Preventable risk factors related to half of CV deaths in US adults
Preventable risk factors accounted for half of CV deaths in U.S. adults aged 45 to 79 years from 2009 to 2010, according to an analysis published in the Annals of Internal Medicine.
Researchers determined that approximately half of CV deaths could be prevented if five major risk factors — high cholesterol, diabetes, hypertension, obesity and smoking — were eliminated. In addition, if all states achieved the risk-factor levels of the best-performing states, slightly less than 10% of CV deaths could be prevented, the researchers concluded.
Shivani A. Patel, PhD, from Hubert Department of Global Health, Rollins School of Public Health, Emory University, and colleagues analyzed self-reported CV risk factor data from 533,306 adults aged 45 to 79 years from the Behavioral Risk Factor Surveillance System in 2009-2010. The HR for CV death for each of the five risk factors was estimated using National Health and Nutrition Examination Survey data from 1988-1994 and 1999-2004, followed through to 2006.
At least one risk factor
Overall, 81.7% of men and 80% of women had at least one of the five risk factors. Elevated cholesterol (men, 46.7%; 95% CI, 20.6-72.8; women, 46.2%; 95% CI, 30.9-61.5) and hypertension (men, 46.6%; 95% CI, 45.4-47.8; women, 45.1%; 95% CI, 43.9-46.3) were the most prevalent risk factors in both sexes. Rates were similar between men and women except for current smoking, which was more prevalent in men (24.8%; 95% CI, 23-26.6 vs. 17.6%; 95% CI, 17-18.2), according to the findings.
Half of CV deaths preventable
Total elimination of all five risk factors would prevent 54% of CV deaths in men and 49.6% of CV deaths in women, according to the researchers’ estimates. The largest preventable risk factors were hypertension (men, 30.4%; 95% CI, 16.2-43.4; women, 38%; 95% CI, 18.5-55.2) and current smoking (men, 36.4%; 95% CI, 23.9-48.3; women, 17.4%; 95% CI, 7.1-28.3).
If risk factor levels for each state were reduced to those states that achieved the best levels in 2009-2010, the preventable fractions for each risk factor among men were as follows: high cholesterol, 2%; diabetes, 1.7%; hypertension, 3.8%; obesity, 2.6%; current smoking, 5.1%. The preventable fractions for each risk factor among women were: high cholesterol, –0.1%; diabetes, 4.1%; hypertension, 7.3%; obesity, 1.7%; current smoking, 4.4%.
Among the states, Mississippi had the highest CV mortality rate per 100,000 persons (477) and Minnesota had the lowest rate (195.2). The researchers noted that the best-performing states tended to be in the West and the worst-performing states tended to be in the South and Midwest.
Colorado was the only state in the best-performing quintile for all five risk factors. Kentucky and West Virginia were in the worst-performing quintile for all five risk factors. Alabama, Louisiana and Mississippi were in the worst-performing quintile for four of the risk factors, the researchers wrote.
“Despite progress in reduction of [CV] mortality over the past 6 decades, modifiable [CV] risk factors continue to be associated with half of the burden of [CV] mortality at the national and state levels, and the best achieved levels are far from the theoretical minimum,” Patel and colleagues wrote. “Large-scale decreases in [CV] mortality may be infeasible without adoption and achievement of more aggressive risk reduction targets for primordial prevention.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.