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Risk Factor Clusters and Cardiovascular Disease in High-Risk Patients: The UCC-SMART Study
Emily I Holthuis1, Frank L J Visseren2, Michiel L Bots1
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL.
Insights
Clustering of cardiovascular risk factors significantly increases the risk of cardiovascular disease (CVD) and all-cause mortality in high-risk patients. Combinations involving smoking and hypertension pose the greatest danger, highlighting the need for targeted interventions.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Vascular risk factor clustering, defined as the presence of two or more risk factors, is linked to increased cardiovascular disease (CVD) risk in the general population.
- Understanding these patterns in high-risk individuals is crucial for effective disease prevention and management.
Purpose of the Study:
- To investigate the patterns of cardiovascular risk factor clustering in high-risk patients.
- To determine the association between these clusters and the risk of recurrent CVD and all-cause mortality.
- To identify specific combinations of risk factors with the highest associated risks and calculate population attributable fractions (PAFs).
Main Methods:
- Analysis of 12,616 patients from the Utrecht Cardiovascular Cohort - Second Manifestations of ARTerial diseases (UCC-SMART) study.
- Construction of sixteen clusters based on four modifiable risk factors: hypertension, dyslipidemia, current smoking, and overweight.
- Utilized Cox proportional hazard models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk and all-cause mortality, with PAFs computed.
Main Results:
- A high prevalence of risk factor clustering was observed: 11.4% had one, 32.0% had two, 44.8% had three, and 10.4% had four risk factors.
- Hazard ratios for CVD risk and all-cause mortality increased with the number of risk factors, reaching 3.74 (95% CI 1.77; 7.93) for four factors.
- The smoking-hypertension-dyslipidemia cluster showed the highest HR (4.06), while hypertension-dyslipidemia had the highest PAF (37.1%).
Conclusions:
- Risk factor clustering is prevalent in high-risk cardiovascular patients and significantly elevates the risk of CVD and all-cause mortality.
- Clusters involving smoking and hypertension were associated with the highest risks.
- These findings underscore the importance of addressing multiple risk factors concurrently in high-risk populations.
Background:
Clustering of vascular risk factors, i.e., the co-existence of two or more risk factors, has been associated with a higher risk of cardiovascular disease (CVD) in the general population. This study aims to firstly, examine patterns of clustering of major cardiovascular risk factors in high-risk patients and their relation with the risk of recurrent cardiovascular disease and all-cause mortality. Secondly, to assess which combinations are associated with the highest risk of CVD and all-cause mortality and to study population attributable fractions.
Methods:
A total of 12,616 patients from the Utrecht Cardiovascular Cohort - Second Manifestations of ARTerial diseases (UCC-SMART) study consisting of patients with or a high risk to develop cardiovascular disease were studied. We constructed sixteen clusters based on four individual modifiable risk factors (hypertension, dyslipidemia, current smoking, overweight). Patients were followed from September 1997 to March 2017. Cox proportional hazard models were used to compute adjusted hazard ratios for CVD risk and all-cause mortality and 95% confidence intervals for clusters, with patients without any risk factor as reference group. The population attributable fractions (PAFs) were calculated. Subgroup analyses were conducted by age and sex.
Results:
During a mean follow-up period of 8.0 years, 1836 CVD events were registered. The prevalence of patients with zero, one, two, three, and four risk factors was 1.4, 11.4, 32.0, 44.8 and 10.4%. The corresponding hazard ratios (HR) for CVD risk and all-cause mortality were 1.65 (95% CI 0.77; 3.54) for one risk factor, 2.61 (1.24; 5.50) for two, 3.25 (1.55; 6.84) for three, and 3.74 (1.77; 7.93) for four risk factors, with patients without any risk factor as reference group. The PAFs were 6.9, 34.0, 50.1 and 22.2%, respectively. The smoking-hypertension-dyslipidemia combination was associated with the highest HR: 4.06 (1.91; 8.63) and the hypertension-dyslipidemia combination with the highest PAF: 37.1%.
Conclusion:
Clusters including smoking and hypertension contributed to the highest risk of CVD and all-cause mortality. This study confirms that risk factor clustering is common among patients at high-risk for CVD and is associated with an increased risk of CVD and all-cause mortality.
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