Residual Lifetime Risk Research Articles

Residual Lifetime Risk of Cardiovascular Diseases in Japan

Risk assessment of cardiovascular diseases (CVD) is shifting from the relative risk to an absolute risk approach. The residual lifetime risk (LTR), which provides an absolute risk assessment, is an epidemiologic measure that expresses the probability of someone of a given age and sex developing a disease condition during their remaining lifespan. The LTR estimation is important because it could be more easily comprehended by clinicians and patients. The LTR for CVD was not estimated for the Japanese population until recently, when the LTR of stroke and acute myocardial infarction (AMI) was reported. The reported LTR of stroke and AMI for middle-aged adults is substantial. The observed probabilities illustrated that approximately 1 in 5 men and women of middle age will suffer from a stroke in their remaining lifetime. On the other hand, approximately 1 in 6 men and 1 in 9 women of middle age will suffer from AMI in their remaining lifetime. Aaginst the backdrop of the aging population and worsening risk factor scenario, these estimates re-emphasize that CVD is a public health burden that requires preventive interventions. These estimates provide a means to communicate the absolute risk of CVD to the lay population, policy makers, as well as health service providers in predicting the disease burden of CVD. This easily comprehended knowledge can be used as an important index to assist in public health education and planning.

Taking a Family History of Hypertension: Is There Patient Care Benefit?

Taking a Family History of Hypertension: Is There Patient Care Benefit?

Hypertension Risk Prediction

Hypertension has been recognized for decades as a major predictor of adverse outcomes, including stroke, heart failure, end-stage renal disease, heart disease, and peripheral vascular disease. These disease risk estimates are the key components for the development and implementation of prevention, treatment, and control guidelines with a general theme of lower blood pressure levels associated with less adverse events.1 The public health burden from high blood pressure and the process to design interventions are further complicated by the high proportion of the population affected (≈1 in 3 adults), a linear increase with age, and disproportionally higher rates for segments of the population, such as blacks and Hispanics.2 Changes in awareness, treatment, and control of hypertension can be assessed and monitored in the population with a series of cross-sectional observational studies. Although these prevalence rates can be determined from single measurements in time, hypertension management and prevention strategies are dependent on incidence rates and the disease progression. These evidence-based guidelines are dependent on incidence and progression rates of …

Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan

Hip fracture incidence from 2004 to 2006 in the Tottori prefecture of Japan was investigated and compared with previously reported rates. The age- and gender-specific incidence of hip fracture in the Tottori prefecture has not plateaued, as has been reported for populations in Northern Europe or North America. Recent data from Northern Europe and North America indicate that the incidence of hip fracture has plateaued, whereas most reports from Asia indicate that the incidence is increasing. The aims of this study were to investigate the recent incidence of hip fracture in the Tottori prefecture, Japan, and to compare it with previous reports. All hip fractures in patients aged 35 years and older occurring between 2004 and 2006 were surveyed in all of the hospitals from the Tottori prefecture. The age- and gender-specific incidence rates were then calculated. Using these and previously reported data, the estimated number of hip fracture patients was determined using the age- and gender-specific incidence rates in each year from 1986 to 2006. The survey identified 851, 906, and 1,059 patients aged 35 years and older, in 2004, 2005, and 2006 respectively. The residual lifetime risk of hip fracture for individuals at 50 years of age was estimated to be 5.6% for men and 20.0% for women. The estimated number of patients from 1986 to 2006 showed a significant increase over time for both genders. The age- and gender-specific incidence of hip fracture in the Tottori prefecture, Japan has not plateaued for either gender.

