06729nas a2201369 4500008004100000022001400041245006600055210006500121260001500186300001000201490000800211520297400219653001003193653000903203653001603212653002203228653001103250653001103261653002003272653000903292653001603301653001403317653002603331653001703357653001103374110004003385700003003425700002103455700001903476700001903495700002503514700002103539700002303560700001303583700002003596700002103616700002303637700001903660700002103679700002003700700002403720700002303744700002803767700002003795700001603815700002403831700002103855700002003876700002203896700002103918700002003939700002203959700003003981700001804011700002204029700002304051700002904074700002004103700002104123700001504144700002504159700002104184700002304205700002104228700002204249700002504271700001804296700001604314700002304330700002504353700001804378700002004396700001904416700001904435700001704454700001904471700002404490700002304514700002604537700002104563700002204584700001804606700002104624700001904645700002504664700002204689700002204711700002504733700001904758700002104777700002004798700001804818700002204836700002204858700002004880700002004900700002104920700001804941700002404959700001904983700002205002700001905024700002105043700001805064700002505082700002105107700002105128700001605149700003205165700002205197700002305219700002205242700001905264700002305283700001705306856003605323 2015 eng d a1538-359800aAssociation of Cardiometabolic Multimorbidity With Mortality.0 aAssociation of Cardiometabolic Multimorbidity With Mortality c2015 Jul 7 a52-600 v3143 a
IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.
OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.
DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.
EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).
MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.
RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.
CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.
10aAdult10aAged10aComorbidity10aDiabetes Mellitus10aFemale10aHumans10aLife Expectancy10aMale10aMiddle Aged10aMortality10aMyocardial Infarction10aRisk Factors10aStroke1 aEmerging Risk Factors Collaboration1 aDi Angelantonio, Emanuele1 aKaptoge, Stephen1 aWormser, David1 aWilleit, Peter1 aButterworth, Adam, S1 aBansal, Narinder1 aO'Keeffe, Linda, M1 aGao, Pei1 aWood, Angela, M1 aBurgess, Stephen1 aFreitag, Daniel, F1 aPennells, Lisa1 aPeters, Sanne, A1 aHart, Carole, L1 aHåheim, Lise, Lund1 aGillum, Richard, F1 aNordestgaard, Børge, G1 aPsaty, Bruce, M1 aYeap, Bu, B1 aKnuiman, Matthew, W1 aNietert, Paul, J1 aKauhanen, Jussi1 aSalonen, Jukka, T1 aKuller, Lewis, H1 aSimons, Leon, A1 aSchouw, Yvonne, T1 aBarrett-Connor, Elizabeth1 aSelmer, Randi1 aCrespo, Carlos, J1 aRodriguez, Beatriz1 aVerschuren, W, M Monique1 aSalomaa, Veikko1 aSvärdsudd, Kurt1 aHarst, Pim1 aBjörkelund, Cecilia1 aWilhelmsen, Lars1 aWallace, Robert, B1 aBrenner, Hermann1 aAmouyel, Philippe1 aBarr, Elizabeth, L M1 aIso, Hiroyasu1 aOnat, Altan1 aTrevisan, Maurizio1 aD'Agostino, Ralph, B1 aCooper, Cyrus1 aKavousi, Maryam1 aWelin, Lennart1 aRoussel, Ronan1 aHu, Frank, B1 aSato, Shinichi1 aDavidson, Karina, W1 aHoward, Barbara, V1 aLeening, Maarten, J G1 aLeening, Maarten1 aRosengren, Annika1 aDörr, Marcus1 aDeeg, Dorly, J H1 aKiechl, Stefan1 aStehouwer, Coen, D A1 aNissinen, Aulikki1 aGiampaoli, Simona1 aDonfrancesco, Chiara1 aKromhout, Daan1 aPrice, Jackie, F1 aPeters, Annette1 aMeade, Tom, W1 aCasiglia, Edoardo1 aLawlor, Debbie, A1 aGallacher, John1 aNagel, Dorothea1 aFranco, Oscar, H1 aAssmann, Gerd1 aDagenais, Gilles, R1 aJukema, Wouter1 aSundström, Johan1 aWoodward, Mark1 aBrunner, Eric, J1 aKhaw, Kay-Tee1 aWareham, Nicholas, J1 aWhitsel, Eric, A1 aNjølstad, Inger1 aHedblad, Bo1 aWassertheil-Smoller, Sylvia1 aEngström, Gunnar1 aRosamond, Wayne, D1 aSelvin, Elizabeth1 aSattar, Naveed1 aThompson, Simon, G1 aDanesh, John uhttps://chs-nhlbi.org/node/6811