Table 1
Baseline characteristics of the UCC-SMART study included in the analyses (N = 12,616).
| Variable | Overall N = 12,616 | Reference group N =174 | 1 Risk factors N = 1422 | 2 Risk factors N = 3997 | 3 Risk factors N = 5586 | 4 Risk factors N = 1300 |
|---|---|---|---|---|---|---|
| Age (years) | 56.3 ± 12.5 | 49.8 ± 15.9 | 53.1 ± 14.2 | 56.3 ± 13.0 | 57.7 ± 11.5 | 54.8 ± 10.6 |
| Men | 8263 (65.5) | 102 (58.6) | 866 (60.9) | 2584 (64.6) | 3734 (66.8) | 901 (69.3) |
| Body mass index (kg/m2) | 26.9 ± 4.4 | 22.3 ± 1.8 | 23.3 ± 2.6 | 25.3 ± 3.8 | 28.4 ± 4.3 | 29.5 ± 3.9 |
| High body mass index (BMI > 25 kg/m2) | 8210 (65.1) | 0 (0) | 173 (12.2) | 1761 (44.1) | 4888 (87.5) | 1300 (100) |
| History of CVD | ||||||
| CAD | 3865 (30.7) | 72 (41.4) | 458 (32.2) | 1280 (32.1) | 1683 (30.1) | 350 (26.9) |
| PAD | 1133 (9) | 3 (1.7) | 68 (4.8) | 286 (7.2) | 57.8 (9.6) | 217 (16.7) |
| CVA | 1849 (14.7) | 27 (15.5) | 224 (15.8) | 585 (14.6) | 771 (13.8) | 228 (17.5) |
| AAA | 356 (2.8) | 2 (1.1) | 15 (1.1) | 124 (3.1) | 163 (2.9) | 49 (3.8) |
| Systolic blood pressure (mm/Hg) | 140.7 ± 21.6 | 121.7 ± 10.9 | 125.0 ± 13.9 | 136.5 ± 20.5 | 146.6 ± 21.5 | 148.4 ± 19.6 |
| Diastolic blood pressure (mm/Hg) | 82.8 ± 12.5 | 73.3 ± 7.9 | 75.3 ± 58.8 | 80.5 ± 11.7 | 85.6 ± 12.6 | 86.9 ± 12.4 |
| Pulse pressure (mm/Hg) | 57.9 ± 15.6 | 48.4 ± 9.1 | 49.7 ± 10.7 | 55.89 ± 15.0 | 60.9 ± 16.3 | 61.4 ± 15.2 |
| Antihypertensive prescription | 5822 (46.1) | 0 (0) | 95 (6.7) | 1319 (33.0) | 3486 (62.4) | 887 (68.2) |
| Hypertension | 8391 (66.5) | 0 (0) | 157 (11.0) | 1973 (49.4) | 4889 (87.5) | 1300 (100) |
| Total cholesterol (mmol/L) | 5.1 ± 1.4 | 3.6 ± 0.5 | 4.8 ± 1.5 | 5.1 ± 1.4 | 5.2 ± 1.3 | 5.4 ± 1.4 |
| Low-density lipoprotein cholesterol (mmol/L) | 3.1 ± 1.2 | 1.8 ± 0.4 | 2.9 ± 1.3 | 3.1 ± 1.2 | 3.1 ± 1.1 | 3.2 ± 1.1 |
| High-density lipoprotein cholesterol (mmol/L) | 1.3 ± 0.4 | 1.5 ± 0.5 | 1.4 ± 0.4 | 1.3 ± 0.4 | 1.2 ± 0.4 | 1.1 ± 0.3 |
| Triglycerides (mmol/L) | 1.8 ± 1.8 | 0.8 ± 0.3 | 1.2 ± 0.6 | 1.6 ± 1.3 | 1.9 ± 2.0 | 2.5 ± 2.9 |
| Lipid lowering medication prescription | 5425 (43) | 0 (0) | 374 (26.3) | 1578 (39.5) | 2753 (49.3) | 709 (54.5) |
| Dyslipidemia | 11488 (91.1) | 0 (0) | 1025 (72.1) | 1973 (49.4) | 5516 (98.7) | 1300 (100) |
| Current smoking | 3544 (28.1) | 0 (0) | 67 (4.7) | 687 (17.2) | 1465 (26.2) | 1300 (100) |
| Diabetes | 2302 (18.2) | 28 (16.1) | 149 (10.5) | 580 (14.5) | 1229 (22.0) | 287 (22.1) |
| eGFR (ml/min/1.73 m2) | 79.9 ± 19.5 | 89.4 ± 21.8 | 83.3 ± 17.7 | 79.9 ± 18.9 | 78.2 ± 19.7 | 81.9 ± 21.1 |
