Generational changes in cardiometabolic disease incidence by risk factor strata in the UK Biobank

OBJECTIVE: We assessed generational changes in the incidence of coronary artery disease (CAD), acute myocardial infarction (AMI), ischemic stroke, peripheral artery disease (PAD), and type 2 diabetes (T2D) by risk factor strata. METHODS: For each disease, we included baseline (2006-2010) disease-free UK Biobank participants and prospectively calculated age-specific incidence rates across seven consecutive five-year birth-cohorts (1936-1940 to 1966-1970). We applied Age-Period-Cohort models to examine age-independent birth-cohort effects in strata by sex, genetic risks, socioeconomic status, smoking history, and body mass index. RESULTS: CAD, AMI, PAD, and T2D incidence declined in more recent generations among both men and women, while stroke incidence remained stable. Compared to the 1936-1940 cohort, the incidence (95%CI) in the 1950-1955 cohort was 34.0% (22.4%, 45.7%) lower for CAD and 53.5% (31.2%, 75.8%) lower for PAD in the 65-69 age group. Age-Period-Cohort models suggested birth-cohort effects in observed declines. Birth-cohort effects on CAD and PAD were most evident among individuals with normal-weight, higher socioeconomic status, and ever-smoked, while T2D declines were strongest in individuals with overweight/obesity. CONCLUSIONS: CAD, AMI, PAD, and T2D incidences have decreased in more recent generations. However, the stable ischemic stroke incidence and diverse subgroup trends indicate disease-specific differences in preventive gains.