Abstract P129: Mid-Life Blood Lipid Levels, Blood Pressure and Smoking in Men: Relation With 5-yr CHD Incidence Compared to Associations With Multi-Morbidity Among Survivors at Late Life
Background: Interest in understanding CHD risk factors observable at earlier age and associated with late-life morbidity has been increasing as case fatality declined and life expectancy rose. The Charlson Comorbidity Index (CCI) developed in 1987 was designed to develop a prospectively applicable method for classifying comorbid conditions Patients, methods. An extensive examination of 10,000 men, civil servants, aged 40-65 yr, took place in 1963. They were reexamined in 1965 and 1968 and the 5-yr incidence of CHD was assessed. Over three decades later, CCI was available for 75% of the survivors, who were insured with a large national HMO (“Clalit“).
We grouped the CCI categories of 1-17 into grouped scores (CCS) in five groups: CCI=7. Odds ratios and hazard ratios (HR) for these endpoints in relation to total HDL and non-HDL cholesterol and risk factor levels were estimated applying multiple logistic regression.
Results: The 5-yr incidence (1963-68) of CHD was 27, 31, 48 and 68 per 1000 in the first to fourth quartile of total serum cholesterol; and 30, 33, 41 and 64/1000 in corresponding percentiles of non-HDL cholesterol. Multivariate-adjusted hazard ratios for the latter were 1, 1.12, 1.32 and 2.23 (p for trend<0.0005) for the 4 quartiles respectively. Among 2086 Clalit-insured men surviving by 2002, aged 79 yr and above (mean age 83.5±4.2 yr), using ordered logistic regression, baseline blood levels of non-HDL cholesterol (OR=1.15, 95%CI 1.04-1.26) as well as HDL (OR=0.88 per 1 SD increment, 95%CI 0.80-0.96) were associated with CCS under proportional odds assumption. Also associated with survivors' increased CCS, in addition to lipids, were age (OR=1.12, CI 1.10-1.14 per one year), ever smoking as of 1963 (OR=1.31, CI 1.11-1.54) and the 1963 to 1968 systolic blood pressure increment (OR=1.12 per mm, CI 1.02-1.24). “Desirable weight” (20<BMI30 Kg/Sqm) were associated with odds ratios (ORs) of 1.06, 1.22 and 1.31 of increased CCS, respectively, relative to lean men (BMI<20 Kg/Sqm) [P for trend = 0.02], however adjustment for lipid levels eliminated the association of baseline BMI with 2002 CCS.
Comment: Despite the remoteness of multi-morbid classification in 2002 from baseline levels in the mid 1960's, mid-life lipid components which had remarkably predicted the incidence of CHD were also related moderately to late-life multi-morbidity, among survivors aged>79 years, in addition to cigarette smoking and blood pressure visit- to-visit increment. The serum lipid levels also explained away the increased late life survivors' morbidity among mid-life overweight and obese men.
Author Disclosures: U. Goldbourt: None. D. Tanne: None.
- © 2015 by American Heart Association, Inc.