Public health significance of four cardiovascular risk factors assessed 25 years ago in a low prevalence country

Abstract

Background: The individual and combined effect of cardiovascular disease (CVD) risk factors (RFs) on CVD mortality varies between populations. Our aim was to examine this association and its public health impact in Switzerland, a country with comparably low CVD mortality.

Methods: We included 9853 men and women aged 25⊟74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983⊟1992) and were followed up for survival until 2008. Adjusted Cox regression was used to calculate CVD mortality hazard ratios (HR). CVD-RFs were obesity (body mass index ≥30 kg/m²), smoking (≥1 cig/d), high blood pressure (≥140 or ≥90 mmHg), and total: high-density lipoprotein cholesterol ratio (≥5.0). Besides age and sex, models were adjusted for diet, physical activity, educational class, marital status, and the respective other CVD-RFs.

Results: After adjustment for age and sex, the HR of CVD death was for obesity 1.86 (95% CI 1.50–2.31), for smoking 1.63 (95% CI 1.32–2.01), for high blood pressure 1.42 (95% CI 1.16–1.73), and for high cholesterol ratio 1.30 (95% CI 1.06–1.60). Adjustment for other covariates moderately attenuated estimates. CVD-RFs had an independent and synergistic effect and accounted for 43.0% of population attributable risk. The presence of all four compared to zero CVD-RFs was associated with a 9.6 years shorter expected survival for a man aged 50.

Conclusions: Most CVD deaths could be avoided by prevention of four traditional CVD-RFs. Reduction of smoking prevalence and avoidance of weight gain in the population are the most effective measures. Particular attention should be dedicated to persons with multiple CVD-RFs.

Keywords

Cardiovascular disease mortality expected survival MONICA population attributable risk risk factors Switzerland

Get full access to this article

View all access options for this article.

References

Lopez

Mathers

Ezzati

Jamison

Murray

CJL

. Measuring the global burden of disease and risk factors, Washington, DC: World Bank, 2006.

Wilson

D’Agostino

Levy

Belanger

Silbershatz

Kannel

. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837–1847.

Yusuf

Hawken

Ounpuu

Dans

Avezum

Lanas

. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–952.

Nilsson

Berglund

. Population-attributable risk of coronary heart disease risk factors during long-term follow-up: the Malmo Preventive Project. J Intern Med 2006; 260: 134–141.

Heidemann

Hoffmann

Klipstein-Grobusch

Weikert

Pischon

Hense

. Potentially modifiable classic risk factors and their impact on incident myocardial infarction: results from the EPIC-Potsdam study. Eur J Cardiovasc Prev Rehabil 2007; 14: 65–71.

Keil

Liese

Hense

Filipiak

Doring

Stieber

. Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984‐1992. Monitoring trends and determinants in cardiovascular diseases. Eur Heart J 1998; 19: 1197–1207.

Conroy

Pyorala

Fitzgerald

Sans

Menotti

De Backer

. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003.

OECD. Health at a Glance: Europe 2010. OECD Publishing. http://dx.doi.org/10.1787/health_glance-2010-en (2010, consulted April 2011).

Swiss Atherosclerosis. http://www.agla.ch/ (consulted April 2011).

10.

Estoppey

Paccaud

Vollenweider

Marques-Vidal

. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997⊟2007. BMC Public Health 2011; 11: 114–114.

11.

Gaspoz JM, Beer-Borst S, Costanza MC and Morabia A. Suivi des facteurs de risque cardiovasculaire dans la population genevoise de 1993 à 2007. Unité d’épidémiologie populationelle. Hôpitaux Universitaires de Gèneve. http://www.bag.admin.ch/themen/ernaehrung_bewegung/05207/05213/index.html?lang=it&download=NHzLpZeg7t,lnp6I0NTU042l2Z6ln1ah2oZn4Z2qZpnO2Yuq2Z6gpJCJfH1_gWym162epYbg2c_JjKbNoKSn6A (accessed November 2011) Geneva, 2009.

12.

Bundesamt für Statistik. Gesundheit und Gesundheitsverhalten in der Schweiz 2007. Schweizerische Gesundheitsbefragung. Neuchâtel. http://www.bfs.admin.ch/bfs/portal/de/index/news/publikationen.Document.137644.pdf (2010, consulted April 2011).

13.

Tunstall-Pedoe

Kuulasmaa

Tolonen

Davidson

Mendis

. with 64 other contributors for the WHO MONICA project. MONICA monograph and multimedia sourcebook, Geneva: World Health Organization, 2003.

