TY - JOUR
T1 - Participant-Reported Health Status Predicts Cardiovascular and All-Cause Mortality Independent of Established and Nontraditional Biomarkers
T2 - Evidence From a Representative US Sample
AU - Barger, Steven D.
AU - Cribbet, Matthew R.
AU - Muldoon, Matthew F.
N1 - Publisher Copyright:
© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
PY - 2016/9
Y1 - 2016/9
N2 - Background: Participant-reported health status is a key indicator of cardiovascular health, but its predictive value relative to traditional and nontraditional risk factors is unknown. We evaluated whether participant-reported health status, as indexed by self-rated health, predicted cardiovascular disease, and all-cause mortality risk excess of 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores and 5 nontraditional risk biomarkers. Methods and Results: Analyses used prospective observational data from the 1999-2002 National Health and Nutrition Examination Surveys among those aged 40 to 79 years (N=4677). Vital status was ascertained through 2011, during which there were 850 deaths, 206 from cardiovascular disease (CVD). We regressed CVD and all-cause mortality on standardized values of self-rated health in survival models, adjusting for age, sex, education, existing chronic disease, race/ethnicity, ASCVD risk, and standardized biomarkers (fibrinogen, C-reactive protein [CRP], triglycerides, albumin, and uric acid). In sociodemographically adjusted models, a 1-SD decrease in self-rated health was associated with increased risk of CVD mortality (hazard ratio [HR], 1.92; 95% CI, 1.51-2.45; P<0.001), and this hazard remained strong after adjusting for ASCVD risk and nontraditional biomarkers (HR, 1.79; 95% CI, 1.42-2.26; P<0.001). Self-rated health also predicted all-cause mortality even after adjustment for ASCVD risk and nontraditional biomarkers (HR, 1.50; 95% CI, 1.35-1.66; P<0.001). Conclusions: Self-rated health provides prognostic information beyond that captured by traditional ASCVD risk assessments and by nontraditional CVD biomarkers. Consideration of self-rated health in combination with traditional risk factors may facilitate risk assessment and clinical care.
AB - Background: Participant-reported health status is a key indicator of cardiovascular health, but its predictive value relative to traditional and nontraditional risk factors is unknown. We evaluated whether participant-reported health status, as indexed by self-rated health, predicted cardiovascular disease, and all-cause mortality risk excess of 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores and 5 nontraditional risk biomarkers. Methods and Results: Analyses used prospective observational data from the 1999-2002 National Health and Nutrition Examination Surveys among those aged 40 to 79 years (N=4677). Vital status was ascertained through 2011, during which there were 850 deaths, 206 from cardiovascular disease (CVD). We regressed CVD and all-cause mortality on standardized values of self-rated health in survival models, adjusting for age, sex, education, existing chronic disease, race/ethnicity, ASCVD risk, and standardized biomarkers (fibrinogen, C-reactive protein [CRP], triglycerides, albumin, and uric acid). In sociodemographically adjusted models, a 1-SD decrease in self-rated health was associated with increased risk of CVD mortality (hazard ratio [HR], 1.92; 95% CI, 1.51-2.45; P<0.001), and this hazard remained strong after adjusting for ASCVD risk and nontraditional biomarkers (HR, 1.79; 95% CI, 1.42-2.26; P<0.001). Self-rated health also predicted all-cause mortality even after adjustment for ASCVD risk and nontraditional biomarkers (HR, 1.50; 95% CI, 1.35-1.66; P<0.001). Conclusions: Self-rated health provides prognostic information beyond that captured by traditional ASCVD risk assessments and by nontraditional CVD biomarkers. Consideration of self-rated health in combination with traditional risk factors may facilitate risk assessment and clinical care.
KW - Biological markers
KW - Cardiovascular disease risk factors
KW - Epidemiology
KW - Health policy and outcomes research
KW - Mortality
KW - Patient reported outcomes
KW - Quality of life
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U2 - 10.1161/JAHA.116.003741
DO - 10.1161/JAHA.116.003741
M3 - Article
C2 - 27572824
AN - SCOPUS:85014635669
SN - 2047-9980
VL - 5
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e003741
ER -