Modifiable Risk Factors Versus Age on Developing High Predicted Cardiovascular Disease Risk in Blacks.
Clinical guidelines recommend using predicted atherosclerotic cardiovascular disease (ASCVD) risk to inform treatment decisions. The objective was to compare the contribution of changes in modifiable risk factors versus aging to the development of high 10-year predicted ASCVD risk.



A prospective follow-up was done of the Jackson Heart Study, an exclusively black cohort at visit 1 (2000-2004) and visit 3 (2009-2012). Analyses included 1115 black participants without high 10-year predicted ASCVD risk (<7.5%), hypertension, diabetes mellitus, or ASCVD at visit 1. We used the Pooled Cohort equations to calculate the incidence of high (≥7.5%) 10-year predicted ASCVD risk at visit 3. We recalculated the percentage with high 10-year predicted ASCVD risk at visit 3 assuming each risk factor (age, systolic blood pressure, antihypertensive medication use, diabetes mellitus, smoking, total and high-density lipoprotein cholesterol), one at a time, did not change from visit 1. The mean age at visit 1 was 45.2±9.5 years. Overall, 30.9% (95% CI 28.3-33.4%) of participants developed high 10-year predicted ASCVD risk. Aging accounted for 59.7% (95% CI 54.2-65.1%) of the development of high 10-year predicted ASCVD risk compared with 32.8% (95% CI 27.0-38.2%) for increases in systolic blood pressure or antihypertensive medication initiation and 12.8% (95% CI 9.6-16.5%) for incident diabetes mellitus. Among participants <50 years, the contribution of increases in systolic blood pressure or antihypertensive medication initiation was similar to aging.



Increases in systolic blood pressure and antihypertensive medication initiation are major contributors to the development of high 10-year predicted ASCVD risk in blacks, particularly among younger adults.
Department of Population Health Sciences, University of Utah, Salt Lake City, UT adam.bress@hsc.utah.edu.
Adam P
AP
Bress
School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, AL.
Lisandro D
LD
Colantonio
School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, AL.
John N
JN
Booth
Department of Population Health, NYU School of Medicine, New York, NY.
Tanya M
TM
Spruill
Department of Population Health, NYU School of Medicine, New York, NY.
Joseph
J
Ravenell
Department of Population Health, NYU School of Medicine, New York, NY.
Mark
M
Butler
Department of Population Health, NYU School of Medicine, New York, NY.
Amanda J
AJ
Shallcross
Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS.
Samantha R
SR
Seals
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Kristi
K
Reynolds
Department of Population Health, NYU School of Medicine, New York, NY.
Gbenga
G
Ogedegbe
Department of Medicine, Columbia University, New York, NY.
Daichi
D
Shimbo
School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, AL.
Paul
P
Muntner
D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D017677:Age Distribution; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
atherosclerotic cardiovascular disease risk; blacks; blood pressure; hypertension; population