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Risk Factors for Recurrent Cardiovascular Events Before Age 65 Years or Within 2.5 Years of a Recent First
M Johanneke van den Berg1, Jan Westerink1, Yolanda van der Graaf2
1Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Smoking, diabetes, and high blood pressure increase the risk of recurrent cardiovascular events in younger patients. Intensive management of modifiable risk factors is crucial for preventing these events.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide.
- Identifying modifiable risk factors for recurrent events is critical for improving patient outcomes.
- Previous studies have focused on general populations, with less emphasis on specific age groups or short-term recurrence risks.
Purpose of the Study:
- To quantify the association between classical cardiovascular risk factors and the risk of recurrent major atherosclerotic cardiovascular events (MACE).
- To analyze this association in two distinct patient groups: those aged under 60 with recurrent MACE under 65 years, and those experiencing recurrent MACE within 2.5 years after a first event.
Main Methods:
- Utilized data from the prospective Second Manifestations of Arterial Disease study, including 5,115 patients with a recent first cardiovascular event.
- Employed survival analysis to assess the relationship between risk factors (smoking, diabetes, BMI, waist circumference, blood pressure, lipids) and recurrent MACE.
- Calculated hazard ratios (HR) and 95% confidence intervals (CI) to determine the significance of these associations.
Main Results:
- In patients <60 years, smoking (HR 1.43), diabetes (HR 1.83), high diastolic blood pressure (HR 1.54), and low HDL cholesterol (HR 1.34) were linked to increased recurrent MACE risk.
- In the overall cohort, smoking (HR 1.65), physical inactivity (HR 1.48), higher BMI (HR 1.04), high diastolic blood pressure (HR 1.61), elevated LDL cholesterol (HR 1.18), and non-HDL cholesterol (HR 1.15) were associated with recurrent MACE within 2.5 years.
Conclusions:
- Smoking, elevated blood pressure, and adverse lipid profiles significantly increase the risk of recurrent cardiovascular events in patients with recent events, particularly in younger individuals and within a short timeframe.
- Intensive management of modifiable risk factors like smoking cessation, blood pressure control, and lipid management is essential for preventing recurrent MACE in these high-risk patients.
Abstract:
The aim of this study was to quantify the relation between classical risk factors (smoking, diabetes, BMI, waist circumference, blood pressure, and lipids), risk factor targets, and risk of recurrent major atherosclerotic cardiovascular events (MACE). This was first done for recurrent MACE ≤65 years in patients aged <60 years and second for recurrent MACE ≤2.5 years after a first cardiovascular event. Data were used from the Second Manifestations of Arterial Disease study (n = 5,115), a prospective cohort of patients with a recent (≤1 year) first cardiovascular event. During follow-up, 746 recurrent MACE occurred. Smoking (hazard ratio [HR] 1.43, 95% CI 1.11 to 1.84), diabetes (HR 1.83, 95% CI 1.11 to 1.84), diastolic blood pressure (>90 vs 70 to 90 mm Hg, HR 1.54, 95% CI 1.15 to 2.07), and high-density lipoprotein cholesterol (≤1.0 vs >1.0 mmol/L, HR 1.34, 95% CI 1.03 to 1.76) were related to increased risk of recurrent MACE ≤65 years in patients aged <60 years. Smoking (HR 1.65, 95% CI 1.23 to 2.22), physical inactivity (highest vs lowest tertile, HR 1.48, 95% CI 1.05 to 2.09), body mass index (per kg/m2, HR 1.04, 95% CI 1.00 to 1.08), diastolic blood pressure (>90 vs 70 to 90 mm Hg, HR 1.61, 95% CI 1.17 to 2.21), low-density lipoprotein cholesterol (per mmol/L, HR 1.18, 95% CI 1.02 to 1.37), and non-high-density lipoprotein cholesterol (per mmol/L, HR 1.15, 95% CI 1.03 to 1.28) were related to recurrent MACE ≤2.5 years of follow-up. In conclusion, in patients with a recent cardiovascular event, smoking, blood pressure, and lipids are related to increased risk of recurrent cardiovascular events at young age or within a short time span, and intensive treatment of modifiable risk factors may contribute to prevent recurrent MACE in these patients.
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