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Elevated Risk Factors Linked to Major Cardiovascular Disease Events



According to an article published in the New England Journal of Medicine (2012;366:321-329), an NIH-supported project analyzed data from 18 population-based studies, involving over 250,000 people. In one of the largest-ever analyses of lifetime risks for cardiovascular disease (CVD), it was found that middle-aged adults who have one or more elevated traditional risk factors for CVD, such as high blood pressure, have a substantially greater chance of having a major CVD event, such as heart attack or stroke, during their remaining lifetime than people with optimal levels of risk factors. This NIH-supported study used health data from 257,384 people and was the first to look simultaneously at multiple risk factors for CVD across age, gender, race, and birth generation.


According to Susan B. Shurin, M.D., acting director of the NIH’s National Heart, Lung, and Blood Institute, the paper adds to the substantial body of evidence that modifiable cardiovascular disease risk factors in healthy men and women heavily influence the likelihood of developing cardiovascular disease later in life, regardless of their backgrounds.


As part of the Cardiovascular Lifetime Risk Pooling Project, investigators analyzed 50 years of data from 18 existing cohort, or population-based, studies in the United States. The investigators pooled the data from the 18 cohorts and measured traditional CVD risk factors – including high blood pressure, high cholesterol levels, diabetes, and smoking status – in men and women from both black and white populations at ages 45, 55, 65, and 75 years.


Results showed that men who were 55 years old with at least two major risk factors were six times as likely to die from CVD by age 80 as were men with none or one CVD risk factor (29.6% vs. 4.7%). Women with at least two major risk factors were three times as likely to die from CVD as were women with no or one CVD risk factor (20.5% vs. 6.4%).


When all CVD events – fatal and non-fatal – were considered, the results were even more striking. Forty-five-year-old men with two or more risk factors had a 49.5% chance of having a major CVD event through age 80, while 45-year-old women had a 30.7% chance. On the other hand, men with optimal risk factor levels only had a 1.4% chance of having a major CVD event, while women had a 4.1% chance of having a major CVD event through age 80.


The results from each individual study were consistent with one another and with those of the pooled group, and showed that traditional risk factors predicted a person’s long-term development of CVD more than age. All of the risk factors appeared to carry the same levels of risk as they did 20, 30, or 40 years ago. While black Americans had a higher prevalence of CVD risk factors than white Americans, their lifetime risks were similar when their risk factor profiles were similar.


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