Quality of Life of Patients with Cardiovascular Disease is Higher with Spirituality
By John M. de Castro, Ph.D.
“Positive beliefs, comfort, and strength gained from religion, meditation, and prayer can contribute to well being. It may even promote healing. Improving your spiritual health may not cure an illness, but it may help you feel better. It also may prevent some health problems and help you cope better with illness, stress, or death.” – FamilyDoctor
Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” (Centers for Disease Control). A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Unfortunately, for a variety of reasons, 60% of heart failure patients decline participation, making these patients at high risk for another attack.
Safe and effective alternative treatments for cardiovascular disease are contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. These practices have also been shown to be helpful for producing the kinds of lifestyle changes needed to prevent heart disease such as smoking cessation, weight reduction, and stress reduction. Indeed, yoga practice is both a mindfulness training technique and a physical exercise.
Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred.” Spirituality has been promulgated as a solution to the challenges of life both in a transcendent sense and in a practical sense. The transcendent claims are untestable with the scientific method. But the practical claims are amenable to scientific analysis. There have been a number of studies of the relationship of spirituality with the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality related to greater personal growth and mental health. So, it would make sense to review what is known regarding the relationship of spirituality and religiosity to the psychological state of patients with cardiovascular disease.
In today’s Research News article “Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: a systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196107/ ), Abu and colleagues review and summarize the published research literature on the relationship of spirituality and religiosity to the quality of life of patients with cardiovascular disease. They found and reviewed 15 published studies that assessed spirituality and/or religiosity and global, mental, physical, or disease-related quality of life. All studies were correlational in nature without any active manipulations. Eleven of the studies included patients with heart failure, 2 with acute myocardial infarction, 1 with congenital heart disease, and 1 with multiple diagnoses.
They report that 10 of the 15 reviewed studies reported significant positive associations between spirituality and/or religiosity and quality of life in patients with cardiovascular disease; the greater the levels of spirituality and/or religiosity, the higher the quality of life. These results are correlational and conclusions regarding causality cannot be confidently made. Even reverse causation is possible such that a higher quality of life with heart disease produces greater spirituality and/or religiosity. In addition, only 2/3 of the studies reported significant results suggesting that the relationships are not highly robust.
The findings, though, regardless of causality suggest that spirituality and/or religiosity is related to better quality of life in patients with cardiovascular disease. Spirituality and/or religiosity have been shown to be related to resilience and low levels of stress, greater mental health, and better adherence to pharmacologic and non-pharmacologic therapy. These relationships with spirituality and/or religiosity would tend to predict better outcomes and quality of life in the patients. It is also possible that the social relationships and support supplied by spiritual or religious communities are responsible for the relationship. Regardless, it would appear that spirituality and/or religiosity are associated with better quality of life in patients with cardiovascular disease.
“There are more than 50 studies in which religious practices were found to be protective against cardiovascular disease, including death due to heart attacks and strokes as well as against numerous risk factors such as high blood pressure and elevated cholesterol and triglyceride levels.” – Michael Murray
CMCS – Center for Mindfulness and Contemplative Studies
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Hawa O. Abu, Christine Ulbricht, Eric Ding, Jeroan J. Allison, Elena Salmoirago-Blotcher, Robert J. Goldberg, Catarina I. Kiefe. Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: a systematic review. Qual Life Res. 2018; 27(11): 2777–2797.
This review systematically identified and critically appraised the available literature that has examined the association between religiosity and/or spirituality (R/S) and quality of life (QOL) in patients with cardiovascular disease (CVD).
We searched several electronic online databases (PubMed, SCOPUS, PsycINFO, and CINAHL) from database inception until October 2017. Included articles were peer-reviewed, published in English, and quantitatively examined the association between R/S and QOL. We assessed the methodological quality of each included study.
The 15 articles included were published between 2002 and 2017. Most studies were conducted in the US and enrolled patients with heart failure. Sixteen dimensions of R/S were assessed with a variety of instruments. QOL domains examined were global, health-related, and disease-specific QOL. Ten studies reported a significant positive association between R/S and QOL, with higher spiritual well-being, intrinsic religiousness, and frequency of church attendance positively related with mental and emotional well-being. Approximately half of the included studies reported negative or null associations.
Our findings suggest that higher levels of R/S may be related to better QOL among patients with CVD, with varying associations depending on the R/S dimension and QOL domain assessed. Future longitudinal studies in large patient samples with different CVDs and designs are needed to better understand how R/S may influence QOL. More uniformity in assessing R/S would enhance the comparability of results across studies. Understanding the influence of R/S on QOL would promote a holistic approach in managing patients with CVD.