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Temporal trends in the population attributable risk for cardiovascular disease: the Atherosclerosis Risk in
Susan Cheng1, Brian Claggett2, Andrew W Correia2
1From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., D.K.G., H.S., S.D.S.); NMR Group Inc, Somerville, MA (A.W.C.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (W.D.R., G.H.); the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (A.R.F.); the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (J.C.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.). scheng@rics.bwh.harvard.edu.
Insights
Cardiovascular disease (CVD) risk factors show changing contributions over time, with higher risks remaining for Black individuals and women, particularly from hypertension and diabetes. Continued risk factor modification is essential for prevention.
Area of Science:
- Cardiovascular disease epidemiology
- Public health research
- Risk factor analysis
Background:
- Traditional cardiovascular disease (CVD) risk factors' evolving impact on disease incidence is not fully understood.
- Assessing changes in the population attributable risk (PAR) of these factors over time is crucial for public health strategies.
Purpose of the Study:
- To analyze the temporal changes in the population attributable risks (PAR) of traditional cardiovascular risk factors for incident CVD.
- To examine how these PARs differ across demographic groups (sex, race) over time.
Main Methods:
- Utilized data from 13,541 participants in the Atherosclerosis Risk in Communities Study (ARIC).
- Estimated 10-year CVD incidence and PAR for hypertension, diabetes mellitus, obesity, hypercholesterolemia, and smoking at multiple examination cycles from 1987-1998.
- Analyzed PAR trends and differences by sex and race.
Main Results:
- The combined PAR for all traditional risk factors decreased slightly from 0.58 to 0.53 between the late 1980s and late 1990s.
- The combined PAR was consistently higher in Black individuals than white individuals, with this disparity widening over time.
- Hypertension and diabetes mellitus showed particularly high PARs, especially in women and Black individuals, by the late 1990s.
Conclusions:
- The overall contribution of traditional risk factors to CVD is greater in Black individuals than white individuals, and this gap may be increasing.
- Hypertension and diabetes mellitus remain significant contributors to CVD risk, particularly in women and Black populations.
- These findings highlight the ongoing necessity for both individual-focused and population-level interventions to manage CVD risk factors effectively.
Background:
The extent to which the relative contributions of traditional cardiovascular risk factors to incident cardiovascular disease (CVD) may have changed over time remains unclear.
Methods And Results:
We studied 13 541 participants (56% women, 26% black) in the Atherosclerosis Risk in Communities Study, aged 52 to 66 years and free of CVD at exams in 1987 through 1989, 1990 through 1992, 1993 through 1995, or 1996 through 1998. At each examination, we estimated the population attributable risks (PAR) of traditional risk factors (hypertension, diabetes mellitus, obesity, hypercholesterolemia, and smoking) for the 10-year incidence of CVD. Overall, the PAR of all risk factors combined appeared to decrease from the late 1980s to the late 1990s (0.58 to 0.53). The combined PAR was higher in women than men in 1987 through 1989 (0.68 versus 0.51, P<0.001) but not by the late 1990s (0.58 versus 0.48, P=0.08). The combined PAR was higher in blacks than whites in the late 1980s (0.67 versus 0.57, P=0.049), and this difference was more pronounced by the late 1990s (0.67 versus 0.48, P=0.002). By the late 1990s, the PAR of hypertension had become higher in women than men (P=0.02) and also appeared higher in blacks than whites (P=0.08). By the late 1990s, the PAR of diabetes mellitus remained higher in women than men (P<0.0001) and in blacks than whites (P<0.0001).
Conclusions:
The contribution to CVD of all traditional risk factors combined is greater in blacks than whites, and this difference may be increasing. The contributions of hypertension and diabetes mellitus remain especially high, in women as well as blacks. These findings underscore the continued need for individual as well as population approaches to CVD risk factor modification.
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