Risk Factor Burden in Middle Age and Lifetime Risks for Cardiovascular and Non-Cardiovascular Death (Chicago Heart Association Detection Project In Industry)

摘要

Data are sparse regarding the association of risk factor burden in middle age with lifetime risks for cardiovascular disease (CVD) and non-CVD death. We straitified participants of the Chicago Heart Association Detection Project in Industry aged 40 to 59 years in 1967–1973 into 5 groups based on risk factor burden: favorable risk factor profile (untreated blood pressure ≤120/≤80 mm Hg, total cholesterol <200 mg/dL, non-smoking, and body mass index [BMI] <25 kg/m²); 0 elevated but ≥1 unfavorable; or any 1, any 2, or ≥3 elevated (systolic ≥140 or diastolic ≥90 mm Hg, or treated hypertension; total cholesterol ≥240 mg/dL; current smoking; or BMI ≥30 kg/m²). We estimated remaining lifetime risks for CVD and non-CVD death through age 85 years. We followed 8033 men and 6493 women for 409,987 person-years; 2582 died of CVD and 3955 died of non-CVD causes. Greater risk factor burden was associated with higher incidence of both CVD and non-CVD death. Compared with participants with ≥3 risk factors, those with favorable profiles had substantially lower lifetime risks for CVD death (20.5% vs. 35.2% in men, 6.7% vs. 31.9% in women) and markedly longer median Kaplan-Meier survival (>35 vs. 26 years in men, >35 vs. 28 years in women). In conclusion, having favorable risk factors in middle age is associated with lower lifetime risk for CVD death and markedly longer survival. These results should encourage efforts aimed at preventing development of risk factors in younger individuals to decrease CVD mortality and promote longevity.