Cardiologist Sunnybrook Health Sciences Centre Toronto, Ontario, Canada
Background: While clinical, lifestyle, and social determinants of health are established risk factors for new onset cardiovascular disease (CVD), little is known about the impact of patient-reported health measures in primary prevention. Our objective was to determine whether an individual’s self-rated health is independently associated with incident cardiovascular disease and whether this association differs by sex.
METHODS AND RESULTS: This study included adults enrolled in the Ontario Health Study (March 1, 2009 - December 31, 2017) with no prior CVD or active cancer. Self-rated health was graded as excellent, average, and poor. Cardiovascular disease events (hospitalization for myocardial infarction, stroke, heart failure, and cardiovascular death) were ascertained to March 31st, 2024. Cause-specific hazard models with an interaction between self-rated health and sex were adjusted for age, traditional cardiovascular risk factors, lifestyle factors, social determinants of health, and a family history of CVD. The cohort consisted of 104,789 women (median age 47 years) and 65,408 men (median age 50 years). There were 11.1% of women and 9.8% of men who rated their health as poor. On the other hand, 16.5% of women and 17.1% of men had excellent self-rated health. After a median of 12.1 years of follow-up and multivariable adjustment, poorer self-rated health was associated with a higher rate of incident CVD. Compared to excellent self-rated health, the hazard ratio (HR) for average self-rated health was 1.28 (95% CI: 1.13 – 1.45) in women which was greater than the HR of 1.04 (95% CI: 0.94 – 1.14) in men. Similarly, the HR for poor self-rated health was 2.18 (95% CI: 1.89 – 2.52) in women compared to 1.49 (95% CI: 1.32 – 1.68) in men (p < 0.01 for interaction).
Conclusion: Up to 1 in 10 individuals without CVD rate their health as poor. Poor self-rated health was an independent risk factor for incident CVD and its relative impact on CVD was greater in women than men. Our findings support the use of a simple self-assessment of health to aid in risk stratification and sex-specific preventative treatment strategies.
