title: Physical distress is associated with cardiovascular events in a high risk population of elderly men.
abstract: BACKGROUND
  Self-reported health perceptions such as physical distress and quality of life are suggested independent predictors of mortality and morbidity in patients with established cardiovascular disease. This study examined the associations between these factors and three years incidence of cardiovascular events in a population of elderly men with long term hyperlipidemia.
  
  
  METHODS
  We studied observational data in a cohort of 433 men aged 64-76 years from a prospective, 2 x 2 factorial designed, three-year interventional trial. Information of classical risk factors was obtained and the following questionnaires were administered at baseline: Hospital Anxiety and Depression Scale, Physical Symptom Distress Index and Life Satisfaction Index. The occurrence of cardiovascular death, myocardial infarction, cerebrovascular incidences and peripheral arterial disease were registered throughout the study period. Continuous data with skewed distribution was split into tertiles. Hazard ratios (HR) were calculated from Cox regression analyses to assess the associations between physical distress, quality of life and cardiovascular events.
  
  
  RESULTS
  After three years, 49 cardiovascular events were registered, with similar incidence among subjects with and without established cardiovascular disease. In multivariate analyses adjusted for age, smoking, systolic blood pressure, serum glucose, HADS-anxiety and treatment-intervention, physical distress was positively associated (HR 3.1, 95% CI 1.2 - 7.9 for 3rd versus 1st tertile) and quality of life negatively associated (HR 2.6, 95% CI 1.1-5.8 for 3rd versus 1st tertile) with cardiovascular events. The association remained statistically significant only for physical distress (hazard ratio 2.8 95% CI 1.2 - 6.8, p < 0.05) when both variables were evaluated in the same model.
  
  
  CONCLUSIONS
  Physical distress, but not quality of life, was independently associated with increased risk of cardiovascular events in an observational study of elderly men predominantly without established cardiovascular disease.
  
  
  BACKGROUND
  Trial registration: NCT00764010.
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway. gunnar.einvik@medisin.uio.no.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Einvik
authors.forename: Oivind
authors.initials: O
authors.lastname: Ekeberg
authors.forename: Tor O
authors.initials: TO
authors.lastname: Klemsdal
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Hjerkinn