title: Heterogeneous impact of classic atherosclerotic risk factors on different arterial territories: the EPIC-Norfolk prospective population study.
abstract: OBJECTIVE
  Particular atherosclerotic risk factors may differ in their association with atherosclerosis across vascular territories. Few studies have compared the associations between multiple risk factors and cardiovascular disease (CVD) manifestations in one population. We studied the strength of the associations between traditional risk factors including coronary artery disease (CAD), ischaemic and haemorrhagic stroke, abdominal aortic aneurysms (AAAs), and peripheral arterial disease (PAD).
  
  
  RESULTS
  This analysis included 21 798 participants of the EPIC-Norfolk population study, without previous CVD. Events were defined as hospitalization or mortality, coded using ICD-10. The associations between the risk factors, such as low-density lipoprotein cholesterol, systolic blood pressure (SBP), and smoking, and the various CVD manifestations were compared using competing risk analyses. During 12.1 years, 3087 CVD events were recorded. The associations significantly differed across CVD manifestations. Low-density lipoprotein cholesterol was strongly associated with CAD [adjusted hazard rate (aHR) highest vs. lowest quartile 1.63, 95% CI 1.44-1.86]. Systolic blood pressure was a strong risk factor for PAD (aHR highest vs. lowest quartile 2.95, 95% CI 1.78-4.89) and ischaemic stroke (aHR highest vs. lowest quartile 2.48, 95% CI 1.55-3.97), but not for AAA. Smoking was strongly associated with incident AAA (aHR current vs. never 7.66, 95% CI 4.50-13.04) and PAD (aHR current vs. never 4.66, 95% CI 3.29-6.61), but not with haemorrhagic stroke.
  
  
  CONCLUSIONS
  The heterogeneity in the risk factor-CVD associations supports the concept of pathophysiological differences between atherosclerotic CVD manifestations and could have implications for CVD prevention.
authors.affiliation: Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Stoekenbroek
authors.affiliation: Department of Cardiology, Academic Medical Center/University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: G Kees
authors.initials: GK
authors.lastname: Hovingh
authors.affiliation: Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.affiliation: Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Department of Cardiology, Academic Medical Center/University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands r.j.peters@amc.uva.nl.
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
mesh_terms: D017677:Age Distribution; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology*; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000378:metabolism; D003324:Coronary Artery Disease / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology*; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*
chemical_list: D008078:Cholesterol, LDL
keywords: Cardiovascular disease; Pathophysiology; Prevention; Risk factors