Copyright © 2003 by the European Society of Cardiology.
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Long-term tracking of cardiovascular risk factors among men and women in a large population-based health system
The Vorarlberg Health Monitoring & Promotion Programme
a Institute of Biostatistics and Documentation, Leopold Franzens University of Innsbruck, Innsbruck, Austria
b Department of Public Health Medicine and Epidemiology, University College Dublin, Dublin, Ireland
c Agency for Social- and Preventive Medicine, Bregenz, Austria
* Corresponding author. Dr H. Ulmer, Leopold Franzens University of Innsbruck, Department of Biostatistics and Documentation, Schoepfstrasse 41, A-6020 Innsbruck, Austria. Tel.: 0512-507-3201; fax: 0512-507-2711
E-mail address: Hanno.Ulmer{at}uibk.ac.at
Received 14 October 2002; revised 10 January 2003; accepted 5 February 2003
Aims To document tracking patterns, if any, over time, of classical cardiovascular risk factors in men and women participants in the Vorarlberg Health Monitoring and Promotion Programme (VHM&PP)
Methods and Results 67413 men and 82237 women underwent a total of 454448 standardised examinations in the 15 year period 1985–1999. Measures included were systolic and diastolic blood pressure, height, weight and fasting sample for total cholesterol, triglycerides, gamma-gt and blood glucose. Tracking coefficients were calculated by multivariable regression models using the GEE estimation method. All variables showed evidence of significant tracking over time, whether estimated in 10-year age bands or among individuals categorized as being at high risk using cut-points proposed by international guidelines. Effects were most marked for body mass index (0.87, SE0.005 in men and 0.89, SE0.003 in women), and were also associated with increasing age. Women who died during follow-up showed stronger tracking patterns for triglycerides and gamma-gt and weaker effects for blood pressure, but there was no effect on patterns according to survival in men. Tracking coefficients were weaker among initially high-risk individuals.
Conclusions This is the largest study yet of adults to demonstrate significant tracking effects of cardiovascular risk factors over time. The strength of this effect should be considered in assessing effectiveness of risk factor modification programmes. The study is novel too in highlighting more fully differences according to gender and social circumstances and in taking account of the impact on long-term survival.
Key Words: Cardiovascular riskfactors • Longitudinal studies • Body mass index • Tracking • Mortality
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