{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T09:26:49Z","timestamp":1772789209637,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Our study focuses on the role of psychological states in the development of cardiovascular disease (CVD) and explores the potential of positive psychological factors in reducing CVD risk. While existing research has predominantly examined negative mental states and risk behavior, this longitudinal study takes a novel approach by investigating positive psychological wellbeing and its impact on sustained health behavior.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The research involved participants (<jats:italic>n<\/jats:italic> = 502) with medium to high cardiovascular risk who underwent a comprehensive risk assessment in 2012, followed by written risk communication. Health behavior and psychological variables were measured in 2012 and 2019. A cross-lagged panel was employed to repeat measures of a cardiovascular health index with latent factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Results indicated an excellent fit for the model (RMSEA = 0.0644, CFI = 0.936, TLI = 0.921, SRMR = 0.050), with significant associations between the observed variables (<jats:italic>p<\/jats:italic> &amp;lt; 0.05) and created latent factors. Furthermore, the model implied significant bivariate correlations (<jats:italic>p<\/jats:italic> &amp;lt; 0.05) between latent constructs of sustained health behavior and positive psychological states in 2012 and 2019. A significant regression relationship between Health Awareness Index 2012 and 2019, between Psychological wellbeing in 2012 and 2019 (B = 1.103 <jats:italic>p<\/jats:italic> = 0.038), latent factors could be identified (B = 1.103 <jats:italic>p<\/jats:italic> = 0.038) using cross-lagged panel model. Results highlighted the importance of cardiovascular health awareness, subjective risk perception, and self-directed efforts in facilitating health behavior change.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Relationships between psychological wellbeing and health awareness emphasize that positive experiences and reinforcement are crucial in sustaining optimal health behavior. Our findings offer a new perspective on cardiovascular risk screening and preventive interventions. Extending cardiovascular risk screening with psychological measures may broaden prevention opportunities by including psychological elements reinforcing positive psychological states. The findings suggest that an effective prevention program must consider stabilizing and maintaining positive psychological states to achieve lasting improvements in cardiovascular health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1400849","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T04:54:35Z","timestamp":1724302475000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Positive cardiovascular health: longitudinal investigation of sustained health behavior in a cross-lagged model"],"prefix":"10.3389","volume":"12","author":[{"given":"Zsofia","family":"Ocsovszky","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanka","family":"Ehrenberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanka","family":"Berenyi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Assabiny","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jozsef","family":"Otohal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamas","family":"Martos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orsolya","family":"Papp-Zipernovszky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanni","family":"Hegedus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bela","family":"Merkely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Csabai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsolt","family":"Bagyura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/eurheartj\/ehz859","article-title":"European Society of Cardiology: Cardiovascular disease statistics 2019","volume":"41","author":"Timmis","year":"2020","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B3","unstructured":"Escardio.org"},{"key":"B4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/eurjpc\/zwab154","article-title":"ESC Guidelines on cardiovascular disease prevention in clinical practice: developed by the task force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)","volume":"29","author":"Visseren","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/S0749-3797(02)00439-7","article-title":"Depression as a predictor for coronary heart disease: a review and meta-analysis","volume":"23","author":"Rugulies","year":"2002","journal-title":"Am J Prev Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1093\/ajh\/hpv047","article-title":"State of the art review: depression, stress, anxiety, and cardiovascular disease","volume":"28","author":"Cohen","year":"2015","journal-title":"Am J Hypertens"},{"key":"B7","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.biopsych.2013.07.012","article-title":"Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder","volume":"74","author":"Turner","year":"2013","journal-title":"Biol Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1207\/s15324796abm3101_5","article-title":"Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the normative aging study","volume":"31","author":"Kubzansky","year":"2006","journal-title":"Ann