Age at first cardiovascular diagnosis and risk of subsequent cardiovascular events in patients with different types of cardiovascular disease

Aims: Cardiovascular disease (CVD) risk increases with age due to prolonged exposure to established risk factors. However, the association between age at first CVD diagnosis and subsequent cardiovascular events in patients with established CVD remains unclear. This study examined this relationship across different CVD subtypes. Methods and results: We included 5057 patients from the prospective UCC-SMART study with a recent (<12 months) first CVD diagnosis; i.e. coronary artery disease (CAD), cerebrovascular disease (CeVD), or peripheral artery disease or abdominal aortic aneurysm (PAD/AAA). The association between age at first CVD diagnosis and a subsequent cardiovascular event (i.e. myocardial infarction and coronary interventions, stroke, major adverse limb events, and cardiovascular death) was analysed using Cox proportional hazards models adjusted for classical risk factors and stratified by sex. Over a median follow-up of 11.0 years (IQR 5.8–16.1), 1595 subsequent cardiovascular events occurred. A higher age at CVD diagnosis was associated with an increased risk of subsequent events in both men and women with CeVD (HR per 10-year increase: 2.78; 95% CI 2.11–3.68 and 1.56; 95% CI 1.33–1.83) and in women PAD/AAA (HR 1.57; 95% CI 1.30–1.90). No significant associations were observed in men and women with CAD, or in men with PAD/AAA. Conclusion: Younger age at first CVD diagnosis is related to lower risk of subsequent cardiovascular events in men and women with CeVD and women with PAD/AAA, but not in men and women with CAD and men with PAD/AAA. These findings highlight the need for more intensive secondary prevention in younger patients within these latter groups.