Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries

Jaakko Reinikainen; Kari Kuulasmaa; Viktor Oskarsson; Philippe Amouyel; Katia Biasch; Hermann Brenner; Roberto De Ponti; Chiara Donfrancesco; Wojciech Drygas; Jean Ferrieres; Guido Grassi; Sameline Grimsgaard; Licia Iacoviello; Pekka Jousilahti; Line L Kårhus; Frank Kee; Allan Linneberg; Dalia Luksiene; Joany Mariño; Marie Moitry; Luigi Palmieri; Annette Peters; Aleksandra Piwonska; Fosca Quarti-Trevano; Veikko Salomaa; Susana Sans; Carsten Oliver Schmidt; Ben Schöttker; Stefan Söderberg; Abdonas Tamosiunas; Barbara Thorand; Hugh Tunstall-Pedoe; Diego Vanuzzo; Giovanni Veronesi; Mark Woodward; Karim Lekadir; Teemu Niiranen

doi:10.1093/eurjpc/zwad359

Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries

Jaakko Reinikainen (Lead / Corresponding author), Kari Kuulasmaa, Viktor Oskarsson, Philippe Amouyel, Katia Biasch, Hermann Brenner, Roberto De Ponti, Chiara Donfrancesco, Wojciech Drygas, Jean Ferrieres, Guido Grassi, Sameline Grimsgaard, Licia Iacoviello, Pekka Jousilahti, Line L Kårhus, Frank Kee, Allan Linneberg, Dalia Luksiene, Joany Mariño, Marie MoitryLuigi Palmieri, Annette Peters, Aleksandra Piwonska, Fosca Quarti-Trevano, Veikko Salomaa, Susana Sans, Carsten Oliver Schmidt, Ben Schöttker, Stefan Söderberg, Abdonas Tamosiunas, Barbara Thorand, Hugh Tunstall-Pedoe, Diego Vanuzzo, Giovanni Veronesi, Mark Woodward, Karim Lekadir, Teemu Niiranen

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Abstract

AIMS: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period.

METHODS: The study sample comprised 553818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors (sex, smoking, diabetes, non-HDL [high-density lipoprotein] cholesterol, systolic blood pressure [BP], and body mass index [BMI]) and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression.

RESULTS: The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the United Kingdom were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (p = 0.043 for overall difference) and those with diabetes had a slightly lower HR in central Europe (p = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol (7% per mmol/L; 95% confidence interval [CI], 3-10%) and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%).

CONCLUSION: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

Original language	English
Article number	zwad359
Pages (from-to)	569-577
Number of pages	28
Journal	European Journal of Preventive Cardiology
Volume	31
Issue number	5
Early online date	17 Nov 2023
DOIs	https://doi.org/10.1093/eurjpc/zwad359
Publication status	Published - Mar 2024

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Reinikainen, J., Kuulasmaa, K., Oskarsson, V., Amouyel, P., Biasch, K., Brenner, H., De Ponti, R., Donfrancesco, C., Drygas, W., Ferrieres, J., Grassi, G., Grimsgaard, S., Iacoviello, L., Jousilahti, P., Kårhus, L. L., Kee, F., Linneberg, A., Luksiene, D., Mariño, J., ... Niiranen, T. (2024). Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries. European Journal of Preventive Cardiology, 31(5), 569-577. Article zwad359. https://doi.org/10.1093/eurjpc/zwad359

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title = "Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries",

abstract = "AIMS: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period.METHODS: The study sample comprised 553818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors (sex, smoking, diabetes, non-HDL [high-density lipoprotein] cholesterol, systolic blood pressure [BP], and body mass index [BMI]) and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression.RESULTS: The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the United Kingdom were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (p = 0.043 for overall difference) and those with diabetes had a slightly lower HR in central Europe (p = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol (7% per mmol/L; 95% confidence interval [CI], 3-10%) and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%).CONCLUSION: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.",

author = "Jaakko Reinikainen and Kari Kuulasmaa and Viktor Oskarsson and Philippe Amouyel and Katia Biasch and Hermann Brenner and {De Ponti}, Roberto and Chiara Donfrancesco and Wojciech Drygas and Jean Ferrieres and Guido Grassi and Sameline Grimsgaard and Licia Iacoviello and Pekka Jousilahti and K{\aa}rhus, {Line L} and Frank Kee and Allan Linneberg and Dalia Luksiene and Joany Mari{\~n}o and Marie Moitry and Luigi Palmieri and Annette Peters and Aleksandra Piwonska and Fosca Quarti-Trevano and Veikko Salomaa and Susana Sans and Schmidt, {Carsten Oliver} and Ben Sch{\"o}ttker and Stefan S{\"o}derberg and Abdonas Tamosiunas and Barbara Thorand and Hugh Tunstall-Pedoe and Diego Vanuzzo and Giovanni Veronesi and Mark Woodward and Karim Lekadir and Teemu Niiranen",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected].",

