Copyright © 2002 by the European Society of Cardiology.
Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12000 men and women from The Copenhagen City Heart Study
a The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark
b Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
c Department of Clinical Biochemistry, Herlev University Hospital, Copenhagen, Denmark
revised June 26, 2001; accepted June 26, 2001
Abstract
Aims The importance of coronary heart disease risk factors may differ between individuals and community and by sex and age.
Methods and Results The Copenhagen City Heart Study followed for 21 years a random sample of 5599 men and 6478 women aged 30 to 79 years at baseline. The importance of risk factors in individuals and the community were evaluated as relative- and population-attributable risks. We traced 2180 coronary events. In Cox regression analysis with ten risk factors entered simultaneously, relative risks for coronary heart disease in men ranged from 1·69 to 1·20 with the highest risks for diabetes, hypertension, smoking, and physical inactivity. In women, relative risks ranged from 2·74 to 1·19 with the highest risks for diabetes, smoking, hypertension, and physical inactivity. Population-attributable risks in men ranged from 22% to 3% with the highest risks for smoking, hypertension, and no daily alcohol intake. In women, attributable risks ranged from 37% to 3% with the highest risks for smoking, hypertension, and hypercholesterolaemia. Several of these rankings differed by age.
Conclusions The importance of coronary heart disease risk factors may differ for individuals, the community, and by sex and age. Consequently, prevention strategies should be tailored accordingly.
Key Words: Coronary disease, relative and population attributable risks.
f1 Correspondence: Dr P. Schnohr, The Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital—entrance 33, DK-2400 Copenhagen NV, Denmark.
References
- McGovern PG, Pankow JS, Shahar E. Minnesota Heart Survey Investigators. N Engl J Med. 1996;334:884–890
[Abstract/Free Full Text] - Hunink MGM, Goldman L, Tosteson ANA. The recent decline in mortality from coronary heart disease, 1980–1990. The effect of secular trends in risk factors and treatment. JAMA. 1997;277:535–542
[Abstract/Free Full Text] - Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J III. Factors of risk in the development of coronary heart disease—six-year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50
[Abstract/Free Full Text] - Appleyard M, Hansen AT, Schnohr P, Jensen G, Nyboe J. The Copenhagen City Heart Study. A book of tables with data from the first examination (1976–78) and a five-year follow-up (1981–83). Scand J Soc Med. 1989;170:1–160
- Rose, GA, Blackburn, H, Cardiovascular survey methods, 1958
- Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis. 1998;140:199–270[CrossRef][Web of Science][Medline]
- Nyboe J, Jensen G, Appleyard M, Schnohr P. Risk factors for acute myocardial infarction in Copenhagen I: hereditary, educational and socioeconomic factors. Eur Heart J. 1989;10:910–916
[Abstract/Free Full Text] - Khoury MJ, Beaty TH, Cohen BH. Fundamentals of genetic epidemiology. Oxford: Oxford University Press; 1993. p. 77–9
- Price JF, Fowkes GR. Risk factors and the sex differential in coronary artery disease. Epidemiology. 1997;8:584–591[CrossRef][Web of Science][Medline]
- Corrao JM, Becker RC, Ockene IS, Hamilton GA. Coronary heart disease risk factors in women. Cardiology. 1990;77:8–24
- Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SH. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? JAMA. 1991;265:627–631
[Abstract/Free Full Text] - Nyboe J, Jensen G, Appleyard M, Schnohr P. Smoking and the risk of first acute myocardial infarction. Am Heart J. 1991;122:438–447[CrossRef][Web of Science][Medline]
- Prescott, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and the risk of myocardial infarction in women and men: longitudinal population study. BMJ. 1998;316:1043–1046
[Abstract/Free Full Text] - Kannel WB, Schwartz MJ, McNamara PM. Blood pressure and risk of coronary heart disease: The Framingham Study. Dis Chest. 1969;56:43–52[Web of Science][Medline]
- MacMahon S, Peto R, Cutler J. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765–774[CrossRef][Web of Science][Medline]
- Shepherd J, Stuart MC, Ford I. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995;333:1301–1307
[Abstract/Free Full Text] - Downs JR, Clearfield M, Weis S. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. Results of AFCAPS/TexCAPS. JAMA. 1998;279:1615–1622
[Abstract/Free Full Text] - Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of highdensity lipoprotein cholesterol level: a meta-analysis of population- based prospective studies. J Cardiovasc Risk. 1996;3:213–219[Medline]
- Rimm EB, Klatsky A, Grobbee, Stampfer MJ. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits. BMJ. 1996;312:731–736
[Abstract/Free Full Text] - Rimm EB, Stamfer MJ, Giovanucci E. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol. 1995;141:1117–1127
[Abstract/Free Full Text] - Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med. 1999;341:427–434
[Free Full Text] - Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341:1097–1105
[Abstract/Free Full Text] - Morris JN, Chave SPW, Adam C, Sirey C, Epstein L. Vigorous exercise in leisure-time and the incidence of coronary heart-disease. Lancet. 1973;i:333–339[CrossRef]
- Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Ann Rev Public Health. 1987;8:253–287[CrossRef][Web of Science][Medline]
- Ekelund L-G, Haskell WL, Johnson JL, Whaley FS, Criqui MH, Sheps DS. Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. N Engl J Med. 1988;319:1379–1384[Abstract]
- Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Jung DL, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993;328:538–545
[Abstract/Free Full Text] - Manson JE, Hu FB, Rich-Edwards JW. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med. 1999;341:650–658
[Abstract/Free Full Text] - Rose G, Marmot MG. Social class and coronary heart disease. Br Heart J. 1981;45:13–19
[Abstract/Free Full Text] - Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997;350:235–239[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. R. Kamstrup, A. Tybjaerg-Hansen, R. Steffensen, and B. G. Nordestgaard Genetically Elevated Lipoprotein(a) and Increased Risk of Myocardial Infarction JAMA, June 10, 2009; 301(22): 2331 - 2339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. H. Allin, S. E. Bojesen, and B. G. Nordestgaard Baseline C-Reactive Protein Is Associated With Incident Cancer and Survival in Patients With Cancer J. Clin. Oncol., May 1, 2009; 27(13): 2217 - 2224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Johannsen, P. R. Kamstrup, R. V. Andersen, G. B. Jensen, H. Sillesen, A. Tybjaerg-Hansen, and B. G. Nordestgaard Hepatic Lipase, Genetically Elevated High-Density Lipoprotein, and Risk of Ischemic Cardiovascular Disease J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1264 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Johansen, S. E. Bojesen, A. K. Mylin, R. Frikke-Schmidt, P. A. Price, and B. G. Nordestgaard Elevated Plasma YKL-40 Predicts Increased Risk of Gastrointestinal Cancer and Decreased Survival After Any Cancer Diagnosis in the General Population J. Clin. Oncol., February 1, 2009; 27(4): 572 - 578. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Freiberg, A. Tybjaerg-Hansen, J. S. Jensen, and B. G. Nordestgaard Nonfasting Triglycerides and Risk of Ischemic Stroke in the General Population JAMA, November 12, 2008; 300(18): 2142 - 2152. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Zacho, A. Tybjaerg-Hansen, J. S. Jensen, P. Grande, H. Sillesen, and B. G. Nordestgaard Genetically Elevated C-Reactive Protein and Ischemic Vascular Disease N. Engl. J. Med., October 30, 2008; 359(18): 1897 - 1908. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R. Kamstrup, A. Tybjaerg-Hansen, R. Steffensen, and B. G. Nordestgaard Pentanucleotide Repeat Polymorphism, Lipoprotein(a) Levels, and Risk of Ischemic Heart Disease J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3769 - 3776. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Freiberg, A. Tybjaerg-Hansen, H. Sillesen, G. B. Jensen, and B. G. Nordestgaard Promotor Polymorphisms in Leukotriene C4 Synthase and Risk of Ischemic Cerebrovascular Disease Arterioscler Thromb Vasc Biol, May 1, 2008; 28(5): 990 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. G. Nordestgaard, M. Benn, P. Schnohr, and A. Tybjaerg-Hansen Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women JAMA, July 18, 2007; 298(3): 299 - 308. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Jeppesen, T. W. Hansen, S. Rasmussen, H. Ibsen, C. Torp-Pedersen, and S. Madsbad Insulin Resistance, the Metabolic Syndrome, and Risk of Incident Cardiovascular Disease: A Population-Based Study J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2112 - 2119. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kuper, H.-O. Adami, T. Theorell, and E. Weiderpass Psychosocial Determinants of Coronary Heart Disease in Middle-Aged Women: A Prospective Study in Sweden Am. J. Epidemiol., August 15, 2006; 164(4): 349 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. N. Hopkins, L. L. Wu, S. C. Hunt, and E. A. Brinton Plasma triglycerides and type III hyperlipidemia are independently associated with premature familial coronary artery disease J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1003 - 1012. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kornerup, B. G. Nordestgaard, T. K. Jensen, B. Feldt-Rasmussen, J. P. Eiberg, K. S. Jensen, and J. S. Jensen Transendothelial exchange of low-density lipoprotein is unaffected by the presence of severe atherosclerosis Cardiovasc Res, November 1, 2004; 64(2): 337 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Klausen, K. Borch-Johnsen, B. Feldt-Rasmussen, G. Jensen, P. Clausen, H. Scharling, M. Appleyard, and J. S. Jensen Very Low Levels of Microalbuminuria Are Associated With Increased Risk of Coronary Heart Disease and Death Independently of Renal Function, Hypertension, and Diabetes Circulation, July 6, 2004; 110(1): 32 - 35. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Tholstrup, L. I. Hellgren, M. Petersen, S. Basu, E. M. Straarup, P. Schnohr, and B. Sandstrom A Solid Dietary Fat Containing Fish Oil Redistributes Lipoprotein Subclasses without Increasing Oxidative Stress in Men J. Nutr., May 1, 2004; 134(5): 1051 - 1057. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.R. Cowie Coronary risk--time for a more sophisticated approach? Eur. Heart J., April 2, 2002; 23(8): 589 - 591. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||