The present study aimed to investigate the association between CVDs and HRQoL in Tehranian men and women who participated in the TLGS. The findings indicate that HRQoL scores were significantly lower in participants with CVDs incident compared to those without CVDs. In addition, a sex-specific pattern was observed for the association between CVDs and HRQoL. While the impairment of HRQoL scores was observed in mental dimensions of HRQoL in women; in men, this impairment was more pronounced in physical dimension of HRQoL.
According to the findings of the current study, HRQoL scores were significantly lower in those with history of CVDs compared to those without history of CVDs. Consistent with our findings, several studies in different countries reported impairments in HRQoL in patients who experienced CVD outcomes compared to their healthy counterparts (8, 11, 21, 23, 37, 38). Similarly, findings of a study conducted in Tehran, Iran, indicated HRQoL scores in all physical and mental subscales were significantly lower in men and women who suffered from MI compared to healthy individuals, with physical subscales more impaired than mental ones (39). Experiencing CVDs is often accompanied with several health consequences such as limitations in physical function, physical disabilities, decreased social interactions, psychological distress such as anxiety and stress, decreased vitality, early retirement due to inability to work, pain and fatigue, shortness of breath, and sleep disturbances; all of which can negatively impact various aspects of HRQoL (12, 40–42).
In the current study, a sex specific pattern was observed in the association between CVDs and HRQoL. In terms of HRQoL subscale scores, impairment of HRQoL in men with CVDs was more prominent in physical subscales; while in women with CVDs, lower HRQoL scores were observed in all mental subscales and to less extent in physical subscales compared to their counterparts without CVDs. There were greater impairments in HRQoL in women compared to men. One possibility for this sex difference may be due to lower compatibility with disease and slower recovery from illnesses in women in comparison to men, ultimately leading to more impairments in HRQoL (43, 44). Another explanation for lower HRQoL scores could be related to factors such as age, psychosocial characteristics, and baseline health-related quality of life scores which have been found to be important predictors of HRQoL in CVD survivors (20). Existing evidence indicate that women develop CVDs in older age, they suffer from depression more often than men, and had lower HRQoL scores compared to their male counterparts. Furthermore, another study found that social support is a significant determinant of HRQoL in female cardiac patients specifically in the mental dimension of HRQoL (45). In the TLGS general population, perceived social support from family was significantly lower in women compared to men (46). If social support is a significant determinant of HRQoL, it makes sense that women in this study experienced lower HRQoL than men, who perceived greater social support from family in their lives.
Furthermore, in the current study in the adjusted models, the chances of reporting poor physical HRQoL in men and poor mental HRQoL in women were significantly higher in those with CVDs compared to their counterparts. Related existing evidence has indicated that mood disorders, psychosomatic and psychological symptoms have been reported more in women with cardiovascular outcomes (47) compared to men, which may exacerbate the mental dimension of HRQoL in women. Despite the higher prevalence of myocardial infarction in men, women appear to have a similar or slightly higher prevalence of stable angina (48). Studies have shown that women are more likely to have non-obstructive coronary artery disease, whereas men have more obstructive coronary artery disease and multivessel involvement in angiographic studies than women in the population referred with acute coronary syndrome (49, 50). These findings justify the reduction of invasive therapeutic interventions in women and the lower risk of developing refractory angina and rehospitalization for unstable angina and ultimately improving their prognosis (51, 52). On the other hand, following the higher prevalence of MI in men, they are more likely to have HFrEF (heart failure with reduced ejection fraction). But regardless of its type either HFpEF(Heart failaure with preserved ejection fraction) or HFrEF(Heart failaure with reduced ejection fraction), women showed to have a better therapeutic response, maybe because compensatory responses at the cellular or molecular level appear to be more effective in women than in men (49, 53) which may contribute to the lower score of physical HRQoL in men.
A strength of this study is the large sample size, which allows for more accurate findings and interpretations. In addition, the use of the SF-12 questionnaire, one of the most common and popular tools for assessing HRQoL in general populations, make the findings of this study more directly comparable to those of other countries that use the same questionnaire. This study also has limitations related to its generalizability and design. Since the participants of this study were all residents of Tehran, a large urban city, the findings cannot be generalized to broader rural or sub-urban communities in Iran. Lastly, the cross-sectional design of the study precludes causal inferences in the relationship between CVDs and HRQoL.