Participant-Reported Health Status Predicts Cardiovascular and All-Cause Mortality Independent of Established and Nontraditional Biomarkers

Evidence From a Representative US Sample

Steven D Barger, Matthew R. Cribbet, Matthew F. Muldoon

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Article numbere003741
JournalJournal of the American Heart Association
Volume5
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Health Status
Cardiovascular Diseases
Biomarkers
Mortality
Health
Sex Education
Nutrition Surveys
Uric Acid
C-Reactive Protein
Fibrinogen
Albumins
Triglycerides
Chronic Disease

Keywords

  • Biological markers
  • Cardiovascular disease risk factors
  • Epidemiology
  • Health policy and outcomes research
  • Mortality
  • Patient reported outcomes
  • Quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{bedd8968cda9467f8a8eba7a1427396e,
title = "Participant-Reported Health Status Predicts Cardiovascular and All-Cause Mortality Independent of Established and Nontraditional Biomarkers: Evidence From a Representative US Sample",
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.",
keywords = "Biological markers, Cardiovascular disease risk factors, Epidemiology, Health policy and outcomes research, Mortality, Patient reported outcomes, Quality of life",
author = "Barger, {Steven D} and Cribbet, {Matthew R.} and Muldoon, {Matthew F.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1161/JAHA.116.003741",
language = "English (US)",
volume = "5",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Participant-Reported Health Status Predicts Cardiovascular and All-Cause Mortality Independent of Established and Nontraditional Biomarkers

T2 - Evidence From a Representative US Sample

AU - Barger, Steven D

AU - Cribbet, Matthew R.

AU - Muldoon, Matthew F.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

KW - Biological markers

KW - Cardiovascular disease risk factors

KW - Epidemiology

KW - Health policy and outcomes research

KW - Mortality

KW - Patient reported outcomes

KW - Quality of life

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U2 - 10.1161/JAHA.116.003741

DO - 10.1161/JAHA.116.003741

M3 - Article

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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M1 - e003741

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