RECENT research, presented during the European Society of Cardiology (ESC) Congress 2023, revealed that over 50% of cardiovascular disease (CVD) cases can be linked to five adjustable risk factors: BMI, systolic blood pressure, non-high-density lipoprotein (HDL) cholesterol, current smoking, and diabetes.
The research team collected individual-level data from 112 cohort studies including 1,518,028 individuals (with a median age of 54.4 years, and 54.1% females) from 34 countries across eight geographic regions. Over a median follow-up period of 7.3 years, 80,596 participants experienced new-onset CVD, while during a median follow-up of 8.7 years, 177,369 participants passed away from various causes.
The combined global population-attributable fraction for the 10-year incidence of CVD due to these five risk factors stood at 57.2% (95% confidence interval [CI]: 52.4–62.1) for females and 52.6% (95% CI: 49.0–56.1) for males. These proportions exhibited regional variations, with North Africa and the Middle East having the highest fraction and North America the lowest.
The collective global population-attributable fraction for 10-year mortality due to these five risk factors was 22.2% in females (95% CI: 16.8–27.5) and 19.1% in males (95% CI: 14.6–23.6). These proportions also exhibited regional disparities, with the highest percentage observed in Asia and the lowest in Western Europe and Australia.
BMI exhibited a J-shaped relationship with CVD, while systolic blood pressure and non-HDL showed linear associations. In terms of mortality, BMI displayed a U-shaped relationship, systolic blood pressure showed a J-shaped association, and non-HDL had an inverted J-shaped connection. Notably, the strength of these associations declined with age, except for BMI, which maintained a consistent association with outcomes throughout the lifespan.
The findings emphasise the need for initiating preventive measures from an early age. The authors suggest it should prompt policymakers to customise global preventive strategies. However, it is important to note that a significant portion of CVD risk still lacks explanation. Therefore, there is a call for funding and research efforts to delve deeper into the residual risk not accounted for by the five traditional risk factors.
