Abstract P053: Modifiable Risk Factors for Prevention of Cardiovascular Disease and Mortality in Middle-Aged Women: Systematic Review and Meta-Analysis
Introduction: Modifiable risk factors can play major role to prevent adverse outcomes but their specific contribution in this phase of women's life course remains unclear.
Hypothesis: We assessed evidence on the effects of different modifiable risk factors on preventing CV events and mortality in middle-aged women.
METHODS: Systematic searches of medical databases (Pubmed, Embase, Medline, WoS, Lilacs, Scielo, PsycInfo, Popline and Google Scholar), reference lists of relevant studies and correspondence with authors in the field were conducted up to August 11th 2014. We selected and extracted data from cohort studies, which reported the association between leisure physical activity (LPA) levels and coronary heart disease (CHD),stroke, CV deaths and all-cause mortality in women (>40 years old). For PA we calculated study specific relative risks (RR) comparing highest to lower exposure categories in each study. Lower categories of LPA were equivalent to ≤ 3 METS h/week, higher categories of LPA were equivalent to ≥21 METS h/week. For smoking we compared current to never smokers. For alcohol intake, we compared moderate intake (≤ 12 g/day) to non-drinkers. Pooled RR were meta-analysed using random effect models. Heterogeneity was analysed by I 2. Quality scores were based on New-Castle Ottawa Scale and levels of adjustment.
RESULTS: Of the 6582 references searched, 37 cohort studies were included in the systematic review reporting effects of modifiable risk factors in 3,637,512 participants and 24,561 CHD events, 18,347 stroke events, 22,833 CV deaths and 166,504 all cause deaths. Meta-analysis of available information on LPA revealed RR (CI 95%) of 0.71 (0.61;0.83) for CHD events (I 2= 47 % p= 0.067), 0.77(0.67;0.88) for stroke events (I 2= 0 % p= 0.68) ,0.70 (0.58;0.84) for CV deaths (I 2= 59.3 % p= 0.086), 0.70 (0.65;0.76) for death from all causes (I 2= 13.4 %; p= 0.329). Meta-analysis of smoking habits showed RR (95%)3.12 (2.15;4.52) for CHD events (I 2= 98.4% p< 0.001), 2.09 (1.51;2.89) for stroke (I 2= 96.3% p< 0.001), 2.76 (1.62;4.71) for CV deaths (I 2= 98.5 % p< 0.001), 2.22 (1.92;2.57) death from all causes (I 2= 97.3 %; p< 0.001). Meta-analysis of alcohol intake showed RR (95%)0.75 (0.62;0.91) for CHD events (I 2= 47.6% p=0.075), 0.61 (0.60;0.62) CV deaths (I 2= 0 % p=0.510), 0.87 (0.79;0.96) death from all causes (I 2= 76 %; p< 0.001). Studies showed generally high quality.
CONCLUSION: Evidence from observational studies indicates that these modifiable risk factors play a major role in CV events and deaths in middle-aged women. Prevention strategies should focus on encouraging middle aged women to practice moderate to vigorous physical activity frequently, never smoking and moderate drinking.
Author Disclosures: V. Colpani: None. C. Baena: None. L. Jaspers: None. Z. Farajzadegan: None. K. Dhana: None. G. Veloso: None. M. Tielemans: None. M. Kavousi: None. R. Chowdhury: None. O. Franco: None.
- © 2015 by American Heart Association, Inc.