Why the study?
The quantitative relationship of incident CVD to lifetime cumulative risk factor exposure is not well understood.
Does cumulative exposure to multiple risk factors over time increase the risk of incident cardiovascular disease in asymptomatic young adults?
Does cumulative exposure to multiple risk factors over time increase the risk of incident cardiovascular disease in asymptomatic young adults?
Cumulative lifetime exposure to multiple risk factors, including lipids and blood pressure, starting from young adulthood is independently associated with incident cardiovascular disease.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In the absence of randomized trial data in younger and middle-aged adults with low 10–30 year risk, the role of additional risk stratification tools—such as hsCRP and coronary artery calcium scoring—becomes critical in guiding individualized decisions about when to begin lipid-lowering pharmacoth...”
“The usual method is to calculate risk by risk factors measured at one point in time.... Even in clinical practice, we still keep working on risks factors measured at a specific day. I think we should really move towards this approach, because it brings new findings, new [perspectives], and new predictions.”
“These data make clear the importance of instituting risk-factor reduction strategies as early in life as is feasible to reduce time-related cumulative exposure to harmful risks. These results suggest that a self-declared Black racial status is a marker of underlying and unexplained differences in risk-factor impact.”
Supports earlier CVD prevention in young adults; leaves open cumulative exposure role in routine risk stratification pending RCTs.
BACKGROUND The quantitative relationship of incident cardiovascular disease (CVD) to lifetime cumulative risk factor exposure is not well understood. OBJECTIVES Using CARDIA (Coronary Artery Risk Development in Young Adults) study data, we examined the quantitative associations of cumulative exposure over time to multiple, simultaneously operating risk factors with CVD incidence and the incidence of its components. METHODS Regression models were developed quantifying the influence of the time course and severity of multiple CVD risk factors, operating simultaneously, on risk of incident CVD. The outcomes were incident CVD and the incidence of its components: coronary heart disease, stroke, and congestive heart failure. RESULTS Our study included 4,958 asymptomatic adults enrolled in CARDIA from 1985 to 1986 (ages 18 to 30 years) who were followed for 30 years. Risk of incident CVD depends on the time course and severity of a series of independent risk factors, the impact of which is mediated by their effects on individual CVD components after age 40 years. Cumulative exposure (AUC vs time) to low-density lipoprotein cholesterol and triglycerides was independently associated with risk of incident CVD. Of the blood pressure variables, areas under the mean arterial pressure vs time curve and the pulse pressure vs time curve were strongly and independently associated with incident CVD risk. CONCLUSIONS The quantitative description of the link between risk factors and CVD informs the construction of individualized CVD mitigation strategies, design of primary prevention trials, and assessment of public health impact of risk factor-based interventions.
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Domanski et al. (2023) studied this question.
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