Lloyd-Jones DM et al. (2006) Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 113: 791–798

Although mortality from cardiovascular disease (CVD) has decreased steadily in the US over the past 40 years, some cardiovascular risk factors are currently increasing in prevalence and threaten to reverse this trend. Lloyd-Jones et al. reviewed the 7,926 participants from the Framingham Heart Study who were free of CVD at 50 years of age to investigate the role of established risk factors in long-term risk of CVD.

During the period 1971–2002, 1,757 participants experienced CVD events and 1,641 died without developing CVD. The estimated lifetime risk of a 50-year-old developing CVD was high—51.7% (95% CI 49.3–54.2%) for men and 39.2% (95% CI 37.0–41.4%) for women. Lifetime risk of CVD increased, and median overall survival decreased, with increasing severity of single risk factors for CVD at 50 years of age. Of the major risk factors, presence of diabetes was associated with the greatest lifetime risk for CVD, followed by increased blood pressure or total cholesterol, then being overweight or obese. Smoking increased intermediate-term risk of CVD but had less influence in the longer term because smokers tended to die early from other causes, such as cancer, before developing CVD. Compared with optimum risk factor levels, having more than one major risk factor was associated with substantially increased lifetime risk of CVD (69% in men and 50% in women) and substantially shorter median survival (by about 10 years).

As a result of these data, Lloyd-Jones et al. call for heightened efforts at preventing development of risk factors for CVD in younger individuals. They note too that improved management is required for individuals who are at high risk of CVD, such as those with diabetes.