Trajectories of cardiovascular disease risk and their association with the incidence of cardiovascular events over 18\xa0years of follow-up: The Tehran Lipid and Glucose study

Fatemeh Koohi,Farzad Hadaegh,Davood Khalili,Nooshin Ahmadi,Fereidoun Azizi,Siavash Safiee

doi:10.1186/s12967-021-02984-2

Abstract

BackgroundUnderstanding long-term patterns (trajectories) of cardiovascular diseases (CVD) risk and identifying different sub-groups with the same underlying risk patterns could help facilitate targeted cardiovascular prevention programs.MethodsA total of 3699 participants of the Tehran Lipid and Glucose Study (TLGS) (43% men, mean age = 53.2 years), free of CVD at baseline in 1999–2001 and attending at least one re-examination cycle between the second (2002–2005) and fourth cycles (2009–2011) were included. We examined trajectories of CVD risk, based on the ACC/AHA pooled cohort equation, over ten years and subsequent risks of incident CVD during eight years later. We estimated trajectories of CVD risk using group-based trajectory modeling. The prospective association of identified trajectories with CVD was examined using Cox proportional hazard model.ResultsThree distinct trajectories were identified (low-low, medium-medium, and high-high risk). The high-high and medium-medium CVD risk trajectories had an increasing trend of risk during the time; still, this rising trend was disappeared after removing the effect of increasing age. Upon a median 8.4 years follow-up, 146 CVD events occurred. After adjusting for age, the medium-medium and high-high trajectories had a 2.4-fold (95% CI 1.46–3.97) and 3.46-fold (95% CI 1.56–7.70) risk of CVD compared with the low-low group, respectively. In all trajectory groups, unfavorable increasing in fasting glucose, but favorable raising in HDL and decreasing smoking and total cholesterol happened over time.ConclusionsAlthough the risk trajectories were stable during the time, different risk factors varied differently in each trajectory. These findings emphasize the importance of attention to each risk factor separately and implementing preventive strategies that optimize CVD risk factors besides the CVD risk.

Highlights

Cardiovascular disease (CVD) remains the leading cause of death globally, and over 75% of these occur in low- and middle-income countries; it is a significant barrier to human development [1]
After identifying cardiovascular diseases (CVD) risk score trajectory groups, we evaluated the associations of trajectory subgroup membership with incident hard CVD after the fourth examination cycle using Cox proportional hazards regression model
The mean (SD) age of participants in the original sample was 53.2 (9.3) years, with a higher level of total cholesterol, LDL, triglycerides, and a higher prevalence of smokers than the sub-sample followed for CVD events

Summary

Introduction

Cardiovascular disease (CVD) remains the leading cause of death globally, and over 75% of these occur in low- and middle-income countries; it is a significant barrier to human development [1]. The INTERHEART study showed that the underlying risk factors for CVD are similar globally. More than 90% of the risk for incident myocardial infarction is attributable to nine modifiable risk factors: abdominal obesity, diabetes mellitus, hypertension, unhealthy diet, abnormal lipids, lack of regular physical activity, smoking, alcohol consumption, and stress [3]. These factors have a constant and progressive impact on total CVD risk, so evaluating all known modifiable risk factors to provide a detailed absolute CVD risk is recommended to prevent CVD appropriately and cost-effectively [4]. Understanding long-term patterns (trajectories) of cardiovascular diseases (CVD) risk and identifying different sub-groups with the same underlying risk patterns could help facilitate targeted cardiovascular prevention programs

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