Association of Cardiometabolic Multimorbidity With Mortality

Emanuele Di Angelantonio; Stephen Kaptoge; David Wormser; Peter Willeit; Adam S Butterworth; Narinder Bansal; Linda M O'Keeffe; Pei Gao; Angela M Wood; Stephen Burgess; Daniel F Freitag; Lisa Pennells; Sanne A Peters; Carole L Hart; Lise Lund Håheim; Richard F Gillum; Børge G Nordestgaard; Bruce M Psaty; Bu B Yeap; Matthew W Knuiman; Paul J Nietert; Jussi Kauhanen; Jukka T Salonen; Lewis H Kuller; Leon A Simons; Yvonne T van der Schouw; Elizabeth Barrett-Connor; Randi Selmer; Carlos J Crespo; Beatriz Rodriguez; W M Monique Verschuren; Veikko Salomaa; Kurt Svärdsudd; Pim van der Harst; Cecilia Björkelund; Lars Wilhelmsen; Robert B Wallace; Hermann Brenner; Philippe Amouyel; Elizabeth L M Barr; Hiroyasu Iso; Altan Onat; Maurizio Trevisan; Ralph B D'Agostino; Cyrus Cooper; Maryam Kavousi; Lennart Welin; Ronan Roussel; Frank B Hu; Shinichi Sato; Emerging Risk Factors Collaboration

doi:10.1001/jama.2015.7008

Association of Cardiometabolic Multimorbidity With Mortality

Emanuele Di Angelantonio, Stephen Kaptoge, David Wormser, Peter Willeit, Adam S Butterworth, Narinder Bansal, Linda M O'Keeffe, Pei Gao, Angela M Wood, Stephen Burgess, Daniel F Freitag, Lisa Pennells, Sanne A Peters, Carole L Hart, Lise Lund Håheim, Richard F Gillum, Børge G Nordestgaard, Bruce M Psaty, Bu B Yeap, Matthew W KnuimanPaul J Nietert, Jussi Kauhanen, Jukka T Salonen, Lewis H Kuller, Leon A Simons, Yvonne T van der Schouw, Elizabeth Barrett-Connor, Randi Selmer, Carlos J Crespo, Beatriz Rodriguez, W M Monique Verschuren, Veikko Salomaa, Kurt Svärdsudd, Pim van der Harst, Cecilia Björkelund, Lars Wilhelmsen, Robert B Wallace, Hermann Brenner, Philippe Amouyel, Elizabeth L M Barr, Hiroyasu Iso, Altan Onat, Maurizio Trevisan, Ralph B D'Agostino, Cyrus Cooper, Maryam Kavousi, Lennart Welin, Ronan Roussel, Frank B Hu, Shinichi Sato, Emerging Risk Factors Collaboration

Department of Clinical Medicine

303 Citations (Scopus)

Abstract

IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.

OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.

DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.

EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).

MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.

RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.

CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

Original language	English
Journal	J A M A: The Journal of the American Medical Association
Volume	314
Issue number	1
Pages (from-to)	52-60
Number of pages	9
ISSN	0098-7484
DOIs	https://doi.org/10.1001/jama.2015.7008
Publication status	Published - 7 Jul 2015

Keywords

Adult
Aged
Comorbidity
Diabetes Mellitus
Female
Humans
Life Expectancy
Male
Middle Aged
Mortality
Myocardial Infarction
Risk Factors
Stroke

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Di Angelantonio, E., Kaptoge, S., Wormser, D., Willeit, P., Butterworth, A. S., Bansal, N., O'Keeffe, L. M., Gao, P., Wood, A. M., Burgess, S., Freitag, D. F., Pennells, L., Peters, S. A., Hart, C. L., Håheim, L. L., Gillum, R. F., Nordestgaard, B. G., Psaty, B. M., Yeap, B. B., ... Emerging Risk Factors Collaboration (2015). Association of Cardiometabolic Multimorbidity With Mortality. J A M A: The Journal of the American Medical Association, 314(1), 52-60. https://doi.org/10.1001/jama.2015.7008

