Lifetime risk for developing CVD substantial

Even in men and women with an optimal CVD risk factor profile, the lifetime risk estimate for CVD is more than 30%, and is more than 50% for men and women overall, according to estimates from a new Journal of the American Medical Association study.

“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, and colleagues wrote.

John T. Wilkins

The study was conducted 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 years. Researchers analyzed a pooled survival analysis of data from 1964 through 2008 from five National Heart, Lung and Blood Institute-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study and Cardiovascular Health Study. All participants were free of CVD at study entry and had data on risk factors and total CVD outcomes, according to a press release.

Across all index ages, 1.7% to 7.9% of participants were in the all optimal risk factor group; however, more than 55% were in the one major or at least two major risk factor strata at all index ages.

Approximately 30% to 35% of participants experienced CVD events at some time during follow-up across all index age groups.

At an index age of 45 years, overall lifetime risk estimates for total CVD through age 95 years were 60.3% for men and 55.6% for women. Women had significantly lower lifetime risk estimates than men at all index ages, according to the press release.

At index ages of 55 and 65 years, lifetime risk estimates to age 95 years exceeded 50% for men and women with at least one elevated risk factor (BP 140-149/90-99 mm Hg; triglycerides 200-239 mg/dL), but no diabetes or smoking; those with one major risk factor; and those with at least two major risk factors (BP >160/100 mm Hg or related treatment; triglycerides >240 mg/dL or related treatment; diabetes; current smoking). At an index age of 55 years, participants with optimal risk factor profiles had remaining lifetime risks for total CVD that exceeded 40% and women had risks that approached 30% through age 85 years. An optimal risk factor profile included BP <120/80 mm Hg, triglycerides <180 mg/dL and no diabetes or smoking.

Participants with optimal risk factor levels had longer survival time free of total CVD when compared with those with at least two major risk factors, across all index ages.

“For example, at an index age of 45 years, individuals with optimal risk factor profiles lived up to 14 years longer free of total CVD than individuals with at least two risk factors,” the researchers wrote.

The researchers noted that “lifetime risks for total CVD were high regardless of index age, indicating that achieving older age free of total CVD does not guarantee an escape from remaining lifetime risk for total CVD.”

They added, “Maintenance of optimal risk factor levels in middle age was associated with substantially longer morbidity-free survival.”

For more information:

Wilkins JT. JAMA. 2012;308:1795-1801.

Disclosure: The researchers report no relevant financial disclosures.