Open Access Research article

Self-perceived physical health predicts cardiovascular disease incidence and death among postmenopausal women

Nazmus Saquib1*, Robert Brunner2, Jessica Kubo3, Hilary Tindle4, Candyce Kroenke5, Manisha Desai3, Martha L Daviglus6, Norrina Allen6, Lisa W Martin7, Jennifer Robinson8 and Marcia L Stefanick1

Author Affiliations

1 Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA

2 University of Nevada, Reno, NE, USA

3 Quantitative Sciences Unit, General Medical Disciplines, Department of Medicine, Stanford University, Stanford, CA, USA

4 School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

5 Oakland Kaiser Permanente, Oakland, CA, USA

6 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

7 George Washington University, Washington DC, USA

8 University of Iowa, Iowa City, IA, USA

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BMC Public Health 2013, 13:468  doi:10.1186/1471-2458-13-468

Published: 14 May 2013



Physical and Mental Component Summary (PCS, MCS, respectively) scales of SF- 36 health-related-quality-of-life have been associated with all-cause and cardiovascular disease (CVD) mortality. Their relationships with CVD incidence are unclear. This study purpose was to test whether PCS and/or MCS were associated with CVD incidence and death.


Postmenopausal women (aged 50–79 years) in control groups of the Women’s Health Initiative clinical trials (n = 20,308) completed the SF-36 and standardized questionnaires at trial entry. Health outcomes, assessed semi-annually, were verified with medical records. Cox regressions assessed time to selected outcomes during the trial phase (1993–2005).


A total of 1075 incident CVD events, 204 CVD-specific deaths, and 1043 total deaths occurred during the trial phase. Women with low versus high baseline PCS scores had less favorable health profiles at baseline. In multivariable models adjusting for baseline confounders, participants in the lowest PCS quintile (reference = highest quintile) exhibited 1.8 (95%CI: 1.4, 2.3), 4.7 (95%CI: 2.3, 9.4), and 2.1 (95%CI: 1.7, 2.7) times greater risk of CVD incidence, CVD-specific death, and total mortality, respectively, by trial end; whereas, MCS was not significantly associated with CVD incidence or death.


Physical health, assessed by self-report of physical functioning, is a strong predictor of CVD incidence and death in postmenopausal women; similar self-assessment of mental health is not. PCS should be evaluated as a screening tool to identify older women at high risk for CVD development and death.

Physical component summary; Mental component summary; Cardiovascular disease; All-cause death