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.