Background and aims: It is unclear whether health status and cognitive function assessments can augment traditional coronary artery disease (CAD) and peripheral artery disease (PAD) biomedical risk prediction frameworks. We examined the association between health status and cognitive function and subsequent adverse cardiovascular and limb events in CAD and PAD.
Methods and results: Stable CAD and PAD patients from the international, multi-centre COMPASS trial completed the visual analogue scale (VAS) of the EQ-5D-3L to assess overall health status, and the Digit Symbol Substitution test (DSST) to assess cognitive function. Main outcomes were incident development of major adverse cardiovascular events, and the combined endpoint major adverse cardiovascular or limb events. The EQ VAS (per 10 unit increase) and DSST (per 5 unit increase) were added to fully adjusted (medications, demographics, cardiovascular history and risk factors) hierarchical Cox regression models. A total of 23 433 patients were in the CAD cohort and 6899 in the PAD cohort. Among both the CAD and PAD groups, higher scores on the EQ VAS (CAD: HR = 0.89, 95%CI 0.88-0.89; PAD HR = 0.89, 95%CI 0.88-0.89) and DSST (CAD HR = 0.95, 95%CI 0.94-0.95) (PAD HR = 0.95, 95%CI 0.94-0.95) were associated with a lower risk of a major adverse cardiovascular or limb events. Population attributable risks associated with the lower two quartiles vs. upper quartiles for the EQ-5D and DSST scores were 7% and 16%, respectively in the CAD cohort; and for PAD, at 14% and 18%, respectively.
Conclusions: Adding health status and cognitive functioning information to biomedical evaluations can augment cardiovascular risk-stratification in CAD and PAD.
Clinicaltrials.gov identifier: NCT01776424.
Keywords: Cardiovascular outcomes; Cognitive functioning; Health status; Risk stratification.
In patients with heart and vascular disease, filling out quick standard test that evaluates your health status and completing a 2-min cognitive test that evaluates aspects such as speed and attention, reveals important information about your future heart and vascular risk. Lower scores on these tests were associated with a higher risk of dying from cardiovascular causes, risk of getting a heart attack, stroke, or amputation, even after controlling for many other known risk factors.These insights may help our understanding of who is at higher risk of future heart and vascular events, and may give us new angles for interventions that may help prevent this risk, such as whole person interventions improving physical fitness, mental health, and cognitive functioning.
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