A multiple risk factor program is associated with decreased risk of cardiovascular disease in 70-year-olds: A cohort study from Sweden

Autoři: Anna Nordström aff001;  Jonathan Bergman aff003;  Sabine Björk aff001;  Bo Carlberg aff004;  Jonas Johansson aff005;  Andreas Hult aff001;  Peter Nordström aff003
Působiště autorů: Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden aff001;  School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway aff002;  Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden aff003;  Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden aff004;  Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway aff005
Vyšlo v časopise: A multiple risk factor program is associated with decreased risk of cardiovascular disease in 70-year-olds: A cohort study from Sweden. PLoS Med 17(6): e32767. doi:10.1371/journal.pmed.1003135
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003135



In individuals below 65 years of age, primary prevention programs have not been successful in reducing the risk of cardiovascular disease (CVD) and death. However, no large study to our knowledge has previously evaluated the effects of prevention programs in individuals aged 65 years or older. The present cohort study evaluated the risk of CVD in a primary prevention program for community-dwelling 70-year-olds.

Method and findings

In 2012–2017, we included 3,613 community-dwelling 70-year-olds living in Umeå, in the north of Sweden, in a health survey and multidimensional prevention program (the Healthy Ageing Initiative [HAI]). Classic risk factors for CVD were evaluated, such as blood pressure, lipid levels, obesity, and physical inactivity. In the current analysis, each HAI participant was propensity-score-matched to 4 controls (n = 14,452) from the general Swedish population using national databases. The matching variables included age, sex, diagnoses, medication use, and socioeconomic factors. The primary outcome was the composite of myocardial infarction, angina pectoris, and stroke. The 18,065 participants and controls were followed for a mean of 2.5 (range 0–6) years. The primary outcome occurred in 128 (3.5%) HAI participants and 636 (4.4%) controls (hazard ratio [HR] 0.80, 95% CI 0.66–0.97, p = 0.026). In HAI participants, high baseline levels of blood pressure and lipids were associated with subsequent initiation of antihypertensive and lipid-lowering therapy, respectively, as well as with decreases in blood pressure and lipids during follow-up. In an intention-to-treat approach, the risk of the primary outcome was lower when comparing all 70-year-olds in Umeå, regardless of participation in HAI, to 70-year-olds in the rest of Sweden for the first 6 years of the HAI project (HR 0.87, 95% CI 0.77–0.97, p = 0.014). In contrast, the risk was similar in the 6-year period before the project started (HR 1.04, 95% CI 0.93–1.17, p = 0.03 for interaction). Limitations of the study include the observational design and that changes in blood pressure and lipid levels likely were influenced by regression towards the mean.


In this study, a primary prevention program was associated with a lower risk of CVD in community-dwelling 70-year-olds. With the limitation of this being an observational study, the associations may partly be explained by improved control of classic risk factors for CVD with the program.

Klíčová slova:

Angina – Blood pressure – Cardiovascular diseases – Hypertension – Lipids – Medical risk factors – Myocardial infarction – Sweden


1. World Health Organization. The top 10 causes of death. Geneva: World Health Organization; 2018 [cited 2018 Apr 5]. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/.

2. Islam SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, Froschl G. Non-communicable diseases (NCDs) in developing countries: a symposium report. Global Health. 2014;10:81. doi: 10.1186/s12992-014-0081-9 25498459

3. Morabia A, Abel T. The WHO report “Preventing chronic diseases: a vital investment” and us. Soz Praventivmed. 2006;51(2):74. doi: 10.1007/s00038-005-0015-7 18027782

4. Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev. 2011;(1):CD001561. doi: 10.1002/14651858.CD001561.pub3 21249647

5. Statistics Sweden. Individregister och mikrodata. Stockholm: Statistics Sweden; 2018 [cited 2018 Mar 1]. Available from: https://www.scb.se/vara-tjanster/bestalla-mikrodata/vilka-mikrodata-finns/individregister/.

6. Swedish National Board of Health and Welfare. The National Patient Register. Stockholm: Swedish National Board of Health and Welfare; 2018 [cited 2018 Nov 29]. Available from: https://www.socialstyrelsen.se/en/statistics-and-data/registers/register-information/the-national-patient-register/.

7. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46(3):399–424. doi: 10.1080/00273171.2011.568786 21818162

8. GBD 2013 Risk Factors Collaborators, Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287–323. doi: 10.1016/S0140-6736(15)00128-2 26364544

9. Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54. doi: 10.1056/NEJMoa1212914 23796131

10. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360(9343):1347–60. doi: 10.1016/S0140-6736(02)11403-6 12423980

11. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13. doi: 10.1016/s0140-6736(02)11911-8 12493255

12. O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–23. doi: 10.1016/S0140-6736(10)60834-3 20561675

13. Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:i717. doi: 10.1136/bmj.i717 26920333

14. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127–248. doi: 10.1016/j.jacc.2017.11.006 29146535

15. Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills KT, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2(7):775–81. doi: 10.1001/jamacardio.2017.1421 28564682

16. Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96(1):308–15. doi: 10.1161/01.cir.96.1.308 9236450

17. Landahl S, Bengtsson C, Sigurdsson JA, Svanborg A, Svardsudd K. Age-related changes in blood pressure. Hypertension. 1986;8(11):1044–9. doi: 10.1161/01.hyp.8.11.1044 3770866

18. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14. doi: 10.1016/j.diabres.2009.10.007 19896746

19. Antithrombotic Trialists’ (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849–60. doi: 10.1016/S0140-6736(09)60503-1 19482214

20. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. doi: 10.1161/CIR.0000000000000152 25520374

21. Lugo A, La Vecchia C, Boccia S, Murisic B, Gallus S. Patterns of smoking prevalence among the elderly in Europe. Int J Environ Res Public Health. 2013;10(9):4418–31. doi: 10.3390/ijerph10094418 24048208

22. Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Br J Sports Med. 2015;49(21):1414–22. doi: 10.1136/bjsports-2015-f5577rep 26476429

Článek vyšel v časopise

PLOS Medicine

2020 Číslo 6
Nejčtenější tento týden
Nejčtenější v tomto čísle

Zvyšte si kvalifikaci online z pohodlí domova

Třikrát z interní medicíny
nový kurz
Autoři: MUDr. Jana Kubátová

Pokročilá Parkinsonova nemoc − úskalí a možnosti léčby
Autoři: doc. MUDr. Marek Baláž, Ph.D.

Léčba diabetes mellitus 2. typu pomocí GLP- 1 RA

Depresivní porucha a zánětlivé procesy
Autoři: MUDr. Juraj Tkáč

Methotrexát a jeho formy podávání v revmatologii
Autoři: MUDr. Liliana Šedová

Všechny kurzy
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.


Nemáte účet?  Registrujte se