Temporal trends in the population attributable risk for cardiovascular disease: The Atherosclerosis Risk in Communities Study

Cheng S, Claggett B, Correia AW, et al. Temporal trends in the population attributable risk for cardiovascular disease: The Atherosclerosis Risk in Communities Study. Circulation. 2014;130:820-828.

This analysis of the ARIC study assessed the proportion of CVD risk attributable to traditional risk factors.

Event rates
The 10-year crude CVD event rate was 1.51 (95% CI, 1.43-1.60) per 100 person-years at the first exam (1987-1989). Similar rates seen at subsequent exams:

  • 1990-1992: 1.59 (95% CI, 1.51-1.68)
  • 1993-1995: 1.52 (95% CI, 1.44-1.61)
  • 1996-1998: 1.45 (95% CI, 1.36-1.55)

Crude 10-year event rates (per 100-person years) at the first exam were higher with greater number of CVD risk factors present (see below); this trend was similar over time.

  • 0 risk factors: 0.8
  • 1 risk factor: 0.9
  • 2 risk factors: 1.6
  • 3 risk factors: 2.5
  • 4 risk factors: 4.4
  • 5 risk factors: 7.5

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Trends in Attributable CVD Risk in the ARIC Study: Event Rates   
Trends in Attributable CVD Risk in the ARIC Study: Event Rates 


Overall trends
Hypertension

  • Largest and most consistent contributor to CVD risk over time
  • No significant differences in risk in visits over time (PAR 0.25 vs 0.25; P=0.82)

Hypercholesterolemia

  • Major contributor to risk at visit 1; contribution decreased by visit 4 (PAR 0.18 vs 0.09; P=0.08)

Smoking

  • Risk did not significantly decrease over time (PAR 0.15 vs 0.13; P=0.16) despite decreased prevalence of smoking

Diabetes

  • Similar risk over time (PAR 0.15 vs 0.17; P=0.17)

Obesity

  • Similar risk over time (PAR 0.06 vs 0.06; P=0.83)



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Overall Trends in Attributable CVD Risk Factors in the ARIC Study   
Overall Trends in Attributable CVD Risk Factors in the ARIC Study 


Trends by gender
When study data were stratified by gender:

  • Variation in estimated PAR for CVD seen in all time periods
  • Significantly higher attributable contribution of all risk factors combined in women vs men at visit 1 in 1987-1989 (PAR 0.68 vs 0.51; P<0.001) but not by late 1990s (PAR 0.58 vs 0.48; P=0.08)
  • Hypertension
    • Greater CVD risk contributor in women vs men in late 1990s (PAR 0.32 vs 0.19; P=0.02) vs late 1980s (PAR 0.28 vs 0.23; P=0.23)
     
  • Diabetes
    • Greater contributor to CVD risk in women vs men
    • Trend consistent over time (late 1980s: PAR 0.22 vs 0.11; P<0.001; late 1990s: PAR 0.21 vs 0.14; P<0.001)
     
  • Smoking
    • Greater contributor to CVD risk in women vs men at visit 1 in 1987-1989 (PAR 0.22 vs 0.10; P<0.001)
    • By late 1990s: PAR 0.14 vs 0.11; P=0.07
     
  • Obesity
    • More important contributor to CVD risk in women vs men in late 1980s (PAR 0.13 vs 0.03; P=0.016) but not by late 1990s (PAR 0.08 vs 0.04; P=0.54)
     
  • Hypercholesterolemia
    • More prevalent in women
    • Contribution to CVD risk similar between genders at all exams
     

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Trends in Attributable CVD Risk by Gender in the ARIC Study   
Trends in Attributable CVD Risk by Gender in the ARIC Study  


Trends by race
When data were stratified by race: marked differences in attributable CVD risks seen between blacks and whites

  • Contribution of all risk factors combined higher in blacks vs whites in the late 1980s (PAR 0.67 vs 0.56; P=0.049); by late 1990s, difference more pronounced: PAR 0.67 vs 0.48; P=0.002
  • Blacks generally had higher prevalences of risk factors vs whites but not greatly different associated hazards
  • Hypertension
    • Greater CVD risk contributor in blacks vs whites in late 1980s (PAR 0.40 vs 0.21; P=0.002); late 1990s: PAR 0.36 vs 0.21; P=0.08
     
  • Diabetes
    • Significantly greater contributor to CVD risk in blacks vs whites (late 1980s: PAR 0.22 vs 0.13; P<0.001; late 1990s: PAR 0.28 vs 0.13; P<0.001)
    • From late 1980s to late 1990s, contribution increased in blacks (PAR 0.22 vs 0.28; P=0.03) but remained the same in whites (PAR 0.13 vs 0.13; P=0.80)
     
  • Hypercholesterolemia
    • Risks similar in blacks and whites; decreased over time among whites (PAR 0.22 vs 0.10; P=0.04)
     
  • Obesity and smoking
    • Contributions to CVD risk not significantly different at any time points despite higher prevalence in blacks
     

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Trends in Attributable CVD Risk by Race in the ARIC Study   
Trends in Attributable CVD Risk by Race in the ARIC Study  

 

About this analysis
This study assessed the proportion of CVD risk attributable to traditional risk factors among subjects in the ARIC study. N=13,541 subjects from ARIC analyzed: no known CVD (coronary heart disease, heart failure, previous cerebrovascular event), aged 52-66 years, 26% black, 56% women. Subjects were examined at 4 visits: 1987-1989 (visit 1), 1990-1992 (visit 2), 1993-1995 (visit 3), 1996-1998 (visit 4). Presence of PAR assessed at each visit: obesity (BMI ≥30 kg/m2), hypertension (BP ≥140/≥90 mm Hg or on antihypertensive medication), hypercholesterolemia (TC ≥200 mg/dL or on cholesterol-lowering medication), diabetes (fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, or diabetes diagnosis), smoking status (active smoking within 1 year before exam). Subjects were assessed for 10-year CVD incidence.

Click on slide thumbnail to view larger. Slide available for download in the slide library.
Trends in Attributable CVD Risk in the ARIC Study   
Trends in Attributable CVD Risk in the ARIC Study 

P values are for comparisons between exam 1 and exam 4

ARIC=Atherosclerosis Risk in Communities
BMI=body mass index; CVD=cardiovascular disease; PAR=population attributable risks; TC=total cholesterol

Related content: 

Overview: ARIC Study: Examining Hypertension Risk Based on A1C  

  

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

September 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 10/16/2014