Favorable Cardiovascular Risk Profile in Young Women and Long-term Risk of Cardiovascular and All-Cause Mortality

Abstract

Context For women, impact of cardiovascular risk factors measured in young adulthood, particularly favorable (low-risk) profile, on mortality has been difficult to assess due to low short-term death rates. Objective To assess the relationship of baseline coronary risk factor status to mortality from coronary heart disease (CHD), cardiovascular diseases (CVDs), and all causes in young women. Design Prospective cohort study. Setting and Participants A total of 7302 women aged 18 to 39 years without prior CHD or major electrocardiographic abnormalities screened between 1967 and 1973 for the Chicago Heart Association Detection Project in Industry. Risk groups were defined using national guidelines for values of systolic and diastolic blood pressure, serum cholesterol level, body mass index, presence of diabetes, and smoking status. Participants were divided into 4 groups: low risk, 0 risk factors high but 1 or more unfavorable, 1 only risk factor high, and 2 or more risk factors high. Main Outcome Measures All-cause mortality, CHD mortality, and CVD mortality; hazard ratio of outcome measures comparing low-risk group with other groups. Results Only 20% met low-risk criteria; 59% had high levels of 1 or more risk factors. During an average follow-up of 31 years, there were 47 CHD deaths, 94 CVD deaths, and 469 deaths from all causes. The age-adjusted CVD death rate per 10000 person-years was lowest for low-risk women and increased with the number of risk factors, ie, 1.5, 1.7, 5.0, and 9.1 for low-risk; 0, 1, and 2 or more risk factors high, respectively. Multivariate-adjusted CVD mortality hazard ratio for low-risk women was 0.19 (95% confidence interval, 0.08-0.45) compared with women with 2 or more risk factors high. Similar patterns were observed for CHD and all-cause mortality and for both blacks and whites. Conclusion For women with favorable levels for all 5 major risk factors at younger ages, CHD and CVD are rare; long-term and all-cause mortality are much lower compared with others.

Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART‐REACH Model

“…In the primary prevention setting, lifetime estimates have been shown to identify patients most likely to benefit from treatment at a much earlier age 11, 13, 14, 17, 32, 33, 34. The present study demonstrates that this likely also applies to patients with established cardiovascular disease.…”

Cardiovascular risk factor trends and options for reducing future coronary heart disease mortality in the United States of America

“…This figure would represent a 96% decrease in the 388 000 CHD deaths observed in 2000 1,3 and is somewhat larger than the 85% reduction predicted by other studies. 24,25 Although probably an overestimate, the results for this third scenario show an aspirational ideal to highlight potential future gains. However, the low-risk stratum in the population of the United States remains frustratingly small, even when defined only by smoking, blood pressure and blood cholesterol: 6% in the 1970s 32 and, even now, only 7.5% among whites and 4% among African Americans.…”

“…In the third scenario, mean population risk factors were assumed to drop to the levels already observed in the "healthiest" stratum of cohorts in the United States, as defined by Stamler et al 24 and Daviglus et al 25 Levels for specific risk factors were as follows: (i) no smoking among men or women; (ii) mean total cholesterol of 175.6 mg/ dl (4.54 mmol/l) for men and 179.6 mg/ dl (4.64 mmol/l) for women; (iii) mean systolic blood pressure of 115.7 mmHg for men and 114.7 mmHg for women, representing a 10 mmHg reduction from 2000 levels; (iv) a mean BMI of 25.5 kg/m² for men and 23.6 kg/m² for women; and (v) zero prevalence of diabetes among both men and women. 24,25 Physical activity was not specifically considered in these studies, 24,25 so we defined the level in the lowest risk stratum as 100%, with everyone undertaking some leisure-time physical activity (Table 3).…”

“…24,25 Physical activity was not specifically considered in these studies, 24,25 so we defined the level in the lowest risk stratum as 100%, with everyone undertaking some leisure-time physical activity (Table 3).…”

Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age

“…Adults who reach middle age with ideal blood pressure, cholesterol, and blood glucose levels (ie, the ideal cardiovascular health [CVH] profile) and without cardiovascular disease (CVD) enjoy exceedingly long life spans in good health1, 2, 3, 4, 5, 6, 7, 8, 9; however, very few US adults retain the ideal CVH profile as they age 10. The American Heart Association (AHA) identified 4 lifestyle components—optimal body mass index (BMI), diet and physical activity patterns, and nonsmoking status—as important components of CVH 11.…”