Residual Lifetime Risk of Fractures in Women and Men

In a sample of 1358 women and 858 men, > or = 60 yr of age who have been followed-up for up to 15 yr, it was estimated that the mortality-adjusted residual lifetime risk of fracture was 44% for women and 25% for men. Among those with BMD T-scores < or = -2.5, the risks increased to 65% in women and 42% in men. Risk assessment of osteoporotic fracture is shifting from relative risk to an absolute risk approach. Whereas BMD is a primary predictor of fracture risk, there has been no estimate of mortality-adjusted lifetime risk of fracture by BMD level. The aim of the study was to estimate the residual lifetime risk of fracture (RLRF) in elderly men and women. Data from 1358 women and 858 men > or = 60 yr of age as of 1989 of white background from the Dubbo Osteoporosis Epidemiology Study were analyzed. The participants have been followed for up to 15 yr. During the follow-up period, incidence of low-trauma, nonpathological fractures, confirmed by X-ray and personal interview, were recorded. Incidence of mortality was also recorded. BMD at the femoral neck was measured by DXA (GE-LUNAR) at baseline. Residual lifetime risk of fracture from the age of 60 was estimated by the survival analysis taking into account the competing risk of death. After adjusting for competing risk of death, the RLRF for women and men from age 60 was 44% (95% CI, 40-48) and 25% (95% CI, 19-31), respectively. For individuals with osteoporosis (BMD T-scores < or = -2.5), the mortality-adjusted lifetime risk of any fracture was 65% (95% CI, 58-73) for women and 42% (95% CI, 24-71) for men. For the entire cohort, the lifetime risk of hip fracture was 8.5% (95% CI, 6-11%) for women and 4% (95% CI, 1.3-5.4%) for men; risk of symptomatic vertebral fracture was 18% (95% CI, 15-21%) for women and 11% (95% CI, 7-14%) for men. These estimates provide a means to communicate the absolute risk of fracture to an individual patient and can help promote the identification and targeting of high-risk individuals for intervention.

Mo-P1:14 Influence of smoking habit on residual lifetime risk of cardiovascular diseases in Japanese representative population

Mo-P1:14 Influence of smoking habit on residual lifetime risk of cardiovascular diseases in Japanese representative population

Regarding the Use of Tamoxifen Post-Oophorectomy to Prevent Hereditary Breast Cancer

Options for the prevention of breast cancer in carriers of a BRCA1 or BRCA2 mutation include oophorectomy and tamoxifen [1]. It is possible to reduce the risk of breast cancer by 60% by performing surgical menopause at age 40 or before [2]; however, given the projected lifetime risk of 80% and penetrance of 30% by age 40, this leaves a residual risk post-oophorectomy of 30%. What can be done to reduce this risk? A healthy diet should be recommended [3] but surely it is optimistic to assume that risk can be managed by diet alone. There is interest in the potential use of aromatase inhibitors in chemo-prevention, but none have yet been approved in this setting, and their side effects have not yet been fully evaluated. Raloxifene and tamoxifen appear to have equivalent effects in chemoprevention in women at average or medium risk [4], but raloxifene has not been studied in mutation carriers. Tamoxifen has been shown to reduce the risk of contralateral and ipsilateral breast cancer in several studies of BRCA1 and BRCA2 carriers [5-8]. Few would dispute that oophorectomy should be recommended by age 40 to reduce the risk of breast and ovarian cancer, but there is no consensus on the use of tamoxifen - and its use is not widespread. There are some data on the joint effect of tamoxifen and oophorectomy in women with BRCA1 and BRCA2 mutations - this is all based on evaluating the risks of contralateral breast cancer. Unfortunately, we should not expect data on primary prevention with tamoxifen any time soon. Therefore, it is important to examine the published data on contralateral risk. Metcalfe et al. conducted a historical cohort study on 491 women with a BRCA1 or BRCA2 mutation who were followed for contralateral breast cancer [6]. The combination of tamoxifen and oophorectomy was particularly effective in women under 50; the hazard ratio associated with this combination of therapy was 0.09 (95% CI, 0.01 to 0.68; P = 0.02). In a matched case-control study, Gronwald et al. studied 285 women with bilateral breast cancer and a BRCA1 or BRCA2 mutation, and 751 control women with unilateral breast cancer and a BRCA1 or BRCA2 mutation [7]. The use of tamoxifen for treating the first breast cancer was compared between bilateral and unilateral cases. The multivariate odds ratio for contralateral breast cancer associated with tamoxifen use was 0.50 for carriers of BRCA1 mutations and was 0.42 for carriers of BRCA2 mutations. However, in contrast to Metcalfe's study, the protective effect of tamoxifen was not present among women who had undergone an oophorectomy (OR = 0.83). However, this subgroup was small and the confidence interval was wide (95%CI, 0.24-2.89). A strong protective effect of tamoxifen was apparent among women who had undergone natural menopause (OR = 0.44; 95% CI, 0.27-0.65). Should tamoxifen be given to women with mutations who have had an oophorectomy? Clearly, more data are needed. In women over 50, or who had an oophorectomy after natural menopause, tamoxifen should be effective. In young women (<50) following surgical menopause, the data are less clear-cut, but I think the drug should be considered. Factors to take into consideration when making this decision should include the estimate of the residual lifetime risk of cancer, the woman's level of interest in mastectomy (there is no point in giving tamoxifen to healthy women after prophylactic mastectomy), the presence of an intact uterus (i.e., risk of endometrial cancer) and access to MRI screening facilities.

