Risk Factors for Atherosclerotic Cardiovascular Outcomes in Different Arterial Territories

BACKGROUND: The major cardiovascular risk factors adversely affect all vascular territories, increasing the vulnerability to multiple clinical manifestations of atherosclerosis. PATIENTS: The population at risk was the Farmingham cohort of 5209 men and women assessed bienially for the development of overt events of coronary heart disease (CHD), congestive heart failure, intermittent claudication, and atheroembolic brain infarction. RESULTS: In persons younger than 65 years, all the major risk factors were found to impact significantly on the incidence of coronary heart disease and intermittent claudication. For stroke and cardiac failure, all but the serum cholesterol level were important. In those older than 65 years, serum total cholesterol levels and smoking no longer influenced the incidence of coronary heart disease. The ratio of total- to high-density-lipoprotein-cholesterol levels, however, was related to all cardiovascular outcomes except stroke at all ages. The impact of cigarette smoking on stroke and intermittent claudication persisted in advanced age. CONCLUSION: Modification of risk factors for the purpose of preventing a particular cardiovascular event should also prevent other outcomes. The impact of any particular risk factor on any atherosclerotic cardiovascular disease outcome is profoundly influenced by the frequent coexistence of other risk factors. A correct appraisal of the hazard and urgency for treatment is best obtained from a cardiovascular risk profile estimating the conditional probability of an event given the existing constellation of factors.