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

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Few data exist regarding the association of risk factor burden in middle age with lifetime risks for cardiovascular disease (CVD) and non-CVD death. In this study, participants in the Chicago Heart Association Detection Project in Industry aged 40 to 59 years in 1967 to 1973 were stratified into 5 groups on the basis of risk factor burden: favorable risk factor profile (untreated blood pressure ≤120/≤80 mm Hg, total cholesterol <200 mg/dl, nonsmoking, and body mass index <25 kg/m2); 0 elevated but ≥1 unfavorable; or any 1, any 2, or ≥3 elevated (systolic ≥140 mm Hg or diastolic ≥90 mm Hg or treated hypertension; total cholesterol ≥240 mg/dl; current smoking; or body mass index ≥30 kg/m2). Remaining lifetime risks for CVD and non-CVD death were estimated through the age of 85 years. Eight thousand thirty-three men and 6,493 women were followed for 409,987 person-years; 2,582 died of CVD, and 3,955 died of non-CVD causes. A greater risk factor burden was associated with a higher incidence of 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 a lower lifetime risk for CVD death and markedly longer survival. These results should encourage efforts aimed at preventing the development of risk factors in younger subjects to decrease CVD mortality and promote longevity.

Section snippets

Study sample

The entry criteria and methods of the CHA study have been published previously.6 Briefly, from November 1967 to January 1973, the CHA study screened 39,523 men and women aged ≥18 years of varied socioeconomic backgrounds and ethnicities employed at 84 Chicago-area businesses and organizations. As previously reported in detail, standardized examination methods were used.7, 8 Trained staff members measured supine blood pressure using a standard mercury sphygmomanometer and serum total cholesterol

Study sample

The study sample included 8,033 men and 6,493 women aged 40 to 59 years, including 414 black men and 368 black women. During 409,987 person-years of follow-up, there were 2,582 deaths due to CVD and 3,955 non-CVD deaths. Table 1 lists the numbers of men and women and the number of CVD deaths during follow-up in each stratum of risk factor burden. Overall, 17.5% of men and 23.3% of women had favorable risk factor profiles or no elevated risk factors, whereas >75% of men and women had ≥1 elevated

Discussion

In this large cohort, we observed that men and women with favorable risk factor profiles in middle age had low remaining lifetime risk for CVD death and prolonged survival. In contrast, greater risk factor burden in middle age was associated with higher risk for CVD and non-CVD death. Despite the higher competing risk for non-CVD death in those with greater CVD risk factor burdens in middle age, remaining lifetime risk for CVD death was substantially higher and median overall survival

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    This study was supported by the American Heart Association, Dallas, Texas, and its Chicago and Illinois affiliates; by Grants R01-HL 15174, R01-HL 21010, and R01-HL 03387 from the National Heart, Lung, and Blood Institute, Bethesda, MD; and by the Chicago Health Research Foundation, Chicago, Illinois.

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