A comprehensive global study revealed that the absence of five classic cardiovascular risk factors at age 50 years may be associated with more than a decade of additional life expectancy compared with having all five risk factors. The study also found that midlife modification of hypertension and smoking yielded the greatest gains in cardiovascular disease-free years and overall survival, respectively.
Key Findings
In the analysis of over 2 million participants, investigators found that individuals without the five major cardiovascular risk factors (hypertension, hyperlipidemia, abnormal BMI, diabetes, and smoking) showed significantly better long-term outcomes.
The lifetime risk of cardiovascular disease was 24% among women and 38% among men for whom all five risk factors were present. By contrast, the estimated lifetime risk of cardiovascular disease prior to 90 years of age was 13% among women and 21% among men who had none of these risk factors.
Most notably, 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 among women and 10.6 among men; the estimated number of additional life-years free of death was 14.5 among women and 11.8 among men.
Risk Factor Modification
The investigators also evaluated how modifying specific risk factors in midlife affected long-term outcomes. As compared with no changes in the presence of all risk factors, modification of hypertension at an age of 55 years to less than 60 years was associated with the most additional life-years free of cardiovascular disease, and the modification of smoking at an age of 55 years to less than 60 years was associated with the most additional life-years free of mortality.
When examining individual risk factors, the analysis revealed that for cardiovascular disease, the absence of diabetes was associated with an estimated lifetime difference of 4.7 years among women and 4.2 years among men; the absence of smoking was associated with a difference of 5.5 years among women and 4.8 years among men.
For overall mortality, the absence of diabetes was associated with a lifetime difference of 6.4 years among women and 5.8 years among men, and the absence of smoking was associated with a difference of 5.6 years among women and 5.1 years among men.
Methodology
Led by the Global Cardiovascular Risk Consortium, the study harmonized individual-level data from nearly 2.1 million participants across 133 cohorts, 39 countries, and 6 continents. Lifetime risk of cardiovascular disease and all-cause mortality 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.
For the main analyses, continuous risk factors were categorized with the use of guideline-based targets: arterial hypertension was identified by a systolic blood pressure of 130 mmHg or more; hyperlipidemia was determined by non–high-density lipoprotein cholesterol levels of 130 mg/dL (3.36 mmol/L) or more; underweight was defined as a BMI of less than 20; and overweight or obesity was defined as a BMI of 25 or more.
The findings suggest that prioritizing the prevention and treatment of these five modifiable risk factors could substantially extend healthy life expectancy worldwide, noted Lead study author Christina Magnussen, MD, of the University Heart and Vascular Center Hamburg, Germany.
Regional Variations
The investigators also revealed geographic variations in lifetime risk and in the impact of specific risk factors. For both cardiovascular disease and all-cause mortality, the lifetime difference between participants without hypertension and those with all five risk factors varied according to geographic region. For cardiovascular disease, the greatest difference was observed among Latin American women (4.9 years). For all-cause mortality, the greatest difference was observed among North American women (5.4 years).
Clinical Implications
This research reinforced the critical significance of primary prevention strategies. The findings suggest that even when risk factors are present in early midlife, their modification between ages 55 and 60 years can still yield substantial health benefits.
The study was funded by the German Center for Cardiovascular Research and registered under ClinicalTrials.gov number NCT05466825.
