Self-Reported Health and Outcomes in Patients With Stable Coronary Heart Disease

Ralph Stewart, Emil Hagstrom, Claes Held, Tom Wang, Paul Armstrong, Philip Aylward, Christopher Cannon, Wolfgang Koenig, Jose Lopez-Sendon, Emile Mohler III, Nermin Hadziosmanovic, Susan Krug-Gourley, Marco Ramos-Corrales, Saulat Siddique, Philippe Steg, Harvey White, Lars Wallentin

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7 Citations (Scopus)


Background--The major determinants and prognostic importance of self-reported health in patients with stable coronary heart disease are uncertain. Methods and Results--The STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial randomized 15 828 patients with stable coronary heart disease to treatment with darapladib or placebo. At baseline, 98% of participants completed a questionnaire that included the question, "Overall, how do you feel your general health is now?" Possible responses were excellent, very good, good, average, and poor. Adjudicated major adverse cardiac events, which included cardiovascular death, myocardial infarction, and stroke, were evaluated by Cox regression during 3.7 years of follow-up for participants who reported excellent or very good health (n=2304), good health (n=6863), and average or poor health (n=6361), before and after adjusting for 38 covariates. Self-reported health was most strongly associated with geographic region, depressive symptoms, and low physical activity (P < 0.0001 for all). Poor/average compared with very good/excellent self-reported health was independently associated with major adverse cardiac events (hazard ratio [HR]: 2.30 [95% confidence interval (CI), 1.92-2.76]; adjusted HR: 1.83 [95% CI, 1.51-2.22]), cardiovascular mortality (HR: 4.36 [95% CI, 3.09-6.16]; adjusted HR: 2.15 [95% CI, 1.45-3.19]), and myocardial infarction (HR: 1.87 [95% CI, 1.46-2.39]; adjusted HR: 1.68 [95% CI, 1.25-2.27]; P < 0.0002 for all). Conclusions--Self-reported health is strongly associated with geographical region, mood, and physical activity. In a global coronary heart disease population, self-reported health was independently associated with major cardiovascular events and mortality beyond what is measurable by established risk indicators.

Original languageEnglish
Article numbere006096
Number of pages35
JournalJournal of the American Heart Association
Issue number8
Publication statusPublished - 1 Aug 2017


  • Coronary artery disease
  • General health
  • Prognostic studies


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