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<jats:sec><jats:title>Objective</jats:title><jats:p>To assess the relationship between risk factor clusters and cardiovascular disease (CVD) incidence in Asian and Caucasian populations and to estimate the burden of CVD attributable to each cluster.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Asia Pacific Cohort Studies Collaboration.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Individual participant data from 34 population-based cohorts, involving 314 024 participants without a history of CVD at baseline.</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>Clusters were 11 possible combinations of four individual risk factors (current smoking, overweight, blood pressure (BP) and total cholesterol). Cox regression models were used to obtain adjusted HRs and 95% CIs for CVD associated with individual risk factors and risk factor clusters. Population-attributable fractions (PAFs) were calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During a mean follow-up of 7 years, 6203 CVD events were recorded. The ranking of HRs and PAFs was similar for Australia and New Zealand (ANZ) and Asia; clusters including BP consistently showed the highest HRs and PAFs. The BP–smoking cluster had the highest HR for people with two risk factors: 4.13 (3.56 to 4.80) for Asia and 3.07 (2.23 to 4.23) for ANZ. Corresponding PAFs were 24% and 11%, respectively. For individuals with three risk factors, the BP–smoking–cholesterol cluster had the highest HR (4.67 (3.92 to 5.57) for Asia and 3.49 (2.69 to 4.53) for ANZ). Corresponding PAFs were 13% and 10%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Risk factor clusters act similarly on CVD risk in Asian and Caucasian populations. Clusters including elevated BP were associated with the highest excess risk of CVD.</jats:p></jats:sec>

Original publication




Journal article


BMJ Open



Publication Date





e019335 - e019335