Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men.

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.

[1]  W. Browner,et al.  Cholesterol screening guidelines. Consensus, evidence, and common sense. , 1997, Circulation.

[2]  S. Grundy,et al.  National Cholesterol Education Program recommendations for cholesterol testing in young adults. A science-based approach. , 1997, Circulation.

[3]  J. Larosa,et al.  Cholesterol screening guidelines consensus, evidence, and the departure from common sense. , 1997, Circulation.

[4]  Detection.  The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) , 1997 .

[5]  R. Califf,et al.  27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. , 1996, Journal of the American College of Cardiology.

[6]  D. Kromhout,et al.  Total cholesterol concentration and mortality at a relatively young age: Do men and women differ? , 1995, BMJ.

[7]  L. Coupal,et al.  Identifying adults at increased risk of coronary disease. How well do the current cholesterol guidelines work? , 1995, JAMA.

[8]  P Whelton,et al.  Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. , 1995, Hypertension.

[9]  V. Brezinka,et al.  Coronary heart disease risk factors in women. , 1994, European heart journal.

[10]  U. Ravnskov.  Doing the right thing: stop worrying about cholesterol. , 1994, Circulation.

[11]  J. A. Martin,et al.  ADVANCE REPORT OF FINAL NATALITY STATISTIC, 1992 , 1994 .

[12]  L. Berkman,et al.  Risk factors for coronary heart disease among older men and women: a prospective study of community-dwelling elderly. , 1993, American journal of epidemiology.

[13]  D T Lackland,et al.  Mortality rates and risk factors for coronary disease in black as compared with white men and women. , 1993, The New England journal of medicine.

[14]  J. Cleeman,et al.  Prevalence of high blood cholesterol among US adults. An update based on guidelines from the second report of the National Cholesterol Education Program Adult Treatment Panel. , 1993, JAMA.

[15]  J. Neaton,et al.  Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. , 1993, Archives of internal medicine.

[16]  H. Tyroler,et al.  Black-white comparisons of 20-year coronary heart disease mortality in the Evans County Heart Study. , 1993, Cardiology.

[17]  A. Dyer,et al.  Relationship of baseline major risk factors to coronary and all-cause mortality, and to longevity: findings from long-term follow-up of Chicago cohorts. , 1993, Cardiology.

[18]  A. Gotto,et al.  Serum cholesterol. Doing the right thing. , 1993, Circulation.

[19]  S. Yusuf,et al.  Report of the Conference on Low Blood Cholesterol: Mortality Associations , 1992, Circulation.

[20]  S. Hulley,et al.  Health policy on blood cholesterol. Time to change directions. , 1992, Circulation.

[21]  R. Clark.  Report of the expert panel on population strategies for blood cholesterol reduction , 1992 .

[22]  C. Isles,et al.  Relation between coronary risk and coronary mortality in women of the Renfrew and Paisley survey: comparison with men , 1992, The Lancet.

[23]  T. Manolio,et al.  Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop. , 1992, Annals of epidemiology.

[24]  M. Higgins,et al.  Cholesterol, coronary heart disease, and total mortality in middle-aged and elderly men and women in Tecumseh. , 1992, Annals of epidemiology.

[25]  C. Ford,et al.  Serum cholesterol and coronary heart disease risk in female and older hypertensives. The experience under usual community care in the Hypertension Detection and Follow-up Program. , 1992, Annals of epidemiology.

[26]  B. Littenberg,et al.  Costs and health consequences of cholesterol screening for asymptomatic older Americans. , 1991, Archives of internal medicine.

[27]  W. Kannel,et al.  Smoking and hypertension as predictors of cardiovascular risk in population studies. , 1990, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[28]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias , 1990, The Lancet.

[29]  D. Brunner,et al.  Multivariate analysis of the twenty-year follow-up of the Donolo-Tel Aviv Prospective Coronary Artery Disease Study and the usefulness of high density lipoprotein cholesterol percentage. , 1989, The American journal of cardiology.

[30]  A. Dyer,et al.  Major and minor electrocardiographic abnormalities and risk of death from coronary heart disease, cardiovascular diseases and all causes in men and women. , 1988, Journal of the American College of Cardiology.

[31]  P. Wolf,et al.  Cardiovascular risk factors, premature heart disease, and all-cause mortality in a cohort of northern California women. , 1988, American journal of obstetrics and gynecology.

[32]  R. D'Agostino,et al.  The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. , 1987, Circulation.

[33]  R. Fulwood,et al.  Coronary heart disease risk factor trends in blacks between the first and second National Health and Nutrition Examination Surveys, United States, 1971-1980. , 1984, American heart journal.

[34]  E. Barrett-Connor,et al.  The sex differential in mortality from all causes and ischemic heart disease. , 1983, American journal of epidemiology.

[35]  A. Dyer,et al.  Multivariate analysis of the relationship of seven variables to blood pressure: findings of the Chicago Heart Association Detection Project in Industry, 1967-1972. , 1975, Journal of chronic diseases.

[36]  A. Dyer,et al.  Multivariate analysis of the relationship of six variables to blood pressure: findings from Chicago community surveys, 1965--1971. , 1975, Journal of chronic diseases.