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

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

Get full access to this article

View all access options for this article.

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.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.50 MB