Auckland City Hospital, Auckland, New Zealand
Department of Medical Sciences Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
J Am Heart Assoc. 2017 Aug 22;6(8):e006096. doi: 10.1161/JAHA.117.006096.
The major determinants and prognostic importance of self-reported health in patients with stable coronary heart disease are uncertain.
The STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial randomized 15 828 patients with stable coronary heart disease to treatment with darapladib or placebo. At baseline, 98% of participants completed a questionnaire that included the question, "Overall, how do you feel your general health is now?" Possible responses were , and . Adjudicated major adverse cardiac events, which included cardiovascular death, myocardial infarction, and stroke, were evaluated by Cox regression during 3.7 years of follow-up for participants who reported excellent or very good health (n=2304), good health (n=6863), and average or poor health (n=6361), before and after adjusting for 38 covariates. Self-reported health was most strongly associated with geographic region, depressive symptoms, and low physical activity (<0.0001 for all). Poor/average compared with very good/excellent self-reported health was independently associated with major adverse cardiac events (hazard ratio [HR]: 2.30 [95% confidence interval (CI), 1.92-2.76]; adjusted HR: 1.83 [95% CI, 1.51-2.22]), cardiovascular mortality (HR: 4.36 [95% CI, 3.09-6.16]; adjusted HR: 2.15 [95% CI, 1.45-3.19]), and myocardial infarction (HR: 1.87 [95% CI, 1.46-2.39]; adjusted HR: 1.68 [95% CI, 1.25-2.27]; <0.0002 for all).
Self-reported health is strongly associated with geographical region, mood, and physical activity. In a global coronary heart disease population, self-reported health was independently associated with major cardiovascular events and mortality beyond what is measurable by established risk indicators.
URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00799903.
稳定型冠心病患者自我报告的健康状况的主要决定因素及其预后意义尚不确定。
STABILITY（通过起始达拉普利治疗稳定动脉粥样硬化斑块）试验将 15828 例稳定型冠心病患者随机分为达拉普利治疗组或安慰剂组。在基线时，98%的参与者完成了一份问卷，其中包括“总的来说，您现在感觉自己的整体健康状况如何？”的问题。可能的回答是，和。在 3.7 年的随访期间，通过 Cox 回归评估了经裁定的主要不良心脏事件，包括心血管死亡、心肌梗死和卒中等，这些事件发生在报告极好或非常好的健康状况（n=2304）、良好健康状况（n=6863）和一般或较差健康状况（n=6361）的参与者中，在调整了 38 个协变量之前和之后。自我报告的健康状况与地理区域、抑郁症状和低体力活动的关系最为密切（所有均<0.0001）。与极好/非常好的自我报告健康状况相比，较差/一般的自我报告健康状况与主要不良心脏事件（风险比[HR]：2.30[95%置信区间（CI），1.92-2.76]；调整后的 HR：1.83[95%CI，1.51-2.22]）、心血管死亡率（HR：4.36[95%CI，3.09-6.16]；调整后的 HR：2.15[95%CI，1.45-3.19]）和心肌梗死（HR：1.87[95%CI，1.46-2.39]；调整后的 HR：1.68[95%CI，1.25-2.27]）独立相关（均<0.0002）。
自我报告的健康状况与地理区域、情绪和体力活动密切相关。在全球冠心病人群中，自我报告的健康状况与主要心血管事件和死亡率独立相关，超过了既定风险指标可测量的范围。
