Sharon MacDonald,* MD, FRCPC; Michel R. Joffres,t MD, PhD; Sylvie Stachenko,4 MD, MSc; ... disease (CVD) risk factors and their synergis- secondary to changes in lifestyle ... ministries ofhealth, health units and heart and strokefoundations.
Multiple cardiovascular disease risk factors in Canadian adults Sharon MacDonald,* MD, FRCPC; Michel R. Joffres,t MD, PhD; Sylvie Stachenko,4 MD, MSc; Louis Horlick,§ MD, FRCPC; George Fodor,11 MD, FRCPC; Canadian Heart Health Surveys Research Group¶ Objective: To estimate the prevalence and distribution of the coexistence of major cardiovascular disease (CVD) risk factors among Canadian adults. Design: Population-based cross-sectional surveys. Setting: Nine Canadian provinces, from 1986 to 1990. Participants: A probability sample of 26 293 men and women, aged 18 to 74 years, was selected from provincial health insurance registries. For 20 582 of these participants, at least two blood pressure (BP) measurements were taken using a standardized technique. At a subsequent visit to a clinic, two additional BP readings, anthropometric measurements and a blood specimen for plasma lipid analysis were obtained. Outcome measures: The percentage distribution of subjects by number of major risk factors (smoking, high BP and elevated blood cholesterol level) and by concomitant factors (body mass index [BMI], ratio of waist to hip circumference [WHR], physical activity, diabetes, awareness of CVD risk factors and education). Main results: Sixty-four percent of men and 63% of women had one or more of the major risk factors. Prevalence increased with age to reach 80% in men and 89% in women aged 65 to 74 years. Prevalence of two or three risk factors was highest among men in the 45-54 age group (34%) and in women in the 65-74 age group (37%). The most common associations were between smoking and high blood cholesterol level (10%) and between high BP and high blood cholesterol level (8%). Prevalence of high BP and elevated blood cholesterol, alone or in combination, increased with BMI and WHR. Smoking, elevated blood cholesterol, BMI and prevalence of one or more risk factors increased with lower level of education. Less than 48% of part-icipants mentioned any single major risk factor as a cause of heart disease. Awareness was lowest in the group with fewest years of education. Conclusion: The findings of this study call for an approach to reduce CVD that stresses collaboration of the different health sectors to reach both the population as a whole and the individuals at high risk. T n he prevalence of the major cardiovascular
disease (CVD) risk factors and their synergistic effect on the risk of developing CVD has been documented in several major prospective studies.'-4 The importance of even moderate elevations of risk factors and the synergistic effect of multiple factors is a current and challenging issue.5 Reduced mortality from cardiovascular events has been attri-
buted to the reduction in prevalence of risk factors secondary to changes in lifestyle at the population level.67 In Canada, there has been a lack of population studies documenting the prevalence, distribution and coexistence of the major CVD risk factors. For the first time, data on more than 20 000 people from nine provinces provide a unique opportunity to
From *Department of Community Health Sciences, Faculty of Medicine, University ofManitoba, Winnipeg, Man.; tDivision of Public Health, Alberta Health, Edmonton, Alta.; tPreventive Health Services, Health Services and Promotion Branch, Health and Welfare Canada, Ottawa, Ont.; §Faculty of Medicine, University of Saskatchewan, Saskatoon, Sask.; and //Department of Community Medicine, Memorial University of Newfoundland, St. John's, Nfld.
ICanadian Heart Health Surveys Research Group: C. Balram, P. Connelly, D. Gelskey, K. Hogan, M. Joffres, R. Lessard,
S. MacDonald, D. MacLean, E. MacLeod, M. Nargundkar, B. O'Connor, A. Petrasovits, B. Reeder, S. Stachenko and T. Young.
This research was funded by the National Health Research Development Program, Health and Welfare Canada, and the provincial ministries of health, health units and heart and stroke foundations. -
For prescribing information see page 2092
This report has not been peer reviewed.
CAN MED ASSOC J 1992; 146 (1 1)
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examine these issues. These data also allow us to estimate the number of people at risk due to specific combinations of factors who may require some form of individual or population-based intervention. We also examined knowledge about the causes of CVD and the prevalence of risk factors by socioeconomic group in Canadian adults.
Results
Overall, 64% of participants had at least one of the major risk factors for CVD: regular smoking (one or more cigarettes per day), elevated blood cholesterol (plasma cholesterol > 5.2 mmol/L) and high blood pressure (diastolic pressure > 90 mm Hg or being treated with medication, salt-restricted diet or weight reduction program) (Table 1). Among men, Methods the prevalence of one or more risk factors increased The data presented in this article refer to the steadily with age, levelling off after the age of 45 non-institutionalized population, aged 18 to 74, in years. In women, the prevalence of one or more risk nine provinces surveyed between 1986 and 1990. factors increased sharply with age (Fig. 1) and Data were compiled into the Heart Health Database levelled off after the age of 55 years. Although 74% on which this report is based. A detailed description of women had at least one risk factor by age 54, men of survey methods and procedures, training, quality reached a similar level (72%) 10 years earlier. About 22% of men and 19% of women had two control and data processing is given in the paper on survey methods and data analysis in this supplement or more of the major risk factors. Generally, the prevalence of single and multiple risk factors in(pages 1969-1974). In brief, a probability sample of 26 293 subjects creased with age. However, men aged 45 to 54 had the highest rate of two or three concurrent risk was selected using the health insurance registration files in each province. Trained survey nurses admin- factors (34%). Among women, the 65-74 age group istered a standard questionnaire and recorded two had the highest prevalence of two or more major risk blood pressure measurements during a home visit. A factors (37%). When considering isolated risk factors (Table 2), subsequent visit to a clinic was conducted within 2 weeks. Two blood pressure measurements were again prevalence of smoking alone was highest in the recorded, anthropometric measurements were per- youngest age group of both men and women (23% in formed, and a blood specimen was taken for plasma the 18-24 age groups). Elevated blood cholesterol lipid determination. level as a single risk factor was most prevalent in the The estimates presented in this report are oldest age group of men (41%) and women (44%). weighted. Age-standardized estimates are based on Among hypertensive people, hypertension occurs the age-sex distribution of the 1986 Canadian popu- without other risk factors in 27% of cases. Among lation. people with elevated blood cholesterol, HBC as an
No. of risk factors;
Sx; age, yr
No. of subjects
tS'-4
1 243 2 816 1194 783
2-34
34 i454i4
