Geographical variation in cardiovascular disease, risk factors, and their control in older women: British Women’s Heart and Health Study

Objectives: To measure the geographical variation in prevalence of cardiovascular disease, risk fac-tors, and their control in a nationally representative sample of older British women. Methods: Baseline survey using general practitioner record review, a self completed questionnaire, research nurse interview, and physical examination in a randomly selected sample of women aged 60–79 drawn from 23 towns in England, Scotland, and Wales. Results: Of 7173 women invited and eligible to participate, information was obtained on 4286 (60%). One in five women had a doctor diagnosis of any one of myocardial infarction, angina, heart failure, stroke, or peripheral vascular disease. Fifty per cent of women were hypertensive, 12% smoked, and over one quarter were obese. Fifty per cent had a total cholesterol level greater than 6.5 mmol/l, though only 3 % had low high density lipoprotein concentrations. Cardiovascular disease prevalence varied by geographical region being highest in Scotland: age adjusted prevalence (95% confidence intervals) 25.0 % (21.5 % to 28.8%) and lowest in South England: age adjusted prevalence (95 % confidence intervals) 15.4 % (13.5 % to 17.6%). The geographical variations in cardiovascular disease prevalence were attenuated by adjustment for risk factors and socioeconomic position; further adjustment for health service use (as indicated by aspirin or statin use) reduced the differences further