Secular trends in cardiovascular risk factors: an age-period cohort analysis of 6 98 954 health examinations in 1 81 350 Austrian men and women

Objectives. It is well established that morbidity and mortality patterns in cardiovascular diseases vary strongly over time, yet the determinants of such trends remain poorly understood. To assess the potential contribution of secular or cross-generation patterns, we evaluated birth cohort-related trends across the 20th century of risk factors in a large database of Austrian men and women. Subjects and setting. Trends in risk factors were investigated for 1 81 350 adults aged 20-79 years born between 1905 and 1975 undergoing 6 98 954 health examinations between 1985 and 2005 as participants of the Vorarlberg Health Monitoring and Promotion Programme. Results. There was clear evidence of cohort-related shifts in all risk factors. Total serum cholesterol and triglyceride declined markedly, particularly in the youngest cohorts, as did systolic and diastolic blood pressure in both men and women. By contrast, fasting glucose showed a strong rising tendency in both sexes and at all ages, most markedly in young males. Average glucose levels were between 4 and 15 mg dL(-1) higher in individuals at the same age born 20 years later. In males, body weight expressed in kg m(-2) (body mass index) was increasing as well; however, in women, patterns were most marked at the 90th percentile. Conclusion. These findings provide strong evidence of population wide secular shifts and suggest that in addition to period influences, most probably through treatment intervention and lifestyle change, determinants across the life-course are programming shifts from childhood onwards.