Lifetime Risk of Heart Disease
- Lifetime risk of CAD (coronary artery disease) increases sharply with higher total cholesterol levels for men and women at all ages. At each index age, total cholesterol level is th principal driver of lifetime risk.1
- The lifetime risk of CAD (through 80 years) at 40 years of age was reported to be 31% for a total cholesterol level of <200 mg/dl, increasing to 43% for a total cholesterol of 200-239 mg/dl and climbing to 57% for a total cholesterol >240 mg/dL.1 For women, the lifetime risk of CAD risks was 15%, 26%, and 33%, respectively. See Table 126 A.
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Table 126A. Differences in Lifetime Risk and 10-year Risk in men and Women at age 40 by Total cholesterol Levels1 |
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| Lifetime risk | 10-yr risk | |||
| Male | Female | Male | Female | |
| TC <200 | 31% | 15% | 3% | 1% |
| TC 200-139 | 43% | 26% | 5% | 2% |
| TC >240 | 57% | 33% | 12% | 5% |
| Lloyd-Jones DM, Arch Intern Med. 2003;163(16):1966-1972. | ||||
- Lifetime risks contrasted sharply with shorter-term risks: at age 40 years, the 10-year cumulative risks of CAD were 3%, 5%, and 12% for men, and 1%, 2%, and 5% for women, respectively.1
- A ten year risk of less than 10% does not mean low long-term risk.2 82% of US adults are at low short-term risk, two thirds of this group, or 87 million people, are at high lifetime predicted risk for CVD.2 These results provide support for public health efforts aimed at increasing the proportion of Americans with low short-term and low lifetime risk for CVD.2
- Individuals with low short-term risk could be divided into those with low lifetime risk and high lifetime risk depending upon evidence of the extent of silent heart disease (subclinical atherosclerosis) usually obtained from coronary calcium score (or carotid intima media thickness).3
- These data support an important role for cholesterol screening in younger patients, and they may help target high-risk patients for lifestyle modification or drug therapy.
Sources
1. Lloyd-Jones DM, Wilson PW, Larson MG, et al. Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Arch Intern Med. Sep 8 2003;163(16):1966-1972.
2. Marma AK, Berry JD, Ning H, Persell SD, Lloyd-Jones DM. Distribution of 10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003 to 2006. Circ Cardiovasc Qual Outcomes. Jan 2010;3(1):8-14.
3. Berry JD, Liu K, Folsom AR, et al. Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis. Circulation. Jan 27 2009;119(3):382-389.