More than half of CVD cases attributable to five modifiable risk factors
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Key takeaways:
- In a global study, more than 50% of CVD cases could be attributed to five modifiable risk factors.
- The associations were strongest earlier in life and varied by region.
After pooling individual-level data from 112 cohort studies, researchers determined that more than 50% of cases of CVD can be attributed to five modifiable risk factors — BMI, systolic BP, non-HDL, current smoking and diabetes.
The five risk factors accounted for more than 50% of cases of CVD in men and women, and systolic BP contributed the most to the attributable fraction of CVD, according to the study by the Global Cardiovascular Risk Consortium that was presented at the European Society of Cardiology Congress and published in The New England Journal of Medicine.
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Approximately 20% of deaths in both sexes were attributable to the five risk factors, according to the researchers.
“We know that just a few modifiable risk factors are related to a certain proportion of CVD,” Christina Magnussen, MD, specialist in cardiology and internal medicine at Center for Population Health Innovation, University Heart and Vascular Center Hamburg and University Medical Center Hamburg-Eppendorf, Germany, said during a presentation. “But this proportion varies according to the populations studied and methods used. The risk factors are differentially related to cardiovascular and non-cardiovascular outcomes. The big question is, which is the proportion of CVD and all-cause mortality that is attributable to five classical risk factors?”
Magnussen and colleagues pooled individual-level data from 112 cohort studies of 1,518,028 individuals (median age, 54.4 years; 54.1% women) from 34 countries in eight geographic regions — Asia, Australia, Eastern Europe and Russia, Latin America, North Africa and the Middle East, North America, sub-Saharan Africa and Western Europe.
The researchers found that incident CVD occurred in 80,596 participants during a median follow-up of 7.3 years and death from any cause occurred in 177,369 participants during a median follow-up of 8.7 years.
By region, the highest event rate for CVD was in North America and the highest event rate for death was in sub-Saharan Africa, Magnussen said during the presentation, noting event rates for both were higher in men than in women in every region.
For the five risk factors, the aggregate global population-attributable fraction for the 10-year incidence of CVD was 57.2% (95% CI, 52.4-62.1) in women and 52.6% (95% CI, 49-56.1) in men, Magnussen and colleagues found. Magnussen said these varied by region, with North Africa and the Middle East showing the highest proportion and North America the lowest.
The aggregate global population-attributable fraction of the five risk factors for 10-year mortality was 22.2% in women (95% CI, 16.8-27.5) and 19.1% in men (95% CI, 14.6-23.6), they found. She said these also varied by region, with the highest proportion seen in Asia and the lowest in Western Europe and Australia.
BMI had a J-shaped association with CVD and systolic BP and non-HDL had linear associations with it, Magnussen said during the presentation. For mortality, BMI had a U-shaped association, systolic BP had a J-shaped association and non-HDL had an inverted J-shaped association.
The strength of the associations for the risk factors decreased with age, except BMI, whose association with outcomes remained stable during the life course, she said.
“This finding calls for the beginning of preventive action early in life,” Magnussen said during the presentation.
Systolic BP contributed most to population-attributable fraction of CVD “and therefore offers the greatest potential for CVD prevention,” followed by non-HDL and diabetes, she said.
“More than 50% of CVD events are explained by targetable risk factors,” Magnussen said during the presentation. “This result should stimulate policymakers to tailor preventive action worldwide. ... But simultaneously, a large proportion of CVD risk remains unexplained, so funding opportunities and research is needed to further itemize the residual risk not explained by the five classical risk factors.”
Reference:
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Magnussen C, et al. Late-breaking science: Registries on cardiovascular risk and prevention. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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