Life satisfaction as modifiable CVD prevention target: cross-cultural mediation in aging cohorts

To examine the prospective association between life satisfaction and cardiovascular disease (CVD) risk among older adults across international cohorts and evaluate potential mediating pathways.

Harmonized data from four aging cohorts-Health and Retirement Study (HRS), ELSA, SHARE, and CHARLS-included 101 474 participants aged ≥60 with 267 903 observations (2010-2020). Life satisfaction was categorized as low/high using validated scales (e.g. Satisfaction With Life Scale). Incident CVD (fatal/non-fatal events) was analysed using generalized estimating equations, adjusting for demographics, health, behaviours, social factors, and depression. Mediation models assessed loneliness as a potential pathway; sensitivity analyses tested robustness to competing risks and reverse causation. Over a median follow-up of 6.2 years, higher life satisfaction was associated with lower CVD risk (pooled HR = 0.86, 95% CI: 0.79-0.91, P < 0.001). This association remained robust after excluding participants with baseline depression (HR = 0.84, 95% CI: 0.78-0.90) and in competing risk models. The inverse association between life satisfaction and CVD was consistent across subgroups such as age, gender, education level, and loneliness status. No statistically significant effect modification was detected (all P for interaction > 0.05). Effect sizes across cohorts ranged from SHARE (HR = 0.79, 95% CI: 0.72-0.86, P < 0.001) to CHARLS (HR = 0.93, 95% CI: 0.88-0.98, P = 0.017). Loneliness mediated 13.4% of the association (P = 0.003).

Elevated life satisfaction is independently associated with reduced CVD risk in older adults, with loneliness as a partial mediator. Enhancing well-being and reducing loneliness may support cardiovascular health in aging populations.