year = "2024",

month = mar,

doi = "10.1093/eurjpc/zwad359",

language = "English",

volume = "31",

pages = "569--577",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "Oxford University Press",

number = "5",

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Reinikainen, J, Kuulasmaa, K, Oskarsson, V, Amouyel, P, Biasch, K, Brenner, H, De Ponti, R, Donfrancesco, C, Drygas, W, Ferrieres, J, Grassi, G, Grimsgaard, S, Iacoviello, L, Jousilahti, P, Kårhus, LL, Kee, F, Linneberg, A, Luksiene, D, Mariño, J, Moitry, M, Palmieri, L, Peters, A, Piwonska, A, Quarti-Trevano, F, Salomaa, V, Sans, S, Schmidt, CO, Schöttker, B, Söderberg, S, Tamosiunas, A, Thorand, B, Tunstall-Pedoe, H, Vanuzzo, D, Veronesi, G, Woodward, M, Lekadir, K & Niiranen, T 2024, 'Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries', European Journal of Preventive Cardiology, vol. 31, no. 5, zwad359, pp. 569-577. https://doi.org/10.1093/eurjpc/zwad359

Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries. / Reinikainen, Jaakko (Lead / Corresponding author); Kuulasmaa, Kari; Oskarsson, Viktor et al.
In: European Journal of Preventive Cardiology, Vol. 31, No. 5, zwad359, 03.2024, p. 569-577.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors

T2 - An analysis of 49 cohorts from 11 European countries

AU - Reinikainen, Jaakko

AU - Kuulasmaa, Kari

AU - Oskarsson, Viktor

AU - Amouyel, Philippe

AU - Biasch, Katia

AU - Brenner, Hermann

AU - De Ponti, Roberto

AU - Donfrancesco, Chiara

AU - Drygas, Wojciech

AU - Ferrieres, Jean

AU - Grassi, Guido

AU - Grimsgaard, Sameline

AU - Iacoviello, Licia

AU - Jousilahti, Pekka

AU - Kårhus, Line L

AU - Kee, Frank

AU - Linneberg, Allan

AU - Luksiene, Dalia

AU - Mariño, Joany

AU - Moitry, Marie

AU - Palmieri, Luigi

AU - Peters, Annette

AU - Piwonska, Aleksandra

AU - Quarti-Trevano, Fosca

AU - Salomaa, Veikko

AU - Sans, Susana

AU - Schmidt, Carsten Oliver

AU - Schöttker, Ben

AU - Söderberg, Stefan

AU - Tamosiunas, Abdonas

AU - Thorand, Barbara

AU - Tunstall-Pedoe, Hugh

AU - Vanuzzo, Diego

AU - Veronesi, Giovanni

AU - Woodward, Mark

AU - Lekadir, Karim

AU - Niiranen, Teemu

PY - 2024/3

Y1 - 2024/3

N2 - AIMS: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period.METHODS: The study sample comprised 553818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors (sex, smoking, diabetes, non-HDL [high-density lipoprotein] cholesterol, systolic blood pressure [BP], and body mass index [BMI]) and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression.RESULTS: The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the United Kingdom were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (p = 0.043 for overall difference) and those with diabetes had a slightly lower HR in central Europe (p = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol (7% per mmol/L; 95% confidence interval [CI], 3-10%) and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%).CONCLUSION: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

AB - AIMS: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period.METHODS: The study sample comprised 553818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors (sex, smoking, diabetes, non-HDL [high-density lipoprotein] cholesterol, systolic blood pressure [BP], and body mass index [BMI]) and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression.RESULTS: The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the United Kingdom were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (p = 0.043 for overall difference) and those with diabetes had a slightly lower HR in central Europe (p = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol (7% per mmol/L; 95% confidence interval [CI], 3-10%) and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%).CONCLUSION: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

U2 - 10.1093/eurjpc/zwad359

DO - 10.1093/eurjpc/zwad359

M3 - Article

C2 - 37976098

SN - 2047-4873

VL - 31

SP - 569

EP - 577

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 5

M1 - zwad359

ER -

Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: An analysis of 49 cohorts from 11 European countries

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