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Similarities and differences between coronary heart disease and stroke in the associations with cardiovascular risk
Masaaki Matsunaga1, Hiroshi Yatsuya1, Hiroyasu Iso2
1Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan.
Insights
Risk factors for coronary heart disease (CHD) and stroke mortality show varying associations in Asians. Hypertension impact was consistent, but smoking and diabetes effects differed, informing public health strategies.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Asian population studies
Background:
- Coronary heart disease (CHD) and stroke share common risk factors, yet their individual impact can vary.
- Understanding these differences is crucial for targeted public health interventions in Asian populations.
Purpose of the Study:
- To assess how the impact of specific risk factors on mortality differs between CHD and stroke in Asian adults.
- To compare the magnitude and direction of associations for various risk factors with CHD versus stroke mortality.
Main Methods:
- A cohort of 104,910 Asian adults (aged 40-79) without prior cancer, CHD, or stroke was followed from 1988 to 2009.
- Competing-risks analysis was employed to evaluate risk factor associations with CHD and stroke mortality.
- Population attributable fractions (PAFs) were calculated to estimate the public health impact of each risk factor.
Main Results:
- Hypertension showed similar associations with CHD and stroke mortality in both men and women.
- Smoking and diabetes exhibited different magnitudes of association with CHD compared to stroke mortality.
- Smoking was the leading risk factor for CHD mortality in men, while hypertension was key for women and both sexes for stroke.
Conclusions:
- While hypertension's impact is consistent across CHD and stroke, other risk factors like smoking and diabetes show divergent effects in Asian populations.
- These findings highlight the need for tailored public health interventions based on specific risk factor profiles for CHD and stroke prevention.
Background And Aims:
Coronary heart disease (CHD) and stroke have common risk factors, but some of these differ in the magnitude or direction of associations between CHD and stroke. We assessed whether the impact of each risk factor differed between CHD and stroke mortality in Asians.
Methods:
In total, 104 910 subjects aged 40-79 years without histories of cancer, CHD and stroke at baseline were followed between 1988 and 2009. Competing-risks analysis was used to test for differences in the associations of each risk factor with two endpoints (CHD and stroke). Population attributable fractions (PAFs) were also calculated for these endpoints to estimate the population impact of each risk factor.
Results:
During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The association of hypertension with CHD was similar to that with stroke in terms of the magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking (CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension in women; that for stroke was caused by hypertension in both sexes.
Conclusions:
Hypertension associations and PAFs were consistent between CHD and stroke, but not for other risk factors. These findings may be useful to optimize public health intervention strategies.