Background It is increasingly recognised that cardiovascular disease (CVD) and cardiovascular ageing are processes which may begin well before later life. However, few prospective epidemiological studies have distinguished the influence of key cardiovascular risk factor exposures at different stages of the life course to relevant markers of cardiovascular disease and ageing in later life. We aimed to examine the associations between established cardiovascular risk factors at three points during adult life (median 45, 65 and 78 years) and carotid intima media thickness (cIMT) and carotid-femoral pulse wave velocity (CFPWV) at 78 years.
Methods The British Regional Heart Study is a prospective study of cardiovascular disease originally based on 7735 men aged 40–59 years from 24 British towns. Men took part in cardiovascular risk assessments providing information on cigarette smoking, body mass index [BMI], SBP, DBP, total, HDL-cholesterol, non-HDL cholesterol, plasma glucose) at median ages 45, 65 and 78 years and had measurements of cIMT (ultrasound) and CFPWV (Vicorder) at 78 years. Life course modelling approaches were used to define models of accumulation, sensitive period and mobility for the development of risk.
Results Among 3137 surviving men, 1696 men (54%) had cIMT measurements and 1577 had CFPWV measurements at 78 years. cIMT was positively associated with BMI levels at 45, 65 and 78 years (stronger at 45 and 65), with SBP at 45, 65 and 78 years (stronger at 45 and 65), with plasma glucose and HDL-cholesterol (inversely) at 78 years and with cigarette smoking at 45 years. Life course models suggested risk accumulation over all three age points for BMI and SBP but were inconclusive for the other risk factors. CFPWV was positively associated with SBP at 45, 65 and 78 years (strongest at 78 years), with DBP at 65 and 78 years (stronger at 78 years) and with non-HDL cholesterol at 78 years only. Life course models suggested a sensitive period at 78 years for both SBP and DBP but were inconclusive for the other risk factors. These results were not materially affected by adjustment for blood pressure and lipid lowering medications.
Conclusion Established CVD risk factors (particularly blood pressure) are strong influences on these markers of cardiovascular disease and ageing. The influence of BP on cIMT appeared to be cumulative, while the influence of BP on CFPWV mainly reflected recent BP. Cardiovascular ageing is likely to be influenced both by longer-term risk accumulation and by recent risk factor exposures.
- Life course risk factors cardiovascular disease
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