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Abstract

Background

To assess the association between health-related quality of life (HRQL) and a composite outcome including incident coronary heart disease (CHD) and cerebrovascular events in a large general population-based cohort.

Design

Prospective analysis on 17,102 men and women (mean age 53 ± 11) free from cardiovascular disease at time of enrolment in the Moli-sani cohort (2005–2010).

Methods

HRQL was assessed by the 36-Item Short Form Health Survey. Hazard ratios with 95% confidence intervals (95% CIs) were calculated using multivariable Cox-proportional hazard models.

Results

At the end of follow-up (median 4.2 years), 237 new events occurred (coronary heart disease n = 197, cerebrovascular disease n = 42). In a multivariable model adjusted for socioeconomic factors, chronic disease and health-related behaviours, both mental and physical HRQL were inversely associated with the risk of the composite outcome (hazard ratio = 0.57; 0.39–0.84 and hazard ratio = 0.62; 0.40–0.94, respectively; highest vs. lowest quartile). Further adjustment for C-reactive protein marginally modified the association with physical HRQL (hazard ratio = 0.67; 0.43–1.02). Similar findings were obtained when only CHD events were analysed (hazard ratio = 0.63; 0.41–0.96 for highest versus lowest mental HRQL) although results with physical HRQL were no longer significant (hazard ratio = 0.65; 0.40–1.04 for highest versus lowest quartile). Associations with incident cerebrovascular disease showed a trend toward protection (hazard ratio = 0.50; 0.22–1.17 and hazard ratio = 0.51; 0.22–1.23 for highest versus lowest tertile of mental and physical HRQL, respectively).

Conclusions

HRQL is an independent predictor of composite CHD/cerebrovascular outcomes in an adult population. The magnitude of the association was not affected either by socioeconomic factors, health conditions or health-related behaviours. Improvement of quality of life may be a major factor in targeting appropriate prevention strategies for cardiovascular health.

Keywords

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References

Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organisation, 2011.

Lunenfeld

Stratton

. The clinical consequences of an ageing world and preventive strategies. Best Pract Res Clin Obstet Gynaecol 2013; 27: 643–659.

Neylon

Canniffe

Anand

et al.

A global perspective on psychosocial risk factors for cardiovascular disease. Prog Cardiovasc Dis 2013; 55: 574–581.

Baumann

Erpelding

Perret-Guillaume

et al.

Health-related quality of life in French adolescents and adults: Norms for the DUKE Health Profile. BMC Public Health 2011; 11: 401–401.

Allen

Badon

Greenlund

et al.

The association between cardiovascular health and health-related quality of life and health status measures among U.S. adults: A cross-sectional study of the National Health and Nutrition Examination Surveys, 2001–2010. Health Qual Life Outcomes 2015; 13: 152–152.

Bonaccio

Di Castelnuovo

Bonanni

et al.

Adherence to a Mediterranean diet is associated with a better health-related quality of life: A possible role of high dietary antioxidant content. BMJ Open 2013; 3: 8–8.

De Smedt

Clays

Höfer

et al.

The use of HeartQoL in patients with coronary heart disease: Association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology. Eur J Prev Cardiol 2016; 23: 1174–1186.

Bardage

Isacson

Pedersen

. Self-rated health as a predictor of mortality among persons with cardiovascular disease in Sweden. Scand J Public Health 2001; 29: 13–22.

Hansen

Thygesen

Zwisler

et al.

Self-reported health-related quality of life predicts 5-year mortality and hospital readmissions in patients with ischaemic heart disease. Eur J Prev Cardiol 2015; 22: 882–889.

10.

Haaf P, Ritter M, Grize L, et al.; BARDOT study group. Quality of life as predictor for the development of cardiac ischemia in high-risk asymptomatic diabetic patients. J Nucl Cardiol 2017; 24: 772–782.

11.

Heidrich

Liese

Löwel

et al.

Self-rated health and its relation to all-cause and cardiovascular mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984–1995. Ann Epidemiol 2002; 12: 338–345.

12.

Bamia

Orfanos

Juerges

et al.

Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium. Maturitas 2017; 103: 37–44.

13.

Nery Guimarães

Chor

Werneck

et al.

Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúde cohort study. BMC Public Health 2012; 12: 676–676.

14.

