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Impact of cardiovascular risk factor control on long-term cardiovascular and all-cause mortality in the general
Emilie Bérard1, Vanina Bongard1, Jean Dallongeville2
1a Department of Epidemiology, Health Economics and Public Health , UMR1027 INSERM- Toulouse III University, Toulouse University Hospital (CHU) , Toulouse , France.
Insights
Controlling cardiovascular risk factors (CVRFs) is crucial for reducing long-term mortality. Failing to manage CVRFs significantly increases both all-cause and cardiovascular death risk in the general population.
Area of Science:
- Public Health
- Epidemiology
- Cardiology
Background:
- Clinical trials demonstrate that managing cardiovascular risk factors (CVRFs) lowers cardiovascular (CV) morbidity and mortality.
- The impact of controlling CVRFs at baseline on long-term mortality in the general population requires further assessment.
Purpose of the Study:
- To evaluate the effect of controlling CVRFs at baseline on long-term all-cause and CV mortality.
- To analyze the association between CVRF control status and mortality outcomes in a general population cohort.
Main Methods:
- Analysis of the Third French MONICA population-based survey (1994-1997) with 18-year vital status follow-up.
- Cox proportional hazards modelling was employed to assess mortality risks.
- Participants (n=3402, aged 35-64) were categorized by CVRF control status: no CVRFs, controlled CVRFs, one uncontrolled CVRF, and two or more uncontrolled CVRFs.
Main Results:
- Participants with one uncontrolled CVRF had a 1.38-fold increased risk of all-cause mortality (aHR=1.38, p=0.029).
- Those with two or more uncontrolled CVRFs faced a 1.80-fold increased risk of all-cause mortality (aHR=1.80, p<0.001).
- For CV mortality, the adjusted hazard ratios were 1.70 for one uncontrolled CVRF and 3.67 for two or more uncontrolled CVRFs compared to controlled groups.
Conclusions:
- Failure to control CVRFs significantly elevates long-term all-cause and CV mortality risk in the French general population.
- Only 30% of individuals with CVRFs achieved control, highlighting a gap in management.
- A residual mortality risk persisted even in patients with controlled CVRFs, indicating the need for comprehensive CV risk management strategies.
Purpose:
In clinical trials, lowering cardiovascular risk factors (CVRFs) reduces cardiovascular (CV) morbidity and mortality. We assessed the impact of controlling CVRFs at baseline on long-term all-cause and CV mortality in the general population.
Methods:
Analysis was based on the Third French MONICA population-based survey (1994-1997). Vital status was obtained 18 years after inclusion. Statistical analysis was based on Cox-modelling.
Results:
About 3402 participants aged 35-64 were included and 569 (17%) presented with 2 or more uncontrolled CVRFs, 1194 (35%) had one uncontrolled CVRF, 770 (23%) had all CVRFs controlled under treatment (or were former smokers) and 869 (25%) exhibited no CVRF. During the follow-up, 389 deaths occurred (76 were due to CV causes). Considering all-cause mortality, the adjusted hazard ratios (aHR) for subjects with one uncontrolled CVRF and for those with two or more were 1.38 [1.03-1.83] (p = 0.029) and 1.80 [1.33-2.43](p < 0.001), respectively, as compared with subjects presenting with all their CVRFs controlled. For subjects exhibiting no CVRF, the aHR was 0.66 [0.44-0.98] (p = 0.042). Considering CV mortality, aHRs for subjects presenting with one and two or more uncontrolled CVRF were 1.70 [0.84-3.42] (p = 0.138) and 3.67 [1.85-7.29] (p < 0.001), respectively, as compared with subjects who had either all their CVRFs controlled or exhibited no CVRF.
Conclusions:
Failing to control CVRFs significantly increases long-term all-cause and CV mortality in the French general population. Key messages Only 30% of patients with cardiovascular risk factors were controlled. Failing to control cardiovascular risk factors significantly increased long-term cardiovascular and all-cause mortality. A residual risk for all-cause mortality remained even when patients were controlled.
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