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

Magnussen, C. ; Engström, G. LU ; Melander, O. LU orcid ; Ziegler, A. and Blankenberg, S. (2023) In New England Journal of Medicine 389(14). p.1273-1285
Abstract
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... (More)
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.) © 2023 Massachusetts Medical Society. (Less)
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keywords
Cardiology, Cardiology General, Coronary Disease/Myocardial Infarction, Diabetes, Endocrinology, Hypertension, Lipids, Obesity, Prevention, Public Health, Public Health General, Cardiovascular Diseases, Cohort Studies, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Risk Factors, Smoking, high density lipoprotein cholesterol, adult, all cause mortality, Article, body mass, cardiovascular disease, cardiovascular mortality, cohort analysis, confidence interval, controlled study, current smoker, death, diabetes mellitus, female, follow up, groups by age and sex, human, incidence, major clinical study, male, middle aged, prevalence, proportional hazards model, risk factor, systolic blood pressure, treatment outcome, smoking
in
New England Journal of Medicine
volume
389
issue
14
pages
13 pages
publisher
Massachusetts Medical Society
external identifiers
  • scopus:85175496095
  • pmid:37632466
ISSN
0028-4793
DOI
10.1056/NEJMoa2206916
language
English
LU publication?
yes
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bba5a231-6c1f-4eed-a0f9-b461172665b8
date added to LUP
2024-01-16 14:19:58
date last changed
2024-07-17 03:00:02
@article{bba5a231-6c1f-4eed-a0f9-b461172665b8,
  abstract     = {{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.)  © 2023 Massachusetts Medical Society.}},
  author       = {{Magnussen, C. and Engström, G. and Melander, O. and Ziegler, A. and Blankenberg, S.}},
  issn         = {{0028-4793}},
  keywords     = {{Cardiology; Cardiology General; Coronary Disease/Myocardial Infarction; Diabetes; Endocrinology; Hypertension; Lipids; Obesity; Prevention; Public Health; Public Health General; Cardiovascular Diseases; Cohort Studies; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Risk Factors; Smoking; high density lipoprotein cholesterol; adult; all cause mortality; Article; body mass; cardiovascular disease; cardiovascular mortality; cohort analysis; confidence interval; controlled study; current smoker; death; diabetes mellitus; female; follow up; groups by age and sex; human; incidence; major clinical study; male; middle aged; prevalence; proportional hazards model; risk factor; systolic blood pressure; treatment outcome; smoking}},
  language     = {{eng}},
  number       = {{14}},
  pages        = {{1273--1285}},
  publisher    = {{Massachusetts Medical Society}},
  series       = {{New England Journal of Medicine}},
  title        = {{Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality.}},
  url          = {{http://dx.doi.org/10.1056/NEJMoa2206916}},
  doi          = {{10.1056/NEJMoa2206916}},
  volume       = {{389}},
  year         = {{2023}},
}