Michihiro Satoh1, Takayoshi Ohkubo2,3, Kei Asayama2,3, Yoshitaka Murakami4, Daisuke Sugiyama5, Takashi Waki6, Sachiko Tanaka-Mizuno6, Michiko Yamada7, Shigeyuki Saitoh8, Kiyomi Sakata9, Fujiko Irie10, Toshimi Sairenchi11, Shizukiyo Ishikawa12, Masahiko Kiyama13, Akira Okayama14, Katsuyuki Miura15,16, Yutaka Imai3, Hirotsugu Ueshima15,16, Tomonori Okamura17. 1. Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University. 2. Department of Hygiene and Public Health, Teikyo University School of Medicine. 3. Tohoku Institute for Management of Blood Pressure. 4. Department of Medical Statistics, Toho University School of Medicine. 5. Faculty of Nursing and Medical Care, School of Medicine, Keio University. 6. Department of Medical Statistics, Shiga University of Medical Science. 7. Department of Clinical Studies, Radiation Effects Research Foundation. 8. Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences. 9. Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine. 10. Department of Health and Welfare, Ibaraki Prefectural Office. 11. Department of Public Health, Dokkyo Medical University School of Medicine. 12. Medical education center, Jichi medical university. 13. Osaka Center for Cancer and Cardiovascular Disease Prevention. 14. Research Institute of Strategy for Prevention. 15. Department of Public Health, Shiga University of Medical Science. 16. Center for Epidemiologic Research in Asia, Shiga University of Medical Science. 17. Department of Preventive Medicine and Public Health, School of Medicine, Keio University.
Abstract
AIM: Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. METHODS: We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP ＜130/＜80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. RESULTS: During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. CONCLUSIONS: High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
AIM: Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. METHODS: We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP ＜130/＜80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. RESULTS: During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHDmortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. CONCLUSIONS: High total cholesterol levels contributed to an elevated LTR of CHDmortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.