Association of cardiometabolic multimorbidity with mortality

Emanuele Di Angelantonio, Stephen Kaptoge, David Wormser, Peter Willeit, Adam S. Butterworth, Narinder Bansal, Linda M. O'Keeffe, Pei Gao, Angela M. Wood, Stephen Burgess, Daniel F. Freitag, Lisa Pennells, Sanne A. Peters, Carole L. Hart, Lise Lund Håheim, Richard F. Gillum, Børge G. Nordestgaard, Bruce M. Psaty, Bu B. Yeap, Matthew W. Knuiman & 69 others Paul J. Nietert, Jussi Kauhanen, Jukka T. Salonen, Lewis H. Kuller, Leon A. Simons, Yvonne T. Van Der Schouw, Elizabeth Barrett-Connor, Randi Selmer, Carlos J. Crespo, Beatriz Rodriguez, W. M.Monique Verschuren, Veikko Salomaa, Kurt Svärdsudd, Pim Van Der Harst, Cecilia Björkelund, Lars Wilhelmsen, Robert B. Wallace, Hermann Brenner, Philippe Amouyel, Elizabeth L.M. Barr, Hiroyasu Iso, Altan Onat, Maurizio Trevisan, Ralph B. D'Agostino, Cyrus Cooper, Maryam Kavousi, Lennart Welin, Ronan Roussel, Frank B. Hu, Shinichi Sato, Karina W. Davidson, Barbara V. Howard, Maarten J.G. Leening, Annika Rosengren, Marcus Dörr, Dorly J.H. Deeg, Stefan Kiechl, Coen D.A. Stehouwer, Aulikki Nissinen, Simona Giampaoli, Chiara Donfrancesco, Daan Kromhout, Jackie F. Price, Annette Peters, Tom W. Meade, Edoardo Casiglia, Debbie A. Lawlor, John Gallacher, Dorothea Nagel, Oscar H. Franco, Gerd Assmann, Gilles R. Dagenais, J. Wouter Jukema, Johan Sundström, Mark Woodward, Eric J. Brunner, Kay Tee Khaw, Nicholas J. Wareham, Eric A. Whitsel, Inger Njølstad, Bo Hedblad, Sylvia Wassertheil-Smoller, Gunnar Engström, Wayne D. Rosamond, Elizabeth Selvin, Naveed Sattar, Simon G. Thompson, John Danesh, Emerging Risk Factors Collaboration

Research output: Contribution to journalArticle

197 Citations (Scopus)

Abstract

IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAINOUTCOMESANDMEASURES: All-cause mortality and estimated reductions in life expectancy. RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

Original languageEnglish
Pages (from-to)52-60
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume314
Issue number1
DOIs
Publication statusPublished - 7 Jul 2015

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Comorbidity
Stroke
Myocardial Infarction
Mortality
Life Expectancy
Life Style
Diabetes Mellitus
Smoking
Diet
Blood Pressure
Lipids
Survival

