Risk factor heterogeneity across cardiovascular disease outcomes in treatment-eligible hypertensive patients

Objective: Prediction of specific cardiovascular outcomes may facilitate precision medicine in hypertension. We aimed to explore risk factor heterogeneity for acute coronary syndrome (ACS), stroke and heart failure in treatment-eligible hypertensive patients. Methods: In this population-based cohort study in Västerbotten, Sweden, middle-aged patients with treatment-eligible hypertension were included. Association between traditional cardiovascular risk factors and ACS, stroke and heart failure was studied. Multinomial logistic regression was performed to determine standardized odds ratios. Results: Over a 10-year period, there were 1190 cardiovascular events in 12 238 participants. Risk factor associations were mainly of the same direction but differed in magnitude across cardiovascular outcomes. Total cholesterol was significantly associated with ACS, but not with heart failure and stroke. Smoking and male sex were more strongly associated with ACS than with heart failure and stroke. BMI and socioeconomic factors were significantly associated with heart failure, but not with ACS and stroke. Diabetes and DBP had stronger associations with stroke compared to ACS and heart failure. Conclusion: We found clinically important differences in the association between different risk factors and ACS, stroke and heart failure in treatment-eligible hypertensive patients. The current model was insufficient to guide treatment decisions but should stimulate further research into risk factor heterogeneity between cardiovascular disease outcomes.