[i] For continuous variables of baseline characteristics, mean ± SD was calculated. For categorical variables, frequencies and percentages were calculated. SES, socioeconomic status; CAD, coronary artery disease; PAD, peripheral artery disease; CVA, cerebrovascular accidents; AAA, abdominal aortic aneurysm; Hypertension, systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or prescribed antihypertensive drugs; Dyslipidemia, non-HDL levels (total cholesterol minus HDL-C) >2.6 mmol/L and/or the prescription of lipid lowering drugs; MDRD-clearance, modification of diet in renal disease.
Table 2
The relation with CVD events, prevalence, and PAF (%) of the four risk factor levels.
| Number of risk factors | HR (95% CI) | Prevalence | PAF, % |
|---|---|---|---|
| 0 | Reference | 1.4 | Reference |
| 1 | 1.65 (0.77; 3.54) | 11.4 | 6.9 |
| 2 | 2.61 (1.24; 5.50) | 32.0 | 34.0 |
| 3 | 3.25 (1.55; 6.84) | 44.8 | 50.1 |
| 4 | 3.74 (1.77; 7.93) | 10.4 | 22.2 |
[i] Reference group are patients (N = 174) with none of the four risk factors. Prevalence per level was calculated as number of patients in that cluster level divided by the total amount of patients analyzed (n = 12,479). PAF calculation was included in the method section.
Table 3
The relation with CVD events, prevalence and, PAF (%) of individual risk factors and the clusters.
| Overall | |||
|---|---|---|---|
| HR (95% CI) | Prevalence | PAF,% | |
| None of the four risk factors | Reference | 1.4 | Reference |
| Current smoking | 2.41 (0.81; 7.17) | 28.2 | 28.4 |
| Hypertension | 1.30 (0.53; 3.18) | 66.6 | 16.7 |
| Dyslipidemia | 1.25 (0.57; 2.70) | 91.4 | 18.6 |
| Overweight | 1.78 (0.75; 4.23) | 65.1 | 33.7 |
| Smoking – Hypertension | 3.17 (1.15; 8.74) | 17.1 | 27.1 |
| Smoking – Dyslipidemia | 2.35 (1.08; 5.13) | 27.1 | 26.8 |
| Smoking – Overweight | 1.11 (0.23; 5.36) | 17.3 | 1.9 |
| Hypertension – Dyslipidemia | 1.95 (0.92; 4.14) | 62 | 37.1 |
| Hypertension – Overweight | 1.40 (0.62; 3.17) | 46.6 | 15.7 |
| Dyslipidemia – Overweight | 1.70 (0.80; 3.61) | 60.6 | 29.8 |
| Smoking – Hypertension – Dyslipidemia | 4.06 (1.91; 8.63) | 16.4 | 33.4 |
| Smoking – Hypertension – Overweight | 2.51 (0.93; 6.73) | 11 | 14.2 |
| Smoking – Dyslipidemia – Overweight | 2.86 (1.33; 6.16) | 16.4 | 23.4 |
| Hypertension – Dyslipidemia – Overweight | 1.99 (0.94; 4.18) | 43.4 | 30.1 |
| Smoking – Hypertension – Dyslipidemia – Overweight | 3.25 (1.53; 6.88) | 10.4 | 19.0 |
[i] Reference group are patients (N = 174) with none of the four risk factors. Prevalence for each risk factor and cluster was calculated as number of patients in that cluster divided by the total amount of patients analyzed (n = 12,479), adding up the prevalence of clusters that also contain that specific risk factor combination (e.g. the 91.4% for L was based on L presence in the L individual risk factor, SL, LO, SHL, SLO, HLO and SHLO clusters). The PAF calculation was included in the method section.
