Five modifiable risk factors contribute to cardiovascular disease and mortality

1. In this retrospective cohort study, five risk factors (body mass index, systolic blood pressure, non–high-density lipoprotein cholesterol, current smoking, and diabetes) contributed to increased incidence of cardiovascular disease. 

2. These factors were also noted to increase the risk of death from any cause.

Evidence Rating Level: 2 (Good)

Study Rundown: Modifiable risk factors such as body mass index, systolic blood pressure, non–high-density lipoprotein cholesterol, smoking status, and diabetes have been used to derive contemporary risk scores for the estimation of the 10-year risk of cardiovascular disease, though they are given different weights. However, there is a gap in knowledge as to understanding the region- and sex-specific associations of these cardiovascular risk factors with the development of cardiovascular disease, which can ultimately help reduce the burden of cardiovascular disease and death from any cause for persons and populations. Overall, this study found 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. This study was limited by residual confounding and the categorization of geographic regions being defined by the World Health Organization, whereas different categorization schemas may produce different results. Nevertheless, these study’s findings are significant, as they demonstrate that these five modifiable risk factors are strongly associated with incident cardiovascular disease and death from any cause.

Click to read the study in NEJM

In-Depth [retrospective cohort study]: This retrospective cohort study utilized patient-level data from 112 cohort studies conducted in 34 countries and eight geographic regions participating in the Global Cardiovascular Risk Consortium. Patients who were included in the prior studies were eligible for the study, whereas patients excluded from the prior studies were excluded from this study. Five risk factors (body mass index, systolic blood pressure, non-HDL cholesterol, current smoking status, and diabetes) and two primary outcomes (cardiovascular disease and death from any cause) were assessed in the study because of the heterogeneity of the effects of the risk factors on outcomes and the widespread availability of these data in the population. Outcomes in the primary analysis were assessed via a two-stage, multivariate, random effects meta-analysis of individual participant data. Based on the primary analysis, 80,596 participants experienced incident cardiovascular disease after a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants experienced death after a median follow-up of 8.7 years (maximum, 47.6). 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 after accounting for all 5 risk factors. Furthermore, the 10-year all-cause mortality was 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6) for women and men, respectively. Overall, this study showed that these five modifiable risk factors are strongly associated with cardiovascular disease and death from any cause among men and women.

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