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Lifetime Risks of Cardiovascular Disease
Study Questions:
What are the lifetime risks of cardiovascular disease across a spectrum of ages?
Methods:
This was a meta-analysis using data from 18 cohort studies, which included black men and women and white men and women, including women whose cardiovascular risk factors were measured at ages 45, 55, 65, and 75 years of age. Data sets were included in the Cardiovascular Lifetime Risk Pooling Project if they met the following criteria: they represented either community-based or population-based samples or large volunteer cohorts, they included at least one baseline examination with direct measurement of physiological and anthropometric (e.g., weight) variables, and they included 10 or more years of follow-up for fatal or nonfatal cardiovascular events or both. Blood pressure, cholesterol level, smoking status, and diabetes status were used to stratify participants according to risk factors into five mutually exclusive categories. The remaining lifetime risks of cardiovascular events were estimated for participants in each category at each age, with death free of cardiovascular disease treated as a competing event.
Results:
A total of 257,384 men and women were included in this meta-analysis. Significant differences in lifetime risk of cardiovascular disease were observed across risk factor strata. Among participants who were 55 years of age, those with an optimal risk factor profile (total cholesterol level <180 mg/dl [4.7 mmol/L]; blood pressure <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking status; and nondiabetic status) had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors (4.7% vs. 29.6% among men, 6.4% vs. 20.5% among women). Those with an optimal risk factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal myocardial infarction (3.6% vs. 37.5% among men, <1% vs. 18.3% among women) and fatal or nonfatal stroke (2.3% vs. 8.3% among men, 5.3% vs. 10.7% among women). Similar trends within risk factor strata were observed among blacks and whites and across diverse birth cohorts.
Conclusions:
The authors concluded that differences in risk factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts.
Perspective:
This study supports the need for preventive care to start prior to the diagnosis of cardiovascular disease risk factors. It is likely that in addition to improving long-term survival, the number of cardiovascular disease risk factors is also inversely related to long-term quality-of-life measures.
Keywords: Myocardial Infarction, Coronary Disease, Risk Factors
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