title: Participant-Reported Health Status Predicts Cardiovascular and All-Cause Mortality Independent of Established and Nontraditional Biomarkers: Evidence From a Representative US Sample.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
authors: Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ steven.barger@nau.edu.
authors: Steven D
authors: SD
authors: Barger
authors: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Matthew R
authors: MR
authors: Cribbet
authors: UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Matthew F
authors: MF
authors: Muldoon
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009749:Nutrition Surveys; D000071066:Patient Reported Outcome Measures; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D057566:Self Report; D012709:Serum Albumin / Q000378:metabolism; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D012709:Serum Albumin; D014280:Triglycerides; D014527:Uric Acid; D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: biological markers; cardiovascular disease risk factors; epidemiology; health policy and outcomes research; mortality; patient reported outcomes; quality of life