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Lifetime risk of coronary heart disease

Coronary heart disease is the leading cause of death worldwide, yet there were no estimates of the lifetime risk of coronary heart disease until this paper was published.

Message

At 40 years old, the lifetime risk of coronary heart disease is one in two for men and one in three for women. If you still need a reason to pin the ten tips for healthy living on your fridge, surely this is it.

Reference

DM Lloyd-Jones et al. Lifetime risk of developing coronary heart disease. The Lancet 1999 353: 89-92.

Study

Participants were from the Framingham Heart Study, an ongoing study which began in 1948. They were assessed every two to four years with medical histories, physical examinations and laboratory tests. For this study, 7733 participants were followed, with ages between 40 and 94, who had been examined at least once between 1971 and 1975, and who had no history, symptoms or signs of coronary heart disease before or at the examination. Coronary heart disease deaths and events were assessed by three physicians using medical records and electrocardiograms. Coronary heart disease events were angina pectoris, coronary insufficiency, myocardial infarction and coronary death.

During the follow-up period, 1157 participants developed coronary heart disease. Results were adjusted for risk of death from non-coronary heart disease causes. Risks were calculated separately for men and women at 40, 50, 60 and 70 years old.

Results

Participants were almost exclusively white. Between 1% and 10% of participants suffered from diabetes, between 19% and 49% were current smokers, between 15% and 69% suffered from hypertension and cholesterol levels ranged from 5.0 to 6.3 mmol/L. (The higher incidence of hypertension and higher cholesterol levels were among the older adults.)

The risk of developing coronary heart disease before 40 years old was low, 1.2% in men and 0.2% in women.

At 40 years old, the lifetime risk of coronary heart disease was 48.6% for men and 31.7% for women. Table 1 shows the risks for men and women at the next three decades.

Table 1. Lifetime risk of first coronary heart disease event

Age

Lifetime risk (95% confidence interval)

Men

Women

40

48.6% (45.8-51.3)

31.7% (29.2-34.2)

50

46.9% (44.0-49.8)

31.1% (28.6-33.7)

60

42.7% (39.5-45.8)

29.0% (26.3-31.6)

70

34.9% (31.2-38.7)

24.2% (21.4-27.0)

 

Comment

These results give context and meaning to the advice related to reducing the risk of heart disease. Bandolier 49 reported that eating fish once a week reduces the risk of sudden cardiac death by half. When one in two or one in three of us will develop coronary heart disease, eating fish once a week suddenly seems a great idea.

The fall in lifetime risk of coronary heart disease with age probably reflects the shorter life expectancy and period at risk for older participants. Furthermore, at older ages competing causes of death may increase in importance because people susceptible to coronary heart disease would have developed it at younger ages.

These risk estimates represent average values. For individuals, the risk will be higher or lower depending on whether they have other risk factors associated with coronary heart disease.