The prevalence and impact of the five major cardiovascular risk factors, including body mass index (BMI), systolic blood pressure (SBP), non-HDL-cholesterol (non-HDL-C), current smoking and diabetes, vary by geographical region and sex globally, according to new research presented at ESC Congress 2023 and simultaneously published in the New England Journal of Medicine.

The study used individual-level data among 1,518,028 participants from 112 cohort studies conducted in 34 countries and eight geographic regions (North America, Latin America, Western Europe, Eastern Europe and Russia, North Africa and Middle East, sub-Saharan Africa, Asia, and Australia) participating in the Global Cardiovascular Risk Consortium. The median age was 54.4 years and 54.1% were women. Researchers examined associations between the risk factors and incident cardiovascular disease and death from any cause and stratified findings according to geographic region, age and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality.

Overall, incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years and 177,369 participants died during a median follow-up of 8.7 years. The aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease across all five risk factors was 57.2% among women and 52.6% among men. The corresponding values for 10-year all-cause mortality were 22.2% and 19.1%, respectively.

Geographically, risk factor levels varied with the highest values for BMI and smoking in Latin America and for SBP and non-HDL-C in Europe. The highest values for diabetes were in North Africa and Middle East. Sex-based differences were also observed, with smoking and diabetes associated with greater risks for women than men in most geographical regions. The steepest associations between cardiovascular disease and BMI were observed in Latin American women, SBP in North American women, and non-HDL-C in Australian women.

According to Christina Magnussen, MD, et al., while all-cause deaths seem to be attributable to five major and potentially modifiable risk factors globally, a substantial proportion of cardiovascular disease and mortality risk remains unexplained. "The present study supports stakeholders on a global and regional scale to tailor geographically adapted and sex-specific initiatives in disease prevention and emphasizes the need for identification of risk factors beyond those used in SCORE risk systems," they said.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia

Keywords: ESC Congress, ESC23, ACC International, Dyslipidemias

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