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Self-Rated Versus Objective Health Indicators as Predictors of Major Cardiovascular Events: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation

Rutledge, Thomas PhD; Linke, Sarah E. MS, MPH; Johnson, B. Delia PhD; Bittner, Vera MD, MSPH; Krantz, David S. PhD; Whittaker, Kerry S. BA; Eastwood, Jo-Ann PhD, RN; Eteiba, Wafia MD; Cornell, Carol E. PhD; Pepine, Carl J. MD; Vido, Diane A. MS; Olson, Marian B. MS; Shaw, Leslee J. PhD; Vaccarino, Viola MD, PhD; Bairey Merz, C. Noel MD

doi: 10.1097/PSY.0b013e3181dc0259
Original Articles

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.

Method: 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.

CAD = coronary artery disease; CVD = cardiovascular disease; DASI = Duke Activity Status Index; HR = hazard ratio; SES = socioeconomic status; WISE = Women’s Ischemia Syndrome Evaluation.

From the VA San Diego Healthcare System (T.R.), San Diego, California; Department of Psychiatry (T.R., S.E.L.), University of California, San Diego, San Diego, California; San Diego Joint Doctoral Program in Clinical Psychology (S.E.L.), San Diego State University/University of California, San Diego, California; Department of Psychiatry (B.D.J., W.E., M.B.O.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Medicine (V.B.), University of Alabama at Birmingham, Birmingham, Alabama; Uniformed Services University of the Health Sciences (D.S.K., K.S.W.), Bethesda, Maryland; UCLA School of Nursing (J.A.E.), Los Angeles, California; Department of Medicine (C.E.C.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Medicine (C.J.P.), University of Florida, Gainesville, Florida; Department of Medicine (D.A.V.), Allegheny General Hospital, Pittsburgh, Pennsylvania; Department of Medicine (L.J.S., V.V.), Emory University, Atlanta, Georgia; and the Department of Medicine (C.N.B.M.), Cedars-Sinai Medical Center, Los Angeles, California.

Address correspondence and reprint requests to Thomas Rutledge, PhD, Psychology Service 116B, VA San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail:

Received for publication December 4, 2009; revision received February 18, 2010.

This work was supported, in part, by Contracts N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164 and Grants U0164829, U01 HL649141, U01 HL649241 from the National Heart, Lung and Blood Institutes; GCRC Grant MO1-RR00425 from the National Center for Research Resources; and grants from the Gustavus and Louis Pfeiffer Research Foundation, Denville, New Jersey; the Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, California; the Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, Pennsylvania; the Edythe Broad Women’s Heart Research Endowment, Cedars-Sinai Medical Center, Los Angeles, California; and the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, California.

Copyright © 2010 by American Psychosomatic Society
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