Public health burden of coronary heart disease risk factors among middle-aged and elderly men

Background. An epidemiological evidence shows that smoking, high total chol esterol, hypertension, overweight, and a low level of physical activity are significant risk factors for coronary heart disease mortality. Therefore, by turning these risk factors in a healthier direction, presumably a substa ntial proportion of the deaths would be preventable. Methods. The avoidable proportion of coronary heart disease deaths associat ed with smoking, a high level of total cholesterol, systolic hypertension, overweight, and a low level of leisure-time physical activity was assessed with the use of the population attributable risks for initially 30- to 63-y ear-old Finnish men (six studies with 1,340-7,928 subjects) who were follow ed up from 7 to 30 years. Results. The theoretical estimates of population attributable risks derived from published studies were as follows: smoking 10 to 33%; high total chol esterol 9 to 21%; hypertension 6 to 15%; overweight 3 to 6%; and low level of leisure-time physical activity 22 to 39%. Conclusions. These estimations, based on observed mortality rates and risk factor prevalences, suggest that, even if modest estimates are used, the bu rden from coronary heart disease deaths can be substantially reduced by con verting the risk factors to more healthful levels. The results also suggest that efforts to increase physical activity deserve as much consideration a s those aimed at influencing more traditional risk factors. (C) 1999 Americ an Health Foundation and Academic Press.