Lifetime risks of cardiovascular disease

Abstract

Background: The lifetime risks of cardiovascular disease have not been reported across the age spectrum in black adults and white adults.

Methods: We conducted a meta-analysis at the individual level using data from 18 cohort studies involving a total of 257,384 black men and women and white men and women whose risk factors for cardiovascular disease were measured at the ages of 45, 55, 65, and 75 years. Blood pressure, cholesterol level, smoking status, and diabetes status were used to stratify participants according to risk factors into five mutually exclusive categories. The remaining lifetime risks of cardiovascular events were estimated for participants in each category at each age, with death free of cardiovascular disease treated as a competing event.

Results: We observed marked differences in the lifetime risks of cardiovascular disease across risk-factor strata. Among participants who were 55 years of age, those with an optimal risk-factor profile (total cholesterol level, <180 mg per deciliter [4.7 mmol per liter]; blood pressure, <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking status; and nondiabetic status) had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors (4.7% vs. 29.6% among men, 6.4% vs. 20.5% among women). Those with an optimal risk-factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal myocardial infarction (3.6% vs. 37.5% among men, <1% vs. 18.3% among women) and fatal or nonfatal stroke (2.3% vs. 8.3% among men, 5.3% vs. 10.7% among women). Similar trends within risk-factor strata were observed among blacks and whites and across diverse birth cohorts.

Conclusions: Differences in risk-factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts. (Funded by the National Heart, Lung, and Blood Institute.).

Figure 1. Lifetime Risk of Death from Cardiovascular Disease among Black Men and White Men at 55 Years of Age, According to the Aggregate Burden of Risk Factors and Adjusted for Competing Risks of Death

The risk-factor profile was considered optimal when a participant had a total cholesterol level of less than 180 mg per deciliter (4.7 mmol per liter) and untreated blood pressure of less than 120 mm Hg systolic and less than 80 mm Hg diastolic, was a nonsmoker, and did not have diabetes. It was considered not to be optimal for nonsmokers without diabetes who had a total cholesterol level of 180 to 199 mg per deciliter or untreated systolic blood pressure of 120 to 139 mm Hg or untreated diastolic blood pressure of 80 to 89 mm Hg. Levels of risk factors were viewed as elevated for nonsmokers without diabetes who had a total cholesterol level of 200 to 239 mg per deciliter (5.17 to 6.18 mmol per liter) or untreated systolic blood pressure of 140 to 159 mm Hg or untreated diastolic blood pressure of 90 to 99 mm Hg. Major risk factors were defined as current smoking, diabetes, treatment for hypercholesterolemia, an untreated total cholesterol level of at least 240 mg per deciliter (6.21 mmol per liter), and treatment for hypertension, untreated systolic blood pressure of at least 160 mm Hg, or untreated diastolic blood pressure of at least 100 mm Hg. The data were derived from the 17 studies in the pooled cohort; data from the Multiple Risk Factor Intervention Trial were not included.

Figure 2. Lifetime Risk of Death from Cardiovascular Disease among Black Women and White Women at 55 Years of Age, According to the Aggregate Burden of Risk Factors and Adjusted for Competing Risks of Death

The data were derived from the 17 studies in the pooled cohort; data from the Multiple Risk Factor Intervention Trial were not included.