Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality.

Global Cardiovascular Risk Consortium; Magnussen, C; Ojeda, FM; Leong, DP; Alegre-Diaz, J; Amouyel, P; Aviles-Santa, L; De Bacquer, D; Ballantyne, CM; Bernabé-Ortiz, AORCID logo; +82 more...Bobak, M; Brenner, H; Carrillo-Larco, RM; de Lemos, J; Dobson, A; Dörr, M; Donfrancesco, C; Drygas, W; Dullaart, RP; Engström, G; Ferrario, MM; Ferrières, J; de Gaetano, G; Goldbourt, U; Gonzalez, C; Grassi, G; Hodge, AM; Hveem, K; Iacoviello, L; Ikram, MK; Irazola, V; Jobe, MORCID logo; Jousilahti, P; Kaleebu, PORCID logo; Kavousi, M; Kee, F; Khalili, DORCID logo; Koenig, W; Kontsevaya, A; Kuulasmaa, K; Lackner, KJ; Leistner, DM; Lind, L; Linneberg, A; Lorenz, T; Lyngbakken, MN; Malekzadeh, R; Malyutina, S; Mathiesen, EBORCID logo; Melander, O; Metspalu, A; Miranda, JJORCID logo; Moitry, M; Mugisha, J; Nalini, M; Nambi, V; Ninomiya, T; Oppermann, K; d'Orsi, E; Pająk, A; Palmieri, L; Panagiotakos, D; Perianayagam, A; Peters, A; Poustchi, H; Prentice, AMORCID logo; Prescott, E; Risérus, U; Salomaa, V; Sans, S; Sakata, S; Schöttker, B; Schutte, AE; Sepanlou, SG; Sharma, SK; Shaw, JE; Simons, LA; Söderberg, SORCID logo; Tamosiunas, A; Thorand, B; Tunstall-Pedoe, H; Twerenbold, R; Vanuzzo, D; Veronesi, G; Waibel, J; Wannamethee, SG; Watanabe, M; Wild, PS; Yao, Y; Zeng, Y; Ziegler, AORCID logo; Blankenberg, S and (2023) Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. The New England journal of medicine, 389 (14). pp. 1273-1285. ISSN 0028-4793 DOI: 10.1056/NEJMoa2206916
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BACKGROUND: Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking. METHODS: We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified according to geographic region, age, and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality. RESULTS: Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants died during a median follow-up of 8.7 years (maximum, 47.6). For all five risk factors combined, the aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6). CONCLUSIONS: Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease among women and men, respectively, and 22.2% and 19.1% of deaths from any cause among women and men, respectively, may be attributable to five modifiable risk factors. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.).


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