Quality of life independently predicts long-term mortality but not vascular events: the Northern Manhattan Study

Abstract

Purpose Cardiovascular disease is a major contributor to morbidity and mortality, and prevention relies on accurate identification of those at risk. Studies of the association between quality of life (QOL) and mortality and vascular events incompletely accounted for depression, cognitive status, social support, and functional status, all of which have an impact on vascular outcomes. We hypothesized that baseline QOL is independently associated with long-term mortality in a large, multi-ethnic urban cohort. Methods In the prospective, population-based Northern Manhattan Study, Spitzer QOL index (SQI, range 0–10, with ten signifying the highest QOL) was assessed at baseline. Participants were followed over a median 11 years for stroke, myocardial infarction (MI), and vascular and non-vascular death. Multivariable Cox proportional hazards regression estimated hazard ratio and 95% confidence interval (HR, 95% CI) for each outcome, with SQI as the main predictor, dichotomized at 10, adjusting for baseline demographics, vascular risk factors, history of cancer, social support, cognitive status, depression, and functional status. Results Among 3298 participants, mean age was 69.7 + 10.3 years; 1795 (54.5%) had SQI of 10. In fully adjusted models, SQI of 10 (compared to SQI <10) was associated with reduced risk of all-cause mortality (HR 0.80, 95% CI 0.72–0.90), vascular death (0.81, 0.69–0.97), non-vascular death (0.78, 0.67–0.91), and stroke or MI or death (0.82, 0.74–0.91). In fully adjusted competing risk models, there was no association with stroke (0.93, 0.74–1.17), MI (0.98, 0.75–1.28), and stroke or MI (1.03, 0.86–1.24). Results were consistent when SQI was analyzed continuously. Conclusion In this large population-based cohort, highest QOL was inversely associated with long-term mortality, vascular and non-vascular, independently of baseline primary vascular risk factors, social support, cognition, depression, and functional status. QOL was not associated with non-fatal vascular events.

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

“…QoL is a broader concept including several dimensions of life such as material resources, social functioning and social relationships, well-being, happiness, and life satisfaction [9]. Beyond the importance of a good SRH and a high QoL in and of themselves, there is also extensive evidence that SRH and QoL are potent predictors for future morbidity and survival/mortality [12–14].…”

Factors Associated With Quality of Life in Patients with Systemic Arterial Hypertension

“…The perception of quality of life has been established as an efficient form of predicting cardiovascular events and survival rate in hypertensive patients. 16 The results of the present study showed that some modifiable factors, such as muscle strength, body mass index, educational level and blood pressure influence the quality of life of these patients, and that has not been sufficiently investigated in the literature. Thus, in practical terms, interventions such as physical exercise and nutritional monitoring that promote previous control of these variables may positively affect the quality of life of hypertensive individuals.…”

“…For example, an improvement in this indicator is associated with greater survival rate in hypertensive patients, while a worse quality of life predicts lower survival rates. 16 In the conceptual model proposed by Wilson and Cleary, 32 several factors influence an individual's quality of life, including physical and social functioning, mental health and general health perception. In this context, the SF-36, which is an instrument that evaluates quality of life, includes eight domains (functional capacity, physical aspects, pain, general health, vitality, social aspects, emotional aspects and mental health) that detail these factors.…”

“…Indeed, the influence of the factors associated with quality of life can predict long-term functional independence, adherence to anti-hypertensive therapy and incidence of survival in hypertensives. [16][17][18] Previous studies have suggested that clinical aspects directly affect the quality of life in hypertensive individuals, 19 such as comorbidities (heart failure, acute myocardial infarction and angina pectoris), 20 medication, 21,22 disease knowledge level and blood pressure values. 22 On the other hand, it is unknown whether physical fitness and demographic characteristics are related to quality of life in hypertensive individuals.…”

Patient-reported outcome measures in systemic sclerosis–related interstitial lung disease for clinical practice and clinical trials

“…In the wake of irreversible biophysical damage, improvement of symptom burden may still be possible through non-disease modifying symptom management strategies. [3][4][5][6][7][8][9][10][11][12] Based on our prior work, primary lung-related biophysical symptoms of interest to patients with SSc and connective tissue disease-related interstitial lung disease (CTD-ILDs) are cough, dyspnea, exercise tolerance, and fatigue. In these studies, patients voiced an inability to discern whether fatigue was predominantly influenced by underlying ILD or the primary CTD itself.…”