Heart Disease Risk Factors in Midlife Predict Subclinical Coronary Atherosclerosis More than 25 Years Later in Survivors without Clinical Heart Disease: The Rancho Bernardo Study

Abstract

To determine which of the classic modifiable coronary heart disease (CHD) risk factors, measured in midlife, are associated with subclinical coronary atherosclerosis in older age. Prospective study. Community based. Participants were 400 community-dwelling middle-aged adults who had no history of CHD at baseline (1972-1974), when CHD risk factors were measured, and who were still free of known CHD in 2000 to 2002. Coronary artery plaque burden was assessed according to coronary artery calcium (CAC) score using computed tomography in 2000 to 2002. Ordinal logistic regression analysis was used to compare baseline risk factors with severity of CAC. Mean age was 42 at baseline and 69 at the time of CAC assessment; 46.5% were male. In analyses adjusted for age, sex, and all other risk factors, one standard deviation increase in body mass index (odds ratio (OR)=1.24, 95%confidence interval (CI)=1.02-1.51; P=.03), cholesterol (OR=1.28, 95% CI=1.03-1.58; P=.020, pulse pressure (OR=1.24, 95% CI=1.03-1.50; P=.03), and log triglycerides (OR=1.22, 95% CI=0.99-1.50; P=.06) each independently predicted the presence and severity of coronary artery atherosclerosis. Modifiable risk factors measured more than 25 years earlier influence plaque burden in elderly survivors without clinical heart disease.