of the main analysis.

Results: A total of 5,120 eligible participants were included in this cohort study, and 827 participants suffered from CVD during follow-up period (the incidence of CVD was 16.15%). Per 1-standard deviation (SD) increase in SWB was associated with 10.5% reduction in the risk of CVD (adjusted relative risk [RR] = 0.895, 95% CI: 0.833 to 0.962). The robustness of the association was verified by sensitivity analyses. The heterogeneity of association was observed in subgroups with different number of healthy lifestyles. In subgroups with a number of healthy lifestyles of 2 to 4, 3 to 5, or 4 to 6, per 1-SD increase in SWB was associated with a 9.6% (adjusted RR = 0.904, 95% CI: 0.836 to 0.977), 13.0% (adjusted RR = 0.870, 95% CI: 0.799 to 0.948) and 17.9% (adjusted RR = 0.821, 95% CI: 0.731 to 0.922) reduction in CVD risk.

Conclusion: An inverse linear association is observed between SWB and CVD risk among Chinese older adults. The strength of the association was greater in subgroups with more healthy lifestyles than that with less healthy lifestyles. Enhancing SWB and fostering more healthy lifestyle behaviors among older adults contributed to the prevention of CVD.