October 12, 1998

Impact of Major Cardiovascular Disease Risk Factors, Particularly in Combination, on 22-Year Mortality in Women and Men

Structured PICO

Do combinations of major cardiovascular disease risk factors increase long-term mortality in women and men?

Population

19,189 adults (8,686 women and 10,503 men) aged 40 to 64 years at baseline from the Chicago Heart Association Detection Project in Industry

Intervention

Presence of 1, 2, or 3 major cardiovascular disease risk factors (elevated cholesterol, elevated blood pressure, smoking)

Comparator

Desirable levels for all 3 major risk factors (cholesterol <5.20 mmol/L [<200 mg/dL], systolic BP <120 mm Hg, diastolic BP <80 mm Hg, and nonsmoking)

Outcome

Coronary heart disease mortality, cardiovascular disease mortality, and all-cause mortalityhard clinical

Combinations of major cardiovascular disease risk factors place both women and men at high relative and absolute risk of coronary heart disease, cardiovascular disease, and all-cause mortality over a 22-year period.

Abstract

BACKGROUND: The appropriateness of current cardiovascular disease (CVD) risk factor guidelines in women continues to be debated. OBJECTIVE: To present new data on the appropriateness of current CVD risk factor guidelines, for women and men, from long-term follow-up of a large population sample. METHODS: Cardiovascular disease risk factor status according to current clinical guidelines and long-term impact on mortality were determined in 8686 women and 10503 men aged 40 to 64 years at baseline from the Chicago Heart Association Detection Project in Industry; average follow-up was 22 years. RESULTS: At baseline, only 6.6% of women and 4.8% of men had desirable levels for all 3 major risk factors (cholesterol level, <5.20 mmol/L <200 mg/dL; systolic and diastolic blood pressure, <120 and <80 mm Hg, respectively; and nonsmoking). With control for age, race, and other risk factors, each major risk factor considered separately was associated with increased risk of death for women and men. In analyses of combinations of major risk factors, risk increased with number of risk factors. Relative risks (RRs) associated with any 2 or all 3 risk factors were similar: for coronary heart disease mortality in women, RR= 5.72 (95% confidence interval CI, 2.35-13.93), and in men, RR = 5.51 (95% CI, 3.10-9.77); for CVD mortality in women, RR = 4.54 (95% CI, 2.33-8.84), and in men, RR = 4.12 (95% CI, 2.56-6.37); and for all-cause mortality in women, RR = 2.34 (95% CI, 1.73-3.15), and in men, RR = 3.20 (95% CI, 2.47-4.14). Absolute excess risks were high in women and men with any 2 or all 3 major risk factors. CONCLUSIONS: Combinations of major CVD risk factors place women and men at high relative, absolute, and absolute excess risk of coronary heart disease, CVD, and all-cause mortality. These findings support the value of (1) measurement of major CVD risk factors, especially in combination, for assessing long-term mortality risk and (2) current advice to match treatment intensity to the level of CVD risk in both women and men.

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