Comparison of Framingham 10-year cardiovascular risks in Sweden- and foreign-born primary health care patients in Sweden

Marina Taloyan; Victor Wågström; Kristin Hjörleifdottir Steiner; Danial Yarbakht; Claes-Göran Östenson; Helena Salminen

doi:10.1186/s12889-023-15449-6

Comparison of Framingham 10-year cardiovascular risks in Sweden- and foreign-born primary health care patients in Sweden

BMC Public Health. 2023 Mar 22;23(1):543. doi: 10.1186/s12889-023-15449-6.

Authors

Marina Taloyan^{1

2}, Victor Wågström³, Kristin Hjörleifdottir Steiner^{4

5}, Danial Yarbakht³, Claes-Göran Östenson⁶, Helena Salminen^{4

5}

Affiliations

¹ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, Huddinge, S-141 83, Stockholm, Sweden. marina.taloyan@ki.se.
² Academic Primary Health Care Centre, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden. marina.taloyan@ki.se.
³ Region Stockholm, Karolinska Hospital, Solna, Sweden.
⁴ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, Huddinge, S-141 83, Stockholm, Sweden.
⁵ Academic Primary Health Care Centre, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden.
⁶ Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Solna, Sweden.

Abstract

Background: The prevalence of cardiovascular disease around the world varies by ethnicity and region of birth. Immigrants living in Sweden may have a higher prevalence of cardiovascular diseases than native-born Swedes, but little is known about their actual cardiovascular risk. This study aimed to examine the relationship in Sweden between 10-year cardiovascular risk and birthplace.

Method: This cross-sectional study was based on cardiovascular risk factor data obtained from the 4D Diabetes Project, a Programme 4D subproject in Sweden. Participants were recruited from two primary healthcare centres in Stockholm without a history of diabetes or pre-diabetes. The outcome variable was 10-year cardiovascular risk based on the calculation of a Framingham Risk Score with six risk factors: age, sex, LDL, HDL, BP, diabetes and smoking for each participant. Multiple linear regression was performed to generate β-coefficients for the outcome.

Results: There was an average of 8.86% cardiovascular risk over 10 years in Sweden-born participants and a 5.45% 10-year risk in foreign-born, (P < 0.0001). Foreign-born participants were about 10 years younger (mean age 46 years vs. 56 years, P < 0.001), with a significantly higher proportion of smokers (23.9% vs. 13.7%; P = 0.001). To be born in Sweden (with parents born in Sweden) was significantly associated with a 10-year cardiovascular risk in the crude model (β- coefficient = 3.40, 95% CI 2.59-4.22; P < 0.0001) and when adjusted for education and alcohol consumption (β- coefficient = 2.70 95% CI 1.86-3.54; P < 0.0001). Regardless of the birthplace, 10-year cardiovascular risk was lower for those with higher education compared to those with less than 10 years of education.

Conclusion: This study found a relationship between 10-year calculated cardiovascular risk and place of birth. Sweden-born participants had a higher association with 10-year cardiovascular risk than foreign-born participants. These results contradict previous reports of higher rates of CVD in residents of Middle-Eastern countries and Middle-Eastern immigrants living in Sweden.

Keywords: Cardiovascular risk factors; Framingham risk score; Primary care; Region of birth; Sweden.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / epidemiology
Cross-Sectional Studies
Diabetes Mellitus*
Emigrants and Immigrants*
Female
Heart Disease Risk Factors
Humans
Middle Aged
Primary Health Care
Risk Factors
Sweden / epidemiology