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Di Angelantonio, E., Kaptoge, S., Wormser, D., Willeit, P., Butterworth, A. S., Bansal, N., ... Emerging Risk Factors Collaboration (2015). Association of cardiometabolic multimorbidity with mortality. JAMA - Journal of the American Medical Association, 314(1), 52-60. https://doi.org/10.1001/jama.2015.7008
Di Angelantonio, Emanuele ; Kaptoge, Stephen ; Wormser, David ; Willeit, Peter ; Butterworth, Adam S. ; Bansal, Narinder ; O'Keeffe, Linda M. ; Gao, Pei ; Wood, Angela M. ; Burgess, Stephen ; Freitag, Daniel F. ; Pennells, Lisa ; Peters, Sanne A. ; Hart, Carole L. ; Håheim, Lise Lund ; Gillum, Richard F. ; Nordestgaard, Børge G. ; Psaty, Bruce M. ; Yeap, Bu B. ; Knuiman, Matthew W. ; Nietert, Paul J. ; Kauhanen, Jussi ; Salonen, Jukka T. ; Kuller, Lewis H. ; Simons, Leon A. ; Van Der Schouw, Yvonne T. ; Barrett-Connor, Elizabeth ; Selmer, Randi ; Crespo, Carlos J. ; Rodriguez, Beatriz ; Verschuren, W. M.Monique ; Salomaa, Veikko ; Svärdsudd, Kurt ; Van Der Harst, Pim ; Björkelund, Cecilia ; Wilhelmsen, Lars ; Wallace, Robert B. ; Brenner, Hermann ; Amouyel, Philippe ; Barr, Elizabeth L.M. ; Iso, Hiroyasu ; Onat, Altan ; Trevisan, Maurizio ; D'Agostino, Ralph B. ; Cooper, Cyrus ; Kavousi, Maryam ; Welin, Lennart ; Roussel, Ronan ; Hu, Frank B. ; Sato, Shinichi ; Davidson, Karina W. ; Howard, Barbara V. ; Leening, Maarten J.G. ; Rosengren, Annika ; Dörr, Marcus ; Deeg, Dorly J.H. ; Kiechl, Stefan ; Stehouwer, Coen D.A. ; Nissinen, Aulikki ; Giampaoli, Simona ; Donfrancesco, Chiara ; Kromhout, Daan ; Price, Jackie F. ; Peters, Annette ; Meade, Tom W. ; Casiglia, Edoardo ; Lawlor, Debbie A. ; Gallacher, John ; Nagel, Dorothea ; Franco, Oscar H. ; Assmann, Gerd ; Dagenais, Gilles R. ; Jukema, J. Wouter ; Sundström, Johan ; Woodward, Mark ; Brunner, Eric J. ; Khaw, Kay Tee ; Wareham, Nicholas J. ; Whitsel, Eric A. ; Njølstad, Inger ; Hedblad, Bo ; Wassertheil-Smoller, Sylvia ; Engström, Gunnar ; Rosamond, Wayne D. ; Selvin, Elizabeth ; Sattar, Naveed ; Thompson, Simon G. ; Danesh, John ; Emerging Risk Factors Collaboration. / Association of cardiometabolic multimorbidity with mortality. In: JAMA - Journal of the American Medical Association. 2015 ; Vol. 314, No. 1. pp. 52-60.
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abstract = "IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAINOUTCOMESANDMEASURES: All-cause mortality and estimated reductions in life expectancy. RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95{\%} CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95{\%} CI, 2.0-2.2) in those with stroke, 2.0 (95{\%} CI, 1.9-2.2) in those with MI, 3.7 (95{\%} CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95{\%} CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95{\%} CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95{\%} CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.",
author = "{Di Angelantonio}, Emanuele and Stephen Kaptoge and David Wormser and Peter Willeit and Butterworth, {Adam S.} and Narinder Bansal and O'Keeffe, {Linda M.} and Pei Gao and Wood, {Angela M.} and Stephen Burgess and Freitag, {Daniel F.} and Lisa Pennells and Peters, {Sanne A.} and Hart, {Carole L.} and H{\aa}heim, {Lise Lund} and Gillum, {Richard F.} and Nordestgaard, {B{\o}rge G.} and Psaty, {Bruce M.} and Yeap, {Bu B.} and Knuiman, {Matthew W.} and Nietert, {Paul J.} and Jussi Kauhanen and Salonen, {Jukka T.} and Kuller, {Lewis H.} and Simons, {Leon A.} and {Van Der Schouw}, {Yvonne T.} and Elizabeth Barrett-Connor and Randi Selmer and Crespo, {Carlos J.} and Beatriz Rodriguez and Verschuren, {W. M.Monique} and Veikko Salomaa and Kurt Sv{\"a}rdsudd and {Van Der Harst}, Pim and Cecilia Bj{\"o}rkelund and Lars Wilhelmsen and Wallace, {Robert B.} and Hermann Brenner and Philippe Amouyel and Barr, {Elizabeth L.M.} and Hiroyasu Iso and Altan Onat and Maurizio Trevisan and D'Agostino, {Ralph B.} and Cyrus Cooper and Maryam Kavousi and Lennart Welin and Ronan Roussel and Hu, {Frank B.} and Shinichi Sato and Davidson, {Karina W.} and Howard, {Barbara V.} and Leening, {Maarten J.G.} and Annika Rosengren and Marcus D{\"o}rr and Deeg, {Dorly J.H.} and Stefan Kiechl and Stehouwer, {Coen D.A.} and Aulikki Nissinen and Simona Giampaoli and Chiara Donfrancesco and Daan Kromhout and Price, {Jackie F.} and Annette Peters and Meade, {Tom W.} and Edoardo Casiglia and Lawlor, {Debbie A.} and John Gallacher and Dorothea Nagel and Franco, {Oscar H.} and Gerd Assmann and Dagenais, {Gilles R.} and Jukema, {J. Wouter} and Johan Sundstr{\"o}m and Mark Woodward and Brunner, {Eric J.} and Khaw, {Kay Tee} and Wareham, {Nicholas J.} and Whitsel, {Eric A.} and Inger Nj{\o}lstad and Bo Hedblad and Sylvia Wassertheil-Smoller and Gunnar Engstr{\"o}m and Rosamond, {Wayne D.} and Elizabeth Selvin and Naveed Sattar and Thompson, {Simon G.} and John Danesh and {Emerging Risk Factors Collaboration}",
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pages = "52--60",
journal = "JAMA: The Journal of the American Medical Association",
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Di Angelantonio, E, Kaptoge, S, Wormser, D, Willeit, P, Butterworth, AS, Bansal, N, O'Keeffe, LM, Gao, P, Wood, AM, Burgess, S, Freitag, DF, Pennells, L, Peters, SA, Hart, CL, Håheim, LL, Gillum, RF, Nordestgaard, BG, Psaty, BM, Yeap, BB, Knuiman, MW, Nietert, PJ, Kauhanen, J, Salonen, JT, Kuller, LH, Simons, LA, Van Der Schouw, YT, Barrett-Connor, E, Selmer, R, Crespo, CJ, Rodriguez, B, Verschuren, WMM, Salomaa, V, Svärdsudd, K, Van Der Harst, P, Björkelund, C, Wilhelmsen, L, Wallace, RB, Brenner, H, Amouyel, P, Barr, ELM, Iso, H, Onat, A, Trevisan, M, D'Agostino, RB, Cooper, C, Kavousi, M, Welin, L, Roussel, R, Hu, FB, Sato, S, Davidson, KW, Howard, BV, Leening, MJG, Rosengren, A, Dörr, M, Deeg, DJH, Kiechl, S, Stehouwer, CDA, Nissinen, A, Giampaoli, S, Donfrancesco, C, Kromhout, D, Price, JF, Peters, A, Meade, TW, Casiglia, E, Lawlor, DA, Gallacher, J, Nagel, D, Franco, OH, Assmann, G, Dagenais, GR, Jukema, JW, Sundström, J, Woodward, M, Brunner, EJ, Khaw, KT, Wareham, NJ, Whitsel, EA, Njølstad, I, Hedblad, B, Wassertheil-Smoller, S, Engström, G, Rosamond, WD, Selvin, E, Sattar, N, Thompson, SG, Danesh, J & Emerging Risk Factors Collaboration 2015, 'Association of cardiometabolic multimorbidity with mortality' JAMA - Journal of the American Medical Association, vol. 314, no. 1, pp. 52-60. https://doi.org/10.1001/jama.2015.7008

