Global Effect of Cardiovascular Risk Factors on Lifetime Estimates
Author(s):
Global Cardiovascular Risk Consortium; Christina Magnussen 1 2 3, Jesus Alegre-Diaz 4, Lubna A Al-Nasser 5, Philippe Amouyel 6, Larissa Aviles-Santa 7, Stephan J L Bakker 8, Christie M Ballantyne 9, Antonio Bernabé-Ortiz 10, Martin Bobak 11, Paolo Boffetta 12 13 14, Hermann Brenner 15 16, Mattias Brunström 17, Gunay Can 18, Rodrigo M Carrillo-Larco 19, William Checkley 20, Jean Dallongeville 21, Dirk De Bacquer 22, Giovanni de Gaetano 23, James A de Lemos 24, Eleonora di Carluccio 25 26, Annette Dobson 27, Chiara Donfrancesco 28, Marcus Dörr 29 30, Eleonora d'Orsi 31, Wojciech Drygas 32 33 34, Robin P F Dullaart 8, Gunnar Engström 35, Marco M Ferrario 36, Jean Ferrières 37, Gemma A Figtree 38 39 40, Bamba Gaye 41 42 43, Majid Ghayour-Mobarhan 44 45, Uri Goldbourt 46, Clicerio Gonzalez 47, Alina Gossling 1 3, Guido Grassi 48, Prakash C Gupta 49, Jiang He 50, Allison M Hodge 51 52, Atsushi Hozawa 53, Kristian Hveem 54 55, Licia Iacoviello 23 56, M Kamran Ikram 57, Manami Inoue 58, Vilma Irazola 59, Modou Jobe 41 60, Pekka Jousilahti 61, Pontiano Kaleebu 62, Maryam Kavousi 63, Frank Kee 64, Davood Khalili 65, Jens Klotsche 66, Wolfgang Koenig 67 68 69, Anna Kontsevaya 70, Sudhirsen Kowlessur 71, Pablo Kuri-Morales 4 72, Kari Kuulasmaa 61, Sun-Seog Kweon 73, Karl J Lackner 74, Ulf Landmesser 75 76 77 78, David M Leistner 79 80 81, Carlos E Leiva Sisnieguez 82 83, Darryl Leong 84, Lars Lind 85, Allan Linneberg 86 87, Thiess Lorenz 1 2 3 41, Magnus N Lyngbakken 88 89, Reza Malekzadeh 90 91, Sofia Malyutina 92, Ellisiv B Mathiesen 93 94, Patrick McElduff 95, Olle Melander 96, Andres Metspalu 97, J Jaime Miranda 38 98, Marie Moitry 99, Joseph Mugisha 62, Julia Munzinger 1 2 3, Mahdi Nalini 91, Vijay Nambi 9 100, Peter M Nilsson 96, Toshiharu Ninomiya 101, Torbjørn Omland 88 89, Sok King Ong 102, Karen Oppermann 103, Andrzej Pajak 104, Luigi Palmieri 28, Demosthenes Panagiotakos 105, Sue K Park 106 107 108, Mangesh S Pednekar 49, Arokiasamy Perianayagam 109 110, Annette Peters 68 111 112 113, Hossein Poustchi 90 91, Dorairaj Prabhakaran 114 115, Andrew M Prentice 60, Eva Prescott 116, Arshed Quyyumi 117, Ulf Risérus 118, Satoko Sakata 101, Martin Salazar 82 83, Veikko Salomaa 61, Susana Sans 119, E Lilian P Sattler 41 120 121 122, Ben Schöttker 15 16, Aletta E Schutte 123 124 125, Sadaf G Sepanlou 91, Sanjib K Sharma 126, Jonathan Shaw 127, Leon A Simons 128, Stefan Söderberg 17, Abdonas Tamosiunas 129 130, Roberto Tapia-Conyer 4, Barbara Thorand 111 112 113, Hugh Tunstall-Pedoe 131, Jaakko Tuomilehto 132, Raphael Twerenbold 1 2 3, Diego Vanuzzo 133, Giovanni Veronesi 36, S Goya Wannamethee 134, Masafumi Watanabe 135, Jessica Weimann 1 3, Philipp S Wild 136 137 138 139, Yao Yao 140 141, Yi Zeng 142 143, Andreas Ziegler 1 3 26 144, Francisco M Ojeda 1 3, Stefan Blankenberg 1 2 3 26; The Global Cardiovascular Risk Consortium
Abstract
Background: Five risk factors account for approximately 50% of the global burden of cardiovascular disease. How the presence or absence of classic risk factors affects lifetime estimates of cardiovascular disease and death from any cause remains unclear.
Methods: We harmonized individual-level data from 2,078,948 participants across 133 cohorts, 39 countries, and 6 continents. Lifetime risk of cardiovascular disease and death from any cause was estimated up to 90 years of age according to the presence or absence of arterial hypertension, hyperlipidemia, underweight and overweight or obesity, diabetes, and smoking at 50 years of age. Differences in life span (in terms of additional life-years free of cardiovascular disease or death from any cause) according to the presence or absence of these risk factors were also estimated. Risk-factor trajectories were analyzed to predict lifetime differences according to risk-factor variation.
Results: The lifetime risk of cardiovascular disease was 24% (95% confidence interval [CI], 21 to 30) among women and 38% (95% CI, 30 to 45) among men for whom all five risk factors were present. In the comparison between participants with none of the risk factors and those with all the risk factors, the estimated number of additional life-years free of cardiovascular disease was 13.3 (95% CI, 11.2 to 15.7) for women and 10.6 (95% CI, 9.2 to 12.9) for men; the estimated number of additional life-years free of death was 14.5 (95% CI, 9.1 to 15.3) for women and 11.8 (95% CI, 10.1 to 13.6) for men. As compared with no changes in the presence of all risk factors, modification of hypertension at an age of 55 to less than 60 years was associated with the most additional life-years free of cardiovascular disease, and modification of smoking at an age of 55 to less than 60 years was associated with the most additional life-years free of death.
Conclusions: The absence of five classic risk factors at 50 years of age was associated with more than a decade greater life expectancy than the presence of all five risk factors, in both sexes. Persons who modified hypertension and smoking in midlife had the most additional life-years free of cardiovascular disease and death from any cause, respectively. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov number, NCT05466825.).
Published: March 30, 2025
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