A multiple risk factor program is associated with decreased risk of cardiovascular disease in 70-year-olds: A cohort study from Sweden

Anna Nordström , Jonathan Bergman, Sabine Björk, Bo Carlberg, Jonas Johansson, Andreas Hult, Peter Nordström



In individuals below 65 years of age, primary prevention programs have not been successful in reducing the risk of cardiovascular disease (CVD) and death. However, no large study to our knowledge has previously evaluated the effects of prevention programs in individuals aged 65 years or older. The present cohort study evaluated the risk of CVD in a primary prevention program for community-dwelling 70-year-olds.


The leading causes of death and morbidity worldwide are noncommunicable diseases (NCDs), such as chronic respiratory disease, cancer, diabetes, and, in particular, ischemic heart disease and stroke [1]. The impact of these NCDs will probably increase with a growing number of older people in the future [2], imposing great challenges on care systems. However, many NCDs share modifiable risk factors such as smoking, substance abuse, unhealthy diet, and physical inactivity. The World Health Organization (WHO) has concluded that stroke, heart disease, and type 2 diabetes can be prevented by lifestyle change in at least 80% of the individuals affected [3]. In addition, appropriate pharmacological interventions decrease the impact of risk factors such as hypertension and hyperlipidemia.


Healthy Ageing Initiative program

The Healthy Ageing Initiative (HAI) is an ongoing primary prevention study in Umeå, a municipality with 127,000 inhabitants in northern Sweden. The study was initiated in May 2012, and is performed at a single clinic. Three trained research nurses conduct all the testing, with the support of 2 chief physicians (AN and PN). The eligibility criteria are residence in Umeå Municipality and age exactly 70 years. There are no exclusion criteria, and public population registers are used for recruitment. During the years of this study, 54% of 70-year olds in Umeå have participated.


In community-dwelling 70-year-olds, a multidimensional prevention program was associated with a 20% lower risk of CVD during follow-up. Consistent with the main results, the risk of CVD was lower in 70-year-olds in the prevention program municipality than in the rest of Sweden after, but not before, the HAI project was initiated. An analysis of intermediate outcomes in HAI participants showed that detected hypertension and high blood lipids at baseline were associated with initiation of therapy, and greater reductions in these risk factors during follow-up.


The authors would like to thank the research staff participating in the project, Magnus Lindblom, David Lapveteläinen, Jim Viklund, and Monica Rasmussen Ahlenius.

Citation: Nordström A, Bergman J, Björk S, Carlberg B, Johansson J, Hult A, et al. (2020) A multiple risk factor program is associated with decreased risk of cardiovascular disease in 70-year-olds: A cohort study from Sweden. PLoS Med 17(6): e1003135.

Academic Editor: David Peiris, The George Institute for Global Health, UNSW Sydney, AUSTRALIA

Received: September 24, 2019; Accepted: May 11, 2020; Published: June 11, 2020

Copyright: © 2020 Nordström et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Researchers, including international researchers, who are interested in obtaining the data can contact SCB via [email protected], and Socialstyrelsen via [email protected] One can visit, (Socialstyrelsen).

Funding: AN and PN received grants from the Swedish research council for the present study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: CVD, cardiovascular disease; HAI, Healthy Ageing Initiative; HR, hazard ratio; LDL, low-density lipoprotein; NCD, noncommunicable disease; WHO, World Health Organization.