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Self-rated health predicts CVD events, death: this was true in women undergoing angiography who rated their health as fair or poor.

SEATTLE -- Women undergoing angiography who rated their health as fair or poor had twice the risk of cardiovascular events and death, compared with women who rated their health as good or excellent, new data show.

Providers should be alert to the possibility of adverse events in such women, even when they appear relatively healthy by objective criteria, according to a study of 900 women undergoing coronary angiography in which nearly 4 in 10 self-rated their health as fair or poor.

This association appeared to be largely attributable to the women's functional capacity, assessed on a scale ranging from the ability to perform simple self-care tasks to the ability to participate in strenuous sports.

"In a clinical population ... we observed evidence that not only are poor and fair self-rated health strongly associated with clinical outcomes, but they are common," said lead investigator Thomas Rutledge, Ph.D.

"This suggests that there is a large population of care-seeking patients out there for whom self-rated health is rarely assessed but is potentially quite important to understanding their actual healthiness."

He and his colleagues analyzed data from the Women's Ischemia Syndrome Evaluation (WISE), a multicenter study conducted among women undergoing coronary angiography because of symptoms of myocardial ischemia.

At baseline, the women were asked to rate their health using a five-category classification: poor, fair, good, very good, or excellent.

Study investigators collected numerous objective measures of health: CVD risk factors (diabetes, body mass index, dyslipidemia, hypertension, current smoking status), coronary artery disease severity score (assessed from angiography), and demographic factors (age, education, and race).

They also collected several dimensions related to the subjective experience of symptoms: mental health treatment (assessed from self-reported current use of antidepressants and anxiolytics), cardiac symptoms (shortness of breath and frequency of chest pain), and functional capacity (assessed with the Duke Activity Status Index [DASI]).

The 900 women with complete data had a median follow-up of 5.9 years, according to Dr. Rutledge, associate professor in residence at the University of California, San Diego.

They were an average age of 60 years, and 17% were of minority races/ethnicities. Most (80%) had at least a high school education.

About 40% had significant coronary artery disease, defined as the presence of stenosis of at least 50% on angiography.

Overall, 10% of the women rated their health as poor, 29% as fair, 35% as good, 19% as very good, and 6% as excellent.

The combined rate of CVD events (myocardial infarction, stroke, heart failure) and death for these groups was 39%, 24%, 21%, 11%, and 8%, respectively.

With the exception of coronary artery disease severity score, all of the objective and subjective measures studied varied significantly across the five categories of self-rated health.

After adjustment for demographic and CVD risk factors, women with fair self-rated health had a 2.0-fold increased risk of CVD events and death and women with poor self-rated health had a 2.1-fold increased risk compared with their counterparts who had very good or excellent self-rated health combined.

The findings were essentially the same after additional adjustment for use of antidepressants or anxiolytics, or for cardiac symptoms.

In contrast, the associations were no longer significant after additional adjustment for functional status, as assessed with DASI scores.

Self-rated health seems to capture more than is typically measured during an office visit and it can be easily assessed with a single question, Dr. Rutledge said.

"For providers that entertain thoughts of including self-rated health assessments, our results suggest that it is those scoring in the poor and fair categories that may warrant extra attention," he asserted.

"It is these patients that may be experiencing the greatest degree of limitations associated with their conditions--limitations that are probably only poorly captured by typical disease severity indicators," Dr. Rutledge said.

And when it comes to management, he said, "it is possible that promoting interventions that more directly target functional status as opposed to symptom management--take for example, the promotion of exercise over pharmacotherapy or talk therapy for a depressed cardiac patient--might be more health promoting for those patients scoring in the low self-rated health categories."


Major Finding: Women undergoing angiography who rated their health as fair or poor had twice the risk of CVD events and death as peers who rated their health as very good or excellent even after objective measures of health were taken into account.

Data Source: Observational study of 900 participants in the Women's Ischemia Syndrome Evaluation.

Disclosures: None was reported.


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Title Annotation:CLINICAL ROUNDS
Author:London, Susan
Publication:OB GYN News
Date:Jul 1, 2010
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