One of the most significant modifications that middle-aged patients can take to prevent cardiovascular disease is lowering arterial hypertension, according to research presented during a Featured Clinical Research Session at ACC.25 in Chicago and simultaneously published in NEJM. At 50 years of age, absence of uncontrolled hypertension and four other cardiovascular risk factors was associated with a decade-longer lifespan compared with the presence of all five.

In the study, the Global Cardiovascular Risk Consortium examined survival data and cardiovascular disease-free survival data from 2,078,948 patients across 133 cohorts from 39 countries and six continents for five major risk factors of cardiovascular disease and death:

1. Systolic blood pressure ≥130 mm Hg (present in 48.6% of participants)
2. Non–HDL-C levels ≥130 mg/dL (73.1%)
3. BMI <20 or >25 (63.9%)
4. Diabetes (7.7%)
5. Current smoking (22.3%).

These five modifiable risk factors account for approximately 50% of the global burden of cardiovascular disease. Investigators defined an incident of cardiovascular disease as the first fatal or nonfatal myocardial infarction (MI), unstable angina, coronary revascularization, ischemic or hemorrhagic stroke, or death from a cardiovascular or unknown cause.

At a median follow-up of 7.6 years, among women, the results showed that having no risk factors was associated with a lifetime risk of cardiovascular disease of 13% compared with 24% when all five were present. Before the age of 90 years, the lifetime risk was 53% vs. 68, respectively. Women with no risk factors, compared with all five, had an estimated additional 13.3 life-years free of cardiovascular disease and 14.5 life-years free of death.

Among men, the lifetime risk of cardiovascular disease was 21% for those with no risk factors and 38% when all five were present. Before the age of 90 years, the lifetime risk was 68% vs. 94% respectively. Men with no risk factors had an estimated additional 10.6 life-years free of cardiovascular disease and 11.8 life-years free of death.

Overall, the study found that the more risk factors that were controlled to target lives was tied to additional life years. Notably, the most additional life years free of cardiovascular disease was associated with controlling hypertension, while smoking was associated with the most additional life years free of death.

The investigators note this is one of the first studies to look beyond a primarily North American and European population and to take risk factors out of the realm of the abstract for patients and translate them instead into additional years of healthy life.