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Multimorbidity of cardiovascular disease subtypes in a prospective cohort of 1.2 million UK women

Abstract:
Objective
Cardiovascular multimorbidity (CVM) is the co-occurrence of multiple cardiovascular disease subtypes (CVDs) in one person. Because common patterns and incidence of CVM are not well-described, particularly in women, we conducted a descriptive study of CVM in the Million Women Study, a large population-based cohort of women.
Methods
UK women aged 50–64 years were followed up using hospital admissions and mortality records for an average of 19 years. CVM was defined as having ≥2 of 19 selected CVDs. The age-specific cumulative incidence of CVM between age 60 and 80 years was estimated. The numbers and proportions of individual, pairs and other combinations of CVDs that comprised incident CVM were calculated. For each individual CVD subtype, age-standardised proportions of the counts of other co-occurring CVDs were estimated.
Results
The age-specific likelihood of having CVM nearly doubled every 5 years between age 60 and 80 years. Among 1.2 million women without CVD at study baseline, 16% (n=196 651) had incident CVM by the end of follow-up. Around half of all women with CVM had a diagnosis of ischaemic heart disease (n=102 536) or atrial fibrillation (n=96 022), almost a third had heart failure (n=72 186) and a fifth had stroke (n=40 442). The pair of CVDs with the highest age-adjusted incidence was ischaemic heart disease and atrial fibrillation (18.95 per 10 000 person-years). Over 60% of individuals with any given CVD subtype also had other CVDs, after age standardisation.
Conclusions
CVM is common. The majority of women with any specific CVD subtype eventually develop at least one other. Clinical and public health guidelines for CVD management should acknowledge this high likelihood of CVM.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1136/openhrt-2023-002552

Authors


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Role:
Author
ORCID:
0009-0004-0962-3850
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Institution:
University of Oxford
Division:
MSD
Department:
Nuffield Department of Population Health
Sub department:
Cancer Epidemiology Unit
Role:
Author
ORCID:
0000-0003-3035-4697
More by this author
Role:
Author
ORCID:
0000-0002-3632-9604


Publisher:
BMJ Publishing Group
Journal:
Open Heart More from this journal
Volume:
10
Issue:
2
Article number:
e002552
Place of publication:
England
Publication date:
2023-12-14
Acceptance date:
2023-11-15
DOI:
EISSN:
2053-3624
Pmid:
38097361


Language:
English
Keywords:
Pubs id:
1582501
Local pid:
pubs:1582501
Deposit date:
2024-01-18

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