An absence of cardiovascular risk factors is linked to over ten additional healthy years

1. In this large global cohort study, individuals aged 50 without five major cardiovascular risk factors (hypertension, hyperlipidemia, abnormal body mass index [BMI], diabetes, and smoking) had a substantially lower lifetime risk of cardiovascular disease (CVD) and death compared to those with all five.

2. Modification of hypertension and smoking between ages 55 and 60 was associated with the greatest gains in life-years free from CVD and all-cause mortality, respectively.

Evidence Rating Level: 2 (Good)

Study Rundown: CVD is the leading cause of death in adults worldwide, with a significant impact on morbidity and quality of life. It is critical to quantify the impact of CVD on global health to establish the actual detrimental effect on global and individual health, as well as to help guide preventative and interventional measures. This global prospective cohort study harmonized individual-level data from over two million participants across 133 cohorts and 39 countries to examine how five common modifiable cardiovascular risk factors influence lifetime risk of CVD and death. At age 50, participants with all five risk factors had a CVD lifetime risk of 24% for women and 38% for men, versus 13% and 21%, respectively, for those with none. Those without risk factors gained an estimated 13.3 (women) and 10.6 (men) additional CVD-free years. Death-free life-years increased by 14.5 (women) and 11.8 (men). Modifying hypertension in midlife yielded the greatest additional CVD-free life-years; modifying smoking yielded the most death-free years. Strengths include unprecedented global scale and robust statistical modeling with recalibration using World Health Organization (WHO) data. Limitations involve observational design, potential residual confounding, and reliance on regional estimates for some data imputations.

Click to read the study in NEJM

Relevant Reading: Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality

In-Depth [prospective cohort]: This prospective cohort study pooled and harmonized individual-level data from 2,078,948 adults, aged 18 years and older, across 133 cohorts in 39 countries and six continents. The objective was to quantify how five modifiable cardiovascular risk factors—hypertension, hyperlipidemia, abnormal body mass index (BMI), diabetes, and smoking—affect lifetime risk of cardiovascular disease (CVD) and all-cause mortality. Lifetime risk was estimated from age 50 to 90 using Weibull survival models adjusted for age, sex, and risk factor profiles, with further recalibration based on WHO population data. At age 50, participants with none of the five risk factors had a significantly lower estimated lifetime risk of CVD—13% for women and 21% for men—compared to 24% and 38%, respectively, among those with all five risk factors. Life expectancy differences were substantial: women without risk factors gained an average of 13.3 CVD-free years and 14.5 years free of death; men gained 10.6 and 11.8 years, respectively. Among individual risk factors, the absence of smoking and diabetes yielded the greatest benefit. Smoking cessation alone was associated with 5.5 (women) and 4.8 (men) additional CVD-free years and up to 5.6 (women) and 5.1 (men) death-free years. Modification of systolic blood pressure from ≥130 mm Hg to <130 mm Hg in midlife (ages 55–60) resulted in 2.4 more CVD-free years for women and 1.2 for men. The study also found regional variability, with the most significant benefit of hypertension control in Latin American women and North American women in terms of CVD and mortality, respectively. While observational, the large-scale, geographic diversity, and modeling rigor of this study make it one of the most comprehensive lifetime risk assessments to date, underscoring the global value of aggressive midlife prevention strategies for CVD.

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