Global Effect of Modifiable Risk Factors on CVD and Mortality

Quick Takes

  • The aggregate global population-attributable fraction, combining five CV modifiable risk factors, is associated with a 10-year incidence of CVD of 57.2% for women and 52.6% for men.
  • The aggregate attributable fraction for 10-year all-cause mortality associated with these five CV risk factors was 22.2% for women and 19.1% for men.
  • Elevated systolic blood pressure appeared to be the largest contributor to the population-attributable fraction of incident CVD events in all regions.

Study Questions:

What is the sex-specific association of modifiable cardiovascular (CV) risk factors with global incidence of cardiovascular disease (CVD) and all-cause mortality rates?


Data from 112 cohort studies conducted in 34 countries and eight geographic regions were pooled, and individual-level data were harmonized as part of the Global Cardiovascular Risk Consortium. In the present study, associations between risk factors, including body mass index (BMI), systolic blood pressure (SBP), non–high-density lipoprotein (non-HDL) cholesterol, current smoking, and diabetes, were examined for association with incident CVD and all-cause death. Stratification by geographic region, age, and sex was performed. Population-attributable fractions were estimated for the 10-year incidence of CVD and 10-year all-cause mortality.


A total of 1,518,028 participants (54.1% women) with a median age of 54.4 years were included in the present analysis. Incident CVD 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 CVD was 57.2% (95% confidence interval [CI], 52.4-62.1) among women and 52.6% (95% CI, 49.0-56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8-27.5) and 19.1% (95% CI, 14.6-23.6). For both CVD and death from any cause, the association with BMI appeared to be consistent across all ages, whereas the strength of the associations with SBP, current smoking, and diabetes decreased with age. The strength of the association between non-HDL cholesterol level and CVD seemed to decline with age but appeared to be stable for death from any cause. Elevated SBP appeared to be the largest contributor to the population-attributable fraction of incident CVD events in all regions.


The authors concluded that harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident CVD 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.


These data support global efforts to prevent modifiable CV risk factors, including elevated blood pressure and smoking, to reduce the elevated global burden of CVD.

Clinical Topics: Prevention, Smoking

Keywords: Blood Pressure, Body Mass Index, Diabetes Mellitus, Risk Factors, Smoking

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