Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review

Int J Epidemiol. 2009 Dec;38(6):1580-94. doi: 10.1093/ije/dyn258. Epub 2009 Mar 4.


It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction 'within' populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVD incidence and mortality indicates that there are additional factors that apply to 'populations' that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others.

Publication types

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

MeSH terms

  • Air Pollution / adverse effects
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Environment*
  • Humans
  • Obesity / complications
  • Population Groups / ethnology*
  • Population Groups / statistics & numerical data
  • Risk Factors
  • Smoking / adverse effects