Question

1. Among the major cardiovascular risk factors listed in Table 1, other than age, which of the remaining four risk factors was associated with the highest incidence rate for CHD mortality among women? HINT: to answer this question, you need to calculate the incidence rate for women in the highest, or most exposed, category for each of the four risk factors below age in Table 1.
2. Towards which one of these four risk factors would you propose developing a public health population-wide intervention program?

TABLE 1. Relative rlsks of coronary heart dlsease (CHD) mortality accordlng to major cardlovascular rlak factore: Flnnlsh Mobllo Clnlc Study, 1988-1984 Men (n - 2,748) Person Relatveconfiance Women (n 2,385) No.of Pei901* Rolatve conidenc No, ol 95% 95% CHO years ๙ cases lolow-up CHD years of Inlervalcases foliow-up dak risk Interval Age (years)t 30-39 40-49 50-59 60-69 1814,943 48 12,560 69 7,677 2 12,627 10 10,972 1.3-26.3 7,63818.5 3.9-70.6 3,86642.6 0.1-179.3 3.21.8-5.5 7,5 4.4-12.5 20 5.8 3,16913.47.8-22.9 28 Smoklng Nonsmoker Current smoker 72 19,090 114 19,259 41 29,827 17 1.8 1.3-2.4 5,114 4.0 2.3-7.2 Body mass index terlle (kg/m2) s24.0 24.1--26.7 >28.7 68 2,585 48 12,925 70 12,823 1311,796 1811,707 27 11,518 0.7 0.5-1.0 0.9 1.0 0,5-1.0 0.6-1.9 Cholesteroi tertile (mg'di) S237 238-280 >280 36 13,079 5712,946 93 12,324 1.40.8-2.2 2.41.7-3.8 15 11,818 11 11,004 32 11,379 0.2-1.1 0.6-1.9 0.5 Hyportensknt Normotensive Borderllne Mild Dellnite 5317,539 113 18,385 986 1,455 1.61.1-2.2 0.6 0.2-2.1 1.01,1-3.4 816,081 3214,040 1,298 3,743 1.90.04.3 2.2 2.1 0.9-5.4 0.6-7.3 Ago adjusted f No adjustment. t Dofnte hypertenslon: systollc blood pressure (SBP) of 170 mmHg an diastolic blood preasuro (DBP) ot 100 mmHg or anthypertensive medicatilon; mld: S0P ol z160 mmHg and DBP ol 295 mmHg, but nol dofnod as dofinite; nomotensve: SBP of <140 mmHg and DBP of «00 mmHg; borderlne: pereons not definod aa doflntoly or mldly hypertongivo or nomotensive

Answer 1

The results have clearly shown that among women there is a high prevalence of diabetes, hypertension, hypercholesterolemia, smoking and physical inactivity, which are all major modifiable risk factors for CHD. This also highlights the frequent clustering of risk factors, especially in women aged 50 years and older, suggesting that a sizeable proportion of our population has a high risk for coronary events. These findings raise concerns about future trends of already increased rates of CHD. From the perspective of public-health service, the appropriate management of such burden of cardiovascular conditions at lower cost is a big challenge. Thus, multifactorial and integrated interventions to reverse this situation, focusing on smoking cessation, promotion of traditional Mediterranean diet, and increasing physical activity, are urgently needed.