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Heart Disease Risk Factors and Lifetime Risk of Cardiovascular Events

Heart disease is the #1 killer of both women and men in the United States. Thanks to decades of research supported by the National Heart, Lung, and Blood Institute (NHLBI), we now understand the key risk factors for heart disease. While some risk factors can’t be controlled—such as a family history of heart disease—most risk factors can be controlled. These include high blood pressure, high blood cholesterol, smoking, diabetes, overweight or obesity, and physical inactivity.

In a new study that represents one of the largest-ever analyses of lifetime risks for cardiovascular disease (CVD), researchers found that middle-aged adults who have one or more elevated traditional risk factors for CVD have a substantially greater chance of having a major cardiovascular event—such as heart attack or stroke—during their lifetimes than people with optimal risk factor profiles.

The findings underscore that prevention and control of CVD through management of modifiable risk factors is a lifetime opportunity and responsibility. Prevention of the development of risk factors (known as primordial prevention) is even better. Health professionals can help individuals understand that it’s never too early to be aware of their risk factors, and it’s also never too late to reduce their risk for CVD.

What was the study?

“Lifetime risks of cardiovascular disease” was published in the New England Journal of Medicine on January 26, 2012. Researchers analyzed 50 years of data from 18 cohort, or population-based, studies in the United States, as part of the Cardiovascular Lifetime Risk Pooling Project. This large meta-analysis of health data from a total of 257,384 people is the first study to look simultaneously at multiple risk factors for CVD across age, sex, race, and birth generation.

  • Traditional CVD risk factors were measured in men and women from both Black and White populations at ages 45, 55, 65, and 75 years.
  • The CVD risk factors examined were:
    • Blood pressure (optimal defined as less than 120 mmHg systolic and less than 80 mmHg diastolic, untreated) (Note: Millimeters of mercury—mmHg—is the unit used to measure blood pressure.)
    • Total cholesterol level (optimal defined as less than 180 milligrams per deciliter)
    • Smoking status (optimal defined as nonsmoking, based on self-report)
    • Diabetes status (optimal defined as nondiabetic)
  • All the analyzed studies included 10 or more years of followup data for fatal or nonfatal cardiovascular events, including:
    • Fatal coronary heart disease or nonfatal myocardial infarction (heart attack)
    • Fatal or nonfatal stroke
    • Death from CVD
    • Total events related to atherosclerotic CVD
  • Data were stratified into categories based on risk factor levels and age.

What did the study find?

  • All of the risk factors appeared to carry the same levels of risk as they did 20, 30, or 40 years ago.
  • There was a stepwise increase between the risk factor profile and the lifetime risk: as the risk factor profile worsened, there was a higher risk of death from CVD.
  • While Black Americans had a higher prevalence of CVD risk factors than White Americans, their lifetime risks were similar when their risk factor profiles were similar.

Optimal risk factor profile

  • Only about 5 percent of participants had optimal risk factor profiles, while approximately two-thirds of participants had at least one major risk factor.
  • Men with optimal risk factor levels only had a 1.4 percent chance of having a major cardiovascular event.
  • Women with optimal risk factor levels only had a 4.1 percent chance of having a major cardiovascular event.

Two or more major risk factors

  • Men who were 55 years old and had at least two major risk factors were six times as likely to die from CVD by age 80 as were men with no or one CVD risk factor (29.6 percent vs. 4.7 percent).
  • Women who were 55 years old and had at least two major risk factors were three times as likely to die from CVD by age 80 as were women with no or one CVD risk factor (20.5 percent vs. 6.4 percent).
  • When both fatal and nonfatal cardiovascular events were considered, results were more pronounced. Men who were 45 years old with two or more risk factors had a 49.5 percent chance of having a major cardiovascular event by age 80. Women who were 45 years old with two or more risk factors had a 30.7 percent chance of having a major cardiovascular event by age 80.

At every age group examined in the study, those with the lowest levels of risk factors had the lowest risk for CVD and the greatest longevity.

