A Global View of the Relationships between the Main Behavioural and Clinical Cardiovascular Risk Factors in the GAZEL Prospective Cohort

PLoS One. 2016 Sep 6;11(9):e0162386. doi: 10.1371/journal.pone.0162386. eCollection 2016.


Although it has been recognized for a long time that the predisposition to cardiovascular diseases (CVD) is determined by many risk factors and despite the common use of algorithms incorporating several of these factors to predict the overall risk, there has yet been no global description of the complex way in which CVD risk factors interact with each other. This is the aim of the present study which investigated all existing relationships between the main CVD risk factors in a well-characterized occupational cohort. Prospective associations between 12 behavioural and clinical risk factors (gender, age, parental history of CVD, non-moderate alcohol consumption, smoking, physical inactivity, obesity, hypertension, dyslipidemia, diabetes, sleep disorder, depression) were systematically tested using Cox regression in 10,736 middle-aged individuals free of CVD at baseline and followed over 20 years. In addition to independently predicting CVD risk (HRs from 1.18 to 1.97 in multivariable models), these factors form a vast network of associations where each factor predicts, and/or is predicted by, several other factors (n = 47 with p<0.05, n = 37 with p<0.01, n = 28 with p<0.001, n = 22 with p<0.0001). Both the number of factors associated with a given factor (1 to 9) and the strength of the associations (HRs from 1.10 to 6.12 in multivariable models) are very variable, suggesting that all the factors do not have the same influence within this network. These results show that there is a remarkably extensive network of relationships between the main CVD risk factors which may have not been sufficiently taken into account, notably in preventive strategies aiming to lower CVD risk.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / physiopathology
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / genetics
  • Cardiovascular Diseases / physiopathology
  • Depression / complications
  • Depression / physiopathology
  • Diabetes Complications
  • Diabetes Mellitus / physiopathology
  • Dyslipidemias / complications
  • Dyslipidemias / physiopathology
  • Female
  • Heredity
  • Humans
  • Hypertension / complications
  • Hypertension / physiopathology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Obesity / complications
  • Obesity / physiopathology
  • Prognosis
  • Risk Factors
  • Sedentary Behavior
  • Sex Factors
  • Sleep Wake Disorders / complications
  • Sleep Wake Disorders / physiopathology
  • Smoking / adverse effects
  • Smoking / physiopathology

Grant support

The GAZEL Cohort Study was funded by EDF-GDF and the Institut National pour la Santé et la Recherche Médicale (INSERM), and received grants from the Cohortes Santé TGIR Program, Agence nationale de la recherche (ANR) and Agence française de sécurité sanitaire de l’environnement et du travail (AFSSET). The present analyses were funded by the Association Robert Debré pour la Recherche Médicale and by INSERM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.