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(Stroke. 1998;29:2329-2333.)
© 1998 American Heart Association, Inc.

Original Contributions

Stroke Was Predicted by Dimensions of Quality of Life in Treated Hypertensive Men

Stefan Agewall, MD, PhD; John Wikstrand, MD, PhD; Björn Fagerberg, MD, PhD

From the Department of Medicine and Wallenberg Laboratory for Cardiovascular Research (J.W.), Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden.

Correspondence to Stefan Agewall, MD, PhD, Department of Medicine, Sahlgrenska University Hospital, Göteborg University, S-413 45 Gothenburg, Sweden. E-mail agewall{at}ss.gu.se

Background and Purpose—Psychosocial factors have been suggested as risk factors for atherosclerotic disease. The purpose of the present study was to examine whether quality of life predicted strokes and acute coronary events in a prospective study.

Methods—The study included 412 treated hypertensive men, aged 50 to 72 years, with 1 of the following: serum cholesterol 6.5 mmol/L, smoking, or diabetes mellitus. The Minor Symptoms Evaluation Profile (MSEP) was used to estimate quality of life at entry. Incidences of stroke and acute coronary events were recorded during follow-up. The median follow-up time was 6.6 years.

Results—Sixty-four patients had an acute coronary event, and 37 had a stroke during the follow-up period. The Cox regression analyses revealed that the 3 dimensions of MSEP at entry were significant predictors of stroke. The relationship between low contentment at entry and the incidence of stroke during follow-up remained significant (relative risk=1.04; 95% CI, 1.01 to 1.06; P=0.003) even after adjustment for other potential cardiovascular risk factors. Vitality also remained an independent predictor for stroke after adjustment for these potential cardiovascular risk factors (relative risk=1.04; 95% CI, 1.02 to 1.06; P<0.0001). There was no relationship between MSEP score at entry and myocardial infarction during follow-up.

Conclusions—An independent and significant association between reduced well-being at entry and future stroke was observed in hypertensive men at high cardiovascular risk. The causal relationship is not known, however.

Key Words: psychiatric status rating scales • quality of life • risk factors • social support • stroke

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