What are the take-home messages?

Heart disease is the #1 killer of Americans. Prevention and control of CVD risk factors are crucial; an increase in the number and severity of risk factors by middle age can affect a person’s remaining lifetime risk for CVD.

Key steps for health professionals:

  • Talk to individuals about their risk factors for developing heart disease.
  • Encourage adults to know their blood pressure and cholesterol numbers, and tell them whether they are at risk for diabetes.
  • Promote healthy lifestyles in children and young adults, since an increase in the number and severity of risk factors by middle age seems to have profound effects on the remaining lifetime risk for CVD.
  • Help individuals understand that it’s never too early or too late to reduce their risk for CVD, and that there are several approaches they can take to improve their heart health:
    • Don’t start smoking. Individuals who currently smoke should quit. Health care providers can help individuals learn about programs and products that can help them quit, and can urge individuals to avoid secondhand smoke. For people who smoke, smoking cessation will reduce their risk of developing heart disease by 50–70 percent.
    • Eat right. Individuals should follow a healthy eating plan, which can help prevent or reduce high blood pressure and high blood cholesterol and help maintain a healthy weight. Two free science-based healthy eating plans are Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH).
    • Be physically active. Individuals can benefit by adding even 10 minutes at a time of moderate-intensity aerobic activity per week. For major health benefits, adults should aim for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week, as recommended by the "2008 Physical Activity Guidelines for Americans."
    • Maintain a healthy weight. Health care providers should work with individuals who are overweight or obese to create a reasonable weight-loss plan, as a loss of just 5–10 percent of weight can lower the risk for CVD. For more information, see Successful Weight Loss: Evidence-Based Obesity Resources.
    • Manage stress. Anger and negative emotions can trigger heart attacks. Health care providers can encourage patients to cultivate supportive relationships and to engage in physical activity and relaxation therapy, which can help relieve stress. Individuals who have difficulty handling life’s everyday challenges may be referred to a stress management program.

Where can I learn more about the study?

  • Berry, J.D., Dyer, A., Cai, X., … & Lloyd-Jones, D.M. (2012). Lifetime Risks of Cardiovascular Disease. New England Journal of Medicine, 366(4), 321-329.
  • Elevated risk factors linked to major cardiovascular disease events across a lifetime, January 26, 2012 (News release)

NHLBI resources

  • Health Topics: Atherosclerosis, Coronary Heart Disease, High Blood Pressure, High Blood Cholesterol, Stroke, Smoking and Your Heart
  • Your Guide to Living Well With Heart Disease
  • Your Guide to a Healthy Heart
  • The Heart Truth® Campaign Web pages
  • Your Heart, Your Life: A Lay Health Educator’s Manual for the Hispanic Community
  • On the Move to Better Heart Health for African Americans
  • Your Guide to Physical Activity and Your Heart

Other resources

  • Million Hearts Campaign. In an effort to help people reduce their risk for CVD, the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services launched this national initiative to prevent 1 million heart attacks and strokes over the next 5 years.
  • Healthy People 2020. The U.S. Department of Health and Human Services (HHS) launched Healthy People 2020 in an effort to promote healthy behaviors and prevent diseases, including CVD. Healthy People 2020 and its specific, measurable health objectives represent the Nation’s disease prevention and health promotion goals for the coming decade.

Additional study information

The NHLBI supported several of the cohort studies involved, including the following:

  • Atherosclerosis Risk in Communities Study (ARIC)
  • Cardiovascular Health Study (CHS)
  • Framingham Heart Study
  • Framingham Offspring Study
  • Honolulu Heart Program (HHP)
  • Puerto Rico Heart Health Program (PRHHP)
  • Women’s Health Initiative (WHI)

February 2012

® The Heart Truth is a registered trademark of the U.S. Department of Health and Human Services (HHS).

Archived page, reproduced from a 2013 copy. It is reference material, not current guidance.