Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age

Area of Science:

• Cardiovascular Disease Epidemiology
• Preventive Cardiology
• Longitudinal Cohort Studies

Background:

• Lifetime risk for atherosclerotic cardiovascular disease (CVD) has not been previously estimated.
• The impact of risk factor burden on lifetime CVD risk remains unknown.

Purpose of the Study:

• To estimate the lifetime risk of CVD from age 50 to 95.
• To determine the effect of cardiovascular risk factor burden on lifetime CVD risk and survival.

Main Methods:

• Analysis of Framingham Heart Study participants free of CVD at age 50.
• Estimation of lifetime risks to age 95, with death free of CVD as a competing event.
• Follow-up of 3564 men and 4362 women for 111,777 person-years.

Main Results:

• At age 50, lifetime CVD risks were 51.7% for men and 39.2% for women.
• Individuals with optimal risk factor levels had substantially lower lifetime risks (5.2% in men, 8.2% in women) and longer median survivals (>39 years).
• Conversely, those with multiple risk factors faced higher risks (68.9% in men, 50.2% in women) and shorter survivals.

Conclusions:

• Absence of CVD risk factors at age 50 is linked to very low lifetime CVD risk and longer survival.
• These findings support preventive efforts targeting risk factor development in younger individuals.
• Data can inform risk communication and intensive preventive therapy for those with intermediate or high risk factor burden at age 50.