Estimated Risks for Developing Obesity in the Framingham Heart Study

The short- and long-term risks for developing overweight or obesity are unknown. To estimate the short-term, long-term, and lifetime risks for developing overweight or obesity in adults in the community. Prospective cohort study, 1971 to 2001. Community-based study, Framingham, Massachusetts. 4117 white participants (51.9% women) from the Framingham Heart Study. The short-term (4 years) and long-term (10 to 30 years) risks for ever becoming overweight or more (body mass index [BMI] > or = 25 kg/m2) or obese (BMI > or = 30 kg/m2) for men and women at 30, 40, and 50 years of age with a normal BMI (between 18.5 kg/m2 and 25.0 kg/m2). The observed 4-year rates of developing overweight varied from 14% to 19% in women and 26% to 30% in men. Four-year rates of developing obesity ranged from 5% to 7% in women and 7% to 9% in men. The long-term (30-year) risk estimates were similar for the 2 sexes generally; varied somewhat with age (in men, being lower for those 50 years of age); and, overall, exceeded 1 in 2 persons for overweight or more, 1 in 4 individuals for obesity, and 1 in 10 people for stage II obesity (BMI > or = 35 kg/m2) across different age groups. The 30-year estimates correspond to the residual lifetime risk for overweight or more or obesity for participants 50 years of age. These findings may not be generalizable to other races or ethnicities. The long-term risks for overweight or more or obesity exceeded 50% and 25%, respectively, indicating a large public health burden. These estimates suggest that the future burden of obesity-associated diseases may be substantial.

Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.

The long-term risk for developing hypertension is best described by the lifetime risk statistic. The lifetime risk for hypertension and trends in this risk over time are unknown. To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk. Community-based prospective cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline (1976-1998). Residual lifetime risk (lifetime cumulative incidence not adjusted for competing causes of mortality) for hypertension, defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications. The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher (greater-than-or-equal to 140/90 mm Hg regardless of treatment) were 90% in both 55- and 65-year-old participants. The lifetime probability of receiving antihypertensive medication was 60%. The risk for hypertension remained unchanged for women, but it was approximately 60% higher for men in the contemporary 1976-1998 period compared with an earlier 1952-1975 period. In contrast, the residual lifetime risk for stage 2 high blood pressure or higher (greater-than-or-equal to 160/100 mm Hg regardless of treatment) was considerably lower in both sexes in the recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to a marked increase in treatment of individuals with substantially elevated blood pressure. The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%, indicating a huge public health burden. Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement, efforts should be directed at the primary prevention of hypertension.

Absolute Risk of Breast Cancer for Australian Women with a Family History

The purpose of the present paper was to estimate the absolute risk of breast cancer over the remainder of a lifetime in Australian women with different categories of family history. Age-specific breast cancer incidence rates were adjusted for screening effects, and rates in those with no family history were estimated using the attributable fraction (AF). Relative risks from a published meta-analysis were applied to obtain incidence rates for different categories of family history, and age-specific incidence was converted to cumulative risk of breast cancer. The risk estimates were based upon Australian population statistics and published relative risks. Breast cancer incidence was from New South Wales women for 1996. The AF was calculated using prevalence of a family history of breast cancer from data on Queensland women. The cumulative absolute risk of breast cancer was calculated from decade and mid-decade ages to age 79 years, not adjusted for competing causes of death. Lifetime risk is approximately 8.6% (1 in 12) for the general population and 7.8% (1 in 13) for those without a family history. Women with one relative affected have lifetime risks of 1 in 6-8 and those with two relatives affected have lifetime risks of 1 in 4-6. The cumulative residual lifetime risk decreases with advancing age; by age 60 years all groups with only one relative affected have well above a 90% probability of not developing breast cancer to age 79 years. These Australian risk statistics are useful for public information and in the clinical setting. Risks given here apply to women with average breast cancer risk from other risk factors.

