Joint effect of modifying selected risk factors on attributable burden of cardiovascular diseases.
BACKGROUND
There are few published studies that consider the joint effect of multiple risk factors on avoidable burden of cardiovascular diseases (CVDs). This study aimed to estimate the joint effect of avoidable burden of multiple risk factors to CVDs.


METHODS
Estimates of avoidable burden to CVDs were made using potential impact fraction (PIF). In order to calculate PIF, data on the Prevalence of the risk factors include diabetes, hypertension, central obesity, and hypercholesterolemia were obtained from 3(rd) national Surveillance of Risk Factors of Non-Communicable Diseases-2007 in Iran and data on corresponding measures of effect were derived from a cohort study with multivariate adjusted hazard ratios. Then, joint effect of risk factors was calculated.


RESULTS
About 37% (95% uncertainty interval: 21.7-50.2) of attributable disability adjusted life years (DALYs) to CVDs in adult males and 59.4% (95% uncertainty interval: 30-76) in adult females due to selected risk factors are avoidable in theoretical minimum risk levels. After changing the current prevalence of these risk factors to the plausible minimum risk levels, 17.8% (95% uncertainty interval: 10.1-25.1) of CVDs' attributable DALYs among adult males and 34% (95% uncertainty interval: 20-46.7) in adult females can be avoided.


CONCLUSIONS
To better priority setting as well as reporting the magnitude of avoidable DALYs rather than the percentage of avoidable burden, PIF should be applied to updated and revised burden of CVDs.
Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Fatemeh Khosravi
FK
Shadmani
Research Center for Health Sciences and Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Manoochehr
M
Karami
Central obesity; diabetes; disability adjusted life years; hypercholesterolemia; hypertension; joint effect; potential impact fraction