Behav Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1037\/0033-2909.131.2.260","article-title":"Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions","volume":"131","author":"Suls","year":"2005","journal-title":"Psychol Bull"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1186\/s12889-016-3764-8","article-title":"Pessimism and risk of death from coronary heart disease among middle-aged and older Finns: an eleven-year follow-up study","volume":"16","author":"Pnklinen","year":"2016","journal-title":"BMC Public Health"},{"key":"B11","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1161\/CIR.0000000000000228","article-title":"Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American heart association: a scientific statement from the American heart association","volume":"132","author":"Havranek","year":"2015","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1016\/S0140-6736(08)61690-6","article-title":"Closing the gap in a generation: health equity through action on the social determinants of health","volume":"372","year":"2008","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1037\/\/0003-066X.55.1.5","article-title":"Positive psychology: an introduction","volume":"55","author":"Seligman","year":"2000","journal-title":"Am Psychol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/j.1464-0597.2008.00351.x","article-title":"Positive health","volume":"57","author":"Seligman","year":"2008","journal-title":"Appl Psychol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1912200","DOI":"10.1001\/jamanetworkopen.2019.12200","article-title":"Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis","volume":"2","author":"Rozanski","year":"2019","journal-title":"JAMA Netw Open"},{"key":"B16","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/PSY.0000000000000274","article-title":"Purpose in life and its relationship to all-cause mortality and cardiovascular events: a meta-analysis","volume":"78","author":"Cohen","year":"2016","journal-title":"Psychosom Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1037\/hea0000174","article-title":"Life satisfaction and use of preventive health care services","volume":"34","author":"Kim","year":"2015","journal-title":"Health Psychol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e002218","DOI":"10.1161\/JAHA.117.002218","article-title":"American Heart Association council on clinical cardiology; council on cardiovascular and stroke nursing; and council on hypertension. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association","volume":"6","author":"Levine","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e12599","DOI":"10.1111\/spc3.12599","article-title":"Positive psychological wellbeing and cardiovascular disease: Exploring mechanistic and developmental pathways","volume":"15","author":"Boehm","year":"2021","journal-title":"Soc Personal Psychol Compass"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e763","DOI":"10.1161\/CIR.0000000000000947","article-title":"Council on Cardiovascular and Stroke Nursing; and Council on Lifestyle and Cardiometabolic Health. Psychological health, wellbeing, and the mind-heart-body connection: a scientific statement from the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology","volume":"10","author":"Levine","year":"2021","journal-title":"Circulation"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1016\/j.jacc.2018.07.042","article-title":"Positive psychological wellbeing and cardiovascular disease: JACC health promotion series","volume":"72","author":"Kubzansky","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.orcp.2016.09.002","article-title":"The effects of mindfulness training on weight-loss and health-related behaviors in adults with overweight and obesity: a systematic review and meta-analysis","volume":"11","author":"Ruffault","year":"2017","journal-title":"Obes Res Clin Pract"},{"key":"B23","doi-asserted-by":"publisher","first-page":"111328","DOI":"10.1016\/j.jpsychores.2023.111328","article-title":"The effects of positive psychology interventions on wellbeing and distress in patients with cardiovascular diseases: a systematic review and meta-analysis","volume":"170","author":"Tnis","year":"2023","journal-title":"J Psychosom Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"107214","DOI":"10.1016\/j.ypmed.2022.107214","article-title":"Can positive psychological interventions improve health behaviors? A systematic review of the literature","volume":"163","author":"Feig","year":"2022","journal-title":"Prev Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/s12529-009-9032-x","article-title":"The relationship between life satisfaction and health behavior: a cross-cultural analysis of young adults","volume":"16","author":"Grant","year":"2009","journal-title":"Int J Behav Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1556\/OH.2014.29969","article-title":"Cardiovascularis sz\u00fcr\u00f6program a k\u00f6z\u00e9p-magyarorsz\u00e1gi r\u00e9gi\u00f3ban","volume":"155","author":"Bagyura","year":"2014"},{"key":"B27","doi-asserted-by":"publisher","first-page":"279","DOI":"10.2105\/AJPH.41.3.279","article-title":"Epidemiological approaches to heart disease: the framingham study","volume":"41","author":"Dawber","year":"1951","journal-title":"Am J Public Health Nations Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1556\/650.2020.31625","article-title":"A t\u00e1rsas t\u00e1mogat\u00e1s \u00e9s az eg\u00e9szs\u00e9ges \u00e9letm\u00f3d \u00f6sszef\u00fcgg\u00e9sei = Correlation of social support