Association of Incident Cardiovascular Disease With Time Course and Cumulative Exposure to Multiple Risk Factors,Journal of the American College of Cardiology

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Association of Incident Cardiovascular Disease With Time Course and Cumulative Exposure to Multiple Risk Factors
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2023-03-20 , DOI: 10.1016/j.jacc.2023.01.024
Michael J Domanski ₁ , Colin O Wu ₂ , Xin Tian ₂ , Ahmed A Hasan ₃ , Xiaoyang Ma ₂ , Yi Huang ₄ , Rui Miao ₂ , Jared P Reis ₅ , Sejong Bae ₆ , Anwar Husain ₁ , David R Jacobs ₇ , Norrina B Allen ₈ , Mei-Ling T Lee ₉ , Charles C Hong ₁ , Michael E Farkouh ₁₀ , Donald M Lloyd-Jones ₈ , Valentin Fuster ₁₁

Affiliation

Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA.
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA; Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland, USA.
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland, USA.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Background

The quantitative relationship of incident cardiovascular disease (CVD) to lifetime cumulative risk factor exposure is not well understood.

Objectives

Using CARDIA (Coronary Artery Risk Development in Young Adults) study data, we examined the quantitative associations of cumulative exposure over time to multiple, simultaneously operating risk factors with CVD incidence and the incidence of its components.

Methods

Regression models were developed quantifying the influence of the time course and severity of multiple CVD risk factors, operating simultaneously, on risk of incident CVD. The outcomes were incident CVD and the incidence of its components: coronary heart disease, stroke, and congestive heart failure.

Results

Our study included 4,958 asymptomatic adults enrolled in CARDIA from 1985 to 1986 (ages 18 to 30 years) who were followed for 30 years. Risk of incident CVD depends on the time course and severity of a series of independent risk factors, the impact of which is mediated by their effects on individual CVD components after age 40 years. Cumulative exposure (AUC vs time) to low-density lipoprotein cholesterol and triglycerides was independently associated with risk of incident CVD. Of the blood pressure variables, areas under the mean arterial pressure vs time curve and the pulse pressure vs time curve were strongly and independently associated with incident CVD risk.

Conclusions

The quantitative description of the link between risk factors and CVD informs the construction of individualized CVD mitigation strategies, design of primary prevention trials, and assessment of public health impact of risk factor-based interventions.

中文翻译：

心血管疾病事件与时间进程和累积暴露于多种危险因素的关系

背景

心血管疾病（CVD）事件与终生累积危险因素暴露的定量关系尚不清楚。

目标

使用 CARDIA（年轻人冠状动脉风险发展）研究数据，我们研究了随着时间的推移累积暴露于多个同时操作的风险因素与 CVD 发病率及其组成部分的发病率之间的定量关联。

方法

开发了回归模型，量化同时发生的多个 CVD 风险因素的时间进程和严重程度对 CVD 事件风险的影响。结果是CVD事件及其组成部分的发生率：冠心病、中风和充血性心力衰竭。

结果

我们的研究包括 1985 年至 1986 年在 CARDIA 注册的 4,958 名无症状成年人（年龄 18 至 30 岁），并对他们进行了 30 年的随访。 CVD 事件的风险取决于一系列独立危险因素的时间进程和严重程度，其影响由这些因素对 40 岁后各个 CVD 成分的影响所介导。低密度脂蛋白胆固醇和甘油三酯的累积暴露（AUC 与时间）与 CVD 风险独立相关。在血压变量中，平均动脉压与时间曲线下的面积和脉压与时间曲线下的面积与 CVD 风险密切且独立相关。