Self-rated versus objective health indicators as predictors of major cardiovascular events: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation.
OBJECTIVE
To determine the association between self-rated health and major cardiovascular events in a sample of women with suspected myocardial ischemia. Previous studies showed that self-rated health is a predictor of objective health outcomes, such as mortality.


METHODS
At baseline, 900 women rated their health on a 5-point scale ranging from poor to excellent as part of a protocol that included quantitative coronary angiography, cardiovascular disease (CVD) risk factor assessment, cardiac symptoms, psychotropic medication use, and functional impairment. Participants were followed for a maximum of 9 years (median, 5.9 years) to determine the prevalence of major CVD events (myocardial infarction, heart failure, stroke, and CVD-related death).


RESULTS
A total of 354 (39.3% of sample) participants reported their health as either poor or fair. After adjusting for demographic factors, CVD risk factors, and coronary artery disease severity, women who rated their health as poor (hazard ratio, 2.1 [1.1-4.2]) or fair (hazard ratio, 2.0 [1.2-3.6]) experienced significantly shorter times to major CVD events compared with women who rated their health as excellent or very good. Further adjustment for functional impairment, however, attenuated the self-rated health relationships with major CVD events.


CONCLUSIONS
Among women with suspected myocardial ischemia, self-rated health predicted major CVD events independent of demographic factors, CVD risk factors, and angiogram-defined disease severity. However, functional impairment seemed to explain much of the self-rated health association. These results support the clinical utility of self-rated health scores in women and encourage a multidimensional approach to conceptualizing these measures.
Rutledge
Thomas
T
VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. Thomas.Rutledge@va.gov
Linke
Sarah E
SE
Johnson
B Delia
BD
Bittner
Vera
V
Krantz
David S
DS
Whittaker
Kerry S
KS
Eastwood
Jo-Ann
JA
Eteiba
Wafia
W
Cornell
Carol E
CE
Pepine
Carl J
CJ
Vido
Diane A
DA
Olson
Marian B
MB
Shaw
Leslee J
LJ
Vaccarino
Viola
V
Bairey Merz
C Noel
CN
D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D054555:National Heart, Lung, and Blood Institute (U.S.); D011336:Probability; D016016:Proportional Hazards Models; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D016387:Women's Health
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