Abstract Background Negative emotions, such as depression, are associated with a high risk of cardiovascular events and reduced quality of life (QOL). Conversely, laughter, a reflection of positive emotions and a potential contributor to improved vascular function, has not been comprehensively investigated in this context. Thus, this study aimed to evaluate the associations among laughter frequency, cardiovascular risk, and QOL in a cardiology outpatient population. Methods A survey of asymptomatic patients attending a cardiology outpatient clinic between April 2023 and March 2024 was performed. Patients with a clinical frailly scale score of ≥3, history of hospitalization, or inability to complete the questionnaire were excluded. Laughter frequency was assessed using a three-point scale (almost daily, 1–5 times a week, and 1–3 times a month). The relationship between laughter frequency and cardiovascular event risk (assessed using the Suita score as a surrogate marker) along with QOL measures (Kansas City Cardiomyopathy Questionnaire overall summary score and EuroQol 5 Dimension) was analyzed. Results Overall, 611 patients (median age, 71 years; male, 65%) were included. Laughter frequency was significantly higher in women than in men (p 0.01). Although no significant association was found between laughter frequency and cardiovascular event risk, a higher laughter frequency was positively associated with both QOL measures. After adjusting for age, sex, grip strength, B-type natriuretic peptide, Meta-analysis Global Group in Chronic Heart Failure score, smoking, exercise habits, gardening habits, pet ownership, and bathing habits, the association with improved QOL remained significant (Figure 1, upper panel, model 1). However, the strength of this association was attenuated after further adjustment for the depression indicator (Patient Health Questionnaire-2 score) (Figure 1, lower panel, model 2). Conclusion The self-reported frequency of laughter was not associated with cardiovascular event risk but showed a positive association with QOL. This association was attenuated after accounting for depression, which signifies partial mediation by mental health factors. Promoting laughter may serve as a simple, nonpharmacological approach to improve the QOL of patients with asymptomatic cardiac conditions, particularly through its effect on mental well-being.Figure1
Saito et al. (Sat,) studied this question.