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Lifetime CVD risk significant even for healthy people

Tuesday November 6, 2012
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Even in men and women with an optimal cardiovascular disease risk factor profile, the lifetime risk estimate for CVD is greater than 30%, and is more than 50% for men and women overall, according to a study.

In background information for the study, which appears in the Nov. 7 issue of the Journal of the American Medical Association, the authors noted that "to date, there have been no published data on the lifetime risk for total CVD. Estimates of lifetime risk for total CVD may provide projections of the future population burden of CVD and may assist in clinician-patient risk communication."

John T. Wilkins, MD, MS, of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a study to estimate lifetime risk for total CVD in separate models for men and women overall and by aggregate risk factor burden at index ages of 45, 55, 65 and 75.

The study consisted of a pooled survival analysis of data from 1964 through 2008 from five National Heart, Lung, and Blood Institute-funded community-based cohorts (the Framingham Heart Study, the Framingham Offspring Study, the Atherosclerosis Risk in Communities Study, the Chicago Heart Association Detection Project in Industry Study and the Cardiovascular Health Study). The primary outcome measure for the study was any total CVD event (including fatal and nonfatal coronary heart disease, all forms of stroke, heart failure and other CVD deaths).

Across all index ages, 1.7% to 7.9% of individuals were in the group with all optimal risk factors. In contrast, more than 55% of individuals across all index ages had either one or two major risk factors. At some time during follow-up across all index age groups, approximately 30% to 35% of individuals experienced CVD events.

The researchers found that at an index age of 45, overall lifetime risk estimates for total CVD through age 95 were 60.3% for men and 55.6% for women. Women had significantly lower lifetime risk estimates than men at all index ages.

At index ages 55 and 65, men and women with either at least one elevated risk factor (BP, 140-149/90-99 mm Hg; or total cholesterol, 200-239 mg/dL; but no diabetes or smoking), one major risk factor (BP, 160/100 mm Hg or greater or receiving treatment; TC, 240 mg/dL or greater or receiving treatment; diabetes mellitus; or current smoking), or two or more major risk factors had lifetime risk estimates to age 95 that exceeded 50%.

At an index age of 55, men with optimal risk factor profiles (BP less than 120/80 mm Hg; TC less than 180 mg/dL; and no smoking or diabetes) had remaining lifetime risks for total CVD that exceeded 40%, and women had risks that approached 30% through age 85.

Longer survival time free of total CVD was experienced by individuals with optimal risk factor levels when compared with participants with at least two major risk factors across all index ages. For example, at an index age of 45, individuals with optimal risk factor profiles lived up to 14 years longer free of total CVD than individuals with at least two risk factors.

"Lifetime risks for total CVD were high regardless of index age, indicating that achieving older age free of total CVD does not guarantee escape from remaining lifetime risk for total CVD," the authors wrote.

They concluded that the finding of a substantial lifetime CVD risk even among individuals with an optimal risk factor profile highlights "the large public health burden and opportunities for prevention of total CVD."

In addition to publication in JAMA, the study was presented Nov. 5 in Los Angeles at the American Heart Associationís Scientific Sessions. The study abstract is available at http://jama.jamanetwork.com/article.aspx?articleid=1389613.


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