Prediction of Lifetime Risk for Cardiovascular Disease
Lifetime Cardiovascular Risk
Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of AgeCited from: Lloyd-Jones m, Circulation. 2006;113:791-798
Despite 4 decades of declining mortality from cardiovascular disease (CVD) in the United States, CVD remains by far the leading cause of morbidity and mortality,1 and it is soon to be the leading cause of morbidity and mortality in the developing world.2 Recent data suggest disturbing increases in the prevalence of CVD risk factors such as diabetes, obesity, and the metabolic syndrome,1,3,4 which may reverse downward trends in CVD mortality. In the face of the enormous public health burden imposed by CVD, renewed efforts are needed to promote prevention.One tool that may be useful in public health education is an understanding of the lifetime risk for CVD, which has not been estimated in any population to date. Given that lifetime risk estimates provide an absolute risk assessment, they may be more easily understood by clinicians and patients than relative risks, and they may help to motivate beneficial changes in lifestyle or health behaviors. The best example of lifetime risk data being used effectively to change behavior is the wide dissemination of data on lifetime risk for breast cancer (1 in 8 for women at 40 years of age),5 which appears to have contributed to markedly increased rates of screening for breast cancer in the early 1990s.6,7 The Framingham Heart Study, with its well-defined cohorts, long-term follow-up, and careful documentation of risk factors and events, provides a unique opportunity to examine factors that may modify remaining lifetime risk for CVD in the context of overall survival. Factors that increase short-term risk for CVD are well known. However, the effect of risk factors on long-term and lifetime risk may be unpredictable because some risk factors also increase risk for non-CVD death, resulting in competing risks. We sought to estimate the lifetime risk for CVD and to examine overall survival in the presence and absence of established risk factors.
These results represent the first estimates of the lifetime risk for developing CVD; for people free of CVD at 50 years of age, more than half of men and nearly 40% of women will develop CVD during their remaining lifespan. Diabetes at 50 years of age confers the highest lifetime risk for CVD of any single risk factor. Participants with optimal risk factor levels at 50 years of age (only 3.2% of men and 4.5% of women in our sample) have very low remaining lifetime risk for CVD and markedly longer survival, whereas participants with 2 major risk factors (20.2% of men and 17.1% of women) have very high lifetime risk even in the face of substantially shorter survival.
Clinical and Public Health Implications
The lifetime risks for CVD are among the highest published for any disease to date. Compared with the present results, the
lifetime risks for cancers are substantially lower. At 50 yearsof age, the most common types are breast cancer in women,
with a lifetime risk of 12.5%, and prostate cancer in men, with a lifetime risk of 19%.19 Lifetime risks for lung cancer are 8% and 6% in men and women, respectively, and for colorectal cancer are 6% and 6%, respectively.19