Association of cardiometabolic multimorbidity with mortality. / Di Angelantonio, Emanuele; Kaptoge, Stephen; Wormser, David; Willeit, Peter; Butterworth, Adam S.; Bansal, Narinder; O'Keeffe, Linda M.; Gao, Pei; Wood, Angela M.; Burgess, Stephen; Freitag, Daniel F.; Pennells, Lisa; Peters, Sanne A.; Hart, Carole L.; Håheim, Lise Lund; Gillum, Richard F.; Nordestgaard, Børge G.; Psaty, Bruce M.; Yeap, Bu B.; Knuiman, Matthew W.; Nietert, Paul J.; Kauhanen, Jussi; Salonen, Jukka T.; Kuller, Lewis H.; Simons, Leon A.; Van Der Schouw, Yvonne T.; Barrett-Connor, Elizabeth; Selmer, Randi; Crespo, Carlos J.; Rodriguez, Beatriz; Verschuren, W. M.Monique; Salomaa, Veikko; Svärdsudd, Kurt; Van Der Harst, Pim; Björkelund, Cecilia; Wilhelmsen, Lars; Wallace, Robert B.; Brenner, Hermann; Amouyel, Philippe; Barr, Elizabeth L.M.; Iso, Hiroyasu; Onat, Altan; Trevisan, Maurizio; D'Agostino, Ralph B.; Cooper, Cyrus; Kavousi, Maryam; Welin, Lennart; Roussel, Ronan; Hu, Frank B.; Sato, Shinichi; Davidson, Karina W.; Howard, Barbara V.; Leening, Maarten J.G.; Rosengren, Annika; Dörr, Marcus; Deeg, Dorly J.H.; Kiechl, Stefan; Stehouwer, Coen D.A.; Nissinen, Aulikki; Giampaoli, Simona; Donfrancesco, Chiara; Kromhout, Daan; Price, Jackie F.; Peters, Annette; Meade, Tom W.; Casiglia, Edoardo; Lawlor, Debbie A.; Gallacher, John; Nagel, Dorothea; Franco, Oscar H.; Assmann, Gerd; Dagenais, Gilles R.; Jukema, J. Wouter; Sundström, Johan; Woodward, Mark; Brunner, Eric J.; Khaw, Kay Tee; Wareham, Nicholas J.; Whitsel, Eric A.; Njølstad, Inger; Hedblad, Bo; Wassertheil-Smoller, Sylvia; Engström, Gunnar; Rosamond, Wayne D.; Selvin, Elizabeth; Sattar, Naveed; Thompson, Simon G.; Danesh, John; Emerging Risk Factors Collaboration.

