Population-attributable risk of coronary heart disease risk factors during long-term follow-up: the Malmö Preventive Project.

P M Nilsson, Jan-Åke Nilsson, Göran Berglund

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Aims To calculate the population-attributable risk (PAR) of coronary events (CE) from 10 risk factors, during long-term follow-up. Methods We used both case-cohort and case-control analyses for calculation of PAR in relation to 10 baseline risk factors. First CE (fatal or nonfatal, n = 3072) in 22 444 males and 10 902 females was recorded during a mean follow-up of 20 years by use of national registers. Results Using a Cox regression analysis in a case-cohort design, smoking (prevalence in men 49%, women 37%) was the strongest risk factor, RR 2.29 (95% CI 2.09-2.52; PAR 39%), followed by hypercholesterolaemia, RR 1.70 (95% CI 1.56-1.86; PAR 18%), and diabetes, RR 1.67 (95% CI 1.41-1.99; PAR 3%). For women the strongest risk factors were smoking, RR 3.16 (95% CI 2.50-3.98; PAR 44%), diabetes, RR 2.59 (95% CI 1.78-3.76; PAR 6%), and hypertension, RR 2.47 (95% CI 1.94-3.14; PAR 23%). In men, smoking was the strongest predictor both after 10 years [RR 2.69 (95% CI 2.23-3.24)] and 20 years [RR 2.45 (95% CI 2.15-2.79)], followed by hypercholesterolaemia (RR 2.16-1.63), hypertension (RR 2.04-1.51), and diabetes (RR 1.85 -1.47). The case-control design gave very similar results. Total PAR varied from 74% (fully adjusted Cox regression, case-control, in men) to 116% in women (case-cohort). Conclusion Smoking is the most important long-term risk factor for CE in both genders, based on data from a population with a high proportion of smokers. Ten measured variables explained almost all variation in risk and could be used as a basis for intervention programmes.
Original languageEnglish
Pages (from-to)134-141
JournalJournal of Internal Medicine
Issue number2
Publication statusPublished - 2006

Subject classification (UKÄ)

  • Other Clinical Medicine
  • Orthopedics


  • Sweden: epidemiology
  • Smoking: adverse effects
  • Non-U.S. Gov't
  • Health Surveys
  • Female
  • Epidemiologic Methods
  • Coronary Disease: prevention & control
  • Coronary Disease: epidemiology
  • Time Factors
  • Adult
  • Humans
  • Male
  • Middle Aged
  • Registries
  • Research Support


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