Population Attributable fraction Estimation of the Cardiovascular Diseases–related factors: An Evidence from western part of Iran

Abstract

Background: Cardiovascular diseases are the first cause of deaths and years of lost life due to disability, worldwide. The population attributable fraction has been widely used in literature to quantify an impact of removing risk factors in occurrence of diseases. This study was designed to estimate the population attributable fraction of prevalent cases of cardiovascular diseases associated with different risk factors, using data from people aged 35-65 years old in Ravansar County.Methods: Data of this study came from 9825 adults aged 35-65 years that were included in the study of Ravansar Non-Communicable disease (RaNCD). First, to identify the confounding variables, we did a comprehensive review of the available resources and then presented the relationship between different risk factors with directed acyclic graphs and for any risk factor. Sequential and average adjusted attributable fractions were used. To calculate 95% confidence intervals, the Monte Carlo simulation was conducted. All statistical analyses were performed using the ’averisk’ package in R version 3.4.4.Results: The age adjusted prevalence for cardiovascular diseases was 12.6% (95% CI: 11.9, 13.2%). Among the modifiable predictors of cardiovascular diseases, the highest amount of population attributable fraction after adjusting for age, sex, and other factors associated with cardiovascular diseases, in men were for hypertension 35.7% (95% CI: 30.2, 40.6%), dyslipidemia 12.2% (95% CI: 7.5, 17.6%), general obesity 5.7% (95% CI: -0.7, 11.9%) and for cigarette smoking 4.0% (95% CI: -6.3, 14.6%), and in women were hypertension 42.8% (95% CI: 36.5, 47.3%), general obesity 10.7% (95% CI: 6.2, 15.3%), central obesity 10.1% (95% CI: -7.0, 23.8%) and for dyslipidemia 9.7% (95% CI: 5.1, 14.5%).Conclusion: Due to the difference in the population attributable fraction of cardiovascular diseases- related factors in men and women, it is advisable to prioritize preventive cardiovascular diseases interventions by sex segregation. Special attention should be paid to control hypertension, dyslipidemia in men, and hypertension, general obesity and dyslipidemia in women, and priority should be given to strategies for preventing cardiovascular diseases.