Highlights
- •Some risk factors are shared by coronary heart disease (CHD) and stroke, while others are not.
- •Hypertension was comparably associated with mortality by CHD and that by stroke.
- •Smoking and diabetes associated more strongly with mortality by CHD than by stroke.
Abstract
Background and aims
Coronary heart disease (CHD) and stroke have common risk factors, but some of these
differ in the magnitude or direction of associations between CHD and stroke. We assessed
whether the impact of each risk factor differed between CHD and stroke mortality in
Asians.
Methods
In total, 104 910 subjects aged 40–79 years without histories of cancer, CHD and stroke
at baseline were followed between 1988 and 2009. Competing-risks analysis was used
to test for differences in the associations of each risk factor with two endpoints
(CHD and stroke). Population attributable fractions (PAFs) were also calculated for
these endpoints to estimate the population impact of each risk factor.
Results
During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The
association of hypertension with CHD was similar to that with stroke in terms of the
magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking
(CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension
in women; that for stroke was caused by hypertension in both sexes.
Conclusions
Hypertension associations and PAFs were consistent between CHD and stroke, but not
for other risk factors. These findings may be useful to optimize public health intervention
strategies.
Keywords
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Article Info
Publication History
Published online: March 05, 2017
Accepted:
March 1,
2017
Received in revised form:
February 20,
2017
Received:
October 21,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
