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cardiovascular disease, clusters, morbidity, mortality, risk factors



  1. Palazon-Bru, Antonio PhD
  2. Ferri-Rufete, David MD
  3. Mares-Garcia, Emma PhD
  4. Durazo-Arvizu, Ramon Angel PhD
  5. Divison-Garrote, Juan Antonio MD, PhD
  6. Carbayo-Herencia, Julio Antonio MD, PhD
  7. Artigao-Rodenas, Luis Miguel MD, PhD
  8. Simarro-Rueda, Marta MD, PhD
  9. Molina-Escribano, Francisca MD, PhD
  10. Ponce-Garcia, Isabel MD, PhD
  11. Gil-Guillen, Vicente Francisco MD, PhD
  12. Perez-Sempere, Angel MD, PhD
  13. GEVA (Group of Vascular Diseases From Albacete)*


Background: Clustering of cardiovascular risk factors (CVRFs) is extraordinarily common and is associated with an increased risk of cardiovascular disease (CVD). However, the particular impact of the sum of CVRFs on cardiovascular morbidity and mortality has not been sufficiently explored in Europe.


Objective: The aim of this study was to analyze the differences in survival-free probability of CVD in relation to the number of CVRFs in a Spanish population.


Methods: A prospective cohort study was conducted from 1992 to 2016 in a Spanish population that included 1144 subjects with no history of CVD (mean age, 46.7 years) drawn from the general population. We calculated the number of CVRFs for each subject (male sex, smoking, diabetes, hypertension, dyslipidemia, obesity, and left ventricular hypertrophy). Cardiovascular morbidity and mortality records were collected, and survival analysis was applied (competing risk models).


Results: There were 196 cardiovascular events (17.1%). The differences in total survival-free probability of cardiovascular morbidity and mortality of the different values of the sum of CVRFs were significant, increasing the risk of CVD (hazard ratio, 1.30; 95% confidence interval, 1.13-1.50) per each additional risk factor.


Conclusion: Differences in survival-free probability of CVD in relation to the number of CVRFs present were statistically significant. Further studies are needed to corroborate our results.