03609nas a2200397 4500008004100000022001400041245007200055210006900127260001600196300001300212490000800225520257600233653001002809653000902819653001902828653002802847653001902875653002202894653001102916653001602927653001102943653002602954653000902980653001602989653001403005653000903019653001703028653001203045100002103057700001803078700001803096700001603114700001803130700002703148856003603175 2012 eng d a1538-359800aLifetime risk and years lived free of total cardiovascular disease.0 aLifetime risk and years lived free of total cardiovascular disea c2012 Nov 07 a1795-8010 v3083 a

CONTEXT: Estimates of lifetime risk for total cardiovascular disease (CVD) may provide projections of the future population burden of CVD and may assist in clinician-patient risk communication. To date, no lifetime risk estimates of total CVD have been reported.

OBJECTIVES: To calculate lifetime risk estimates of total CVD by index age (45, 55, 65, 75 years) and risk factor strata and to estimate years lived free of CVD across risk factor strata.

DESIGN, SETTING, AND PARTICIPANTS: Pooled survival analysis of as many as 905,115 person-years of data from 1964 through 2008 from 5 National Heart, Lung, and Blood Institute-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study, and Cardiovascular Health Study. All participants were free of CVD at baseline with risk factor data (blood pressure [BP], total cholesterol [TC], diabetes, and smoking status) and total CVD outcome data.

MAIN OUTCOME MEASURES: Any total CVD event (including fatal and nonfatal coronary heart disease, all forms of stroke, congestive heart failure, and other CVD deaths).

RESULTS: At an index age of 45 years, overall lifetime risk for total CVD was 60.3% (95% CI, 59.3%-61.2%) for men and 55.6% (95% CI, 54.5%-56.7%) for women. Men had higher lifetime risk estimates than women across all index ages. At index ages 55 and 65 years, men and women with at least 1 elevated risk factor (BP, 140-149/90-99 mm Hg; or TC, 200-239 mg/dL; but no diabetes or smoking), 1 major risk factor, or at least 2 major risk factors (BP, ≥160/100 mm Hg or receiving treatment; TC, ≥240 mg/dL or receiving treatment; diabetes mellitus; or current smoking) had lifetime risk estimates to age 95 years that exceeded 50%. Despite an optimal risk factor profile (BP, <120/80 mm Hg; TC, <180 mg/dL; and no smoking or diabetes), men and women at the index age of 55 years had lifetime risks (through 85 years of age) for total CVD of greater than 40% and 30%, respectively. Compared with participants with at least 2 major risk factors, those with an optimal risk factor profile lived up to 14 years longer free of total CVD.

CONCLUSIONS: Lifetime risk estimates for total CVD were high (>30%) for all individuals, even those with optimal risk factors in middle age. However, maintenance of optimal risk factor levels in middle age was associated with substantially longer morbidity-free survival.

10aAdult10aAged10aBlood Pressure10aCardiovascular Diseases10aCohort Studies10aDiabetes Mellitus10aFemale10aForecasting10aHumans10aKaplan-Meier Estimate10aMale10aMiddle Aged10aMorbidity10aRisk10aRisk Factors10aSmoking1 aWilkins, John, T1 aNing, Hongyan1 aBerry, Jarett1 aZhao, Lihui1 aDyer, Alan, R1 aLloyd-Jones, Donald, M uhttps://chs-nhlbi.org/node/5861