Journal article
Comparison of lifestyle-based and traditional cardiovascular disease prediction in a multiethnic cohort of nonsmoking women
Circulation (New York, N.Y.), Vol.130(17), pp.1466-1473
10/21/2014
DOI: 10.1161/CIRCULATIONAHA.114.012069
PMCID: PMC4206581
PMID: 25156990
Abstract
Healthy levels of lifestyle factors can reduce the risk of cardiovascular disease. However, except for smoking status, often considered a traditional risk factor, their effect on cardiovascular risk prediction is unclear.
We used a case-cohort design of postmenopausal nonsmokers in the multiethnic Women's Health Initiative Observational Study (1587 cases and 1808 subcohort participants) with a median follow-up of 10 years in noncases. Compared with nonsmokers with no other healthy lifestyle factors (healthy diet, recreational physical activity, moderate alcohol use, and low adiposity), the risk of cardiovascular disease was lower for each additional factor (hazard ratio for trend, 0.82; 95% confidence interval, 0.76-0.89), with a 45% reduction in risk with all factors (95% confidence interval, 0.36-0.84). When lifestyle factors were added to traditional risk factor models (variables from the Pooled Cohort and Reynolds risk scores), only recreational physical activity remained independently associated with the risk of cardiovascular disease. The addition of detailed lifestyle measures to traditional models showed a change in the integrated discrimination improvement and continuous net reclassification improvement (P<0.01 for both) but had little impact on more clinically relevant risk stratification measures.
Although lifestyle factors have important effects on cardiovascular disease risk factors and subsequent risk, their addition to established cardiovascular disease risk models does not result in clear improvement in overall prediction.
Details
- Title: Subtitle
- Comparison of lifestyle-based and traditional cardiovascular disease prediction in a multiethnic cohort of nonsmoking women
- Creators
- Nina P Paynter - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.). npaynter@partners.orgMichael J LaMonte - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)JoAnn E Manson - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)Lisa W Martin - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)Lawrence S Phillips - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)Paul M Ridker - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)Jennifer G Robinson - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)Nancy R Cook - From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.)
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.130(17), pp.1466-1473
- DOI
- 10.1161/CIRCULATIONAHA.114.012069
- PMID
- 25156990
- PMCID
- PMC4206581
- NLM abbreviation
- Circulation
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Publisher
- Lippincott Williams & Wilkins; United States
- Grant note
- U01 DK091958 / NIDDK NIH HHS N01WH32111 / WHI NIH HHS HHSN271201100004C / NIA NIH HHS HHSN268201100004I / NHLBI NIH HHS N01WH42132 / WHI NIH HHS U01 DK098246 / NIDDK NIH HHS N01WH32106 / WHI NIH HHS N01WH32119 / WHI NIH HHS HHSN268201100003C / PHS HHS N01WH32115 / WHI NIH HHS HHSN268200960011C / NHLBI NIH HHS N01WH32102 / WHI NIH HHS N01WH24152 / WHI NIH HHS HHSN268201100004C / WHI NIH HHS N01WH42126 / WHI NIH HHS HHSN268201100002C / WHI NIH HHS HHSN268201100004C / PHS HHS N01WH44221 / WHI NIH HHS HHSN268200960011C / PHS HHS N01WH32109 / WHI NIH HHS HHSN268201100003C / WHI NIH HHS N01WH32105 / WHI NIH HHS N01WH32118 / WHI NIH HHS N01WH42107 / WHI NIH HHS HHSN268201100002I / NHLBI NIH HHS HHSN268201100046C / PHS HHS HHSN268201100001C / WHI NIH HHS R01 HL113080 / NHLBI NIH HHS N01WH42129 / WHI NIH HHS N01WH32122 / WHI NIH HHS N01WH32108 / WHI NIH HHS HHSN271201100004C / PHS HHS HL113080 / NHLBI NIH HHS N01WH32113 / WHI NIH HHS R18 DK066204 / NIDDK NIH HHS N01WH32100 / WHI NIH HHS HHSN268201100046C / NHLBI NIH HHS R21 DK099716 / NIDDK NIH HHS HHSN268201100001I / NHLBI NIH HHS R01 FD003527 / FDA HHS HHSN268201100002C / PHS HHS N01WH22110 / WHI NIH HHS U34 DK091958 / NIDDK NIH HHS HHSN268201100001C / PHS HHS DK066204 / NIDDK NIH HHS
- Language
- English
- Date published
- 10/21/2014
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9983996186402771
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