Temporal trends in the contribution of modifiable cardiovascular risk factors to cardiovascular and all-cause...

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Cardiovascular (CV) events are often linked to modifiable risk factors.
• The impact of these factors on mortality trends, particularly in lower-income countries, requires ongoing evaluation.
• Understanding temporal changes in risk factor burden is crucial for public health strategies.

Purpose of the Study:

• To assess temporal trends in the population attributable fraction (PAF) of modifiable risk factors for CV mortality.
• To evaluate the impact of risk factors like sedentary lifestyle, hypertension, and diabetes on CV mortality over time.
• To determine if the impact of modifiable CV risk factors has changed in recent years.

Main Methods:

• A cohort of 25,127 patients undergoing myocardial perfusion imaging (MPI) from 2010-2018 in Brazil was analyzed.
• Modifiable risk factors included hypertension, dyslipidemia, diabetes, sedentary lifestyle, obesity, and smoking.
• Population attributable fractions (PAF) were calculated for each risk factor across three-year periods using multivariable Cox regression.

Main Results:

• Sedentary lifestyle had the highest PAF for CV death (49%) in the initial period, followed by hypertension (17%), diabetes (8%), and smoking (6%).
• The overall PAF for combined risk factors remained stable across triennia (2010-2012: 57%; 2013-2015: 64%; 2016-2018: 47%).
• Obesity did not show an independent association with CV or overall mortality.

Conclusions:

• The population attributable fraction of modifiable cardiovascular risk factors did not decrease over the study decade.
• Sedentary lifestyle consistently emerged as the leading contributor to cardiovascular mortality.
• Interventions targeting physical activity are essential for mitigating the burden of cardiovascular disease.