Population Attributable Risks of Hypertension and Diabetes for Cardiovascular Disease and Stroke in the Northern Manhattan Study

Abstract

BackgroundUnderstanding the population‐level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations.Methods and ResultsThe Northern Manhattan Study (n=3298) is a population‐based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race‐ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non‐Hispanic whites (2.6%; 95% CI, −33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (−0.3%; 95% CI, −34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, −8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/race‐ethnicity.ConclusionsHTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.

Impact of hypertension on mortality and cardiovascular disease burden in patients with cardiovascular risk factors from a general practice setting

“…factors (33% in men and 37% in women). These data are in agreement with the data from the WHO, in which high blood pressure is considered as the first cause of mortality as well as lost years of life worldwide [26], and the data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) study in which hypertension was the highest cardiovascular risk factor of excess risk of mortality [27]. The importance of hypertension is even more relevant because it is the first attributable risk factor not only for mortality but also for the hospitalization of stroke.…”

“…Concerning hospitalization of CHD, hypertension also demonstrated the highest PAR in women (43%). In several recent studies performed in different continents and ethnics, hypertension was also the most important factor in cardiovascular burden [26][27][28][29][30][31], the agestandardized cardiovascular mortality attributable to higher-than-optimal SBP ranged from 200 to 220 per 100 000 to 410 per 100 000 for men in different parts of USA [32], and the lack of control contributed largely to the risk [27]. The present data stress the necessity for the primary prevention of hypertension as well as improvement in blood pressure control.…”

Circulating cell-free mitochondrial DNA as the probable inducer of early endothelial dysfunction in the prediabetic patient

“…Recently, it has been reported that older adults with coronary heart disease show depressive symptoms and poorer exercise capacity that are associated with functional decline over 5 years (Sin et al, 2015). Willey et al (2014) established that hypertension and diabetes have important effects on the burden of stroke, especially in individuals b 80 years of age and Hispanics. In addition, Dei Cas et al (2015) reported that the frequency of patients with heart failure and DM will increase with the general aging of the population.…”

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

“…The degree to which modest population‐wide blood pressure shifts may affect the incidence of HF also remains unknown, as do the effects of blood pressure shifts in African American populations,19 who shoulder higher burdens of elevated blood pressure as well as CVD than do white populations 1. Further, the majority of published studies estimated cardiovascular benefits from interventions that completely eliminated hypertension or uncontrolled hypertension from the population, despite the implausibility of such goals 24, 25, 26. Therefore, in a biracial, population‐based setting, we assessed the impact of 2 types of pragmatic, hypothetical interventions on reducing the incidence of CHD, stroke, and HF after full implementation: a population‐wide intervention that reduced SBP by 1 or 2 mm Hg and targeted interventions that achieved a 10% reduction in the proportion of the population with unaware, untreated, or uncontrolled blood pressure above goal.…”