and healthy lifestyle","volume":"161","author":"Ocsovszky","year":"2020","journal-title":"Orv Hetil"},{"key":"B29","unstructured":"2010"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1002\/9781118133880.hop202023","article-title":"Structural equation modeling","volume":"2","author":"Ullman","year":"2012","journal-title":"Handb Psychol"},{"key":"B31","volume-title":"Structural Equation Modeling","author":"Kline","year":"1998"},{"key":"B32","first-page":"77","article-title":"Struktur\u00e1lis egyenletek modelljei: oks\u00e1gi viszonyok \u00e9s komplex elm \u00e9letek vizsg\u00e1lata pszichol\u00f3giai kutat\u00e1sokban","volume":"12","author":"M\u00fcnnich","year":"2012","journal-title":"Alkalmazott Pszichol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1146\/annurev.psych.51.1.201","article-title":"Applications of structural equation modeling in psychological research","volume":"51","author":"MacCallum","year":"2000","journal-title":"Annu Rev Psychol"},{"key":"B34","first-page":"227","article-title":"Structural equation modeling","author":"Klem","year":"2000"},{"key":"B35","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1080\/10705511.2018.1431046","article-title":"Drawing conclusions from cross-lagged relationships: re-considering the role of the time-interval","volume":"25","author":"Kuiper","year":"2018","journal-title":"Struct Equ Modeling"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1111\/cdev.12660","article-title":"On the practical interpretability of cross-lagged panel models: rethinking a developmental workhorse","volume":"88","author":"Berry","year":"2017","journal-title":"Child Dev"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1756-0500-3-267","article-title":"Structural equation modeling in medical research: a primer","volume":"3","author":"Beran","year":"2010","journal-title":"BMC Res Notes"},{"key":"B38","doi-asserted-by":"publisher","first-page":"2901","DOI":"10.3758\/s13428-023-02254-7","article-title":"semPower: general power analysis for structural equation models","volume":"56","author":"Moshagen","year":"2023","journal-title":"Behav Res Methods"},{"key":"B39","doi-asserted-by":"publisher","first-page":"670","DOI":"10.21449\/ijate.661803","article-title":"Jamovi: an easy to use statistical software for the social scientists","volume":"6","author":"Ahin","year":"2019","journal-title":"Int J Assess Tools Educ"},{"key":"B40","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1556\/650.2023.32685","article-title":"A cardiovascularis rizik\u00f3becsl\u00e9s \u00e9s az eg\u00e9szs\u00e9gmagatart\u00e1s kapcsolata pszichoszoci\u00e1lis t\u00e9nyez'\u0301ok t\"ukr\u00e9ben: a Budakal\u00e1sz Epidemiol\u00f3giai Vizsg\u00e1lat ut\u00e1nk\u00f6vet\u00e9se","volume":"164","author":"Ocsovszky","year":"2023","journal-title":"Orv Hetil"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e0259280","DOI":"10.1371\/journal.pone.0259280","article-title":"Longitudinal stability and interrelations between health behavior and subjective wellbeing in a follow-up of nine years","volume":"16","author":"Stenlund","year":"2021","journal-title":"PLoS ONE"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct Equ Model"},{"key":"B43","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1037\/\/0033-2909.88.3.588","article-title":"Significance tests and goodness of fit in the analysis of covariance structures","volume":"88","author":"Bentler","year":"1980","journal-title":"Psychol Bull"},{"key":"B44","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s12170-012-0273-x","article-title":"The promise of wellbeing interventions for improving health risk behaviors","volume":"6","author":"Boehm","year":"2012","journal-title":"Curr Cardiovasc Risk Rep"},{"key":"B45","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1177\/1090198110376352","article-title":"Emotional outlook on life predicts increases in physical activity among initially inactive men","volume":"38","author":"Baruth","year":"2011","journal-title":"Health Educ Behav"},{"key":"B46","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1080\/08870446.2011.633241","article-title":"Global positive expectancies in adolescence and health-related behaviors: longitudinal models of latent growth and cross-lagged effects","volume":"27","author":"Carvajal","year":"2012","journal-title":"Psychol Heal"},{"key":"B47","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1123\/jpah.2022-0455","article-title":"Cross-lagged associations between physical activity, self-rated health, and psychological resilience among older American adults: a 3-wave study","volume":"20","author":"Lee","year":"2023","journal-title":"J Phys Act Health"},{"key":"B48","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s12160-009-9153-0","article-title":"The value of positive psychology for health psychology: progress and pitfalls in examining the relation of positive phenomena to health","volume":"39","author":"Aspinwall","year":"2010","journal-title":"Ann Behav Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1400849\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T16:14:29Z","timestamp":1724948069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1400849\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":48,"alternative-id":["10.3389\/fpubh.2024.1400849"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1400849","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]},"article-number":"1400849"}}