Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project
Objective: The Pooled Cohort Equations (PCE) serve as the platform for quantitative risk assessment for atherosclerotic cardiovascular disease (ASCVD). Data are sparse regarding the benefit of adding health-related quality of life (HRQoL) measures to the PCE. We sought to estimate the association of...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | American Journal of Preventive Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667721000775 |
| _version_ | 1818923148283740160 |
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| author | Hongyan Ning Kiarri N. Kershaw Norrina Bai Allen John Wilkins Donald M Lloyd-Jones |
| author_facet | Hongyan Ning Kiarri N. Kershaw Norrina Bai Allen John Wilkins Donald M Lloyd-Jones |
| author_sort | Hongyan Ning |
| collection | DOAJ |
| description | Objective: The Pooled Cohort Equations (PCE) serve as the platform for quantitative risk assessment for atherosclerotic cardiovascular disease (ASCVD). Data are sparse regarding the benefit of adding health-related quality of life (HRQoL) measures to the PCE. We sought to estimate the association of HRQoL with ASCVD events and evaluate the potential utility of adding HRQoL to the PCE in refining quantitative risk assessment for primary prevention decisions. Methods: Three multi-ethnic longitudinal cohorts were included in the study. HRQoL was measured using the SF-12 physical component summary (PCS) and mental component summary (MCS); higher PCS or MCS scores indicate better HRQoL. We constructed a four-level HRQoL status variable: MCS <50 and PCS <50; MCS <50 and PCS ≥50; MCS ≥50 and PCS <50; MCS ≥50 and PCS ≥50. Harrell's C statistics and net reclassification improvement (NRI) analyses were used to assess the added predictive ability of HRQoL for incident ASCVD. Results: A total of 9,904 individuals were included in the analysis, of whom 4,743 were in the low risk subgroup (<5% predicted 10-year risk). HRQoL status, PCS and its subscale scores were independent predictors of ASCVD events. HRQoL improved both discrimination (delta C: 0.004, p = 0.05) and reclassification (cNRI: 0.15, p<0.01) modestly when added to PCE; 3% and 6% of individuals with events were correctly reclassified to higher risk in the overall sample and low risk subgroup, respectively. Conclusion: HRQoL is an independent predictor of ASCVD events, and improves ASCVD risk prediction significantly, though modestly, overall and in low-risk individuals. HRQoL may be a cost-effective risk-enhancing factor for refining quantitative risk assessment for primary prevention decisions. |
| first_indexed | 2024-12-20T02:04:50Z |
| format | Article |
| id | doaj.art-ba6526c954d3433a94838b2c73c5caaa |
| institution | Directory Open Access Journal |
| issn | 2666-6677 |
| language | English |
| last_indexed | 2024-12-20T02:04:50Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj.art-ba6526c954d3433a94838b2c73c5caaa2022-12-21T19:57:14ZengElsevierAmerican Journal of Preventive Cardiology2666-66772021-09-017100222Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling ProjectHongyan Ning0Kiarri N. Kershaw1Norrina Bai Allen2John Wilkins3Donald M Lloyd-Jones4Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesCorresponding author at: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States.; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesObjective: The Pooled Cohort Equations (PCE) serve as the platform for quantitative risk assessment for atherosclerotic cardiovascular disease (ASCVD). Data are sparse regarding the benefit of adding health-related quality of life (HRQoL) measures to the PCE. We sought to estimate the association of HRQoL with ASCVD events and evaluate the potential utility of adding HRQoL to the PCE in refining quantitative risk assessment for primary prevention decisions. Methods: Three multi-ethnic longitudinal cohorts were included in the study. HRQoL was measured using the SF-12 physical component summary (PCS) and mental component summary (MCS); higher PCS or MCS scores indicate better HRQoL. We constructed a four-level HRQoL status variable: MCS <50 and PCS <50; MCS <50 and PCS ≥50; MCS ≥50 and PCS <50; MCS ≥50 and PCS ≥50. Harrell's C statistics and net reclassification improvement (NRI) analyses were used to assess the added predictive ability of HRQoL for incident ASCVD. Results: A total of 9,904 individuals were included in the analysis, of whom 4,743 were in the low risk subgroup (<5% predicted 10-year risk). HRQoL status, PCS and its subscale scores were independent predictors of ASCVD events. HRQoL improved both discrimination (delta C: 0.004, p = 0.05) and reclassification (cNRI: 0.15, p<0.01) modestly when added to PCE; 3% and 6% of individuals with events were correctly reclassified to higher risk in the overall sample and low risk subgroup, respectively. Conclusion: HRQoL is an independent predictor of ASCVD events, and improves ASCVD risk prediction significantly, though modestly, overall and in low-risk individuals. HRQoL may be a cost-effective risk-enhancing factor for refining quantitative risk assessment for primary prevention decisions.http://www.sciencedirect.com/science/article/pii/S2666667721000775Atherosclerotic cardiovascular diseasePooled cohort equationsHealth related quality of lifeRisk-enhancing factor |
| spellingShingle | Hongyan Ning Kiarri N. Kershaw Norrina Bai Allen John Wilkins Donald M Lloyd-Jones Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project American Journal of Preventive Cardiology Atherosclerotic cardiovascular disease Pooled cohort equations Health related quality of life Risk-enhancing factor |
| title | Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project |
| title_full | Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project |
| title_fullStr | Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project |
| title_full_unstemmed | Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project |
| title_short | Association of Health-Related Quality of Life with Atherosclerotic Cardiovascular Disease: Lifetime Risk Pooling Project |
| title_sort | association of health related quality of life with atherosclerotic cardiovascular disease lifetime risk pooling project |
| topic | Atherosclerotic cardiovascular disease Pooled cohort equations Health related quality of life Risk-enhancing factor |
| url | http://www.sciencedirect.com/science/article/pii/S2666667721000775 |
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