CVD events rarely occur without presence of traditional risk factors

The presence of nonoptimal levels of one or more traditional risk factors is “nearly universal” prior to the onset of a cardiovascular disease (CVD), suggests a study.

Two population-based prospective cohorts (Korean National Health Insurance Service [KNHIS] and Multi-Ethnic Study of Atherosclerosis [MESA]) were included in this analysis.

The researchers determined the prevalence of ≥1 traditional risk factor above optimal level—systolic blood pressure (BP) ≥120 mm Hg or diastolic BP ≥80 mm Hg or BP-lowering treatment, total cholesterol ≥200 mg/dL or lipid-lowering treatment, fasting glucose ≥100 mg/dL or diagnosis of diabetes or glucose-lowering treatment, or past or current smoking—at any visit before CVD onset among participants who developed incident coronary heart disease, heart failure (HF), or stroke during follow-up.

A total of 601,025 and 1,188 CVD events in KNHIS and MESA, respectively, were analysed. A high prevalence (99.7 percent and 99.6 percent) of ≥1 nonoptimal risk factor before CVD was observed, with similar patterns before HF (99.4 percent and 99.5 percent) and stroke (99.3 percent and 99.5 percent) in both KNHIS and MESA, respectively.

There was a consistently high prevalence (>99 percent) of ≥11 risk factors before CVD across age groups in both men and women. The lowest proportion was noted for HF and stroke (>95 percent) when occurring at ages <60 years in women.

Notably, the prevalence of ≥2 risk factors was also common (93.2 percent to 97.2 percent) before CVD events.

“These results not only challenge claims that CHD events frequently occur without antecedent major risk factors but also demonstrate that other CVD events, including HF or stroke, rarely occur in the absence of nonoptimal traditional risk factors, highlighting the importance of primordial prevention efforts,” the researchers said.