Adapted from JAMA Cardiology/ Original Investigation
Association of Lipid, Inflammatory and Metabolic Biomarkers With Age at Onset of Incident Coronary Heart Disease in Women. Sagar B. Dugani MD PhD et al. 2021.
A prospective group of US women health professionals, in the Women’s Health Study was conducted over 21 years. At the start over 28,000 women aged 45 years or older without known cardiovascular disease were recruited between 1993 and 1996. Data from over 50 biomarkers were tracked. Data was grouped from the under 55s, 55-65s, 65-75s and over 75s.
Results showed that diabetes and insulin resistance, hypertension, obesity and smoking were the strongest risk factors to cause premature onset cardiovascular disease. Risk factors became less important as later ages approached.
The relative risks for the various factors were:
Diabetes 10.7 in under 55s and 3.47 in the over 75s.
Metabolic syndrome 6.09 in under 55
Hypertension 4.58
Obesity 4.33
Smoking 3.92
Myocardial infarction in a parent before the age of 60 gave a 1.5-2 factor risk of a heart attack up till the age of 75.
Blood results (not all of these are tested for in the UK)
Lipoprotein insulin resistance 6.4
LDL cholesterol 1.38
Apoliprotein B 1.89
Triglycerides 2.14
Inflammatory biomarkers 1.2-1.8
For the group of women under 55, the average age was 48. Almost all were white. The mean BMI was 28.9. 38% of them were smokers. The average systolic blood pressure was 135. 57% were physically inactive. 30% reported that a parent had had a myocardial infarction under the age of 60. Of the 24 women who were post-menopausal, 17 were on HRT.
My comment: I’m surprised that even in the mid-1990s so many of this group of educated, white, female health professionals, were considerably overweight, physically inactive smokers! I wonder what a similar group would be like now?
Looking at the group over the age of 75, the average BMI had dropped a little to 26.1. Smoking was less at 12.8%. Physical inactivity was still high at 46.5% despite all of these women being retired. All would be post -menopausal and 35% of them were on HRT.
Premature coronary heart disease generally refers to the age under 65 in women and 55 in men. Mortality rates in this group reduced by 5.5% in men and 4.6% in women between 1979 and 1989. But over the next 20 years mortality for women went unchanged. Between 2010 and 2015 in the USA CHD mortality declined in all groups except for those aged between 55 and 65.
In Western Australia from 1996 to 2007 the yearly heart attack rate for women aged 35 to 54 increased by 2.3%. In British Columbia, Canada there was a yearly increase in acute MI of 1.7% in women aged 20 to 55. This increase was not seen in men. In the UK cardiac deaths also showed none or minimal improvement from 1985 to 2005.
Favourable factors that reduced cardiac risk were increased levels of HDL and higher levels of particle HDL size. Lower creatinine levels were also favourable. This is a measure of renal function.
The strongest associations for LDL were seen for small LDL particles, total LDL particles and smaller average LDL size. Large and medium LDL particles had almost no correlation to cardiovascular risk (1.02 and 1.13) . LDL particle average size indicated reduced risk at 0.64. Small HDL particles were associated with higher cardiovascular risk (1.60) and average to larger particles were associated with reduced cardiovascular risk (0.65 and 0.74).
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