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. 2021 Dec 21;16(1):85.
doi: 10.5334/gh.897. eCollection 2021.

Risk Factor Clusters and Cardiovascular Disease in High-Risk Patients: The UCC-SMART Study

Emily I Holthuis  1 , Frank L J Visseren  2 , Michiel L Bots  1 , Sanne A E Peters  1   3   4 ; UCC-SMART study group
Affiliations

Risk Factor Clusters and Cardiovascular Disease in High-Risk Patients: The UCC-SMART Study

Emily I Holthuis et al. Glob Heart. .

Abstract

Background: Clustering of vascular risk factors, i.e., the co-existence of two or more risk factors, has been associated with a higher risk of cardiovascular disease (CVD) in the general population. This study aims to firstly, examine patterns of clustering of major cardiovascular risk factors in high-risk patients and their relation with the risk of recurrent cardiovascular disease and all-cause mortality. Secondly, to assess which combinations are associated with the highest risk of CVD and all-cause mortality and to study population attributable fractions.

Methods: A total of 12,616 patients from the Utrecht Cardiovascular Cohort - Second Manifestations of ARTerial diseases (UCC-SMART) study consisting of patients with or a high risk to develop cardiovascular disease were studied. We constructed sixteen clusters based on four individual modifiable risk factors (hypertension, dyslipidemia, current smoking, overweight). Patients were followed from September 1997 to March 2017. Cox proportional hazard models were used to compute adjusted hazard ratios for CVD risk and all-cause mortality and 95% confidence intervals for clusters, with patients without any risk factor as reference group. The population attributable fractions (PAFs) were calculated. Subgroup analyses were conducted by age and sex.

Results: During a mean follow-up period of 8.0 years, 1836 CVD events were registered. The prevalence of patients with zero, one, two, three, and four risk factors was 1.4, 11.4, 32.0, 44.8 and 10.4%. The corresponding hazard ratios (HR) for CVD risk and all-cause mortality were 1.65 (95% CI 0.77; 3.54) for one risk factor, 2.61 (1.24; 5.50) for two, 3.25 (1.55; 6.84) for three, and 3.74 (1.77; 7.93) for four risk factors, with patients without any risk factor as reference group. The PAFs were 6.9, 34.0, 50.1 and 22.2%, respectively. The smoking-hypertension-dyslipidemia combination was associated with the highest HR: 4.06 (1.91; 8.63) and the hypertension-dyslipidemia combination with the highest PAF: 37.1%.

Conclusion: Clusters including smoking and hypertension contributed to the highest risk of CVD and all-cause mortality. This study confirms that risk factor clustering is common among patients at high-risk for CVD and is associated with an increased risk of CVD and all-cause mortality.

Keywords: Prevalence; cardiovascular risk factors; clustering; secondary prevention.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Hazard ratio and its corresponding 95% CI (on the log-scale) for individual risk factors and risk factor clusters adjusted for age and sex. A no difference in CVD risk between cluster and the reference group giving a value of one is displayed in the plot. Reference group are patients (N = 174) with none of the four risk factors. L, dyslipidemia; S, current smoking; H, hypertension; O, overweight.
Figure 2
Figure 2
Hazard ratios and its corresponding 95% CIs (on the log scale) by sex. A no difference in CVD risk between clusters and the reference group giving a value of 1 is displayed in the plot. Reference group are patients (N = 174) with none of the four risk factors. L, dyslipidemia; S, current smoking; H, hypertension; O, overweight.
Figure 3
Figure 3
Hazard ratios and its corresponding 95% CIs (on the log scale) by age. A no difference in CVD risk between clusters and the reference group giving a value of 1 is displayed in the plot. Reference group are patients (N = 174) with none of the four risk factors. L, dyslipidemia; S, current smoking; H, hypertension; O, overweight.
See this image and copyright information in PMC

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