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Cardiovascular disease and all-cause mortality associated with individual and combined cardiometabolic risk factors
Xue Cao1, Linfeng Zhang1, Xin Wang1
1Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China.
Insights
Managing cardiometabolic risk factors like hypertension and diabetes significantly reduces cardiovascular disease (CVD) and mortality. Addressing these conditions collectively is crucial for preventing CVD and improving life expectancy.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) risk is linked to cardiometabolic factors, but their attributable burden is not fully understood.
- Limited evidence exists on the impact of individual and combined risk factors on CVD and mortality.
- Quantifying these associations is essential for public health strategies.
Purpose of the Study:
- To investigate and quantify the associations of cardiometabolic risk factors with CVD and all-cause mortality.
- To determine the population attributable fraction (PAF) for CVD and mortality.
- To calculate the loss of CVD-free years and life expectancy associated with these risk factors.
Main Methods:
- Included 22,596 participants (≥35 years) without baseline CVD.
- Utilized Cox regression to analyze associations between hypertension, diabetes, high LDL-C, and outcomes.
- Followed participants for CVD events and mortality until 2018/2019.
Main Results:
- Increased hazard ratios for CVD and mortality were observed with one, two, or three risk factors.
- Diabetes and hypertension combined accounted for 21.48% of CVD and 15.38% of all-cause mortality.
- Individuals with three risk factors aged 40-60 lost ~4.3 years of life expectancy.
Conclusions:
- Cardiometabolic risk factors multiplicatively increase CVD incidence and mortality risk.
- Comprehensive management of hypertension, diabetes, and dyslipidemia is vital for CVD prevention.
- Addressing combined risk factors can significantly improve population health outcomes.
Background:
Previous studies have investigated the association between cardiometabolic risk factors and cardiovascular disease (CVD), but evidence of the attributable burden of individual and combined cardiometabolic risk factors for CVD and mortality is limited. We aimed to investigate and quantify the associations and population attributable fraction (PAF) of cardiometabolic risk factors on CVD and all-cause mortality, and calculate the loss of CVD-free years and years of life lost in relation to the presence of cardiometabolic risk factors.
Methods:
Twenty-two thousand five hundred ninety-six participants aged ≥ 35 without CVD at baseline were included between October 2012 and December 2015. The outcomes were the composite of fatal and nonfatal CVD events and all-cause mortality, which were followed up in 2018 and 2019 and ascertained by hospital records and death certificates. Cox regression was applied to evaluate the association of individual and combined cardiometabolic risk factors (including hypertension, diabetes and high low-density lipoprotein cholesterol (LDL-C)) with CVD risk and all-cause mortality. We also described the PAF for CVD and reductions in CVD-free years and life expectancy associated with different combination of cardiometabolic conditions.
Results:
During the 4.92 years of follow-up, we detected 991 CVD events and 1126 deaths. Hazard ratio were 1.59 (95% confidential interval (CI) 1.37-1.85), 1.82 (95%CI 1.49-2.24) and 2.97 (95%CI 1.85-4.75) for CVD and 1.38 (95%CI 1.20-1.58), 1.66 (95%CI 1.37-2.02) and 2.97 (95%CI 1.88-4.69) for all-cause mortality, respectively, in participants with one, two or three cardiometabolic risk factors compared with participants without diabetes, hypertension, and high LDL-C. 21.48% of CVD and 15.38% of all-cause mortality were attributable to the combined effect of diabetes and hypertension. Participants aged between 40 and 60 years old, with three cardiometabolic disorders, had approximately 4.3-year reductions life expectancy compared with participants without any abnormalities of cardiometabolic disorders.
Conclusions:
Cardiometabolic risk factors were associated with a multiplicative risk of CVD incidence and all-cause mortality, highlighting the importance of comprehensive management for hypertension, diabetes and dyslipidemia in the prevention of CVD.
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