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A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease
Michihiro Satoh1, Takayoshi Ohkubo2,3, Kei Asayama2,3
1Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University.
Insights
High blood pressure and cholesterol significantly increase lifetime risk of coronary heart disease (CHD) mortality in Asian adults. Early lifestyle changes are crucial for high-risk individuals.
Area of Science:
- Cardiovascular Epidemiology
- Public Health
- Preventive Medicine
Background:
- Lifetime risk (LTR) quantifies the absolute risk of developing a disease over an individual's remaining life.
- Assessing LTR for coronary heart disease (CHD) mortality linked to blood pressure (BP) and total cholesterol is vital for preventive strategies.
- Previous studies have not comprehensively evaluated these combined risks in Asian populations.
Purpose of the Study:
- To determine the lifetime risk (LTR) of coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels.
- To analyze these risks in an Asian population using a meta-analysis of individual participant data.
- To provide data for guiding high-risk individuals toward early interventions.
Main Methods:
- Meta-analysis of individual participant data from 105,432 Japanese individuals across 13 cohorts.
- Defined 'normal BP' as <130/<80 mmHg and 'high BP' as 130-139/80-89 mmHg, excluding grade 1 and 2-3 hypertension.
- Estimated sex-specific LTR, accounting for the competing risk of death.
Main Results:
- Over a mean 15-year follow-up, 889 CHD deaths occurred.
- The LTR of CHD mortality at age 35 significantly increased with higher BP in individuals with high total cholesterol (≥5.7 mmol/L).
- Men/women with grade 2-3 hypertension and high cholesterol faced LTRs of 7.73%/5.77%; differences were minimal in normal/high BP groups without high cholesterol.
Conclusions:
- Elevated total cholesterol levels exacerbate the lifetime risk of CHD mortality, particularly in hypertensive individuals.
- Findings highlight the importance of managing both BP and cholesterol for cardiovascular health.
- These insights can inform targeted lifestyle modifications and treatments for young individuals at high risk.
Aim:
Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk.
Methods:
We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP ＜130/＜80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death.
Results:
During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women.
Conclusions:
High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
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