Advertisement

Association of Traditional Risk Factors With Cardiovascular Death Across 0 to 10, 10 to 20, and >20 Years Follow-Up in Men and Women

  • Author Footnotes
    1 Dr. Berry received support from a Ruth Kirschstein NRSA/ NHLBI fellowship at Northwestern University Feinberg School of Medicine (T32HL069771).
    Jarett D. Berry
    Correspondence
    Corresponding author: Tel.: 312-503-0197; fax: 312-908-9588.
    Footnotes
    1 Dr. Berry received support from a Ruth Kirschstein NRSA/ NHLBI fellowship at Northwestern University Feinberg School of Medicine (T32HL069771).
    Affiliations
    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

    Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    Search for articles by this author
  • Alan Dyer
    Affiliations
    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    Search for articles by this author
  • Mercedes Carnethon
    Affiliations
    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    Search for articles by this author
  • Lu Tian
    Affiliations
    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    Search for articles by this author
  • Philip Greenland
    Affiliations
    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

    Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    Search for articles by this author
  • Donald M. Lloyd-Jones
    Affiliations
    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

    Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    Search for articles by this author
  • Author Footnotes
    1 Dr. Berry received support from a Ruth Kirschstein NRSA/ NHLBI fellowship at Northwestern University Feinberg School of Medicine (T32HL069771).
      Previous studies have evaluated the strength of the association between traditional risk factors and cardiovascular disease (CVD) across varying lengths of follow-up in men. However, to our knowledge, little is known regarding the behavior of these risk factors across time in women. Thus, we sought to determine the association between traditional risk factors in men and women across follow-up periods of 0 to 10, 10 to 20, and >20 years. We studied 9,033 men and 7,575 women (ages 40 to 59 years) from 1967 to 1973 from the Chicago Heart Association Detection Project in Industry. Multivariable-adjusted Cox proportional hazard models were constructed to compare the hazard ratios (HRs) and 95% confidence intervals (CI) for CVD risk factors measured at baseline across different periods of follow-up (0 to 10, 10 to 20, and >20 years). In women, the HRs for smoking and diabetes mellitus were strongest at 0 to 10 years (HR 5.38, 95% CI 2.99 to 9.67 and 3.84, 95% CI 1.82 to 8.13, respectively) but decreased at >20 years (HR 1.71, 95% CI 1.48 to 1.97 and 1.60, 95% CI 1.10 to 2.32, respectively). In men, the HR (per 4 kg/m2) for body mass index appeared to increase (0 to 10 years, 1.01, 95% CI 0.90 to 1.14; >20 years, 1.20, 95% CI 1.13 to 1.28). In women, the association was similar across all follow-up periods. For both men and women, the HR for total serum cholesterol remained unchanged across the follow-up. In conclusion, we found gender differences in the patterns of association between risk factors measured at baseline and CVD death across different periods of follow-up. In women, the increased risk associated with both diabetes mellitus and smoking was most prominent in the early follow-up periods.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Greenland P.
        • Knoll M.D.
        • Stamler J.
        • Neaton J.D.
        • Dyer A.R.
        • Garside D.B.
        • Wilson P.W.
        Major risk factors as antecedents of fatal and nonfatal coronary heart disease events.
        JAMA. 2003; 290: 891-897
        • Stamler J.
        • Daviglus M.L.
        • Garside D.B.
        • Dyer A.R.
        • Greenland P.
        • Neaton J.D.
        Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity.
        JAMA. 2000; 284: 311-318
        • Stamler J.
        • Dyer A.R.
        • Shekelle R.B.
        • Neaton J.
        • Stamler R.
        Relationship of baseline major risk factors to coronary and all-cause mortality, and to longevity: findings from long-term follow-up of Chicago cohorts.
        Cardiology. 1993; 82: 191-222
        • Prescott E.
        • Hippe M.
        • Schnohr P.
        • Hein H.O.
        • Vestbo J.
        Smoking and risk of myocardial infarction in women and men: longitudinal population study.
        BMJ. 1998; 316: 1043-1047
        • Al-Delaimy W.K.
        • Manson J.E.
        • Solomon C.G.
        • Kawachi I.
        • Stampfer M.J.
        • Willett W.C.
        • Hu F.B.
        Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus.
        Arch Intern Med. 2002; 162: 273-279
        • Hu G.
        Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes.
        Diabetologia. 2003; 46: 608-617
        • Natarajan S.
        • Liao Y.
        • Sinha D.
        • Cao G.
        • McGee D.L.
        • Lipsitz S.R.
        Sex differences in the effect of diabetes duration on coronary heart disease mortality.
        Arch Intern Med. 2005; 165: 430-435
        • Hu F.B.
