{"id":45731,"date":"2014-10-27T17:24:33","date_gmt":"2014-10-27T21:24:33","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=45731"},"modified":"2014-10-30T15:19:34","modified_gmt":"2014-10-30T19:19:34","slug":"traditional-cvd-risk-factors-mediate-between-lifestyle-factors-and-cardiovascular-risk","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/10\/27\/traditional-cvd-risk-factors-mediate-between-lifestyle-factors-and-cardiovascular-risk\/","title":{"rendered":"Traditional CVD Risk Factors Mediate Between Lifestyle Factors and Cardiovascular Risk in Women"},"content":{"rendered":"

CardioExchange\u2019s Harlan M. Krumholz<\/b> interviews Nina P. Paynter<\/b> about her research group\u2019s case-cohort study comparing lifestyle-based with traditional cardiovascular disease prediction among women in the Women\u2019s Health Initiative Observational Study. <\/i>The article, published in <\/i>Circulation,<\/a>\u00a0includes complete lists of the\u00a0lifestyle-based and traditional risk factors<\/em>. <\/i><\/p>\n

Krumholz:<\/i><\/b> This is a very interesting study. Please describe your main results for our readers.\u2028<\/b><\/p>\n

Paynter: <\/i><\/b>In a multiethnic cohort of nonsmoking postmenopausal women, when lifestyle factors were added to traditional risk factors in the \u201cpooled cohort\u201d risk score (from\u00a0the most recent ACC\/AHA guidelines<\/a>) or the Reynolds risk score, only recreational physical activity remained independently associated with 10-year\u00a0cardiovascular disease (CVD) risk. A greater number of healthy lifestyle factors reduced the risk for CVD \u2014 and adding lifestyle factors to\u00a0traditional factors\u00a0did improve\u00a0the overall model fit but<\/i> had little effect on\u00a0risk-stratification\u00a0measures.<\/p>\n

Krumholz:<\/i><\/b> So healthy lifestyle factors did not add to predictive models. Does that mean that lifestyle has little effect on risk, beyond how it affects traditional\u00a0risk factors?\u2028<\/b><\/p>\n

Paynter:<\/i><\/b> Our results suggest that knowing someone\u2019s lifestyle today, in addition to his or her traditional risk factors today, does not change the category of 10-year CVD risk for most people (i.e., whether they are high, intermediate, or low risk today). However, physical activity had an independent effect on\u00a0risk, even after controlling for traditional risk factors.<\/p>\n

Krumholz:<\/i><\/b> Does this mean that if someone has his or her traditional CVD risk factors under control, lifestyle contributes little to the person\u2019s future\u00a0risk?\u2028<\/b><\/p>\n

Paynter: <\/i><\/b>Much\u00a0of the effect of lifestyle factors is through the traditional risk factors, so a healthy lifestyle may explain the control of the traditional risk factors. Although we did not directly study this issue,\u00a0control of risk factors via lifestyle may be more beneficial than medical treatment is.<\/p>\n

Krumholz:<\/i> You focused on whether risk models should incorporate lifestyle factors, but isn\u2019t the finding more profound for what we should recommend to patients? It seems that, in the end, these factors contribute relatively little to future risk, beyond traditional factors.\u2028<\/b><\/p>\n

Paynter:<\/i><\/b> \u2028Our analysis (and assessment of prediction in general) is not set up to look at causal contributions. One factor might be a great predictor and not at all\u00a0causal, whereas another factor might be causal and not a great predictor. Risk prediction, though an important tool, is only one part of decision making about treatment. In this case, there is a wide consensus that lifestyle factors significantly affect health, and although they may not dramatically change\u00a0predictions of 10-year risk, they do matter for treatment recommendations. As mentioned above, the traditional risk factors are mediators between lifestyle behaviors and CVD risk \u2014 by improving\u00a0their lifestyle, patients may reduce their risk without the need for medication.<\/p>\n

JOIN THE DISCUSSION<\/b><\/p>\n

How will Dr. Paynter\u2019s findings affect how you advise patients about lifestyle-based and traditional CVD risk factors?<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

Nina Paynter discusses her case-cohort study comparing lifestyle-based with traditional cardiovascular disease prediction among women in the Women\u2019s Health Initiative Observational Study.<\/p>\n","protected":false},"author":211,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[1777,1553,2406],"class_list":["post-45731","post","type-post","status-publish","format-standard","hentry","category-prevention","tag-healthy-lifestyle","tag-risk-prediction","tag-womens-health-observational-study"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/45731","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/211"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=45731"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/45731\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=45731"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=45731"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=45731"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}