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Risk factors measured in middle-aged men predicting coronary events in geriatric age
Alessandro Menotti1, Paolo Emilio Puddu2
1Association for Cardiac Research, - Associazione per la Ricerca Cardiologica, Rome, Italy.
Insights
Major coronary risk factors predict heart disease for 30-40 years. A single measurement of factors like smoking and blood pressure remains significant into older age.
Area of Science:
- Cardiology
- Epidemiology
- Preventive Medicine
Background:
- Coronary heart disease (CHD) poses a significant public health challenge.
- Identifying the long-term predictive power of traditional risk factors is crucial for effective prevention strategies.
Purpose of the Study:
- To determine how long major coronary risk factors, measured once in middle-aged men, predict the incidence and mortality of coronary heart disease (CHD).
- To analyze the predictive duration over a 50-year follow-up period.
Main Methods:
- Utilized data from 1677 CHD-free men (aged 40-59) from the Italian Rural Areas of the Seven Countries Study, enrolled in 1960.
- Measured baseline age, cigarette smoking, systolic blood pressure, and serum cholesterol.
- Employed partitioned Cox proportional hazards models for sequential 10-year periods over 50 years of follow-up.
Main Results:
- Risk factors like smoking, blood pressure, and cholesterol showed increasing predictive trends for CHD incidence and mortality for the first 30-40 years.
- A decline in predictive association was observed after 30-40 years, particularly for serum cholesterol.
- Model analysis confirmed a loss of predictive power beyond 30-40 years, even with interaction terms.
Conclusions:
- A single assessment of major coronary risk factors retains predictive association with CHD incidence and mortality for at least 30-40 years.
- These risk factors remain relevant into the gerontologic age, underscoring the importance of long-term risk assessment.
Objectives:
To explore the duration of the predictive power of major coronary risk factors measured on a single occasion in middle aged men for the occurrence of coronary heart disease (CHD) incidence and mortality during 50years of follow-up.
Material And Methods:
In the Italian Rural Areas of the Seven Countries Study 1677 CHD-free men aged 40-59 were enrolled in 1960 and age, cigarette smoking, systolic blood pressure and serum cholesterol were measured. During 50years of follow-up 1641 men died, 451 had a major fatal or non-fatal CHD event (incidence) and 263 died from CHD. Five partitioned Cox proportional hazards models were computed, one for each independent and subsequent 10-year period. Five 10-year partitioned hazard scores, derived from multivariable coefficients, were cumulated for each risk factor and plotted against time.
Results:
The resulting curves showed increasing time trends for CHD incidence and mortality as a function of cigarette smoking, systolic blood pressure and serum cholesterol for the first 30-40years followed by a decline in the association that was more evident for serum cholesterol. The curves fit straight lines with large correlation coefficient ranging 0.82 to 0.99. The loss of predictive power after 30-40years was confirmed in a model covering 50years of follow-up and including the interaction term of risk factors/time.
Conclusion:
A single measurement of major coronary risk factors is associated with CHD incidence and mortality for at least 30-40years of follow-up, entering the gerontologic age.
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