Key result
Cardiovascular multimorbidity develops in 16% of women, most commonly ischemic heart disease and AF.
Why the study?
Common patterns and incidence of cardiovascular multimorbidity are not well described, particularly in women.
Cardiovascular multimorbidity is highly common in women, with over 60% of those developing a specific cardiovascular disease eventually developing at least one other, highlighting the need for comprehensive cardiovascular management.
May warrant holistic CVD care in women; extends subtype data but leaves open intervention effects.
Objective Cardiovascular multimorbidity (CVM) is the co-occurrence of multiple cardiovascular disease subtypes (CVDs) in one person. Because common patterns and incidence of CVM are not well-described, particularly in women, we conducted a descriptive study of CVM in the Million Women Study, a large population-based cohort of women. Methods UK women aged 50–64 years were followed up using hospital admissions and mortality records for an average of 19 years. CVM was defined as having ≥2 of 19 selected CVDs. The age-specific cumulative incidence of CVM between age 60 and 80 years was estimated. The numbers and proportions of individual, pairs and other combinations of CVDs that comprised incident CVM were calculated. For each individual CVD subtype, age-standardised proportions of the counts of other co-occurring CVDs were estimated. Results The age-specific likelihood of having CVM nearly doubled every 5 years between age 60 and 80 years. Among 1.2 million women without CVD at study baseline, 16% (n=196 651) had incident CVM by the end of follow-up. Around half of all women with CVM had a diagnosis of ischaemic heart disease (n=102 536) or atrial fibrillation (n=96 022), almost a third had heart failure (n=72 186) and a fifth had stroke (n=40 442). The pair of CVDs with the highest age-adjusted incidence was ischaemic heart disease and atrial fibrillation (18.95 per 10 000 person-years). Over 60% of individuals with any given CVD subtype also had other CVDs, after age standardisation. Conclusions CVM is common. The majority of women with any specific CVD subtype eventually develop at least one other. Clinical and public health guidelines for CVD management should acknowledge this high likelihood of CVM.
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Suh et al. (2023) studied this question. Among 1.2 million women, 16% developed cardiovascular multimorbidity by the end of follow-up, with ischaemic heart disease and atrial fibrillation most common.
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