Abstract 18744: Time Trends in the Population Attributable Risk for Cardiovascular Disease: Atherosclerosis Risk in Communities Study
BACKGROUND: Traditional cardiovascular disease (CVD) risk factors remain widely prevalent in the community. Whether relative contributions of risk factors to incident CVD may have changed over time, in the population at large or in important subgroups, is unclear.
METHODS: We studied 13,541 participants (56% women, 26% black) in the Atherosclerosis Risk in Communities Study who were aged 52-66 years and free of CVD at visits 1 (1987-1989), 2 (1990-1992), 3 (1993-1995), or 4 (1996-1998). In this middle-aged sample at each visit, and in sex- and race-stratified analyses, we estimated multivariable-adjusted population attributable risks (PAR) for the 10-year incidence of new-onset CVD.
RESULTS: Overall, the contributions of smoking (PAR 0.15 [95% CI 0.12-0.17] to 0.12 [0.10-0.14], P=0.05) and dyslipidemia (0.18 [0.10-0.24] to 0.09 [0.03-0.16], P=0.085) to CVD risk appeared to decrease from visit 1 to visit 4; the contributions of obesity (P=0.79), hypertension (P=0.70), and diabetes (P=0.28) were unchanged. The contribution of all risk factors combined was higher in women than men at visit 1 (P<0.001) but not by visit 4 (P=0.11) (Figure). The contribution of all risk factors combined appeared higher in blacks than whites at visit 1 (P=0.06) and this difference was more pronounced by visit 4 (P=0.02). Differences by sex (P=0.051) and race (P=0.089) in the contribution of hypertension to CVD risk had decreased and were borderline significant by visit 4. However, the contribution of diabetes remained substantially higher in women than men (P<0.001) and in blacks than whites (P<0.001) by visit 4.
CONCLUSION: The contribution to incident CVD of all traditional risk factors combined is greater in blacks than whites, and this difference may be increasing. The CVD risks attributable to hypertension and diabetes have remained especially high, in women as well as blacks, highlighting the need for continued targeted risk factor modification particularly in these subgroups.
- © 2013 by American Heart Association, Inc.