ArticleMayo Clinic proceedings. Digital health2026
Clustering of Cardiovascular Risk Factors in Midlife Forms Trajectories That Affect Heart Aging Biomarker and Incidence of Cardiovascular Disease.
Article in Mayo Clinic proceedings. Digital health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To (1) identify multivariable longitudinal midlife patterns of systolic and diastolic blood pressure, body mass index, and non-high density lipoprotein cholesterol and (2) assess whether electrocardiogram derived heart age acceleration (δ-age) mediates their associations with incident myocardial infarction (MI), stroke, and all-cause mortality. Patients and Methods: We analyzed 5244 participants from the observational cohort study, the Tromsø Study, who were free of MI or stroke at baseline (Tromsø7, 2015-2016) and attended at least 3 surveys (Tromsø3-7, 1986-2016). Age-standardized risk factor Results: Four distinct clusters were identified: stable low-risk (cluster 1, n=1604, 30.6%), dyslipidemia (cluster 2, n=1340, 25.6%), hypertension (cluster 3, n=1476, 28.1%), and high-risk trajectory (cluster 4, n=824, 15.7%). Each 1-SD increment in δ-age was associated with 27% to 30% of excess MI, stroke, and death, independent of age and sex. Clusters 3 and 4 carried the greatest excess risk of clinical events, whereas mediation by δ-age was modest (4%-8% of total effect for MI and stroke) and not statistically significant. Conclusion: Joint multivariable life-course clustering of conventional risk factors identified clinically distinct long-term cardiovascular risk phenotypes. Although δ-age adds independent prognostic information, it explained little of the excess risk associated with chronic hypertension, dyslipidemia, or obesity, indicating it functions primarily as a parallel marker and not a causal mediator.
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