| Summary: | <p><strong>Background:</strong> Multimorbidity is the presence of two or more chronic diseases in one person, and in this thesis, cardiovascular multimorbidity (CVM) refers to the co-occurrence of two or more cardiovascular disease subtypes. Multimorbidity is a major public health concern in the UK and CVM is a key component. However, there is currently limited large-scale, prospective evidence on risk factors for CVM.</p>
<p><strong>Aim:</strong> This thesis aims to provide a broad overview of CVM, its component conditions and potential risk factors in UK women.</p>
<p><strong>Methods:</strong> This was a population-based prospective cohort study of 1.2 million women aged 50-64 years at recruitment in 1996-2001. Using linked hospital admission and death records up to 31 December 2016, each participant was followed-up for nineteen subtypes of incident cardiovascular disease. CVM was defined either by counting the number of cardiovascular diseases in one person or as specific pairs of diseases. Established cardiovascular risk factors, socioeconomic, and reproductive factors were investigated.</p>
<p><strong>Main results:</strong> More than 40% of UK women with any incident cardiovascular disease developed CVM (≥2 cardiovascular diseases). The most common components of CVM were ischaemic heart disease (in 55% of CVM cases), atrial fibrillation (46%), heart failure (30%), and other arrhythmias (28%). Smoking, obesity, diabetes, hypertension, and hyperlipidaemia was each associated with 1.7-2.5 times the risk of CVM. Taller height was associated with higher CVM risk, which appeared to be driven by the association between height and atrial fibrillation. There was evidence of somewhat higher CVM risks associated with lower educational attainment and higher area deprivation. However, 80% or more of each of the observed associations was accounted for by four health behaviours measured at recruitment: smoking, alcohol consumption, physical activity, and BMI. Similarly, over 75% of each of the associations between reproductive factors (age at menarche, parity, and breastfeeding) and CVM was accounted for by those four factors.</p>
<p><strong>Conclusion:</strong> Roughly 1 in every 2.5 UK women with incident cardiovascular disease had CVM. Established cardiovascular risk factors were also independent risk factors for CVM. Much of the difference in CVM risk by levels of socioeconomic and reproductive factors could be attributed to known modifiable cardiovascular risk factors.</p>
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