Risk factors and compression of cardiovascular morbidity: a life history analysis of the 46-year follow-ups of the Framingham Heart Study

The information available on major cardiovascular risk factors does not provide a full understanding of the lifetime consequences of the risk factors. The objective of this study is to investigate whether being at optimal risk for the major cardiovascular risk factors at middle age compresses cardiovascular morbidity (CVD). Methods: We used 46 years of follow-up of the Framingham Heart Study (FHD) original cohort. Four risk factors were considered: smoking, blood pressure, total cholesterol and obesity. Each risk factor distinguished three risk status levels between age 30 and 50 year: optimal, elevated and high-risk. Age-specific transition rates for the transitions from NoCVD to CVD, CVD to death and NoCVD to death were estimated using a Gompertz regression model. Separate multistate life tables were constructed for males and females and for each risk status level. Results: Life table estimates showed that across all single risk factor categories, males who did not smoke and females who had optimal blood pressure at middle age were shown to have the highest life expectancy at age 50, namely 30.82 years for males and 34.72 years for females. A high-risk at middle age shortens the duration of life. In contrast of never smoking, optimal levels of blood pressure, cholesterol and body mass index increase the number of years lived free of cardiovascular disease and decrease the years lived with cardiovascular disease.Conclusion: Our findings suggest that an optimal level of blood pressure, cholesterol and body mass index in middle age compresses cardiovascular morbidity.