title: Accumulation of non-traditional risk factors for coronary heart disease is associated with incident coronary heart disease hospitalization and death.
abstract: BACKGROUND
  Assessing multiple traditional risk factors improves prediction for late-life diseases, including coronary heart disease (CHD). It appears that non-traditional risk factors can also predict risk. The objective was to investigate contributions of non-traditional risk factors to coronary heart disease risk using a deficit accumulation approach.
  
  
  METHODS
  Community-dwelling adults with no known history of CHD (n = 2195, mean age 46.9±18.7 years, 51.8% women) participated in the 1995 Nova Scotia Health Survey. Three risk factor indices were constructed to quantify the proportion of deficits present in individuals: 1) a 17-item Non-Traditional Risk Factor Index (e.g. sinusitis, arthritis); 2) a 9-item Traditional Risk Factor Index (e.g. hypertension, diabetes); and 3) a frailty index (25 items combined from the other two index measures). Ten-year risks of CHD events (defined as CHD-related hospitalization and CHD-related mortality) were evaluated.
  
  
  RESULTS
  The Non-Traditional Risk Factor Index, made up of health deficits unrelated to CHD, was independently associated with incident CHD events over 10 years after controlling for age, sex, and the Traditional Risk Factor Index [adjusted {adj.} Hazard Ratio {HR} = 1.31; Confidence Interval {CI} 1.14-1.51]. When all health deficits, both those related and unrelated to CHD, were included in a frailty index the corresponding adjusted hazard ratio was 1.61; CI 1.40-1.85.
  
  
  CONCLUSIONS
  Both traditional and non-traditional risk factor indices are independently associated with incident CHD events. CHD risk assessment may benefit from consideration of general health information as well as from traditional risk factors.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Lindsay M K
authors.initials: LM
authors.lastname: Wallace
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Olga
authors.initials: O
authors.lastname: Theou
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Kirkland
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Michael R H
authors.initials: MR
authors.lastname: Rockwood
authors.affiliation: Department of Medicine, Columbia University, Presbyterian Hospital, New York, New York, United States of America.
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.affiliation: Department of Medicine, Columbia University, Presbyterian Hospital, New York, New York, United States of America.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Centre for Health Care of Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index