title: Association of cardiometabolic risk factors and prevalent cardiovascular events.
abstract: BACKGROUND
  Although cardiovascular disease causes substantial morbidity and mortality, how individual and groups of risk factors contribute to cardiovascular outcomes is incompletely understood. This study evaluated cardiometabolic risk factors and their relationship to prevalent diagnosis of acute myocardial infarction (AMI) and stroke.
  
  
  METHODS
  We used retrospective data from 3 integrated health-care systems that systematically collect and store detailed patient-level data. Adult enrollees were eligible for inclusion if they had all of the following clinical measurements: weight, height, blood pressure, high density lipoproteins, triglycerides, and fasting blood glucose or evidence of diabetes from July 1, 2003, to June 30, 2005. We used National Cholesterol Education Program Adult Treatment Panel III guidelines to determine qualifying levels for cardiometabolic risk factors.
  
  
  RESULTS
  A total of 170,648 persons met the inclusion/exclusion criteria; 11,757 had no qualifying risk factors, 25,684 had 1, 38,176 had 2, and 95,031 had 3 or more risk factors. Compared to those without risk factors, persons with any 1 risk factor were 2.21 (95% confidence interval [CI], 1.78-2.74) times more likely to have had a diagnosis of AMI or stroke. The risk increased to 2.79 (95% CI, 2.26-3.42) for persons with 2, 3.45 (95% CI, 2.80-4.24) for persons with 3, 4.35 (95% CI, 3.54-5.35) for persons with 4, and 5.73 (95% CI, 4.65-7.07) for persons with 5 risk factors. The highest risk was conferred by having the combination of risk factors of diabetes, hypertension, and dyslipidemia, with or without weight risk.
  
  
  CONCLUSIONS
  This study demonstrates a direct association between an increasing number of cardiometabolic risk factors and prevalent diagnosis of AMI and stroke. The combination of risk factors conferring the highest risk was diabetes, hypertension, and dyslipidemia.
authors.affiliation: College of Pharmacy, University of Arizona, Tucson, Arizona 85721-0202, USA. malone@pharmacy.arizona.edu
authors.forename: Dan C
authors.initials: DC
authors.lastname: Malone
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
authors.forename: Greg A
authors.initials: GA
authors.lastname: Nichols
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Adrianne C
authors.initials: AC
authors.lastname: Feldstein
authors.forename: Rami H
authors.initials: RH
authors.lastname: Ben-Joseph
authors.forename: Lynn J
authors.initials: LJ
authors.lastname: Okamoto
authors.forename: Audra N
authors.initials: AN
authors.lastname: Boscoe
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008055:Lipids