Abstract
BackgroundFew studies have examined long-term associations of unfavorable and favorable changes in vascular risk factors with incident coronary heart disease (CHD). We examined this issue in a middle-aged disease-free population. MethodsWe used repeat data from the Whitehall II cohort study. Five biomedical, behavioral and psychosocial examinations of 8335 participants without CHD produced up to 20,357 person-observations to mimic a non-randomized pseudo-trial. After measurement of potential change in 6 risk factors twice (total cholesterol, blood pressure, smoking, overweight, psychological distress, problems in social relationships), a 5-year follow-up of CHD was undertaken. ResultsIncidence of CHD was 7.4/1000 person-years. Increases from normal to high cholesterol (hazard ratio, HR = 1.59, 95% CI 1.26–2.00) and from normal to high blood pressure (HR = 1.64, 95% CI 1.33–2.03), as compared to remaining at the normal level, were associated with increased risk of CHD. In contrast, decreases from high to low levels of cholesterol (HR = 0.73, 95% CI 0.58–0.91), psychological distress (HR = 0.68, 95% CI 0.51–0.90), and problems in social relationships (HR = 0.65, 95% CI 0.50–0.85), and quitting smoking (HR = 0.49, 95% CI 0.29–0.82) were associated with a reduced CHD risk compared to remaining at high risk factor levels. The highest absolute risk was associated with persistent exposure to both high cholesterol and hypertension (incidence 18.1/1000 person-years) and smoking and overweight (incidence 17.7/1000 person-years). ConclusionsWhile persistent exposures and changes in biological and behavioral risk factors relate to the greatest increases and reductions in 5-year risk of CHD, also favorable changes in psychosocial risk factors appear to reduce CHD risk.
Highlights
In 2016, cardiovascular diseases were the leading cause of years of life lost globally [1] and the leading risk factors to years lost due to death or disability were smoking, high body mass index and high systolic blood pressure [2]
Onset, reversed and persistent high cholesterol and blood pressure levels were associated with increased risk of coronary heart disease (CHD) when compared to having normal cholesterol or blood pressure levels at both times (HRs ranging from 1.27 to 1.79 in the multivariable adjusted models)
Overweight, psychological distress and relationship problems, only persistent exposure was associated with CHD risk, when compared with persistent non-exposure to these risk factors (HRs ranging from 1.43 to 1.82)
Summary
In 2016, cardiovascular diseases were the leading cause of years of life lost globally [1] and the leading risk factors to years lost due to death or disability were smoking, high body mass index and high systolic blood pressure [2]. Few studies have examined long-term associations of unfavorable and favorable changes in vascular risk factors with incident coronary heart disease (CHD). We examined this issue in a middle-aged disease-free population. After measurement of potential change in 6 risk factors twice (total cholesterol, blood pressure, smoking, overweight, psychological distress, problems in social relationships), a 5-year followup of CHD was undertaken. Decreases from high to low levels of cholesterol (HR = 0.73, 95% CI 0.58–0.91), psychological distress (HR = 0.68, 95% CI 0.51– 0.90), and problems in social relationships (HR = 0.65, 95% CI 0.50–0.85), and quitting smoking (HR = 0.49, 95% CI 0.29–0.82) were associated with a reduced CHD risk compared to remaining at high risk factor levels. Conclusions: While persistent exposures and changes in biological and behavioral risk factors relate to the greatest increases and reductions in 5-year risk of CHD, favorable changes in psychosocial risk factors appear to reduce CHD risk
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