The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis

Gitanjali M Singh; Goodarz Danaei; Farshad Farzadfar; Gretchen A Stevens; Mark Woodward; David Wormser; Stephen Kaptoge; Gary Whitlock; Qing Qiao; Sarah Lewington; Emanuele Di Angelantonio; Stephen Vander Hoorn; Carlene M M Lawes; Mohammed K Ali; Dariush Mozaffarian; Majid Ezzati; Anne Tybjærg-Hansen; Ruth Frikke-Schmidt; Marianne Benn; Børge G. Nordestgaard

doi:10.1371/journal.pone.0065174

The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis

Gitanjali M Singh, Goodarz Danaei, Farshad Farzadfar, Gretchen A Stevens, Mark Woodward, David Wormser, Stephen Kaptoge, Gary Whitlock, Qing Qiao, Sarah Lewington, Emanuele Di Angelantonio, Stephen Vander Hoorn, Carlene M M Lawes, Mohammed K Ali, Dariush Mozaffarian, Majid Ezzati, Anne Tybjærg-Hansen, Ruth Frikke-Schmidt, Marianne Benn, Børge G. Nordestgaard

Department of Clinical Medicine

280 Citations (Scopus)

Abstract

Background: The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. Methods: We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. Results: Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55-64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09-2.24), followed by effects on both stroke subtypes (1.66; 1.39-1.98 for hemorrhagic stroke and 1.63; 1.57-1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29-1.61) for IHD and 1.20 (1.15-1.25) for ischemic stroke. The RRs for 5 kg/m² higher BMI for ages 55-64 ranged from 2.32 (2.04-2.63) for diabetes, to 1.44 (1.40-1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08-1.29) for IHD and 1.14 (1.01-1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. Conclusion: Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.

Original language	English
Article number	e65174
Journal	P L o S One
Volume	8
Issue number	7
Pages (from-to)	1-10
Number of pages	10
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0065174
Publication status	Published - 30 Jul 2013

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10.1371/journal.pone.0065174

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Singh, G. M., Danaei, G., Farzadfar, F., Stevens, G. A., Woodward, M., Wormser, D., Kaptoge, S., Whitlock, G., Qiao, Q., Lewington, S., Di Angelantonio, E., Vander Hoorn, S., Lawes, C. M. M., Ali, M. K., Mozaffarian, D., Ezzati, M., Tybjærg-Hansen, A., Frikke-Schmidt, R., Benn, M., & Nordestgaard, B. G. (2013). The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis . P L o S One, 8(7), 1-10. [e65174]. https://doi.org/10.1371/journal.pone.0065174

Singh, GM, Danaei, G, Farzadfar, F, Stevens, GA, Woodward, M, Wormser, D, Kaptoge, S, Whitlock, G, Qiao, Q, Lewington, S, Di Angelantonio, E, Vander Hoorn, S, Lawes, CMM, Ali, MK, Mozaffarian, D, Ezzati, M, Tybjærg-Hansen, A , Frikke-Schmidt, R , Benn, M & Nordestgaard, BG 2013, 'The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis ', P L o S One, vol. 8, no. 7, e65174, pp. 1-10. https://doi.org/10.1371/journal.pone.0065174

@article{6960e460a92a4f7d8362a6ac875706d3,

title = "The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis ",

abstract = "Background: The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. Methods: We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. Results: Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55-64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09-2.24), followed by effects on both stroke subtypes (1.66; 1.39-1.98 for hemorrhagic stroke and 1.63; 1.57-1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29-1.61) for IHD and 1.20 (1.15-1.25) for ischemic stroke. The RRs for 5 kg/m2 higher BMI for ages 55-64 ranged from 2.32 (2.04-2.63) for diabetes, to 1.44 (1.40-1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08-1.29) for IHD and 1.14 (1.01-1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. Conclusion: Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.",

author = "Singh, {Gitanjali M} and Goodarz Danaei and Farshad Farzadfar and Stevens, {Gretchen A} and Mark Woodward and David Wormser and Stephen Kaptoge and Gary Whitlock and Qing Qiao and Sarah Lewington and {Di Angelantonio}, Emanuele and {Vander Hoorn}, Stephen and Lawes, {Carlene M M} and Ali, {Mohammed K} and Dariush Mozaffarian and Majid Ezzati and Anne Tybj{\ae}rg-Hansen and Ruth Frikke-Schmidt and Marianne Benn and Nordestgaard, {B{\o}rge G.}",

year = "2013",

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doi = "10.1371/journal.pone.0065174",

language = "English",

volume = "8",

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journal = "PLoS Computational Biology",

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TY - JOUR

T1 - The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes

T2 - A Pooled Analysis

AU - Singh, Gitanjali M

AU - Danaei, Goodarz

AU - Farzadfar, Farshad

AU - Stevens, Gretchen A

AU - Woodward, Mark

AU - Wormser, David

AU - Kaptoge, Stephen

AU - Whitlock, Gary

AU - Qiao, Qing

AU - Lewington, Sarah

AU - Di Angelantonio, Emanuele

AU - Vander Hoorn, Stephen

AU - Lawes, Carlene M M

AU - Ali, Mohammed K

AU - Mozaffarian, Dariush

AU - Ezzati, Majid

AU - Tybjærg-Hansen, Anne

AU - Frikke-Schmidt, Ruth

AU - Benn, Marianne

AU - Nordestgaard, Børge G.

PY - 2013/7/30

Y1 - 2013/7/30

N2 - Background: The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. Methods: We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. Results: Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55-64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09-2.24), followed by effects on both stroke subtypes (1.66; 1.39-1.98 for hemorrhagic stroke and 1.63; 1.57-1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29-1.61) for IHD and 1.20 (1.15-1.25) for ischemic stroke. The RRs for 5 kg/m2 higher BMI for ages 55-64 ranged from 2.32 (2.04-2.63) for diabetes, to 1.44 (1.40-1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08-1.29) for IHD and 1.14 (1.01-1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. Conclusion: Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.

AB - Background: The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. Methods: We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. Results: Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55-64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09-2.24), followed by effects on both stroke subtypes (1.66; 1.39-1.98 for hemorrhagic stroke and 1.63; 1.57-1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29-1.61) for IHD and 1.20 (1.15-1.25) for ischemic stroke. The RRs for 5 kg/m2 higher BMI for ages 55-64 ranged from 2.32 (2.04-2.63) for diabetes, to 1.44 (1.40-1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08-1.29) for IHD and 1.14 (1.01-1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. Conclusion: Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.

U2 - 10.1371/journal.pone.0065174

DO - 10.1371/journal.pone.0065174

M3 - Journal article

SN - 1932-6203

VL - 8

SP - 1

EP - 10

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 7

M1 - e65174

ER -

The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis

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