Affiliation:
1. Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ
2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
3. UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine