Impaired health-related quality of life is associated with subclinical atherosclerosis and cardiovascular risk factors in asymptomatic adult population

Background: Health-related quality of life (QoL) questionnaires represent easy-administered and useful tools in the medical clinical evaluation. An impaired health status seems to be associated with further cardiovascular (CV) events, but this role is not well established in the asymptomatic population. Purpose: The aim of our study was to determine whether low values of health status were associated with subclinical atherosclerosis and CV risk factors in a population free of CV diseases. Methods: In the current prospective study, 111 adults, aged 35-75, have been randomized from an urban general population. The persons were free of any CV diseases and medical treatment. General CV risk factor profile was evaluated in all participants. Subclinical atherosclerosis was determined by using various investigations: intima-media thickness by carotid ultrasound, aortic stiffness parameters (pulse wave velocity - PWV, augmentation indexes), left ventricular mass index by echocardiography. The health-related QoL was assessed by using the Short Form 36 Health Survey (SF-36) questionnaire whose results summed into eight scales and two major measures for physical and mental health assessment. Higher scores were correlated with better health status. Results: Mean age of participants was 51.87 ± 10.64. Women reported lower QoL levels on all scales, especially for physical functioning (PF) (p = 0.012) and mental health (MH) (p = 0.05). Obesity was negatively correlated with SF-36 parameters but particularly with physical role (RP) (r = -0.22; p = 0.02), general health (GH) (r = -0.20; p = 0.03) and the physical component summary (PCS) (r = -0.26; p = 0.005). Age, heart rate or blood pressure presented no correlations with SF-36 results. Among subclinical atherosclerosis markers, only aortic stiffness parameters correlated with decreased QoL. Increased aortic PWV was associated with lower levels on all survey scales. Furthermore, the augmentation indexes presented good relation with SF-36, especially for social functioning (SF). Moreover, by dividing subjects into two groups according to the PWV pathological limit (10 m/s), health status proved to be severely altered in the increased PWV group: RP (p = 0.012), GH (p = 0.044), SF (p = 0.045) and PCS (p = 0.05). Conclusions: Low QoL levels are associated with female gender, obesity and aortic stiffness parameters as markers of subclinical atherosclerosis. We recommend the use of easily-administered health status questionnaires in asymptomatic patients since they bring additional data on CV risk, starting with subclinical stages.