Risk of Cardiovascular and All-Cause Mortality: Impact of Impaired Health-Related Functioning and Diabetes

Williams, Emily D.; Rawal, Lal; Oldenburg, Brian; Renwick, Carla; Shaw, Jonathan E.; Tapp, Robyn J.

doi:10.2337/dc11-1288

Cited by 31 publications

(33 citation statements)

References 27 publications

(52 reference statements)

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“…Although these findings are similar to what have been reported in the literature [6,28], they should be taken with caution, as the subscales are highly correlated with one another, and hence their effects are not independent.…”

Section: Discussionsupporting

confidence: 90%

Self-perceived physical health predicts cardiovascular disease incidence and death among postmenopausal women

et al. 2013

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BackgroundPhysical and Mental Component Summary (PCS, MCS, respectively) scales of SF- 36 health-related-quality-of-life have been associated with all-cause and cardiovascular disease (CVD) mortality. Their relationships with CVD incidence are unclear. This study purpose was to test whether PCS and/or MCS were associated with CVD incidence and death.MethodsPostmenopausal women (aged 50–79 years) in control groups of the Women’s Health Initiative clinical trials (n = 20,308) completed the SF-36 and standardized questionnaires at trial entry. Health outcomes, assessed semi-annually, were verified with medical records. Cox regressions assessed time to selected outcomes during the trial phase (1993–2005).ResultsA total of 1075 incident CVD events, 204 CVD-specific deaths, and 1043 total deaths occurred during the trial phase. Women with low versus high baseline PCS scores had less favorable health profiles at baseline. In multivariable models adjusting for baseline confounders, participants in the lowest PCS quintile (reference = highest quintile) exhibited 1.8 (95%CI: 1.4, 2.3), 4.7 (95%CI: 2.3, 9.4), and 2.1 (95%CI: 1.7, 2.7) times greater risk of CVD incidence, CVD-specific death, and total mortality, respectively, by trial end; whereas, MCS was not significantly associated with CVD incidence or death.ConclusionPhysical health, assessed by self-report of physical functioning, is a strong predictor of CVD incidence and death in postmenopausal women; similar self-assessment of mental health is not. PCS should be evaluated as a screening tool to identify older women at high risk for CVD development and death.

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Section: Discussionsupporting

confidence: 90%

Self-perceived physical health predicts cardiovascular disease incidence and death among postmenopausal women

et al. 2013

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“…For external validation, we used data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab)27 28 including participants aged 45–65 at baseline (1999/2000) with available disability information at follow-up (2011/2012) or died before 30 November 2012 (n=2182; mean age 55, 47% men). Disability at follow-up was defined as having some difficulty to at least one of eating, bathing, dressing, transferring and toileting.…”

Section: Methodsmentioning

confidence: 99%

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

Wong

Stevenson

Backholer

et al. 2014

J Epidemiol Community Health

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BackgroundWe aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop a disability risk algorithm to estimate the risk of future disability for those aged 45–65 years.MethodsFOS is a longitudinal study. We used examination 5 (1991–1995; ‘baseline’) and examination 8 (2005–2008; ‘follow-up’). We included participants aged between 45–65 years at ‘baseline’ with complete predictor and outcome measures (n=2031; mean age 53.9 years). Predictors considered were body mass index, smoking, hypertension, diabetes and dyslipidaemia. We used multinomial logistic regression to identify predictors of disability or death.We assessed external validity using Australian data.ResultsBy examination 8, 156 participants had disability and 198 had died. Disability was associated with smoking (OR (95% CI) 1.81 (1.18 to 2.78)); obesity (2.95 (1.83 to 4.77)); diabetes 1.96 (1.11 to 3.45) and being female (OR 1.67 (1.13 to 2.45). The model performed moderately well in predicting disability and death in an Australian population. Based on our algorithm, a 45-year-old man/woman with the combined risk factors of obesity, diabetes and smoking has similar likelihood of surviving free of disability to a 65-year-old man/woman without any of the same risk factors.Conclusions and relevanceThe derived risk algorithm allows, for the first time, quantification of the substantial combined impact on future disability of key modifiable risk factors in mid-life. Here we demonstrated the combined impact of obesity, diabetes and smoking to be similar to 20 years of aging.

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“…The ZODIAC-18 study of type 2 diabetes patients from the Netherlands reported that a 10-point increase on the PCS decreased the risk for mortality by approximately 10% [Landman 2010]. The AusDiab study reported that those with a co-occurrence of diabetes and impaired PCS had an almost three-fold increase in cardiovascular mortality compared to those with diabetes and with average physical functioning [Williams 2012]. …”

Section: Discussionmentioning

confidence: 99%

“…Subjective health status, including self-reported physical functioning, may be a marker for increased risk of mortality as well [Jylha 2009; McEwen 2009; Landman 2010]. The prospective AusDiab and ZODIAC-18 studies, conducted in Australia and the Netherlands, respectively, reported that the co-occurrence of diabetes and poor self-rated physical functioning was associated with increased risk of mortality [Landman 2010; Williams 2012]. However, it is unclear if this association exists in the United States or differs by race/ethnicity.…”

Section: Introductionmentioning

confidence: 99%

Self-reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD

Ylitalo

McEwen

Karter

et al. 2013

Journal of Diabetes and its Complications

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Diabetes is a risk factor for mortality. Subjective health status, including self-reported physical functioning, may also be a marker for mortality. This study examined the association between self-reported physical functioning and mortality in people with diabetes, and determined if this association differed by race/ethnicity. We studied 7,894 type 2 diabetic patients who participated in Translating Research Into Action for Diabetes (TRIAD), a prospective study of diabetes care in managed care. At baseline in 2000, participants completed a questionnaire and had a medical record review. Physical functioning was assessed with the Short Form Health Survey (SF-12). The National Death Index was searched annually for deaths over 10 years of follow-up (2000-2009). At baseline, mean age was 61.7 years, 50% were non-Hispanic white, 22% were black, and 16% of participants reported “good physical functioning” (better than norms for U.S. adults). Over 10 years, 28% of participants died (2,111/7,894); 39% (856/2,111) due to cardiovascular disease. Relative to those reporting good functioning, those reporting poor physical functioning had a 37% higher all-cause death rate, after adjusting for age, sex, race/ethnicity, education, income, body mass index, smoking, and comorbidities (Hazard Ratio (HR)=1.37; 95% Confidence Interval (CI): 1.15, 1.63). Similarly, those reporting poor physical functioning had a 42% higher adjusted cardiovascular death rate compared to those reporting good functioning (HR= 1.42; 95% CI: 1.06, 1.90). Although blacks were less likely than whites to report good functioning (p<0.01), the association between functioning and mortality was consistent across race/ethnicity. In this managed care population with diabetes, self-reported physical functioning was a robust predictor of mortality, in addition to traditional biological risk factors, for all race/ethnic groups. Physical functioning assessments are easy to perform and may be useful benchmarks for tailoring the care of persons with chronic disease.

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Risk of Cardiovascular and All-Cause Mortality: Impact of Impaired Health-Related Functioning and Diabetes

Cited by 31 publications

References 27 publications

Self-perceived physical health predicts cardiovascular disease incidence and death among postmenopausal women

Self-perceived physical health predicts cardiovascular disease incidence and death among postmenopausal women

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

Self-reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD

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