Does the predictive value of baseline coronary risk factors change over a 30-year follow-up?

Area of Science:

• Cardiovascular epidemiology
• Preventive cardiology
• Longitudinal cohort studies

Background:

• Coronary heart disease (CHD) remains a leading cause of mortality globally.
• Identifying reliable long-term risk factors for CHD is crucial for effective prevention strategies.
• The predictive power of traditional risk factors may change over extended follow-up periods.

Purpose of the Study:

• To analyze the association of baseline serum total cholesterol, systolic blood pressure, smoking, and body mass index with CHD mortality over 30 years.
• To assess how the predictive value of these risk factors evolves across different decades of follow-up.
• To compare the long-term predictive power of classical coronary risk factors.

Main Methods:

• Analysis of 1,619 men aged 40-59 at baseline, followed for 30 years.
• Assessment of coronary heart disease (CHD) mortality (n = 450).
• Stratified analyses for the first, second, and third decades of follow-up.

Main Results:

• Serum total cholesterol and smoking (>9 cigarettes/day) were strong predictors of CHD death throughout the 30-year follow-up.
• Systolic blood pressure lost its association with CHD risk after 20 years.
• The highest tertile of body mass index (>24.7 kg/m2) became associated with increased CHD risk only after 20 years.
• Correlations between baseline and 30-year risk factor values varied: 0.42 for cholesterol, 0.28 for blood pressure, and 0.57 for BMI.

Conclusions:

• The long-term predictive power of coronary risk factors for CHD mortality differs significantly.
• Serum cholesterol and smoking demonstrate sustained predictive value, while BMI's impact emerges later.
• Systolic blood pressure's predictive utility diminishes over time, highlighting the dynamic nature of cardiovascular risk assessment.