Di Angelantonio, E, Kaptoge, S, Wormser, D, Willeit, P, Butterworth, AS, Bansal, N, O'Keeffe, LM, Gao, P, Wood, AM, Burgess, S, Freitag, DF, Pennells, L, Peters, SA, Hart, CL, Håheim, LL, Gillum, RF, Nordestgaard, BG, Psaty, BM, Yeap, BB, Knuiman, MW, Nietert, PJ, Kauhanen, J, Salonen, JT, Kuller, LH, Simons, LA, van der Schouw, YT, Barrett-Connor, E, Selmer, R, Crespo, CJ, Rodriguez, B, Verschuren, WMM, Salomaa, V, Svärdsudd, K, van der Harst, P, Björkelund, C, Wilhelmsen, L, Wallace, RB, Brenner, H, Amouyel, P, Barr, ELM, Iso, H, Onat, A, Trevisan, M, D'Agostino, RB, Cooper, C, Kavousi, M, Welin, L, Roussel, R, Hu, FB, Sato, S & Emerging Risk Factors Collaboration 2015, 'Association of Cardiometabolic Multimorbidity With Mortality', J A M A: The Journal of the American Medical Association, vol. 314, no. 1, pp. 52-60. https://doi.org/10.1001/jama.2015.7008

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title = "Association of Cardiometabolic Multimorbidity With Mortality",

abstract = "IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.",

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doi = "10.1001/jama.2015.7008",

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pages = "52--60",

journal = "J A M A: The Journal of the American Medical Association",

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TY - JOUR

T1 - Association of Cardiometabolic Multimorbidity With Mortality

AU - Di Angelantonio, Emanuele

AU - Kaptoge, Stephen

AU - Wormser, David

AU - Willeit, Peter

AU - Butterworth, Adam S

AU - Bansal, Narinder

AU - O'Keeffe, Linda M

AU - Gao, Pei

AU - Wood, Angela M

AU - Burgess, Stephen

AU - Freitag, Daniel F

AU - Pennells, Lisa

AU - Peters, Sanne A

AU - Hart, Carole L

AU - Håheim, Lise Lund

AU - Gillum, Richard F

AU - Nordestgaard, Børge G

AU - Psaty, Bruce M

AU - Yeap, Bu B

AU - Knuiman, Matthew W

AU - Nietert, Paul J

AU - Kauhanen, Jussi

AU - Salonen, Jukka T

AU - Kuller, Lewis H

AU - Simons, Leon A

AU - van der Schouw, Yvonne T

AU - Barrett-Connor, Elizabeth

AU - Selmer, Randi

AU - Crespo, Carlos J

AU - Rodriguez, Beatriz

AU - Verschuren, W M Monique

AU - Salomaa, Veikko

AU - Svärdsudd, Kurt

AU - van der Harst, Pim

AU - Björkelund, Cecilia

AU - Wilhelmsen, Lars

AU - Wallace, Robert B

AU - Brenner, Hermann

AU - Amouyel, Philippe

AU - Barr, Elizabeth L M

AU - Iso, Hiroyasu

AU - Onat, Altan

AU - Trevisan, Maurizio

AU - D'Agostino, Ralph B

AU - Cooper, Cyrus

AU - Kavousi, Maryam

AU - Welin, Lennart

AU - Roussel, Ronan

AU - Hu, Frank B

AU - Sato, Shinichi

AU - Emerging Risk Factors Collaboration

PY - 2015/7/7

Y1 - 2015/7/7

N2 - IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

AB - IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

KW - Adult

KW - Aged

KW - Comorbidity

KW - Diabetes Mellitus

KW - Female

KW - Humans

KW - Life Expectancy

KW - Male

KW - Middle Aged

KW - Mortality

KW - Myocardial Infarction

KW - Risk Factors

KW - Stroke

U2 - 10.1001/jama.2015.7008

DO - 10.1001/jama.2015.7008

M3 - Journal article

C2 - 26151266

SN - 0098-7484

VL - 314

SP - 52

EP - 60

JO - J A M A: The Journal of the American Medical Association

JF - J A M A: The Journal of the American Medical Association

IS - 1

ER -

Association of Cardiometabolic Multimorbidity With Mortality

Abstract

Keywords

UN SDGs

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