Presence of risk factors at middle age defines future cardiovascular risk

Risk factors present at middle age define an individual’s lifetime risk for cardiovascular disease, according to results from a meta-analysis conducted by U.S. researchers.

Key Point: Risk factors present at middle age predict lifetime risk of cardiovascular disease, which reinforces the importance of preventive care.

As part of the Cardiovascular Lifetime Risk Pooling Project, 4 risk factors—hypertension, diabetes, hypercholesterolemia, and smoking—were assessed in a pooled analysis of 257,000 subjects followed for at least 10 years from 18 longitudinal studies performed over the past 50 years.

Cardiovascular diseases have assumed epidemic proportions in India, according to a review article published on behalf of the Indian Council of Medical Research in 2010. It’s estimated that at least 1.6 million people in India died in 2010 due to[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] coronary heart disease (CHD), and the overall burden of CHD in India is estimated to be more than 32 million patients. In addition, those numbers are steadily increasing.

In the recent U.S. study, marked differences in the lifetime risks of cardiovascular disease were observed across the different strata of risk factor burden. “Among men and women with an index age of 55 years, a higher burden of risk factors was associated with a higher lifetime risk of death from cardiovascular disease,” the authors wrote. “Lifetime risks tended to be very low among persons who had an optimal risk-factor profile at all index ages. Lifetime risks became substantially higher once any risk factor level or status was not considered to be optimal, with stepwise increases in remaining lifetime risk across groups with less favorable profiles for aggregate risk.”

For example, a 55 year-old man with no cardiovascular risk factors at age 55 had only a 4.7% lifetime risk of death from cardiovascular disease by age 80, and this risk was only 6.4% for women. With 2 or more risk factors by age 55, the risk of cardiovascular death by age 80 was 29.6% for men and 20.5% for women.

The presence of risk factors was more important than year of birth, the authors emphasize, such that among 55-year-old men with 2 or more major risk factors, “the 20-year adjusted risk of death from cardiovascular disease was only 4% lower among men born in or after 1920 than it was among those born before 1920 (16.8% vs. 20.7%), presumably reflecting the potential influences of subsequent treatment.”

Because of the importance of risk factor burden on future cardiovascular disease risk, reducing the burden of cardiovascular disease depends more on preventing the development of risk factors than treating risk factors once they develop, the authors stated.

Source: Berry JD, Dyer A, Cai X, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366:321-329.

Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: The need & scope. J Med Res. 2010;132:634-642.

Access the original journal information here:
http://www.nejm.org/doi/full/10.1056/NEJMoa1012848?query=TOC
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This entry was posted in Cardiology, Cardiovascular, Cardiovascular Disease, Diabetes, Hypertension, Non-Communicable Disease, Primary Care and tagged , , , , , , , , , . Volume: .

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