Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality

Abstract

Background: Five modifiable risk factors are associated with cardiovascular disease (CVD) and all-cause mortality. The regional and sex-specific prevalence of these modifiable risk factors and their impact on CVD and all-cause mortality have not been evaluated using individual-level data. Methods: The Global Cardiovascular Risk Consortium harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions. Associations between body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, smoking, and diabetes with incident CVD and all-cause mortality were examined using Cox regression analyses and stratified by geographic region, age and sex. Population-attributable fractions were estimated for 10-year incident CVD and all-cause mortality. Results: Among 1,518,028 individuals (54.1% women, median age 54.4 years), there were regional variations in the prevalence of the five modifiable risk factors. Incident CVD occurred in 80,596 individuals (median and maximum follow-up, 7.3 and 47.3 years, respectively) and 177,369 individuals died (median and maximum follow-up, 8.7 and 47.6 years, respectively). Aggregate global CVD population-attributable fractions were 57.2% (95% confidence interval [CI], 52.4 to 62.1) in women and 52.6% (95% CI, 49.0 to 56.1) in men for all risk factors combined. Aggregate global all-cause mortality population-attributable fractions were 22.2% in women and 19.1% in men. Conclusions: Harmonized individual-level data from a global cohort found that 57.2% of incident CVD in women and 52.6% in men, and 22.2% of deaths in women and 19.1% in men may be attributable to five modifiable risk factors. The prevalence and impact of these risk factors on incident CVD and all-cause mortality varies by sex and across geographic regions. ClinicalTrials.gov number NCT05466825