World Health Organization. Statistics Netherlands. Health interview surveys: Towards international harmonization of methods and instruments 1996; Vol 58: Copenhagen: WHO Regional Office for Europe, WHO Regional Publications, European.

15.

Jürges

Avendano

Mackenbach

. Are different measures of self-rated health comparable? An assessment in five European countries. Eur J Epidemiol 2008; 23: 773–781.

16.

Di Castelnuovo

Costanzo

Persichillo

et al.

Distribution of short and lifetime risks for cardiovascular disease in Italians. Eur J Prev Cardiol 2012; 19: 723–730.

17.

Apolone

Mosconi

. The Italian SF-36 Health Survey: Translation, validation and norming. J Clin Epidemiol 1998; 51: 1025–1036.

18.

Ware

Jr Gandek

. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998; 51: 903–912.

19.

Ware

Sherbourne

. The MOS 36-item short form health survey (SF-36). Conceptual frame-work and item selection. Med Care 1992; 30: 473–481.

20.

Pisani

Faggiano

Krogh

et al.

Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres. Int J Epidemiol 1997; 26(Suppl. 1): S152–S160.

21.

Trichopoulou

Costacou

Bamia

et al.

Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.

22.

McFadden

Luben

Wareham

et al.

Occupational social class, educational level, smoking and body mass index, and cause-specific mortality in men and women: A prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol 2008; 23: 511–522.

23.

Bonaccio M, Di Castelnuovo A, Pounis G, et al. Relative contribution of health-related behaviours and chronic diseases to the socioeconomic patterning of low-grade inflammation. Int J Public Health 2017; 62: 551–562.

24.

Khang

Lynch

Yang

et al.

The contribution of material, psychosocial, and behavioural factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: Relative and absolute perspectives. Soc Sci Med 2009; 68: 858–866.

25.

Luepker

Apple

Christenson

et al.

Case definitions for acute coronary heart disease in epidemiology and clinical research studies: A statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention. Circulation 2003; 108: 2543–2549.

26.

Giampaoli

Palmieri

Panico

et al.

Favorable cardiovascular risk profile (low risk) and 10-year stroke incidence in women and men: Findings on twelve Italian population samples. Am J Epidemiol 2006; 163: 893–902.

27.

Thong

Kaptein

Benyamini

et al.

Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group. Association between a self-rated health question and mortality in young and old dialysis patients: A cohort study. Am J Kidney Dis 2008; 52: 111–117.

28.

Von Rueden

Gosch

Rajmil

et al.

Socioeconomic determinants of health related quality of life in childhood and adolescence: Results from a European study. J Epidemiol Community Health 2006; 60: 130–135.

29.

Huguet

Kaplan

Feeny

. Socioeconomic status and health-related quality of life among elderly people: Results from the Joint Canada/United States Survey of Health. Soc Sci Med 2008; 66: 803–810.

30.

Stranges

Donahue

. Health-related quality of life and risk of hypertension in the community: Prospective results from the Western New York Health Study. J Hypertens 2015; 33: 720–726.

31.

Rosengren

Hawken

Ounpuu

et al.

Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): Case–control study. Lancet 2004; 364: 953–962.

32.

Virtanen

Ferrie

Tabak

et al.

Psychological distress and incidence of type 2 diabetes in high-risk and low-risk populations: The Whitehall II Cohort Study. Diabetes Care 2014; 37: 2091–2097.

33.

Henderson

Clark

Lewis

et al.

Psychosocial distress and stroke risk in older adults. Stroke 2013; 44: 367–372.

34.

Mostofsky

Maclure

Sherwood

et al.

Risk of acute myocardial infarction after the death of a significant person in one’s life: The Determinants of Myocardial Infarction Onset Study. Circulation 2012; 125: 491–496.

35.

Everson-Rose

Lewis

. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health 2005; 26: 469–500.

36.

Hamer

Molloy

Stamatakis

. Psychological distress as a risk factor for cardiovascular events: Pathophysiological and behavioral mechanisms. J Am Coll Cardiol 2008; 52: 2156–2162.

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Health-related quality of life and risk of composite coronary heart disease and cerebrovascular events in the Moli-sani study cohort

Abstract

Background

Design

Methods

Results

Conclusions

Keywords

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References

Supplementary Material