title: Projections of preventable risks for cardiovascular disease in Canada to 2021: a microsimulation modelling approach.
abstract: BACKGROUND
  Reductions in preventable risks associated with cardiovascular disease have contributed to a steady decrease in its incidence over the past 50 years in most developed countries. However, it is unclear whether this trend will continue. Our objective was to examine future risk by projecting trends in preventable risk factors in Canada to 2021.
  
  
  METHODS
  We created a population-based microsimulation model using national data on births, deaths and migration; socioeconomic data; cardiovascular disease risk factors; and algorithms for changes in these risk factors (based on sociodemographic characteristics and previous cardiovascular disease risk). An initial population of 22.5 million people, representing the Canadian adult population in 2001, had 13 characteristics including the risk factors used in clinical risk prediction. There were 6.1 million potential exposure profiles for each person each year. Outcome measures included annual prevalence of risk factors (smoking, obesity, diabetes, hypertension and lipid levels) and of co-occurring risks.
  
  
  RESULTS
  From 2003 to 2009, the projected risks of cardiovascular disease based on the microsimulation model closely approximated those based on national surveys. Except for obesity and diabetes, all risk factors were projected to decrease through to 2021. The largest projected decreases were for the prevalence of smoking (from 25.7% in 2001 to 17.7% in 2021) and uncontrolled hypertension (from 16.1% to 10.8%). Between 2015 and 2017, obesity was projected to surpass smoking as the most prevalent risk factor.
  
  
  CONCLUSIONS
  Risks of cardiovascular disease are projected to decrease modestly in Canada, leading to a likely continuing decline in its incidence.
authors: Statistics Canada, Ottawa, Ont. ; Ottawa Hospital Research Institute, Ottawa, Ont. ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors: Douglas G
authors: DG
authors: Manuel
authors: Statistics Canada, Ottawa, Ont. ; Ottawa Hospital Research Institute, Ottawa, Ont. ; Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ont.
authors: Meltem
authors: M
authors: Tuna
authors: Statistics Canada, Ottawa, Ont. ; Ottawa Hospital Research Institute, Ottawa, Ont.
authors: Deirdre
authors: D
authors: Hennessy
authors: Ottawa Hospital Research Institute, Ottawa, Ont. ; Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ont.
authors: Carol
authors: C
authors: Bennett
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Que.
authors: Anya
authors: A
authors: Okhmatovskaia
authors: Statistics Canada, Ottawa, Ont.
authors: Philippe
authors: P
authors: Finès
authors: Ottawa Hospital Research Institute, Ottawa, Ont. ; Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ont. ; Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ont.
authors: Peter
authors: P
authors: Tanuseputro
authors: Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont.
authors: Jack V
authors: JV
authors: Tu
authors: Statistics Canada, Ottawa, Ont.
authors: William
authors: W
authors: Flanagan