Impact of Multiple Risk Factors and Preventive Interventions on Cardiovascular Diseases and Disparities

Major cardiovascular risk factors have changed over the past 3-4 decades throughout the world. While adiposity and diabetes are rising worldwide, blood pressure and cholesterol are declining in high-income and even some middle-income countries, possibly due to improvements in diet or better diagnosis and treatment; the same risk factors have remained unchanged or even increased in low-income countries. To formulate effective prevention and health system policies, there is need to understand the implications of these diverse trends for cardiovascular diseases (CVDs). This dissertation focuses on quantifying the impact of multiple risk factors and preventive interventions on CVDs and their disparities at the population level. Answering this question requires information on how much of the effects of adiposity on CVDs are mediated through other metabolic risk factors (i.e. high blood pressure, high serum cholesterol and high blood glucose), which themselves have other determinants. The first paper quantifies the direct as well as the mediated effects of excess weight on coronary heart disease (CHD) and stroke through blood pressure, serum cholesterol and blood glucose. The analyses us