New study highlights dangers of cumulative exposure to cardiovascular risks and need for earlier primary prevention strategies

May 19, 2023
UM School of Medicine faculty develop tool to assess risks earlier in vulnerable patients.

With heart disease the most common cause of death worldwide, researchers have attempted to quantify how cumulative exposure to multiple risk factors, like high blood pressure, obesity, and elevated cholesterol, affect an individual’s risk of having a heart attack or stroke. Using sophisticated modeling techniques, University of Maryland School of Medicine (UMSOM) researchers have developed a new tool that can predict the risk of heart disease in those over 40 based on their total exposure, through the years, to heart disease risk factors.

The new research findings, published in March in the Journal of the American College of Cardiology, used data from the Coronary Artery Risk Development in Young Adults (CARDIA), which recruited about 5,000 healthy young adults from four U.S. cities and followed them for 30 years. The researchers were able to calculate from this data the cumulative effect of individual risk factors, such as high blood pressure, diabetes, elevated cholesterol, and the additive effects of multiple risk factors that can cause cardiovascular disease. 

Black patients were found to have a 46 percent greater risk of developing heart disease compared to white patients. This finding is independent of other risk factors, including family history, smoking habits, and college attendance (a marker of socioeconomic status). Black patients also were found to be more susceptible to cardiovascular effects of uncontrolled high blood pressure as compared to white patients. White patients, on the other hand, were found to be more susceptible to elevated low-density lipoprotein (LDL) levels than Black patients. 

The R Shiny app, developed in this study, is a tool that allows medical providers to insert cardiovascular risks, patient history, and patient race to determine individual risks and how best to address them. Electronic medical records are now widely available, making the development of tools such as the R Shiny app possible. R Shiny can be used to estimate cardiovascular risks after age 40 based on severity of risk factors earlier in adulthood. The app is hosted on NHLBI’s website.

During the two-decade follow-up period after age 40, the researchers found that 316 people in the study experienced their first cardiovascular event, including heart disease, strokes, and congestive heart failure.

UMSOM release