Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease: Sex and Gender Differences: The TWIST (Tweesteden Mild Stenosis) Study.

BACKGROUND: Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population. METHODS AND RESULTS: In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age-decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group. CONCLUSIONS: In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01788241.

Reliability of World Health Organization's Quality of Life-BREF versus Short Form 36 Health Survey questionnaires for assessment of quality of life in patients with coronary artery disease.

OBJECTIVE: The objective of this study was to ascertain the reliability and predictive power of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF) and Short Form 36 Health Survey questionnaire (SF-36) in coronary artery disease patients. METHODS: Between May and September 2006, patients with coronary artery disease hospitalized in Tehran Heart Center were divided randomly into two groups of 268 patients (for assessment of QOL with the SF-36 questionnaire) and 275 patients (for assessment of QOL with the WHOQOL-BREF questionnaire). Cronbach's alpha coefficient was used to test reliability of the two questionnaires and a value of 0.7 or higher was considered satisfactory. RESULTS: For the SF-36 and the WHOQOL-BREF questionnaires, Cronbach's alpha was 0.825 and 0.701, respectively, both of which exceeded 0.7. In SF-36 questionnaire, with the deletion of four items in the scales of mental health (1), role limitation - physical (16), and bodily pain (19), Cronbach's alpha was significantly increased. Also, in the BREF questionnaire, deletion of each of items 3, 4, 8, 9, 22, and/or 26 led to an increase in Cronbach's alpha. CONCLUSION: Although the WHOQOL-BREF questionnaire is a reliable tool for the evaluation of QOL in coronary artery disease patients, its reliability was significantly lower than that of the SF-36 questionnaire and thus it can be less applicable than SF-36 for this purpose.