In: JAMA - Journal of the American Medical Association, Vol. 314, No. 1, 07.07.2015, p. 52-60.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of cardiometabolic multimorbidity with mortality

AU - Di Angelantonio, Emanuele

AU - Kaptoge, Stephen

AU - Wormser, David

AU - Willeit, Peter

AU - Butterworth, Adam S.

AU - Bansal, Narinder

AU - O'Keeffe, Linda M.

AU - Gao, Pei

AU - Wood, Angela M.

AU - Burgess, Stephen

AU - Freitag, Daniel F.

AU - Pennells, Lisa

AU - Peters, Sanne A.

AU - Hart, Carole L.

AU - Håheim, Lise Lund

AU - Gillum, Richard F.

AU - Nordestgaard, Børge G.

AU - Psaty, Bruce M.

AU - Yeap, Bu B.

AU - Knuiman, Matthew W.

AU - Nietert, Paul J.

AU - Kauhanen, Jussi

AU - Salonen, Jukka T.

AU - Kuller, Lewis H.

AU - Simons, Leon A.

AU - Van Der Schouw, Yvonne T.

AU - Barrett-Connor, Elizabeth

AU - Selmer, Randi

AU - Crespo, Carlos J.

AU - Rodriguez, Beatriz

AU - Verschuren, W. M.Monique

AU - Salomaa, Veikko

AU - Svärdsudd, Kurt

AU - Van Der Harst, Pim

AU - Björkelund, Cecilia

AU - Wilhelmsen, Lars

AU - Wallace, Robert B.

AU - Brenner, Hermann

AU - Amouyel, Philippe

AU - Barr, Elizabeth L.M.

AU - Iso, Hiroyasu

AU - Onat, Altan

AU - Trevisan, Maurizio

AU - D'Agostino, Ralph B.

AU - Cooper, Cyrus

AU - Kavousi, Maryam

AU - Welin, Lennart

AU - Roussel, Ronan

AU - Hu, Frank B.

AU - Sato, Shinichi

AU - Davidson, Karina W.

AU - Howard, Barbara V.

AU - Leening, Maarten J.G.

AU - Rosengren, Annika

AU - Dörr, Marcus

AU - Deeg, Dorly J.H.

AU - Kiechl, Stefan

AU - Stehouwer, Coen D.A.

AU - Nissinen, Aulikki

AU - Giampaoli, Simona

AU - Donfrancesco, Chiara

AU - Kromhout, Daan

AU - Price, Jackie F.

AU - Peters, Annette

AU - Meade, Tom W.

AU - Casiglia, Edoardo

AU - Lawlor, Debbie A.

AU - Gallacher, John

AU - Nagel, Dorothea

AU - Franco, Oscar H.

AU - Assmann, Gerd

AU - Dagenais, Gilles R.

AU - Jukema, J. Wouter

AU - Sundström, Johan

AU - Woodward, Mark

AU - Brunner, Eric J.

AU - Khaw, Kay Tee

AU - Wareham, Nicholas J.

AU - Whitsel, Eric A.

AU - Njølstad, Inger

AU - Hedblad, Bo

AU - Wassertheil-Smoller, Sylvia

AU - Engström, Gunnar

AU - Rosamond, Wayne D.

AU - Selvin, Elizabeth

AU - Sattar, Naveed

AU - Thompson, Simon G.

AU - Danesh, John

AU - Emerging Risk Factors Collaboration

PY - 2015/7/7

Y1 - 2015/7/7

N2 - IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAINOUTCOMESANDMEASURES: All-cause mortality and estimated reductions in life expectancy. RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

AB - IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAINOUTCOMESANDMEASURES: All-cause mortality and estimated reductions in life expectancy. RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

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DO - 10.1001/jama.2015.7008

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Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, Bansal N et al. Association of cardiometabolic multimorbidity with mortality. JAMA - Journal of the American Medical Association. 2015 Jul 7;314(1):52-60. https://doi.org/10.1001/jama.2015.7008