Lifetime and 10-year risks of cardiovascular mortality in relation to risk factors in middle and old age: 50-year follow-up of the Whitehall study of London Civil Servants

R Clarke; J Halsey; J Emberson; R Collins; D A Leon; M Kivimäki; M J Shipley

doi:10.1016/j.puhe.2024.02.020

Lifetime and 10-year risks of cardiovascular mortality in relation to risk factors in middle and old age: 50-year follow-up of the Whitehall study of London Civil Servants

Public Health. 2024 May:230:73-80. doi: 10.1016/j.puhe.2024.02.020. Epub 2024 Mar 20.

Authors

R Clarke¹, J Halsey², J Emberson³, R Collins², D A Leon⁴, M Kivimäki⁵, M J Shipley⁶

Affiliations

¹ Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: robert.clarke@ndph.ox.ac.uk.
² Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
³ Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ London School of Hygiene and Tropical Medicine, London, UK.
⁵ University College London Brain Sciences, University College London, London, UK.
⁶ Department of Epidemiology and Public Health, University College London Medical School, London, UK.

PMID: 38513300
DOI: 10.1016/j.puhe.2024.02.020

Abstract

Background: Cardiovascular disease (CVD)-related mortality has declined substantially in the United Kingdom (UK) in recent decades, but the continued relevance of conventional risk factors for prediction of CVD mortality throughout the life-course is uncertain. We compared the 10-year risks and lifetime risks of CVD mortality associated with conventional risk factors recorded in middle and old age.

Methods: The Whitehall study was a prospective study of 19,019 male London civil servants (mean age 52 years) when enrolled in 1967-1970 and followed-up for 50 years for cause-specific mortality. In 1997, 7044 (83%) survivors (mean age 77 years) were re-surveyed. The 10-year and lifetime risks of CVD mortality were estimated by levels of CVD risk factors recorded in middle-age and old-age, respectively.

Results: By July 2020, 97% had died (22%, 51% and 80% before age 70, 80 and 90 years, respectively) and 7944 of 17,673 deaths (45%) were from CVD. The 10-year and lifetime risks of CVD death increased linearly with higher levels of CVD risk factors recorded in middle-age and in old-age. Individuals in the top versus bottom 5% of CVD risk scores in middle age had a 10.3% (95% CI:7.2-13.4) vs 0.6% (0.1-1.2) 10-year risk of CVD mortality, a 61.4% (59.4-65.3) vs 31.3% (24.1-34.5) lifetime risk of CVD mortality and a 12-year difference in life expectancy from age 50 years. The corresponding differences using a CVD risk score in old-age were 11.0% (4.4-17.5) vs 0.8% (0.0-2.2) for 10-year risk and 42.1% (28.2-50.0) vs 30.3% (6.0-38.0) for lifetime risk of CVD mortality and a 6-year difference in life expectancy from age 70 years.

Conclusions: Conventional risk factors remained highly predictive of CVD mortality and life expectancy through the life-course. The findings highlight the relevance of estimation of both lifetime risks of CVD and 10-year risks of CVD for primary prevention of CVD.

Keywords: 10-year risks and lifetime risks; Cardiovascular mortality; Life expectancy.

MeSH terms

Aged
Cardiovascular Diseases* / prevention & control
Child
Follow-Up Studies
Humans
London / epidemiology
Male
Middle Aged
Prospective Studies
Risk Factors