Figure 1
Hazard ratio and its corresponding 95% CI (on the log-scale) for individual risk factors and risk factor clusters adjusted for age and sex. A no difference in CVD risk between cluster and the reference group giving a value of one is displayed in the plot. Reference group are patients (N = 174) with none of the four risk factors. L, dyslipidemia; S, current smoking; H, hypertension; O, overweight.
Figure 2
Hazard ratios and its corresponding 95% CIs (on the log scale) by sex. A no difference in CVD risk between clusters and the reference group giving a value of 1 is displayed in the plot. Reference group are patients (N = 174) with none of the four risk factors. L, dyslipidemia; S, current smoking; H, hypertension; O, overweight.
Figure 3
Hazard ratios and its corresponding 95% CIs (on the log scale) by age. A no difference in CVD risk between clusters and the reference group giving a value of 1 is displayed in the plot. Reference group are patients (N = 174) with none of the four risk factors. L, dyslipidemia; S, current smoking; H, hypertension; O, overweight.
Table 4
The relation with CVD events, prevalence and PAF (%) of individual risk factors and the clusters stratified by sex and age.
| Men (n = 8187) | Women (n = 4292) | |||||
|---|---|---|---|---|---|---|
| HR (95% CI) | Prevalence | PAF,% | HR (95% CI) | Prevalence | PAF,% | |
| None of the four risk factors | Reference | 1.2 | Reference | Reference | 1.7 | Reference |
| Smoking | 3.45 (1.05;11.30) | 29.0 | 41.5 | N.A. | 26.9 | N.A. |
| Hypertension | 1.17 (0.40; 3.42) | 65.5 | 10.0 | 1.71 (0.33; 8.84) | 68.3 | 32.7 |
| Dyslipidemia | 1.33 (0.53; 3.30) | 68.4 | 18.4 | 1.05 (0.24; 4.54) | 91.9 | 4.4 |
| Overweight | 1.98 (0.73; 5.35) | 68.7 | 40.2 | 1.15 (0.16; 8.15) | 58.8 | 8.1 |
| Smoking – Hypertension | 2.38 (0.64; 8.87) | 17.1 | 19.1 | 4.50 (0.82; 24.56) | 17 | 37.3 |
| Smoking – Dyslipidemia | 2.52 (1.01; 6.32) | 27.1 | 29.2 | 1.95 (0.45; 8.44) | 24.9 | 19.1 |
| Smoking – overweight | 0.76 (0.09; 6.54) | 18.4 | 0 | 2.12 (0.19; 23.24) | 14.1 | 13.6 |
| Hypertension – Dyslipidemia | 2.04 (0.84; 4.97) | 60.3 | 38.5 | 1.68 (0.41; 6.84) | 63.4 | 30.1 |
| Hypertension – Overweight | 1.58 (0.61; 4.09) | 48.1 | 21.8 | 0.90 (0.17; 4.63) | 44.1 | 0 |
| Dyslipidemia – Overweight | 1.80 (0.74; 4.40) | 63.1 | 33.5 | 1.48 (0.35; 6.20) | 54.9 | 20.9 |
| Smoking – Hypertension – Dyslipidemia | 4.35 (1.78; 10.62) | 16.1 | 35.0 | 3.31 (0.81; 13.55) | 15.8 | 26.7 |
| Smoking – Hypertension – Overweight | 3.18 (1.04; 9.73) | 11.6 | 20.2 | 0.91 (0.08; 10.08) | 9.8 | 0 |
