Cardiovascular Risk Factors in Middle Age Have Long-Term Consequences

People with one or more risk factors for cardiovascular disease (CVD) in middle age are significantly more likely to suffer a major cardiovascular event, such as heart attack or stroke, for decades afterwards, a large-scale analysis of previous studies indicates.

“We found that the presence of elevated levels of risk factors at all ages translated into markedly higher lifetime risks of cardiovascular disease across the lifespan,” the researchers write in their article, which was published online yesterday in the New England Journal of Medicine.

The researchers used data from 18 cohort studies involving a total of 257,384 men and women to survey the subjects’ risk factors for cardiovascular disease at age 45, 55, 65, and 75. The researchers sorted the participants into five mutually exclusive categories according to blood pressure, cholesterol level, smoking status, and diabetes status.

Optimal cardiovascular health was found in those who did not smoke, did not have diabetes, and had cholesterol below 180 mg per deciliter and blood pressure below 120 mm Hg systolic and 80 mm Hg diastolic.

The researchers calculated the remaining lifetime risks of cardiovascular events for the participants in each category at each age and found significant differences in lifetime expectancy according to CVD risk factors.

Those with optimal cardiovascular health at age 45 had a significantly lower chance of suffering a major CVD event (1.4% for men and 4.1% for women) through age 80 compared with those who had two or more risk factors at age 45 (49.5% for men and 30.7% for women).

Those with two or more major risk factors at age 55 were six times more likely to die from CVD (29.6% for men and 20.5% for women) compared with those who were in optimal cardiovascular health at age 55 (4.7% for men and 6.4% for women).

The researchers also found that, compared with those who had two or more CVD risk factors at age 55, individuals in optimal cardiovascular health at the same age had decreased 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).

“We believe these findings have important implications for clinical disease prevention and public health practice,” the researchers write, as the “present estimates of lifetime risk, made on the basis of current or projected risk-factor levels, may be important in estimating the future burden of cardiovascular disease in the general population.”