Aggregation of cardiovascular risk factors in a cohort of 40-year-olds participating in a population-based health screening program in Sweden.

Background: It is important to identify and evaluate cardiovascular risk factors at an early stage to address them accordingly. Among the younger population, the metabolic syndrome is less common than in older ages. However, each separate metabolic risk factor still has an additive effect on cardiovascular risk factor burden. Non-metabolic risk factors that occur in the younger population include family history, smoking, psychological distress and socioeconomic vulnerability. In 2021 a voluntary health intervention program was introduced in an urban area in Sweden where a cohort of 40-year-olds was invited for cardiovascular risk identification. The aim of this study was to identify how cardiovascular risk factors tend to aggregate in individuals participating in a voluntary health screening program and how the metabolic risk factors associate with non-metabolic cardiovascular risk factors.

Methods: This was a cross-sectional study with 1831 participants. Data from questionnaires and baseline measurements were used to calculate the prevalence of metabolic- (blood pressure, lipids, fasting plasma glucose, BMI, waist-hip ratio) and non-metabolic risk factors (family history of CVD, smoking, psychological distress, socioeconomic vulnerability) for CVD. SCORE2 was calculated according to the algorithm provided by the SCORE2 working group and ESC (European Society of Cardiology) Cardiovascular Risk Collaboration. Associations among each of the metabolic risk factors and non-metabolic risk factors were estimated using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: More than half of the study population had at least one metabolic risk factor, and more than 1/3 was considered to be suffering from psychological distress. Furthermore, obesity or central obesity demonstrated individual associations with all of the non-metabolic risk factors in the study; smoking (1.49; 1.32-2.63), family history of CVD (1.41; 1.14-1.73), socioeconomic vulnerability (1.60; 1.24-2.07), and psychological distress (1.40; 1.14-1.72). According to SCORE2 25% of the men were at moderate risk (2.5-7.5%) of developing a cardiovascular event within 5-10 years, but only 2% of the women.

Conclusions: Obesity/central obesity should be a prioritized target in health screening programs. The non-metabolic risk factors, socioeconomic vulnerability, and psychological distress should not be ignored and addressed with adequate guidance to create health equity.