30-Year High Cardiovascular Risk Incidence and its Determinants: CUME Study

This is a prospective cohort of 2,854 adults aged 20 to 59. The incidence of the outcome was calculated using the Framingham equation and its determinants were determined through multivariate Cox regression.

Results:

After an average of 2.62 years, the incidence of high cardiovascular risk was 8.09 and 20.1 cases per 1,000 person-years, for females and males respectively. Being male (HR: 2.34; 95% CI: 1.58 - 3.46), employment (HR: 2.13; 95% CI: 1.13 - 3.99), high consumption of processed foods (HR: 2.44; 95% CI: 1.21 - 4.90), and being physically active (HR: 0.63; 95% CI: 0.41 - 0.98) were associated with high cardiovascular risk.

Conclusions:

Among highly educated adults, being male, employment, and high consumption of processed foods are predictors of high cardiovascular risk, while being physically active acts as a protective factor.

Descriptors:
Incidence; Cardiovascular Risk; Risk Factors; Cohort Studies; Epidemiologic Determinants

Characteristics	High Cardiovascular Risk
Characteristics	No (n = 2,753) n (%)	Yes (n = 101) n (%)
Demographic and Socioeconomic
Gender ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
Female	1,941 (70.50)	49 (48.51)
Male	812 (29.50)	52 (51.49)
Age [average, (SD)]^†	34.16 (7.56)	44.25 (7.27)
Race/Skin Color
White	1,765 (64.11)	68 (67.33)
Black/Brown/Yellow/Indigenous	988 (35.89)	33 (32.67)
In a Stable Relationship ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
No	1,478 (53.69)	42 (41.58)
Yes	1,275 (46.31)	59 (58.42)
Healthcare Professional
No	1,973 (71.67)	78 (77.23)
Yes	780 (28.33)	23 (22.77)
Education Level ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
Undergraduate	741 (26.92)	20 (19.80)
Specialization	619 (22.48)	34 (33.66)
Master's/Doctorate	1,393 (50.60)	47 (46.53)
Currently Employed ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
No	678 (24.63)	11 (10.89)
Yes	2,075 (75.37)	90 (89.11)
Family Income (minimum wages) [average (SD)]	10.38 (18.23)	11.93 (7.56)
Lifestyle Habits
Current Smoking ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
No	2,551 (92.66)	86 (85.15)
Yes	202 (7.34)	15 (14.85)
Heavy Episodic Drinking (times/month)^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
0	1,604 (58.26)	62 (61.39)
1 to 2	617 (22.41)	14 (13.86)
3 to 4	313 (11.37)	9 (8.91)
5 or more	219 (7.95)	16 (15.84)
Physical Activity (min/week)
Sedentary	635 (23.07)	32 (31.68)
Insufficient	574 (20.85)	16 (15.84)
Active	1,544 (56.08)	53 (52.48)
Dietary Intake (grams/day)
Natural Foods/Culinary Ingredients [average (SD)]	65.98 (13.29)	66.30 (11.43)
Processed Foods [average (SD)]^†	9.90 (5.79)	11.47 (6.80)
Ultraprocessed Foods [average (SD)]	25.31 (11.17)	23.99 (10.50)
Health Conditions
Systolic Blood Pressure (mmHg) [average (SD)]^†	113.68 (10.26)	120.40 (11.60)
Use of Antihypertensive Medication ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
No	2,667 (96.88)	74 (73.27)
Yes	86 (3.12)	27 (26.73)
Diagnosis of Type 2 Diabetes Mellitus ^* * p value < 0.05 by Pearson's chi-squared test; †p value < 0.05 by t-Student test.
No	2,725 (98.98)	91 (90.10)
Yes	28 (1.02)	10 (9.90)
Body Mass Index (BMI) (Kg/m^2) [average (SD)]^†	24.15 (4.05)	29.00 (4.88)

Characteristics	Incidence (cases/1.000 person-years)	HR^*	95% CI^*
Demographic and Socioeconomic
Gender
Female	8.09	1 (Ref.)	-
Male	20.10	2.42	1.64 - 3.58
Race/Skin Color
White	12.25	1 (Ref.)	-
Black/Brown/Yellow/Indigenous	10.67	0.85	0.56 - 1.29
Stable Relationship
No	14.37	1 (Ref.)	-
Yes	9.25	1.43	0.96 - 2.13
Healthcare Professional
No	12.61	1 (Ref.)	-
Yes	9.37	1.29	0.81 - 2.06
Education Level
Bachelor's Degree	8.92	1 (Ref.)	-
Specialization	17.25	1.89	1.09 - 3.29
Master's/Doctorate	10.61	1.10	0.65 - 1.87
Employed
No	5.49	1 (Ref.)	-
Yes	13.55	2.29	1.22 - 4.29
Family Income (in minimum wages)
< 5	8.36	1 (Ref.)	-
5 to 9	10.26	1.03	0.55 - 1.92
10 and above	13.58	1.45	0.80 - 2.63

Characteristics	Incidence (cases/1.000 person-years)	HR^*	95% CI^*
Lifestyle Habits
Physical Activity
Sedentary	15.89	1 (Ref.)	-
Insufficient	8.81	0.57	0.31 - 1.05
Active	11.01	0.68	0.44 - 1.06
Heavy Episodic Drinking (times/month)
0	12.29	1 (Ref.)	-
1 to 2	7.25	0.56	0.31 - 1.00
3 to 4	9.22	0.74	0.36 - 1.49
5 or more	23.09	1.98	1.14 - 3.44
Dietary Habits
Whole Foods/Culinary Ingredients
1st quintile	11.18	1 (Ref.)	-
2nd quintile	11.86	1.01	0.55 - 1.87
3rd quintile	8.65	0.74	0.38 - 1.45
4th quintile	14.15	1.23	0.68 - 2.24
5th quintile	12.69	1.12	0.61 - 2.08
Processed Foods
1st quintile	6.28	1 (Ref.)	-
2nd quintile	12.93	2.07	1.01 - 4.25
3rd quintile	9.27	1.38	0.64 - 2.99
4th quintile	13.01	2.14	1.04 - 4.42
5th quintile	17.11	2.81	1.40 - 5.63
Ultra-Processed Foods
1st quintile	13.68	1 (Ref.)	-
2nd quintile	12.90	0.91	0.50 - 1.64
3rd quintile	12.87	0.93	0.51 - 1.69
4th quintile	9.94	0.70	0.38 - 1.32
5th quintile	9.39	0.65	0.34 - 1.23

Characteristics	HR^*	95% CI^*
Distal Block
Demographic and Socioeconomic
Gender
Female	1 (Ref.)	-
Male	2.34	1.58 - 3.46
Employed
No	1 (Ref.)	-
Yes	2.13	1.13 - 3.99
Proximal Block
Lifestyle Habits
Physical Activity (min/week)
Sedentary	1 (Ref.)	-
Insufficient	0.59	0.32 - 1.07
Active	0.63	0.41 - 0.98
Dietary Habits
Processed Foods
1st quintile	1 (Ref.)	-
2nd quintile	2.01	0.97 - 4.12
3rd quintile	1.23	0.57 - 2.66
4th quintile	1.84	0.89 - 3.82
5th quintile	2.44	1.21 - 4.90

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E-mail: reben@abennacional.org.br

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[1] Corresponding author: Renata Soares Passinho, E-mail: renatapassinho@gmail.com