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Stroke was predicted by dimensions of quality of life in treated hypertensive men
S Agewall1, J Wikstrand, B Fagerberg
1Department of Medicine and Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden. agewall@ss.gu.se
Insights
Reduced quality of life, specifically low contentment and vitality, independently predicted strokes in hypertensive men. This study highlights the importance of psychosocial factors in cardiovascular risk assessment.
Area of Science:
- Cardiovascular Medicine
- Psychosocial Epidemiology
- Clinical Risk Prediction
Background:
- Psychosocial factors are increasingly recognized as potential contributors to atherosclerotic disease development.
- Understanding the interplay between mental well-being and cardiovascular events is crucial for comprehensive risk management.
Purpose of the Study:
- To prospectively investigate the predictive value of quality of life on the incidence of strokes and acute coronary events.
- To determine if psychosocial well-being is an independent risk factor for major adverse cardiovascular events in a high-risk population.
Main Methods:
- A cohort of 412 treated hypertensive men (aged 50-72) with at least one additional cardiovascular risk factor (high cholesterol, smoking, or diabetes) was studied.
- Quality of life was assessed at baseline using the Minor Symptoms Evaluation Profile (MSEP).
- Follow-up data on stroke and acute coronary events were collected over a median period of 6.6 years.
Main Results:
- A total of 37 strokes and 64 acute coronary events occurred during follow-up.
- Cox regression analysis indicated that all three MSEP dimensions significantly predicted stroke incidence.
- Reduced contentment (RR=1.04, P=0.003) and vitality (RR=1.04, P<0.0001) remained independent predictors of stroke after adjusting for traditional cardiovascular risk factors.
- No significant association was found between MSEP scores and myocardial infarction.
Conclusions:
- Reduced quality of life, particularly low contentment and vitality, is independently associated with an increased risk of future stroke in hypertensive men with high cardiovascular risk.
- These findings suggest that psychosocial well-being may play a significant role in stroke pathogenesis.
- The underlying causal mechanisms require further investigation.
Background And Purpose:
Psychosocial factors have been suggested as risk factors for atherosclerotic disease. The purpose of the present study was to examine whether quality of life predicted strokes and acute coronary events in a prospective study.
Methods:
The study included 412 treated hypertensive men, aged 50 to 72 years, with >/=1 of the following: serum cholesterol >/=6.5 mmol/L, smoking, or diabetes mellitus. The Minor Symptoms Evaluation Profile (MSEP) was used to estimate quality of life at entry. Incidences of stroke and acute coronary events were recorded during follow-up. The median follow-up time was 6.6 years.
Results:
Sixty-four patients had an acute coronary event, and 37 had a stroke during the follow-up period. The Cox regression analyses revealed that the 3 dimensions of MSEP at entry were significant predictors of stroke. The relationship between low contentment at entry and the incidence of stroke during follow-up remained significant (relative risk=1.04; 95% CI, 1.01 to 1.06; P=0.003) even after adjustment for other potential cardiovascular risk factors. Vitality also remained an independent predictor for stroke after adjustment for these potential cardiovascular risk factors (relative risk=1.04; 95% CI, 1. 02 to 1.06; P<0.0001). There was no relationship between MSEP score at entry and myocardial infarction during follow-up.
Conclusions:
An independent and significant association between reduced well-being at entry and future stroke was observed in hypertensive men at high cardiovascular risk. The causal relationship is not known, however.