Multiple risk factors and population attributable risk for ischemic heart disease mortality in the United States, 1971-1992

The objective of this study was to assess the associations and population a ttributable risks (PAR) of risk factor combinations and ischemic heart dise ase (IHD) mortality in the United States. We used logistic regression model s to assess the association of risk factors with IHD in the First National Health and Nutrition Examination Survey (1971-1974) and Epidemiologic Follo w-up Study (1982-1992) among white and black men and women. We examined eig ht modifiable risk factors: hypertension, elevated serum cholesterol, diabe tes, overweight, current smoking, physical inactivity, depression, and nonu se of replacement hormones. Risk factors associated with IHD mortality were the same among white and black men (i.e., age, education, smoking, diabete s, hypertension, and serum cholesterol). Age, education, smoking, diabetes, and hypertension were the risk factors among white and black women. Physic al inactivity, nonuse of replacement hormones, serum cholesterol, and overw eight were the additional risk factors among white women. Adjusted for demo graphic risk factors, overall PARs for study risk factors were 41.2% for wh ite men, 60.5% for white women (with five risk factors only), 49.2% for bla ck men, and 71.2% for black women. Much IHD mortality attributable to indiv idual risk factors is caused by those factors in combination with other ris k factors; relatively little mortality is attributable to each risk factor in isolation. Analysis that does not examine risk factor combinations may g reatly overestimate PARs associated with individual risk factors. (C) 2001 Elsevier Science Inc. All rights reserved.