Original articleHealth-related quality of life with coronary heart disease prevention and treatment
Introduction
Several pharmacoeconomic studies have estimated the cost-effectiveness of dyslipidemia treatment to prevent coronary heart disease (CHD) 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. However, these analyses were limited by the lack of comprehensive and standardized information on the preference-based health-related quality of life (HRQOL) for CHD and dyslipidemia.
Dyslipidemia may be associated with lower HRQOL due to rigid dietary prescriptions, side effects of medications, and the need for regular medical follow-up [11]. Several other aspects of the diagnosis and treatment of dyslipidemia may cause adverse psychologic responses [12]. For example, people may confuse a risk factor with actual disease and consider themselves as unhealthy (labeling effect). The inherent biologic variability of the blood cholesterol level may be a source of frustration and misunderstanding for patients. In addition, the dietary efforts to reduce the cholesterol level are not uniformly effective and may cause disappointment, confusion, and a sense of failure.
Few studies have investigated the impact of detecting and treating dyslipidemia on HRQOL. Forrow et al. conducted a prospective study on 1052 voluntary participants involved in a cholesterol screening program and found that people classified as being at high risk of CHD had increased worry and concern about health [13]. Havas et al. could not identify a negative labeling effect as a result of a community-based screening, education, and referral programs [14]. However, their negative results were attributable to the positive and supportive approach taken by the research team. In another screening study by Irvine and Logan [15], no psychological effects of screening were observed but approximately half of the participants did not believe they actually had hypercholesterolemia despite being told otherwise. In the Beaver Dam Health Outcomes Study, no significant impairment was observed when comparing the HRQOL of participants taking dyslipidemia medication (n = 78) with the other participants [16]. However, this study was limited by the small number of dyslipidemia subjects.
This study was therefore conducted to measure, using a standardized methodology and a large sample size, the preference of asymptomatic individuals with and without dyslipidemia and symptomatic patients with CHD for their current health. We have chosen a patient-center preference assessment because people experiencing the health states may produce more accurate appreciation of their conditions and are more likely to capture the possible subtle effect of dyslipidemia on HRQOL [17].
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Study population
We interviewed consecutive outpatients attending cardiology, internal medicine, lipid, and hypertension clinics, accompanying friends and family members of consecutive patients undergoing day surgery, and hospital workers in two university teaching hospitals. Approvals from the Institutional Review Boards were obtained and participants signed an informed consent. Participants were also offered the possibility of winning cash prizes in a lottery to encourage study participation.
Subjects were
Results
We approached 2786 individuals. A total of 781 refused or were unable to participate and 1127 did not comply with the eligibility criteria due to: language difficulties (146), temporary illness (172), pregnancy (4), trying to quit smoking (81), congestive heart failure without a loop diuretic (2), coronary diseases < 6 months (25), dyslipidemia < 1 month (3), age outside the appropriate range (106) and/or subjects with significant comorbid conditions (717). A total of 878 interviews were
Discussion
In this study asymptomatic participants who declared having high blood cholesterol confirmed by a physician and receiving cholesterol-lowering treatment [diet with or without lipid-lowering drug(s)] reported a small reduction in HRQOL on the SF-36 General Health scale and the RS, when compared to a similar group of asymptomatic participants without dyslipidemia and who were not treated for their cholesterol. No significant differences were observed on the TTO and SG. These results may indicate
Acknowledgements
Dr. Lalonde was a Ph.D. student supported by the National Health Research and Development Program and the Fonds FCAR. She is now a post-doctoral fellow supported by the Medical Research Council of Canada (MRC). Drs. Clarke, Grover and Joseph are research scientists (Chercheur-boursier) supported by the Fonds de la recherche en santé du Québec (FRSQ). The authors thank Robert Darsigny and Martine LeComte for their assistance in recruiting and interviewing participants, Nadine Bouchard for her
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Including: LE Cassidy, MD, L Green, MD, D Larochelle, DT.P., R Motchula, DT.P., J McCans, MD, PJ McLeod, MD, R Repa Fortier, DT.P., JA Stewart, MD from The Montreal General Hospital, and DW Blank, MD, F Charbonneau, MD, BM Gilfix, MD, PhD, M Sami, MD, MH Sherman, MD, and M Smilovitch, MD from the Royal Victoria Hospital, Montreal, Quebec, Canada.