| Smoking – Dyslipidemia – Overweight | 3.00 (1.22; 7.38) | 17.4 | 25.8 | 2.77 (0.64; 11.92) | 13.4 | 19.1 |
| Hypertension – Dyslipidemia – Overweight | 2.22 (0.92; 5.36) | 44.5 | 35.2 | 1.42 (0.35; 5.73) | 41.3 | 14.8 |
| Smoking – Hypertension – Dyslipidemia – Hypertension | 3.46 (1.42; 8.41) | 11 | 21.3 | 2.71 (0.66; 11.06) | 9.3 | 13.7 |
| Age < 60 (n = 7398) | Age > 60 (n = 5081) | |||||
| HR (95% CI) | Prevalence | PAF,% | HR (95% CI) | Prevalence | PAF,% | |
| None of the four risk factors | Reference | 1.6 | Reference | Reference | 1.1 | Reference |
| Smoking | 3.63 (0.81; 16.21) | 34.6 | 47.6 | 1.39 (0.25; 7.59) | 18.9 | 6.9 |
| Hypertension | 2.62 (0.63; 10.95) | 60.0 | 49.3 | 1.34 (0.42; 4.28) | 76.3 | 20.6 |
| Dyslipidemia | 1.25 (0.38; 4.09) | 92.4 | 18.8 | 1.46 (0.53; 4.05) | 86.5 | 28.5 |
| Overweight | 4.28 (1.16; 15.81) | 64.0 | 67.7 | 1.49 (0.47; 4.75) | 63.0 | 23.6 |
| Smoking – Hypertension | 3.59 (0.80; 16.06) | 19.1 | 33.1 | 3.08 (0.77; 12.32) | 14.1 | 22.7 |
| Smoking – Dyslipidemia | 2.50 (0.78; 8.05) | 32.3 | 32.6 | 2.57 (0.90; 7.40) | 17.5 | 21.6 |
| Smoking – overweight | 1.00 (0.10; 9.63) | 21.2 | 0 | 1.35 (0.15; 12.12) | 10.6 | 3.6 |
| Hypertension – Dyslipidemia | 2.31 (0.72; 7.39) | 56.2 | 42.4 | 2.55 (0.95; 6.87) | 70.4 | 52.2 |
| Hypertension – Overweight | 1.64 (0.39; 6.85) | 42.6 | 21.4 | 1.82 (0.64; 5.19) | 52.4 | 30.1 |
| Dyslipidemia – Overweight | 2.07 (0.65; 6.59) | 60.1 | 39.1 | 1.84 (0.68; 5.01) | 56.8 | 32.3 |
| Smoking – Hypertension – Dyslipidemia | 5.26 (1.66; 16.70) | 17.9 | 43.3 | 4.65 (1.72; 12.61) | 13.7 | 33.3 |
| Smoking – Hypertension – Overweight | 3.18 (0.71; 14.23) | 12.9 | 21.9 | 2.63 (0.71; 9.80) | 8.2 | 11.8 |
| Smoking – Dyslipidemia – Overweight | 3.18 (1.00; 10.08) | 20.2 | 30.6 | 2.67 (0.95; 7.53) | 9.9 | 14.2 |
| Hypertension – Dyslipidemia – Overweight | 2.47 (0.79; 7.72) | 40.3 | 37.2 | 2.42 (0.91; 6.49) | 48.1 | 40.6 |
| Smoking – Hypertension – Dyslipidemia – Hypertension | 3.71 (1.18; 11.67) | 12.3 | 25.0 | 3.76 (1.39; 10.16) | 7.7 | 17.5 |
[i] Reference group are patients (N = 174) with none of the four risk factors. Prevalence for each risk factor and cluster was calculated as number of patients in that cluster divided by the total amount of patients analyzed in that sub-group, adding up the prevalence of clusters that also contain that specific risk factor combination (e.g. the 60.3% for HL in men was based on HL presence in the HL cluster, SHL, HLO and SHLO clusters). The PAF calculation was included in the method section.