NEJM: The Worldwide Impact of Modifiable Cardiovascular Risk Factors

Harlan M. Krumholz, MD, SM, reviewing The Global Cardiovascular Risk Consortium. N Engl J Med 2023 Aug 26

We know the traditionally identified modifiable cardiovascular risk factors: body-mass index, systolic blood pressure, non–high-density lipoprotein cholesterol level, tobacco smoking, and diabetes. But what are their quantifiable global consequences? Investigators pooled individual-level data from 112 cohort studies in 34 countries and 8 geographic regions to assess the regional and sex-specific prevalence of these risk factors and their worldwide impact (NCT05466825).

The combined studies involved more than 1.5 million participants (mean age, 54 years; 54% women). The incidence of age- and sex-standardized 10-year cardiovascular disease events varied by region (10% in North America, 8% in North Africa and the Middle East, 8% in Eastern Europe and Russia, 5% in Western Europe, and 3% in Asia). The event rates were 4% in women and 8% in men. The five risk factors accounted for 57% of the cardiovascular disease in women and 53% in men. For all five factors combined, the population-attributable fraction was similar across regions (ranging from 50% to 64%), with the highest contribution from systolic blood pressure (29% for women, 22% for men).