Prevention & lipidsCohort study
Differences in long-term impact of traditional risk factors for atherosclerosis on different arterial territories: insights from over 20 years of follow-up in the EPIC-Norfolk prospective population study
- Prospective cohort study
- population-based
- multivariable-adjusted
Authors' conclusion
Risk factor impact was consistent across arterial territories, but variation in magnitude and sex differences suggest underlying pathophysiological distinctions.
Study context
- Population
- EPIC-Norfolk participants without cardiovascular disease (CVD)56% women
- Participants
- 23,581 participants
- Exposure
- Low-density lipoprotein cholesterol (LDL-C) >3 mmol/L, systolic blood pressure (SBP) >140 mmHg and smoking, individually and in clusters, vs absence
- Outcome
- First CVD event:
- Hospitalisation or death from IHD
- Ischemic stroke
- Haemorrhagic stroke
- PAD
- AA
- Follow-up
- Median 21.3 years
Main finding
As reported in the abstract
First CVD event (total CVD)
Adjusted hazard ratio (95% CI)
LDL-C
1.35(1.24–1.46)
SBP
1.29(1.22–1.37)
smoking
1.69(1.56–1.82)
- First CVD event incidence higher in men
- 1.7 times
Observational data: associations, not effects.
Further findings
| Outcome | aHR (CI) | P value | |
|---|---|---|---|
| IHD, all three risk factors · IHD risk increased with each additional factor | 2.86 (2.36–3.48) | ||
| 0.20.5125Adjusted hazard ratio (log scale) |
Ischemic and haemorrhagic stroke
| Comparison | aHR (CI) | P value | |
|---|---|---|---|
| SBP · ischemic stroke | 1.45 (1.29–1.64) | ||
| SBP · haemorrhagic stroke | 1.34 (1.10–1.64) | ||
| 0.512Adjusted hazard ratio (log scale) |
Aortic aneurysm (AA)
| Comparison | aHR (CI) | P value | |
|---|---|---|---|
| Smoking | 3.56 (2.93–4.34) | ||
| LDL-C and SBP combined | 1.78 (1.16–2.71) | ||
| 0.20.5125Adjusted hazard ratio (log scale) |
Sex differences: LDL-C and total CVD; SBP and ischemic heart disease (IHD), peripheral arterial disease (PAD)
| Comparison | aHR (CI) | P value | |
|---|---|---|---|
| LDL-C, men · total CVD; women 1.20, 1.06-1.35 · Sex-specific estimates from interaction terms | 1.47 (1.19–1.80) | P = 0.018 | |
| SBP, women · IHD; men 1.20, 1.02-1.40 · Sex-specific estimates from interaction terms | 1.36 (1.24–1.50) | P = 0.037 | |
| SBP, women · PAD; men 1.12, 0.86-1.47 · Sex-specific estimates from interaction terms | 1.49 (1.26–1.76) | P = 0.008 | |
| 0.512Adjusted hazard ratio (log scale) |
Ischemic and haemorrhagic stroke
- SBP was the most important risk factor for ischemic and haemorrhagic stroke
AA
- Smoking most strongly associated with AA, exceeding LDL-C and SBP combined
Original publication
Differences in long-term impact of traditional risk factors for atherosclerosis on different arterial territories: insights from over 20 years of follow-up in the EPIC-Norfolk prospective population study. Eur J Prev Cardiol. Published 15 October 2025. doi:10.1093/eurjpc/zwaf664
Summarised from the published abstract; every number is checked against it