Purpose in Life: A Missing Variable in Cardiovascular Mortality

Cardiovascular disease (CVD) remains the leading cause of mortality globally and in India. We routinely screen for hypertension, diabetes, dyslipidemia, smoking, obesity, and sedentary lifestyle. Yet, an important and measurable determinant of cardiovascular outcomes often escapes clinical attention: purpose in life.

Traditionally viewed as a psychological or philosophical construct, purpose is increasingly recognized as a measurable health determinant with cardiovascular implications.

Evidence Linking Purpose and Cardiovascular Outcomes

Longitudinal cohort studies demonstrate that individuals reporting a strong sense of purpose exhibit significantly lower all-cause mortality. More importantly for clinicians, purpose has been independently associated with reduced incidence of myocardial infarction and stroke.

In a meta-analysis published in Psychosomatic Medicine, higher purpose in life was associated with reduced risk of cardiovascular events and mortality, even after adjusting for traditional risk factors (1). Data from large cohort studies have shown that individuals with greater life purpose had lower risk of myocardial infarction over follow-up (2). Further, higher purpose has been associated with reduced overall mortality across adulthood (3).

Importantly, these associations persist even after controlling for baseline health status, depressive symptoms, and socioeconomic factors—suggesting that purpose is not merely a byproduct of good health.

Possible Biological Mechanisms

Several plausible biological pathways may explain this association:

1. Neuroendocrine Regulation

A defined sense of purpose is associated with better stress modulation. Individuals with higher psychological well-being demonstrate improved autonomic balance and healthier heart rate variability, reflecting more stable sympathetic–parasympathetic interplay.

2. Inflammatory Modulation

Chronic low-grade inflammation underlies atherosclerosis. Higher psychological well-being, including purpose, has been linked to lower levels of inflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP) (4).

3. Health Behavior Adherence

Purpose-driven individuals are more likely to engage in preventive health behaviors—regular exercise, medication adherence, follow-up visits, and lifestyle modification (5).

4. Depression Reduction

Depression independently worsens cardiovascular outcomes. Purpose appears protective against depressive symptoms, thereby indirectly reducing cardiac risk. (6)

Thus, purpose may operate through both biological regulation and behavioural reinforcement loops.

Clinical Implications

Should purpose be assessed in cardiovascular care?

While no standardized “purpose index” exists in cardiology practice, brief screening questions may provide insight:

• “What keeps you engaged daily?”

• “Do you feel your activities are meaningful?”

• “What are you looking forward to?”

Post-myocardial infarction patients often experience existential uncertainty. Cardiac rehabilitation programs that integrate goal-setting, social engagement, and psychological counselling may enhance recovery beyond physical training alone.

In older adults, retirement frequently disrupts identity. Loss of structured role can diminish motivation and adherence. Integrating purpose-based counselling into geriatric cardiovascular care may strengthen long-term outcomes.

Indian Context

India’s demographic transition is accelerating. With increasing longevity, the burden of cardiovascular disease in older adults will rise. Yet psychosocial restructuring after retirement is rarely addressed within clinical pathways.

Community-based engagement programs for seniors—mentorship roles, structured volunteerism, peer health groups—may serve as low-cost, high-impact preventive strategies.

Conclusion

Purpose in life is not abstract philosophy. Emerging evidence suggests it functions as a protective cardiovascular variable—modulating stress physiology, inflammation, behavioural adherence, and emotional resilience.

As clinicians, we measure blood pressure, lipid levels, and glucose control. It may be time to also assess direction.

Because survival in cardiovascular medicine may depend not only on arterial patency—but also on the reasons a person chooses to live well.

References

1. Cohen R, Bavishi C, Rozanski A. Purpose in life and its relationship to all-cause mortality and cardiovascular events: A meta-analysis. Psychosom Med. 2016;78(2):122–133.

2. Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced risk of myocardial infarction among older adults. J Behav Med. 2013;36(5):593–602.

3. Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci. 2014;25(7):1482–1486.

4. Friedman EM, Ryff CD. Living well with medical comorbidities: A biopsychosocial perspective. J Gerontol B Psychol Sci Soc Sci. 2012;67B(5):535–544.

5. Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of preventive health care services. J Behav Med. 2014;37(6):1145–1153.

6. Li X, Zhou J, Wang M, Yang C, Sun G. Cardiovascular disease and depression: a narrative review. Front Cardiovasc Med. 2023 Nov 21;10:1274595. doi: 10.3389/fcvm.2023.1274595. PMID: 38084332; PMCID: PMC10710900.