Abstract 19455: Risk Factor Changes Had a Minor Net Contribution to the Decline in Cardiovascular Mortality in the US, 1988-2004
Introduction: The role of primary prevention and changes in risk factors in explaining cardiovascular disease (CVD) mortality trends is controversial. Previous studies did not consider simultaneous changes in multiple cardiovascular risk factors over time.
Objectives: To evaluate the impact of changes in smoking, obesity, physical inactivity, hypertension, diabetes, chronic kidney disease and dyslipidemia to explain the decreasing trend in CVD mortality that occurred in the US from 1988-1994 to 1999-2004.
Methods: Cohort study of 25,297 adult men and women ≥20 years old participating in the National Health and Nutrition Examination Survey (NHANES) III and 1999-2004 Mortality Follow-up. We used causal mediation analyses with additive hazard models to estimate the absolute and relative reductions in CVD mortality rates over time explained through risk factor changes.
Results: CVD mortality rates in the US decreased from 1988-1994 to 1999-2004 by 52.7% in men and by 45.5% women. Net changes in CVD risk factors explained 12.6 and 10.9% of this decline in men and women, respectively. The reductions in smoking and in leisure time physical inactivity rates were the main factors explaining this decline. The increased in chronic kidney disease, however, independently attenuated the decline in CVD mortality in both men and women. Adjustment for changes in self-reported use of risk factor treatments did not materially change the findings.
Conclusions: The net impact of changes in CVD risk factors on mortality changes in the US was small. While prevention strategies have intensified, increases in the prevalence of certain risk factors, such as chronic kidney disease, seem to attenuate the impact of primary prevention interventions. The mortality decline may have been driven by clinical interventions in patients with events, by secondary prevention, or by changes in non-traditional risk factors. Our findings also suggest that primordial prevention strategies are needed to control the increase recent trends in chronic kidney disease and to maximize the benefit of preventive interventions.
Author Disclosures: M. Tellez-Plaza: None. R. Pastor-Barriuso: None. J. Redon: None. A. Navas-Acien: None. E. Guallar: None.
- © 2015 by American Heart Association, Inc.