At any given age, the residual lifetime risk (RLR) is the chance of developing an outcome throughout the rest of one’s life. Data from a single community-based cohort study of primarily White participants were used to calculate the RLR for atherosclerotic cardiovascular disease (ASCVD) over three 20-year periods. The Framingham study’s longitudinal data were analyzed in three epochs (epoch 1, 1960–1979; epoch 2, 1980–1999; and epoch 3, 2000–2018). The RLR of a first ASCVD event (myocardial infarction, coronary heart disease death, or stroke) from 45 years of age (adjusting for competing risk of death) in the three epochs was compared overall and by the following strata: sex, BMI, blood pressure and cholesterol categories, diabetes, smoking, and Framingham risk score groups.
During the three epochs, there were 317,849 person-years of observations (56% women; 94% White), and 4,855 deaths. Over the three epochs, life expectancy increased by 10.1 years for males and 11.9 years for women. In epoch 1, 1,085 ASCVD events occurred over a period of 91,330 person-years, 1,330 ASCVD events occurred over a period of 107,450 person-years, and 775 ASCVD events occurred over a period of 119,069 person-years in era 3. In the third epoch, the average age at the commencement of the first ASCVD incident was 8.1 years (men) and 10.3 years (women) higher than in the first epoch. The RLR of ASCVD decreased from 43.7% in epoch 1 to 28.1% in epoch 3 (P<0.0001) in both sexes (RLR [epoch 1 against epoch 3], 36.3% compared 26.5% [women]; 52.5% versus 30.1% [men]; P<0.001 for both). The reduced RLR of ASCVD in the last two epochs was consistently found across all body mass index, blood pressure, cholesterol, diabetes, smoking, and Framingham risk score strata (P<0.001). In both sexes, the RLR of coronary heart disease events and stroke decreased (P<0.001).
In the community-based, largely White Framingham study, mean life expectancy has grown while the RLR of ASCVD has declined over the last six decades. The persistent burden of ASCVD emphasizes the significance of ongoing and successful primary preventive initiatives, including improved risk factor screening and treatment.
Reference:www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057889
