Sex Differences in Self-Rated Health and Cardiovascular Disease Events.
Maneesh Sud1,2, Feng Qiu3, Olivia Haldenby3
1Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
JAMA Network Open
|April 1, 2026
Summary
Self-rated health is a significant predictor of cardiovascular disease (CVD) risk. Poorer self-rated health, especially in women, is linked to increased CVD events, supporting its use in primary prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Clinical, lifestyle, and social determinants of health show sex-specific links to cardiovascular disease (CVD).
- The influence of patient-reported health measures on CVD development in individuals without pre-existing CVD remains under-explored.
Purpose of the Study:
- To investigate the independent association between self-rated health and the incidence of CVD.
- To determine if this association varies between sexes.
Main Methods:
- Retrospective cohort study of community-dwelling adults from the Ontario Health Study (2009-2017).
- Exclusion of participants with prior CVD or active cancer.
- CVD events (myocardial infarction, stroke, heart failure, cardiovascular death) ascertained via administrative databases.
- Cause-specific hazard models adjusted for demographics, risk factors, lifestyle, social determinants, and family history, with interaction analysis for self-rated health and sex.
Main Results:
- The cohort comprised 170,197 participants (61.6% women) with a median follow-up of 12.1 years.
- Fair to poor self-rated health was reported by 11.1% of women and 9.8% of men.
- After adjustment, fair to poor self-rated health showed a higher CVD risk (HR 2.08 in women, 1.45 in men) compared to excellent health, with a significant interaction by sex (P < .001).
Conclusions:
- Fair to poor self-rated health is an independent risk factor for new CVD events in individuals without prior CVD.
- The association between poorer self-rated health and CVD risk is stronger in women than in men.
- Self-assessment of health can be a valuable tool for CVD risk stratification in primary prevention.
Related Concept Videos
01:23Assessment of the Cardiovascular System I: Subjective Data
1.1K
A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
1.1K
01:27Psychoneuroimmunology: Cardiovascular Disease
673
Psychoneuroimmunology (PNI) is a multidisciplinary field that examines how psychological factors, particularly stress, interact with the immune system and impact physical health. Research in PNI has shown that chronic or traumatic stress can disrupt both the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. These disruptions contribute to serious health conditions, including cardiovascular diseases.
A key area of focus in PNI is the relationship between stress and coronary...
A key area of focus in PNI is the relationship between stress and coronary...
673
02:45Self-Discrepancy Theory
19.1K
One influential perspective on what motivates people's behavior is detailed in Tory Higgin's self-discrepancy theory (Higgins, 1987). He proposed that people hold disagreeing internal representations of themselves that lead to different emotional states.
19.1K
01:29Self-Discrepancy and Its Effects
451
Self-discrepancy theory explains how people compare their actual self to their ideal and ought selves and how mismatches between these self-guides can lead to emotional distress. Developed by E. Tory Higgins, the theory distinguishes among three components of self-concept: the actual self, the ideal self, and the ought self. These refer respectively to how individuals perceive themselves, how they aspire to be, and how they believe they are obligated to be. Emotional well-being, self-esteem,...
451
01:29Assessment of the Cardiovascular System II: Inspection
1.1K
Inspection is the initial step in assessing the cardiovascular system. It involves a detailed visual examination that provides crucial information about a patient's circulatory and cardiac health. This systematic process, conducted from head to toe, helps identify signs of cardiovascular conditions by observing physical appearance, skin and mucous membranes, jugular and carotid pulsations, chest symmetry, and the condition of the extremities.
Head and Neck
Head and Neck
1.1K
01:20Disorders of the Male Reproductive System
5.4K
Men's health issues are increasingly recognized as significant, with several conditions posing common threats. Among these, testicular cancer is especially prevalent in younger men, particularly those aged 20 to 35 years. The disease often manifests as a painless mass in the testicles, sometimes accompanied by a sensation of heaviness or a dull ache.
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
5.4K