        • Stampfer M.J.
        • Solomon C.G.
        • Liu S.
        • Willett W.C.
        • Speizer F.E.
        • Nathan D.M.
        • Manson J.E.
        The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up.
        Arch Intern Med. 2001; 161: 1717-1723
        • Stamler J.
        • Rhomberg P.
        • Schoenberger J.A.
        • Shekelle R.B.
        • Dyer A.
        • Shekelle S.
        • Stamler R.
        • Wannamaker J.
        Multivariate analysis of the relationship of seven variables to blood pressure: findings of the Chicago Heart Association Detection Project in Industry, 1967–1972.
        J Chronic Dis. 1975; 28: 527-548
        • Levine J.B.
        • Zak B.
        Automated determination of serum total cholesterol.
        Clin Chim Acta. 1964; 10: 381-384
        • Prineas R.J.
        • Castle C.H.
        • Curb J.D.
        • Harrist R.
        • Lewin A.
        • Stamler J.
        Hypertension detection and follow-up program: baseline electrocardiographic characteristics of the hypertensive participants.
        Hypertension. 1983; 5: IV160-IV189
        • Wexler D.J.
        • Grant R.W.
        • Meigs J.B.
        • Nathan D.M.
        • Cagliero E.
        sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes.
        Diabetes Care. 2005; 28: 514-520
        • Haffner S.M.
        • Lehto S.
        • Ronnemaa T.
        • Pyorala K.
        • Laakso M.
        Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.
        N Engl J Med. 1998; 339: 229-234
        • Barrett-Connor E.
        • Giardina E.-G.V.
        • Gitt A.K.
        • Gudat U.
        • Steinberg H.O.
        • Tschoepe D.
        Women and heart disease: the role of diabetes and hyperglycemia.
        Arch Intern Med. 2004; 164: 934-942
        • Wannamethee S.G.
        • Shaper A.G.
        • Whincup P.H.
        • Walker M.
        Role of risk factors for major coronary heart disease events with increasing length of follow up.
        Heart. 1999; 81: 374-379
        • Wilhelmsen L.
        • Lappas G.
        • Rosengren A.
        Risk of coronary events by baseline factors during 28 years follow-up and three periods in a random population sample of men.
        J Intern Med. 2004; 256: 298-307
        • Njolstad I.
        • Arnesen E.
        • Lund-Larsen P.G.
        Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction: a 12-year follow-up of the Finnmark Study.
        Circulation. 1996; 93: 450-456
        • Richey Sharrett A.
        • Coady S.A.
        • Folsom A.R.
        • Couper D.J.
        • Heiss G.
        Smoking and diabetes differ in their associations with subclinical atherosclerosis and coronary heart disease: the ARIC Study.
        Atherosclerosis. 2004; 172: 143-149
        • Kornitzer M.
        • Dramaix M.
        • Beriot I.
        • Lannoy M.
        • Gheyssens H.
        • Kittel F.
        Twenty-five-year mortality follow-up in the Belgian Bank Study.
        Cardiology. 1993; 82: 153-171
        • Menotti A.
        • Lanti M.
        Coronary risk factors predicting early and late coronary deaths.
        Heart. 2003; 89: 19-24
        • Moller C.S.
        • Zethelius B.
        • Sundstrom J.
        • Lind L.
        Impact of follow-up time and re-measurement of the electrocardiogram and conventional cardiovascular risk factors on their predictive value for myocardial infarction.
        J Intern Med. 2006; 260: 22-30
        • Pekkanen J.
        • Nissinen A.
        • Puska P.
        • Punsar S.
        • Karvonen M.J.
        Risk factors and 25 year risk of coronary heart disease in a male population with a high incidence of the disease: the Finnish cohorts of the seven countries study.
        BMJ. 1989; 299: 81-85
        • Pekkanen J.
        • Tervahauta M.
        • Nissinen A.
        • Karvonen M.J.
        Does the predictive value of baseline coronary risk factors change over a 30-year follow-up?.
        Cardiology. 1993; 82: 181-190
        • Ragland D.R.
        • Brand R.J.
        Coronary heart disease mortality in the Western Collaborative Group Study: follow-up experience of 22 years.
        Am J Epidemiol. 1988; 127: 462-475
        • Welin L.
        • Eriksson H.
        • Larsson B.
        • Svardsudd K.
        • Wilhelmsen L.
        • Tibblin G.
        Risk factors for coronary heart disease during 25 years of follow-up: the study of men born in 1913.
        Cardiology. 1993; 82: 223-228
        • Dyer A.R.
        • Stamler J.
        • Garside D.B.
        • Greenland P.
        Long-term consequences of body mass index for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study.
        Ann Epidemiol. 2004; 14: 101-108
        • Menotti A.
        • Kromhout D.
        • Blackburn H.
        • Jacobs D.
        • Lanti M.
        Early and late coronary deaths in the US Railroad study predicted by major coronary risk factors.
        Eur J Cardiovasc Prev Rehabil. 2004; 11: 382-388
        • Lloyd-Jones D.M.
        • Martin D.O.
        • Larson M.G.
        • Levy D.
        Accuracy of death certificates for coding coronary heart disease as the cause of death.
        Ann Intern Med. 1998; 129: 1020-1026