Liang John W, Cheung Ying Kuen, Willey Joshua Z, Moon Yeseon P, Sacco Ralph L, Elkind Mitchell S V, Dhamoon Mandip S
Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
Divisions of Cerebrovascular Disease, Critical Care and Neurotrauma, Thomas Jefferson University, Philadelphia, PA, USA.
Qual Life Res. 2017 Aug;26(8):2219-2228. doi: 10.1007/s11136-017-1567-8. Epub 2017 Mar 29.
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.
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.
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.
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.
心血管疾病是发病和死亡的主要原因，预防依赖于准确识别高危人群。生活质量（QOL）与死亡率和血管事件之间关联的研究未充分考虑抑郁、认知状态、社会支持和功能状态，而这些因素均会对血管结局产生影响。我们假设在一个大型多民族城市队列中，基线生活质量与长期死亡率独立相关。
在基于人群的前瞻性北曼哈顿研究中，在基线时评估Spitzer生活质量指数（SQI，范围为0至10，10表示最高生活质量）。对参与者进行了为期中位数11年的随访，观察中风、心肌梗死（MI）以及血管性和非血管性死亡情况。多变量Cox比例风险回归估计每个结局的风险比和95%置信区间（HR，95%CI），以SQI作为主要预测因素，以10为界进行二分法分析，并对基线人口统计学、血管危险因素、癌症病史、社会支持、认知状态、抑郁和功能状态进行调整。
在3298名参与者中，平均年龄为69.7±10.3岁；1795名（54.5%）的SQI为10。在完全调整的模型中，SQI为10（与SQI<10相比）与全因死亡率降低相关（HR 0.80，95%CI 0.72 - 0.90）、血管性死亡（0.81，0.69 - 0.97）、非血管性死亡（0.78，0.67 - 0.91）以及中风或心肌梗死或死亡（0.82，0.74 -
0.91）。在完全调整的竞争风险模型中，与中风（0.93，0.74 - 1.17）、心肌梗死（0.98，0.75 - 1.28）以及中风或心肌梗死（1.03，0.86 - 1.24）无关联。当对SQI进行连续分析时，结果一致。
在这个基于人群的大型队列中，最高生活质量与长期血管性和非血管性死亡率呈负相关，独立于基线主要血管危险因素、社会支持、认知、抑郁和功能状态。生活质量与非致命性血管事件无关。
