Work

Clustering of atherosclerotic risk factors associated with differential complications across the arterial territories in the EPIC-Norfolk Cohort

Year: 2025

Type: article

Abstract: Introduction The clustering of atherosclerotic risk factors has been associated with an increased risk of cardiovascular disease (CVD) events. However, these studies have been conducted in patients with established CVD, focused on a limited number of outcome events, or were limited by relatively short-term follow-up. We investigated the associations between individual atherosclerotic risk factors, as well as their clustering, and territory-specific cardiovascular events in a large, CVD-free cohort with over 20 years of follow-up. Methods We included individuals without baseline CVD from the EPIC-Norfolk prospective population cohort. Competing risk-adjusted regression was conducted for each dichotomized risk factor (LDL-c > 3 mmol/L, systolic blood pressure (SBP) > 140 mmHg, and smoking) individually, as well as for clusters of two or three risk factors, to evaluate associations with the first occurrence of a CVD event. CVD events were defined as hospitalisation or death due to ischemic heart disease (IHD), ischemic stroke, haemorrhagic stroke, peripheral arterial disease (PAD) or aortic aneurysm (AA). Patients were followed-up until the first event, non-CVD death (competing risk) or end of study (15-03-2018). The model was adjusted for sex, age, diabetes, HDL-c, kidney function and body mass index. Results We included 23,581 participants (56% women) with a median baseline age of 58 years [interquartile range (IQR) 51-66]. During median follow-up of 21.3 years (IQR 19.0-22.8), 26.4% of individuals experienced a first CVD event. The first event of occurrence was IHD in 17.3%, ischemic stroke in 3.6%, haemorrhagic stroke in 1.4%, PAD in 3.1% and AA in 1.4%. The risk of IHD increased substantially when all three risk factors were present (HR 2.8, 95%CI 2.3-3.5) (Figure 1). Elevated systolic blood pressure strongly associated with both ischemic and hemorrhagic stroke, in isolation (HR 1.5, 95%CI 1.3-1.7 and HR 1.4, 95%CI 1.1-1.7), and in combination with the other two risk factors: LDL-c (HR 1.7, 95%CI 1.3-2.2 and HR 1.3, 95%CI 0.9-1.9) and smoking (HR 1.7, 95%CI 1.3-2.2 and HR 1.5, 95%CI 1.0-2.3). Conversely, smoking demonstrated the strongest association with aortic aneurysm (HR 3.4, 95%CI 2.8–4.2), exceeding the combined impact of elevated LDL-c and systolic blood pressure (HR 1.8, 95%CI 1.6–2.6). Conclusion Clustering of risk factors is associated with increased risk of CVD events, with IHD risk rising substantially with three risk factors. Specific risk factors impacted specific arterial territories, both in isolation and in combination with the other risk factors, with elevated SBP predominantly driving risk of both ischemic and haemorrhagic stroke, and smoking being the major contributor to AA.

Source: European Journal of Preventive Cardiology

DOI: 10.1093/eurjpc/zwaf236.155

Authors: M Van Den Bogaart, M Snaterse, F M A C Martens, S M Boekholdt, H T Jorstad

Institutions: Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers

Language: English

Topic: Cardiovascular Health and Risk Factors

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

OpenAlex ID: W4410500268