The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries

Background Cardiovascular disease mortality has declined and diabetes mortality has increased in high-income countries. We estimated the potential role of trends in population body mass index, systolic blood pressure, serum total cholesterol and smoking in cardiometabolic mortality decline in 26 industrialized countries. Methods Mortality data were from national vital statistics. Body mass index, systolic blood pressure and serum total cholesterol were from a systematic analysis of population-based data. We estimated the associations between change in cardiometabolic mortality and changes in risk factors, adjusted for change in per-capita gross domestic product. We calculated the potential contribution of risk factor trends to mortality decline. Results Between 1980 and 2009, age-standardized cardiometabolic mortality declined in all 26 countries, with the annual decline between <1% in Mexico to similar to 5% in Australia. Across the 26 countries together, risk factor trends may have accounted for similar to 48% (men) and similar to 40% (women) of cardiometabolic mortality decline. Risk factor trends may have accounted for >60% of decline among men and women in Finland and Switzerland, men in New Zealand and France, and women in Italy; their benefits were smallest in Mexican, Portuguese, and Japanese men and Mexican women. Risk factor trends may have slowed down mortality decline in Chilean men and women and had virtually no effect in Argentinean women. The contributions of risk factors to mortality decline seemed substantially larger among men than among women in the USA, Canada and The Netherlands. Conclusions Industrialized countries have varied widely in the extent of risk factor prevention, and its likely benefits for cardiometabolic mortality.