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Predicting risk of death from coronary heart disease in young men

 

Many studies have identified risk factors for coronary heart disease in adults who are at least 40 years of age (e.g. cholesterol level, blood pressure and cigarette smoking). This study examines whether the same factors can also predict risk of death from coronary heart disease in younger adults, from 18 years of age.

Message

Age, cholesterol level, blood pressure and smoking can predict future risk of death from coronary heart disease in men, aged 18 to 39 years. For young people predisposed to heart disease an early risk assessment could motivate them to adopt healthier lifestyles.

Reference

EL Navas-Nacher et al. Risk factors for coronary heart disease in men 18 to 39 years of age. Annals of Internal Medicine 2001 134: 433-439.

Study

Participants were 11,016 men, 18 to 39 years of age, from 84 companies taking part in the Chicago Heart Association Detection Project in Industry. A group of 8,955 men, 40 to 59 years of age, was used for comparison. Between 1967 and 1973 questionnaires collected demographic information and medical history. Measurements taken included height, weight, blood pressure and total serum cholesterol. Participants were followed for 20 years.

Deaths from coronary heart disease were ascertained through local records and the National Death Index. Death certificates were coded by physicians.

During 20 years, 455 men died. One third of deaths were due to cardiovascular disease (155) with coronary heart disease the leading cause of death (123).

Results

The average age of the younger men was 29.7 years. Their average serum cholesterol level was 4.92 mmol/L, average systolic blood pressure was 134.6 mm Hg and diastolic blood pressure was 78.2 mm Hg. Approximately half were current smokers, having an average of 21 cigarettes a day.

In the group of men aged 40 to 59 years, average age was 48.7 years. Their average serum cholesterol level was 5.50 mmol/L, average systolic blood pressure was 141.4 mm Hg and diastolic blood pressure was 84.1 mm Hg. Of the 41% who smoked, their average was 23 cigarettes a day.

Age, serum cholesterol level, blood pressure and smoking were associated with death from coronary heart disease in both the young and middle-aged men (shown in Table 1).

Table 1. Increased risk of death from coronary heart disease (with relative risks and 95% CIs) over 20 years in young and middle aged men. Risk factors for death from coronary heart disease in young and middle-aged men

Risk factor

Men aged 18-39 years

Men aged 40-59 years

 

%

RR

%

RR

Age (per 6-year increase) 63% 1.63 (1.30 to 2.04) 60% 1.60 (1.47 to 1.75)
Serum cholesterol (per 1.04 mmol/L increase) 92% 1.92 (1.64 to 2.24) 18% 1.18 (1.12 to 1.25)
Systolic blood pressure (per 20 mm Hg increase) 32% 1.32 (1.07 to 1.64) 29% 1.29 (1.20 to 1.38)
Diastolic blood pressure (per 10 mm Hg increase) 20% 1.20 (1.02 to 1.42) 26% 1.26 (1.18 to 1.33)
Cigarettes smoked per day (per 10 cigarette increase) 36% 1.36 (1.21 to 1.52) 25% 1.25 (1.19 to 1.31)

Comment

This study has several shortcomings, for example risk factors were only measured once and so estimates do not take into account lifestyle changes made over the follow-up period; and other factors such as dietary intake were not considered. Nevertheless, it adds to the evidence that early development of coronary atherosclerosis is associated with risk factors which are largely modifiable. Furthermore, it indicates that it would be worthwhile to assess young people (e.g. for cholesterol) who are genetically predisposed to heart disease so they can make early lifestyle changes if necessary.