Lifetime Risk and Years Lived Free of Total Cardiovascular Disease

Study Questions:

What are the lifetime risk estimates for total cardiovascular disease (CVD) by age and risk factor strata?

Methods:

Pooled survival data from five National Heart, Lung, and Blood Institute–funded community-based cohorts were used for the present analysis. These cohorts included Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study, and Cardiovascular Health Study. A total of 905,115 person-years from 1964 through 2009 was included. All participants were free of CVD at baseline and had information on risk factors including blood pressure (BP), total cholesterol, diabetes, smoking status as well as CVD outcomes. Risk factors were defined as optimal (BP <120 and <80 mm Hg, and total cholesterol <180 dl, and no diabetes and no smoking); one or more not optimal (BP 120-139 or 80-89 mm Hg, or total cholesterol 180-199 dl, and no diabetes and no smoking); one or more elevated (BP 140-159 or 90-99 mm Hg or treated hypertension, total cholesterol 200-230 dl, no diabetes and no smoking); one major (BP ≥160 or ≥100 mm Hg, or total cholesterol ≥240 dl, or diabetes or smoking); and two or more major (BP 140-159 or 90-99 mm Hg or treated hypertension, and/or total cholesterol ≥240 dl, and/or diabetes and/or smoking). The primary outcome of interest was total CVD events including fatal and nonfatal coronary heart disease, all forms of stroke, congestive heart failure, and other CVD deaths.

Results:

At the age of 45 years, the overall lifetime risk for total CVD was 60.3% (95% confidence interval [CI], 59.3%-61.2%) for men and 55.6% (95% CI, 54.5%-56.7%) for women. Men were observed to have higher risk across all age groups compared to women. At index ages 45, 55, and 65 years, the lifetime risk for total CVD through age 95 years exceeded 50% in participants with one major or at least two major risk factors for men and women. Lifetime risks for total CVD were more than 40% for men and more than 30% for women with one or more not optimal risk factor levels at index ages 55 and 65 years. Despite an optimal risk factor profile, men and women at the index age of 55 years had lifetime risks (through 85 years of age) for total CVD of >40% and 30%, respectively. Compared with participants with at least two major risk factors, those with an optimal risk factor profile lived up to 14 years longer free of total CVD.

Conclusions:

The investigators concluded that lifetime risk estimated for total CVD is high, even among men and women with optimal risk factors in middle age. However, optimal risk factors were associated with significantly longer survival.

Perspective:

This detailed analysis of existing data highlights the high prevalence of total CVD in this country. Data such as these are important to use in the planning of prevention efforts and in the estimation of health care costs as our population ages.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Hypertension, Smoking

Keywords: Stroke, Atherosclerosis, Blood Pressure, Risk Factors, Smoking, Prevalence, Cholesterol, Chicago, Cardiology, Heart Failure, Cardiovascular Diseases, United States, Diabetes Mellitus, Hypertension


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