Participant-Reported Health Status Predicts Cardiovascular and All-Cause Mortality Independent of Established and Nontraditional Biomarkers: Evidence From a Representative US Sample

Background: participant-reported health status is a key indicator of cardiovascular health,but its predictive value relative to traditional and nontraditional risk factors is unknown. we evaluated whether participant-reported health status,as indexed by self-rated health,predicted cardiovascular disease,and all-cause mortality risk excess of 10-year atherosclerotic cardiovascular disease (ascvd) risk scores and 5 nontraditional risk biomarkers. methods and results: analyses used prospective observational data from the 1999-2002 national health and nutrition examination surveys among those aged 40 to 79 years (n=4677). vital status was ascertained through 2011,during which there were 850 deaths,206 from cardiovascular disease (cvd). we regressed cvd and all-cause mortality on standardized values of self-rated health in survival models,adjusting for age,sex,education,existing chronic disease,race/ethnicity,ascvd risk,and standardized biomarkers (fibrinogen,c-reactive protein [crp],triglycerides,albumin,and uric acid). in sociodemographically adjusted models,a 1-sd decrease in self-rated health was associated with increased risk of cvd mortality (hazard ratio [hr],1.92; 95% ci,1.51-2.45; p<0.001),and this hazard remained strong after adjusting for ascvd risk and nontraditional biomarkers (hr,1.79; 95% ci,1.42-2.26; p<0.001). self-rated health also predicted all-cause mortality even after adjustment for ascvd risk and nontraditional biomarkers (hr,1.50; 95% ci,1.35-1.66; p<0.001). conclusions: self-rated health provides prognostic information beyond that captured by traditional ascvd risk assessments and by nontraditional cvd biomarkers. consideration of self-rated health in combination with traditional risk factors may facilitate risk assessment and clinical care. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.