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

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Abstract

OBJECTIVES:

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.

DESIGN:

Prospective study.

SETTING:

Community based.

PARTICIPANTS:

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.

MEASUREMENTS:

Coronary artery plaque burden was assessed according to coronary artery calcium (CAC) score using computed tomography in 2000 to 2002.

RESULTS:

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.

CONCLUSION:

Modifiable risk factors measured more than 25 years earlier influence plaque burden in elderly survivors without clinical heart disease.

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