Number and burden of cardiovascular diseases in relation to health-related quality of life in a cross-sectional population-based cohort study

OBJECTIVES: To clarify whether a greater number of cardiovascular diseases or a larger burden of disease are associated with poorer health-related quality of life (HRQoL) in an unselected general population. DESIGN: A population-based cross-sectional postal survey. SETTINGS: A random sample of the Swedish general population aged 40–79 years matched for national distributions of age, gender and region. PARTICIPANTS: Out of 6969 eligible individuals, 4910 (70.5%) participated. PRIMARY AND SECONDARY MEASURES: To create a reference database for HRQoL outcomes in the general population. To assess certain diseases and their relation to HRQoL. METHODS: Predefined cardiovascular diseases and HRQoL were assessed from validated questionnaires (EORTC QLQ-C30). Aspects of HRQoL included in the analyses were global quality of life, physical function, role function, emotional function, fatigue and dyspnoea. Individuals were categorised into: ‘good function’ versus ‘poor function’ and ‘no or minor symptoms’ versus ‘symptomatic’. Multivariable logistic regression calculated OR with 95% CI for poor HRQoL. The exposures were the number of cardiovascular diseases and the subjective disease burden. RESULTS: Out of the 4910 participants, 1358 (28%) reported having a cardiovascular disease and hypertension was most common. Reporting a greater number of cardiovascular diseases was associated with an increased risk of poor HRQoL, especially regarding dyspnoea. The OR for symptomatic dyspnoea was 1.37 (95% CI 1.08 to 1.74) for participants with one cardiovascular disease, 4.81 (95% CI 3.24 to 7.13) for two diseases and 4.18 (95% CI 2.24 to 7.80) for those with three or more cardiovascular diseases. Among the 271 participants who assessed their cardiovascular disease burden as major, the highest risk for poor HRQoL was found for physical function (OR 6.18, 95% CI 3.72 to 10.30). CONCLUSIONS: Increased number of cardiovascular diseases and a greater burden of disease are generally associated with poorer HRQoL in people with cardiovascular disease from an unselected population.