14.

Wietlisbach

. Théorie et pratique de l’échantillonnage: l’exemple de l’enquête MONICA. Soz Praeventivmed 1987; 32: 52–62.

15.

Wietlisbach

Paccaud

Rickenbach

Gutzwiller

. Trends in cardiovascular risk factors (1984⊟1993) in a Swiss region: results of three population surveys. Prev Med 1997; 26: 523–533.

16.

Bopp

Braun

Faeh

Gutzwiller

. Establishing a follow-up of the Swiss MONICA participants (1984⊟1993): record linkage with census and mortality data. BMC Public Health 2010; 10: 562–562.

17.

Bopp

Spoerri

Zwahlen

Gutzwiller

Paccaud

Braun-Fahrlander

. Cohort profile: the Swiss National Cohort − a longitudinal study of 6.8 million people. Int J Epidemiol 2009; 38: 379–384.

18.

Lewington

Whitlock

Clarke

Sherliker

Emberson

Halsey

. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370: 1829–1839.

19.

US Department of Health and Human Services. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institutes of Health, National Heart, Lung, and Blood Institute. NIH publication no. 04-5230. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf (2004, consulted April 2011).

20.

Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i‐xii, 1–253.

21.

United Nations Educational, Scientific and Cultural Organization. International Standard Classification of Education, ISCED 1997. http://www.unesco.org/education/information/nfsunesco/doc/isced_1997.htm (1997, consulted April 2011).

22.

Bruzzi

Green

Byar

Brinton

Schairer

. Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol 1985; 122: 904–914.

23.

Dhaliwal

Welborn

. Central obesity and cigarette smoking are key determinants of cardiovascular disease deaths in Australia: a public health perspective. Prev Med 2009; 49: 153–157.

24.

Jousilahti

Tuomilehto

Vartiainen

Pekkanen

Puska

. Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland. Circulation 1996; 93: 1372–1379.

25.

Clarke

Emberson

Fletcher

Breeze

Marmot

Shipley

. Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19,000 men in the Whitehall study. BMJ 2009; 339: b3513–b3513.

26.

Menotti

Kromhout

Blackburn

Jacobs

Lanti

. Forty-year mortality from cardiovascular diseases and all causes of death in the US Railroad cohort of the Seven Countries Study. Eur J Epidemiol 2004; 19: 417–424.

27.

The Emerging Risk Factors C. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 2011; 1085–1095.

28.

Lowe

Greenland

Ruth

Dyer

Stamler

. Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. Arch Intern Med 1998; 158: 2007–2014.

29.

Wilson

D’Agostino

Sullivan

Parise

Kannel

. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: 1867–1872.

30.

Bogers

Bemelmans

Hoogenveen

Boshuizen

Woodward

Knekt

. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med 2007; 167: 1720–1728.

31.

Faeh

Braun

Tarnutzer

Bopp

. BMI and mortality in Switzerland: Obesity but not overweight is associated with increased risk. Eur J Epidemiol 2011; 26(8): 647–655.

32.

Lloyd-Jones

Dyer

Wang

Daviglus

Greenland

. Risk factor burden in middle age and lifetime risks for cardiovascular and non-cardiovascular death (Chicago Heart Association Detection Project in Industry). Am J Cardiol 2007; 99: 535–540.

33.

Melander

Newton-Cheh

Almgren

Hedblad

Berglund

Engstrom

. Novel and conventional biomarkers for prediction of incident cardiovascular events in the community. JAMA 2009; 302: 49–57.

34.

Ingelsson

Schaefer

Contois

McNamara

Sullivan

Keyes

. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA 2007; 298: 776–785.

35.

Ford

Ajani

Croft

Critchley

Labarthe

Kottke

. Explaining the decrease in U.S. deaths from coronary disease, 1980⊟2000. N Engl J Med 2007; 356: 2388–2398.

36.

Finucane

Stevens

Cowan

Danaei

Lin

Paciorek

. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377: 557–567.

37.

Stamler

Neaton

Wentworth

Daviglus

Garside

. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999; 282: 2012–2018.

38.

Lloyd-Jones

Martin

Larson

Levy

. Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med 1998; 129: 1020–1026.

39.

Berry

Dyer

Carnethon

Tian

Greenland

Lloyd-Jones

. Association of traditional risk factors with cardiovascular death across 0 to 10, 10 to 20, and >20 years follow-up in men and women. Am J Cardiol 2008; 101: 89–94.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.09 MB