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

• Type of Material: Article
• Authors: Gitanjali M. Singh, Harvard University; Goodarz Danaei, Harvard University; Farshad Farzadfar, Tehran University of Medical Sciences; Gretchen A. Stevens, WHO; Mark Woodward, University of Sydney; David Wormser, University of Cambridge; Stephen Kaptoge, University of Cambridge; Gary Whitlock, University of Oxford; Qing Qiao, University of Helsinki; Sarah Lewington, University of Oxford; Emanuele Di Angelantonio, University of Cambridge; Stephen vander vander Hoorn, University of Melbourne; Carlene M. M. Lawes, University of Auckland; Mohammed K Ali, Emory University; Dariush Mozaffarian, Harvard University; Majid Ezzati, Imperial College London
• Language: English
• Date: 2013-07-30
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Singh et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0065174
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 8
• Issue: 7
• Start Page: e65174
• End Page: e65174
• Grant/Funding Information: The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit manuscript.; ME is supported by a strategic award from the UK Medical Research Council and by the National Institute for Health Research Comprehensive Biomedical Research Centre at Imperial College Healthcare National Health Service Trust.; GMS is supported a T32 training grant in Academic Nutrition (Grant Number DK007703) from the National Institute of Diabetes and Digestive and Kidney Diseases.; GAS is a staff member of the World Health Organization and alone is responsible for the views expressed in this publication, which do not necessarily represent the decisions, policy, or views of the World Health Organization.
• Keywords: CORONARY-HEART-DISEASE; Multidisciplinary Sciences; HEALTH EXAMINATION SURVEYS; SYSTEMATIC ANALYSIS; Science & Technology - Other Topics; BLOOD-GLUCOSE CONCENTRATION; COLLABORATIVE ANALYSIS; SERUM-CHOLESTEROL CONCENTRATION; ASIA-PACIFIC REGION; BODY-MASS INDEX; VASCULAR MORTALITY; Science & Technology; RANDOMIZED CONTROLLED-TRIALS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

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/m 2 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.