Trends in population attributable fraction of modifiable risk factors for cardiovascular diseases across three decades

Aims: 

To evaluate temporal trends, across three decades, in the population attributable fractions (PAFs) of modifiable risk factors for 5-year risk of cardiovascular diseases (CVDs). 

Methods and results: 

Within population-based Rotterdam Study, we defined three time groups of individuals without established CVD at 'baseline' with a mean age of 70 years, and followed for five years: Epoch 1990s (1989-93, n = 6195), Epoch 2000s (1997-2001, n = 5572), and Epoch 2010s (2009-14, n = 5135). The prevalence of risk factors and related relative risks were combined to quantify PAFs. The PAF of the six risk factors combined for global CVD was 0.57 [95% confidence interval (CI) 0.47-0.65], 0.52 (0.39-0.62), and 0.39 (0.18-0.54) in three respective epochs. Hypertension contributed the highest PAF to global CVD in Epoch 1990s (0.37, 95% CI: 0.28-0.44) and 2000s (0.34, 95% CI: 0.22-0.43), while smoking was the largest contributor in Epoch 2010s (0.20, 95% CI: 0.06-0.32). Dyslipidaemia changed population-level coronary heart disease risk over time. For stroke, hypertension became a less significant contributor over time, but smoking became a larger contributor. For heart failure, all risk factors showed non-significant PAFs in Epoch 2010s. PAFs related to individual risk factor varied among women and men. 

Conclusion: 

Six modifiable risk factors to population-level global CVD risk decreased over time, but still explained 39% of total CVD in the latest decade. PAFs changed considerably for hypertension, dyslipidaemia, and smoking. Risk factors had different PAFs for different CVDs with pronounced sex differences.