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BackgroundTo examine the association between potentially modifiable risk factors with cardiovascular disease (CVD) and all-cause mortality and to quantify their population attributable fractions (PAFs) among a sample of Tehran residents.MethodsOverall, 8108 participants (3686 men) aged≥30 years, were investigated. To examine the association between risk factors and outcomes, multivariate sex-adjusted Cox proportional hazard regression analysis were conducted, using age as time-scale in two models including general/central adiposity: 1)adjusted for different independent variables including smoking, education, family history of CVD and sex for both outcomes and additionally adjusted for prevalent CVD for all-cause mortality 2)further adjusted for obesity mediators (hypertension, diabetes, lipid profile and chronic kidney disease). Separate models were used including either general or central adiposity.ResultsDuring median follow-up of >10 years, 827 first CVD events and 551 deaths occurred. Both being overweight (hazard ratio (HR), 95%CI: 1.41, 1.18–1.66, PAF 13.66) and obese (1.51, 1.24–1.84, PAF 9.79) played significant roles for incident CVD in the absence of obesity mediators. Predicting CVD, in the presence of general adiposity and its mediators, significant positive associations were found for hypercholesterolemia (1.59, 1.36–1.85, PAF 16.69), low HDL-C (1.21, 1.03–1.41, PAF 12.32), diabetes (1.86, 1.57–2.27, PAF 13.87), hypertension (1.79, 1.46–2.19, PAF 21.62) and current smoking (1.61, 1.34–1.94, PAF 7.57). Central adiposity remained a significant positive predictor, even after controlling for mediators (1.17, 1.01–1.35, PAF 7.55). For all-cause mortality, general/central obesity did not have any risk even in the absence of obesity mediators. Predictors including diabetes (2.56, 2.08–3.16, PAF 24.37), hypertension (1.43, 1.11–1.84, PAF 17.13), current smoking (1.75, 1.38–2.22, PAF 7.71), and low education level (1.59, 1.01–2.51, PAF 27.08) were associated with higher risk, however, hypertriglyceridemia (0.83, 0.68–1.01) and being overweight (0.71, 0.58–0.87) were associated with lower risk.ConclusionsModifiable risk factors account for more than 70% risk for both CVD and mortality events.

Background The impact of different combinations of glucose tolerance and blood pressure status on the development of type 2 diabetes mellitus (T2 DM ), hypertension ( HTN ), and chronic kidney disease ( CKD ) still needs to be investigated. Methods and Results A total of 12 808 Iranian adults aged ≥20 years were included in 3 separate analyses to investigate incidence of T2 DM , HTN , and CKD . Multivariate Cox proportional hazard models were used to calculate hazard ratios (95% CI ). During a median follow‐up of >10 years, the overall incidence rate for T2 DM , HTN , and CKD was 12.2, 29.8, and 24.8 per 1000 person‐years. For incident T2 DM , considering normal glucose tolerance/normal blood pressure as reference, prediabetes (Pre DM )/ HTN had the highest risk (hazard ratio: 7.22 [5.71–9.12]) while Pre DM /normal blood pressure also showed a significant risk (5.58 [4.41–7.05]). Furthermore, risk of Pre DM / HTN was higher than Pre DM /normal blood pressure ( P <0.05). For incident HTN , normal glucose tolerance/prehypertension was a strong predictor (3.28 [2.91–3.69]); however, addition of Pre DM or T2 DM did not increase the risk. For incident CKD , every category that included HTN and/or T2 DM showed significant risk; this risk was marginally significant for the Pre DM / HTN group (1.19 [0.98–1.43], P =0.06). In addition, Pre DM / normal blood pressure was a marginally significant risk factor for incident HTN while normal glucose tolerance/prehypertension was a significant predictor of T2 DM . Conclusions Presence of HTN was associated with increased risk of T2 DM among the Pre DM population; however, dysglycemia did not increase the risk of HTN among individuals with prehypertension. For incident CKD , intensive management of HTN and T2 DM , rather than their predisease states, should be considered.