What is the predictive value of established risk factors for total and cardiovascular disease mortality when measured before middle age? Pooled analyses of two prospective cohort studies from Scotland.
OBJECTIVE
To examine the association of physiological, behavioural and social characteristics in pre-middle age with future total and cardiovascular disease (CVD) mortality.


RESULTS
Risk factor data on 1503 individuals aged 16-35 years at baseline were collected in two prospective cohort studies using standard protocols. Their association with total and CVD mortality ascertained during 40 years of follow-up was summarized using Cox proportional hazards regression. A median follow-up of 39.6 years gave rise to 255 deaths (103 from CVD). In age-adjusted and sex-adjusted analyses, impaired lung function [one standard deviation increases in forced expiratory volume in 1 s: hazards ratio 0.69; 95% confidence interval 0.55, 0.86; and in forced vital capacity: 0.76; 0.59, 0.98], current cigarette smoking (4.16; 2.22, 7.80) and higher alcohol consumption (one standard deviation increase in standard units consumed: 1.20; 1.02, 1.41) were associated with CVD. In fully adjusted analyses associations generally held. For total mortality, these factors and obesity and socioeconomic disadvantage were predictive.


CONCLUSIONS
A range of risk factors measured before middle age were related to risk of total and CVD mortality up to four decades later, indicating that public health interventions should be implemented earlier in the life course than is currently the case.
Gray
Linsay
L
MRC Social and Public Health Sciences Unit, Glasgow, UK. l.gray@sphsu.mrc.ac.uk
Hart
Carole L
CL
Smith
George Davey
GD
Batty
G David
GD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000009:adverse effects / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control; D002423:Cause of Death; D005260:Female; D005541:Forced Expiratory Volume; D006293:Health Promotion; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D009765:Obesity / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D011314:Preventive Health Services; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D012959:Socioeconomic Factors; D013997:Time Factors; D014797:Vital Capacity; D055815:Young Adult