Association between coexisting hypertension, dyslipidaemia and elevated C reactive protein with cardiovascular disease and mortality: a cross-sectional and longitudinal analysis in a representative cohort of older US adults.

Abstract

Objective: Hypertension and dyslipidemia are established risk factors for cardiovascular disease (CVD), but are often insufficient alone in predicting CVD. Inflammation also contributes to CVD, but research on the co-occurrence of inflammation, hypertension, and dyslipidemia and CVD risk is limited. Knowledge of inflammatory status in addition to other risk factors is vital for clinicians to correctly evaluate patients for CVD risk.

Methods: Prospective data from the Health and Retirement Study, a representative cohort of US adults over 50 years of age (n = 7895) were used. The average participant age was 68.8 years, and 54.9% were female. 80.7% were Non-Hispanic White, 10.1% were Non-Hispanic Black, and 9.2% were Hispanic. Hypertension, dyslipidemia, and elevated C-reactive protein (CRP) were used to create a CVD risk score: low (0-1 factors), medium (2 factors), or high (all 3 factors). Measurement and definition guidelines for these variables are thoroughly explained in the methods section. Weighted logistic regression models estimated the odds ratio (OR) of 1) prevalent and incident CVD for medium and high-risk groups versus the low-risk group and 2) 4-year mortality adjusting for covariates.

Results: Cross-sectionally, high-risk participants (n=1706) had significantly higher odds of CVD prevalence compared to participants with low-risk (n=3107) (adjusted OR = 1.54, 95% CI: [1.29 - 1.84]). Medium-risk (n=3082) participants had higher odds of CVD prevalence, though this did not reach significance. Prospectively, medium and high-risk participants had significantly higher odds of 4-year CVD incidence (medium-risk adjusted OR = 1.57, 95% CI: [1.18 - 2.09]; high-risk adjusted OR = 1.67, 95% CI: [1.19 - 2.36]) compared to those with low-risk. Risk of 4-year mortality was higher in high-risk (OR = 2.12, 95% CI: [1.60 - 2.8]) participants vs. low-risk, and non-significantly elevated in medium-risk participants.

Conclusions: Co-occurrence of hypertension, dyslipidemia, and elevated CRP was strongly associated with increased CVD prevalence, higher incident CVD, and elevated 4-year mortality in older US adults, emphasizing the importance of multifactor screening for CVD risk.