A comparison of methods currently used in clinical practice to estimate familial breast cancer risks

With the identification of genes predisposing to hereditary breast cancer, the accurate and consistent estimation of a woman's risk of developing breast cancer based on her family history is of paramount importance if national service guidelines are to be developed. The residual lifetime risk of developing breast cancer was estimated for 200 women attending a breast cancer genetic assessment clinic by three different methods currently in use in the UK. Risks were computed on the basis of the Cancer and Steroid Hormone (CASH) study data and were classified as 'low/moderate' (<20%) or 'high' (>20%). These risk categories are representative of those currently used to allocate surveillance and genetic testing. Risks were then compared to estimates derived by other methods used in current clinical practice, including those of Houlston and Murday. The CASH data-based method ascribed 27% to the high risk category, as compared to 53% for the combined Houlston and Murday methods. A method based on the number of affected relatives alone ascribed only 14% to the high risk category. Overall, 108 (54%) women were placed in the same risk category by all three methods. This study demonstrates that there is a significant degree of variability between methods currently used to estimate breast cancer risk which has serious implications for individual patient management, service provision and multicentre studies evaluating the benefits of genetic testing for breast cancer susceptibility.

Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation

Hip fractures are common in elderly women, and early risk assessment of future hip fractures is relevant in relation to prevention. We studied the predictive value of radial and humeral fractures in women. The influence of weather conditions on the risk was also studied. Women aged 20-99 years with a fracture of the distal radius (n = 1162) or proximal humerus (n = 406) were followed for 0 to 9 years. The relative risk (RR) and 95% confidence limits (CL) of subsequent fracture among women suffering radial or humeral fractures compared with the background population were calculated. Women 60-79 years of age who had suffered a fracture of the distal radius or proximal humerus had relative risks of sustaining a hip fracture of 1.9 (1.3-2.6, 95% CL) and 2.5 (1.3-3.6, 95% CL) respectively. The relative risk of hip fracture was highest within the first years following a fracture of the radius or the humerus. Women suffering an upper extremity fracture (radius or humerus) in snowy or icy weather had a marginally increased risk (RR = 1.3, 0.4-2.3, 95% CL and RR = 1.8, 0.3-3.4, 95% CL) for a later hip fracture. A woman 50 years old with a radial or a humeral fracture had an estimated residual lifetime risk of sustaining a subsequent hip fracture of 17% and 16% respectively compared with 11% for the background population.(ABSTRACT TRUNCATED AT 250 WORDS)

Changing incidence and residual lifetime risk of common osteoporosis-related fractures

Changes in incidence and lifetime risk of fractures are of major importance in the epidemiology of osteoporosis. We focused on hip fractures in women and men and on radial and humeral fractures in women. The study subjects comprised 4500 women and men 20 years old or more with fractures. In women 1735 fractures of the distal radius, 747 fractures of the proximal humerus, 878 cervical and 635 trochanteric hip fractures were included. In men 273 cervical and 232 trochanteric hip fractures were included. The fractures were registered during the period 1976 to 1984 and changes in age-specific incidence were calculated (chi-squared test for linear trend; p-values less than 0.05 were considered significant). On the basis of life tables and population background data, the lifetime risk was estimated. The incidence of cervical hip fractures in women aged 60-89 years decreased significantly (p < 0.05) during the observation period, while no significant decrease was found in the incidence of trochanteric fractures. No significant changes in incidence were observed in women with radial or humeral fractures, or in men with hip fractures. A women 60 years old with a life expectancy of 81 years had an estimated residual lifetime risk of radial, humeral or hip fracture of 17%, 8% and 14% respectively. A man 60 years of age with a life expectancy of 77 years had an estimated risk of hip fracture of 6%.(ABSTRACT TRUNCATED AT 250 WORDS)