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Early Death Predicted with Cardio Risk Factors

Feb 22, 2013
Adolescents and young adults with a range of cardiometabolic risk factors have an increased risk of dying before they turn 55….

According to Sharon Saydah, PhD, of the CDC’s Division of Diabetes Translation in Atlanta, and colleagues, among individuals ages 12 to 39, central obesity, smoking, and hyperglycemia at a single assessment were associated with premature death from any cause within the next 12 to 18 years (relative hazards 1.86 to 3.81),

Additionally, the presence of hypertension at a young age was associated with dying from endogenous causes — diseases or self-inflicted injury but not accidents or homicides — before age 55 (RH 1.84, 95% CI 1.02 to 3.32).

The authors wrote, "Although it is well established that many early deaths, especially among teenagers and young adults, are caused by injuries, the extent to which risk factors for disease are also associated with early deaths has not been well studied. Our findings suggest that, at least in the United States, certain cardiometabolic risk factors also contribute substantially to the overall risk for early death and to the social loss that such deaths entail."

The researchers examined data from the third National Health and Nutrition Examination Survey (NHANES), which was conducted from 1988 to 1994. The analysis included 9,245 participants ages 12 to 39 (mean age 26.1) at the time of the survey. Most of the participants (77.2%) were non-Hispanic white, 14.7% were non-Hispanic black, and 8.1% were Mexican American.

Through 2006, 298 patients (3.2%) died before reaching age 55; about three-quarters of the deaths were from endogenous causes. The top three causes of death were accidents, self-injury, and circulatory for those ages 12 to 25, cancer, circulatory, and accidental for those ages 26 to 32, and cancer, circulatory, and genetic for those ages 33 to 39.

After adjustment for age, sex, and race/ethnicity, the following factors were associated with an increased risk of dying prematurely from any cause:

  • Glycated hemoglobin (HbA1c) level of at least 6.5% versus less than 5.7% (RH 3.81, 95% CI 1.98 to 7.31)
  • Waist-to-height ratio of at least 0.65 versus less than 0.5 (RH 2.39, 95% CI 1.34 to 4.29)
  • Elevated cotinine levels (RH 1.89, 95% CI 1.17 to 3.08)
  • Currently versus never smoking (RH 1.86, 95% CI 1.25 to 2.76)

Those factors — in addition to hypertension, elevated body mass index, and large waist circumference — were also related to a greater risk of death from endogenous causes.

"These findings underscore the importance of obesity prevention and tobacco control interventions for adolescents and young adults," the authors wrote.

In general, additional adjustment for a self-reported history of chronic disease weakened the relationships, which "was not surprising, given that diabetes is defined largely on the basis of elevated HbA1c levels and heart disease is associated with elevated blood pressure," they wrote.

There were some differences according to sex. Women, but not men, had a greater risk of all-cause death associated with hypertension and elevated total and non-high density lipoprotein (HDL) cholesterol.

"However," the researchers wrote, "caution is urged in interpreting these findings because they are based on fewer than 90 deaths among female subjects."

The findings were not affected by race or ethnicity.

The authors acknowledged that the study was limited by the inability to perform analyses of specific causes of death and by the lack of information on how changes in the various cardiometabolic risk factors could have influenced the risk of premature death.

Saydah S, et al "Cardiometabolic risk factors among U.S. adolescents and young adults and risk of early mortality" Pediatrics 2013; DOI: 10.1542/peds.2012-2583.