Using health-related quality of life to predict cardiovascular disease events

  • Laura C. PinheiroEmail author
  • Evgeniya Reshetnyak
  • Madeline R. Sterling
  • Joshua S. Richman
  • Lisa M. Kern
  • Monika M. Safford



Although strong associations between self-reported health and mortality exist, quality of life is not conceptualized as a cardiovascular disease (CVD) risk factor. Our objective was to assess the independent association between health-related quality of life (HRQOL) and incident CVD.


This study used the REasons for Geographic And Racial Differences in Stroke data, which enrolled 30,239 adults from 2003 to 2007 and followed them over 10 years. We included 22,229 adults with no CVD history at baseline. HRQOL was measured using the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, which range from 0 to 100, with higher scores indicating better HRQOL. Scores were normed to the general US population with mean 50 and standard deviation 10. We constructed a four-level HRQOL variable: (1) individuals with PCS & MCS < 50, (2) PCS < 50 & MCS ≥ 50, (3) MCS < 50 & PCS ≥ 50, and (4) PCS & MCS ≥ 50, which was the reference. The primary outcome was incident CVD (non-fatal myocardial infarction (MI), fatal MI or coronary heart disease (CHD) death, fatal and non-fatal stroke). Cox proportional hazards models examined associations between HRQOL and CVD.


Median follow-up was 8.4 (IQR 5.9–10.0) years. We observed 1766 CVD events. Compared to having PCS & MCS ≥ 50, having MCS & PCS < 50 was associated with increased CVD risk (aHR 1.46; 95% 1.24–1.70), adjusting for demographics, comorbidities, and CVD risk factors. Associations between MCS & PCS < 50 and CVD were consistent for CHD (aHR 1.54 [1.26–1.89]) and stroke (aHR 1.35 [1.05–1.72]) endpoints.


Given strong, adjusted associations between poor HRQOL and incident CVD, self-reported health may be an excellent complement to current approaches to CVD risk identification.


Quality of life Cardiovascular events Risk assessments 



The authors thank the other investigators, the staff, and participants of the REGARDS study for all of their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at


This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, and R01 HL80477 from the National Heart Lung and Blood Institute, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or financial disclosures.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. This study was approved by the participating institutions’ Institutional Review Boards. All authors have read and approved the manuscript for submission to Quality of Life Research.

Informed consent

For this type of study, formal consent is not required. All participants provided written informed consent.

Supplementary material

11136_2019_2103_MOESM1_ESM.docx (91 kb)
Supplementary material 1 (DOCX 90 KB)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkUSA
  2. 2.Department of SurgeryUniversity of Alabama at Birmingham Medical SchoolBirminghamUSA

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