Abstract P400: Trajectories of Psychological Well-Being Are Associated With High Cardiovascular Health Late in Life: Findings From the Women’s Health Initiative
Authors: Wong Eugenia , Franceschini Nora , Psioda Matt , Fredrickson Barbara L , Jones Berkeley Sara B , Naughton Michelle , Allison Matthew A , Garcia Lorena , Shadyab Aladdin , Ryu Rita , Rosamond Wayne D 
Published: May 2024

Introduction:
Psychological well-being (PWB) may influence cardiovascular health (CVH) through what the American Heart Association has called the “mind-heart-body connection”. However, few studies have examined longitudinal relationships between positive PWB and CVH. We estimated associations between trajectories of PWB and Life’s Essential 8 (LE8) achievement.

Hypothesis:
We hypothesized that women who maintained high levels of PWB over time would have higher LE8 scores later in life.

Methods:
We conducted group-based trajectory modelling in the Women’s Health Initiative (WHI) to identify latent trajectories of PWB among those with ≥3 measurements of purpose in life (PIL, N=29,717) and personal growth (PG, N=12,148). PIL and PG scores were calculated according to participants’ responses to the FACIT-Sp Meaning Subscale and Ryff’s Scales of PWB, collected between 2000-2021. The selection of trajectory models was informed by statistical criteria and prior literature. Late life CVH (2018-2021) was summarized by LE8, with scoring adapted based on available data: self-reported treatment for hypertension, diabetes, and hypercholesterolemia, and historical food frequency questionnaires were used. Logistic regression was performed to estimate associations between PIL and PG trajectory group membership and high CVH (LE8≥80), summarized by odds ratios (OR) and 95% confidence intervals (CI). Logistic models adjusted for baseline age, WHI study arm, race, marital status, income, and education in those with complete data (PIL N=28,033; PG N=11,495).

Results:
On average, PIL trajectories spanned 17 years (age 66-83) and three latent groups were identified: high/decreasing (n=12,073; 47.4%), moderate/decreasing (n=12,096; 44.1%), and low/stable (n=2,548; 8.6%). Compared to those in the low/stable group, women in the moderate/decreasing and high/decreasing PIL groups had significantly higher odds of having high CVH (OR 1.47 [1.35, 1.61] and OR 2.09 [1.92, 2.28], respectively). These associations were robust to adjustment for demographics and social determinants of health: moderate/decreasing (aOR 1.40 [1.27, 1.53]), high/decreasing (aOR 1.88 [1.71, 2.07]). PG trajectories spanned 9 years (age 74-83) and high/stable (n=3,832, 31.5%), moderate/stable (n=5,692, 46.9%), and low/stable (n=2,624, 21.6%) latent groups were identified. Membership in moderate/stable (OR 1.53 [1.40, 1.69] and high/stable (OR 1.95 [1.75, 2.16]) PG trajectory groups was also significantly associated with odds of having high CVH. These associations remained significant after adjustment (moderate/stable aOR 1.40 [1.27, 1.55]; high/stable aOR 1.64 [1.46, 1.84]).

Conclusions:
Maintaining high levels of PIL and PG may contribute to better CVH late in life. Further research is needed to investigate how strategies to improve PWB may be integrated within cardiovascular care among older adults.