Cardiovascular Disease Incidence and Risk Factor Contributions in Adults Aged 45 to 59 Years With Low 10-Year and...

The American Heart Association's Predicting Risk of Cardiovascular Disease (CVD) Events equations enable 30-year CVD risk estimation for adults 30 to 59 years of age, facilitating the identification of individuals with low 10-year but high 30-year risk. Little is known about the characteristics and determinants of incident CVD in adults within this predicted risk group.

We examined participants aged 45 to 59 years without prevalent total CVD from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Participants were categorized into 3 groups based on the Predicting Risk of CVD Events total CVD risk equations: low 10-year/low 30-year predicted risk (<7.5%/<20%), low 10-year/high 30-year predicted risk (<7.5%/≥20%), and high 10-year predicted risk (≥7.5%). All analyses were sex-stratified. Using adjudicated events for total CVD (atherosclerotic CVD or heart failure), we accounted for the competing risk of non-CVD death to calculate the 10-year cumulative incidence of total CVD for the 3 risk groups. Population attributable risk quantified the contribution of risk factors for the low 10-year/high 30-year risk group.

Among 6761 participants, 41.9% were categorized as low 10-year/high 30-year risk (mean age [SD], 55.2 [3.4] years; 52.8% female). Over 10 years, the cumulative incidence of total CVD was higher in the low 10-year/high 30-year risk group compared with those with low 10-year/low 30-year risk in both women (4.8% versus 1.8%) and men (6.0% versus 1.5%). Hypertension was the leading contributor to CVD events among participants with low 10-year/high 30-year predicted risk, accounting for 57.8% (95% CI, 45.1%-70.0%) of events in women and 28.9% (95% CI, 14.8%-43.2%) in men.

Using Predicting Risk of CVD Events 30-year predicted total CVD risk identified a subgroup of younger adults with low 10-year and high 30-year risk who may benefit from earlier preventive interventions. Hypertension was the leading contributor to CVD in this risk category.