Association of Cardiometabolic Multimorbidity With Mortality
Authors: 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, 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
Journal: JAMA (2015)

<h3>Importance</h3> The prevalence of cardiometabolic multimorbidity is increasing. <h3>Objective</h3> To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). <h3>Main Outcomes and Measures</h3> All-cause mortality and estimated reductions in life expectancy. <h3>Results</h3> 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. <h3>Conclusions and Relevance</h3> 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.