Masaaki Matsunaga1, Hiroshi Yatsuya2, Hiroyasu Iso3, Kentaro Yamashita4, Yuanying Li1, Kazumasa Yamagishi5, Naohito Tanabe6, Yasuhiko Wada7, Chaochen Wang8, Atsuhiko Ota1, Koji Tamakoshi9, Akiko Tamakoshi10. 1. Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan. 2. Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan. Electronic address: yatsuya@fujita-hu.ac.jp. 3. Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. 4. Department of Cardiology, National Hospital Organization Nagoya Medical Center, Aichi, Japan. 5. Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 6. Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, Japan. 7. Faculty of Nutrition, University of Kochi, Kochi, Japan. 8. Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan. 9. Department of Nursing, Nagoya University School of Health Science, Nagoya, Japan. 10. Department of Public Health, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
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.
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.