Global Effect of Cardiovascular Risk Factors on Lifetime Estimates
Authors: Christina Magnussen, Jesus Alegre-Diaz, Lubna A Al-Nasser, Philippe Amouyel, Larissa Aviles-Santa, Stephan J L Bakker, Christie M Ballantyne, Antonio Bernabé-Ortiz, Martin Bobak, Paolo Boffetta, Hermann Brenner, Mattias Brunström, Gunay Can, Rodrigo M Carrillo-Larco, William Checkley, Jean Dallongeville, Dirk De Bacquer, Giovanni de Gaetano, James A de Lemos, Eleonora di Carluccio, Annette Dobson, Chiara Donfrancesco, Marcus Dörr, Eleonora d'Orsi, Wojciech Drygas, Robin P F Dullaart, Gunnar Engström, Marco M Ferrario, Jean Ferrières, Gemma A Figtree, Bamba Gaye, Majid Ghayour-Mobarhan, Uri Goldbourt, Clicerio Gonzalez, Alina Gossling, Guido Grassi, Prakash C Gupta, Jiang He, Allison M Hodge, Atsushi Hozawa, Kristian Hveem, Licia Iacoviello, M Kamran Ikram, Manami Inoue, Vilma Irazola, Modou Jobe, Pekka Jousilahti, Pontiano Kaleebu, Maryam Kavousi, Frank Kee, Davood Khalili, Jens Klotsche, Wolfgang Koenig, Anna Kontsevaya, Sudhirsen Kowlessur, Pablo Kuri-Morales, Kari Kuulasmaa, Sun-Seog Kweon, Karl J Lackner, Ulf Landmesser, David M Leistner, Carlos E Leiva Sisnieguez, Darryl Leong, Lars Lind, Allan Linneberg, Thiess Lorenz, Magnus N Lyngbakken, Reza Malekzadeh, Sofia Malyutina, Ellisiv B Mathiesen, Patrick McElduff, Olle Melander, Andres Metspalu, J Jaime Miranda, Marie Moitry, Joseph Mugisha, Julia Munzinger, Mahdi Nalini, Vijay Nambi, Peter M Nilsson, Toshiharu Ninomiya, Torbjørn Omland, Sok King Ong, Karen Oppermann, Andrzej Pajak, Luigi Palmieri, Demosthenes Panagiotakos, Sue K Park, Mangesh S Pednekar, Arokiasamy Perianayagam, Annette Peters, Hossein Poustchi, Dorairaj Prabhakaran, Andrew M Prentice, Eva Prescott, Arshed Quyyumi, Ulf Risérus, Satoko Sakata, Martin Salazar, Veikko Salomaa, Susana Sans, E Lilian P Sattler, Ben Schöttker, Aletta E Schutte, Sadaf G Sepanlou, Sanjib K Sharma, Jonathan Shaw, Leon A Simons, Stefan Söderberg, Abdonas Tamosiunas, Roberto Tapia-Conyer, Barbara Thorand, Hugh Tunstall-Pedoe, Jaakko Tuomilehto, Raphael Twerenbold, Diego Vanuzzo, Giovanni Veronesi, S Goya Wannamethee, Masafumi Watanabe, Jessica Weimann, Philipp S Wild, Yao Yao, Yi Zeng, Andreas Ziegler, Francisco M Ojeda, Stefan Blankenberg
Journal: New England Journal of Medicine (2025)

BackgroundFive risk factors account for approximately 50% of the global burden of cardiovascular disease. How the presence or absence of classic risk factors affects lifetime estimates of cardiovascular disease and death from any cause remains unclear.MethodsWe harmonized individual-level data from 2,078,948 participants across 133 cohorts, 39 countries, and 6 continents. Lifetime risk of cardiovascular disease and death from any cause was estimated up to 90 years of age according to the presence or absence of arterial hypertension, hyperlipidemia, underweight and overweight or obesity, diabetes, and smoking at 50 years of age. Differences in life span (in terms of additional life-years free of cardiovascular disease or death from any cause) according to the presence or absence of these risk factors were also estimated. Risk-factor trajectories were analyzed to predict lifetime differences according to risk-factor variation.ResultsThe lifetime risk of cardiovascular disease was 24% (95% confidence interval [CI], 21 to 30) among women and 38% (95% CI, 30 to 45) among men for whom all five risk factors were present. In the comparison between participants with none of the risk factors and those with all the risk factors, the estimated number of additional life-years free of cardiovascular disease was 13.3 (95% CI, 11.2 to 15.7) for women and 10.6 (95% CI, 9.2 to 12.9) for men; the estimated number of additional life-years free of death was 14.5 (95% CI, 9.1 to 15.3) for women and 11.8 (95% CI, 10.1 to 13.6) for men. As compared with no changes in the presence of all risk factors, modification of hypertension at an age of 55 to less than 60 years was associated with the most additional life-years free of cardiovascular disease, and modification of smoking at an age of 55 to less than 60 years was associated with the most additional life-years free of death.ConclusionsThe absence of five classic risk factors at 50 years of age was associated with more than a decade greater life expectancy than the presence of all five risk factors, in both sexes. Persons who modified hypertension and smoking in midlife had the most additional life-years free of cardiovascular disease and death from any cause, respectively. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov number, NCT05466825.)