Substantial lifetime risk for CVD, even among persons without classical risk factors
ACC.25 – According to the Global Cardiovascular Risk Consortium, the lifetime risk for CVD among persons with none of the classical risk factors was 13% in women and 21% in men. Modifying the risk of hypertension at midlife was related to the most additional life-years free from CVD.
This summary is based on the presentation of Christina Magnussen, MD, PhD (Hamburg, Germany) at the ACC.25 Scientific Session - Global effect of cardiovascular risk factors on lifetime estimates.
Introduction and methods
Five modifiable classical risk factors account for approximately 50% of the total CV burden worldwide. Current estimates for the lifetime risk of CVD are in the range of 5 to 50%, depending on the CV outcome, follow-up duration and different risk populations. There is a need for robust global, individual-level data on lifetime risk estimates.
The Global Cardiovascular Risk Consortium harmonized individual-level data from 2,078,948 participants across 133 cohorts of 39 countries and 8 geographic regions. The five classical risk factors were arterial hypertension (SBP ≥130 mmHg), hyperlipidemia (non-HDL-c levels ≥130 mg/dL), underweight or overweight/obesity (BMI <20 or ≥25 kg/m²), current smoking, and diabetes. The index age was 50 years, and predictions were made up to 90 years.
The two major outcomes were CVD, defined as a composite of MI, unstable angina, coronary revascularization, ischemic and hemorrhagic stroke, cardiovascular mortality and unclassifiable death, and all-cause mortality.
Main results
- Lifetime risk for CVD was estimated to be at 13% in women with none of the classical risk factors and 24% in women with all five of the risk factors (estimated lifetime difference: 13.3 years; 95%CI: 11.2–15.7). In men, these estimates were 21% and 38%, respectively (estimated lifetime difference: 10.6 years; 95%CI: 9.2–12.9).
- Compared with the presence of all five risk factors at age 50, the absence of all five risk factors was associated with a life expectancy of more than a decade longer (+14.5 years in women and +11.8 years in men).
- Modification of hypertension between the age of 55 and <60 versus no change in all risk factors led to the greatest addition of life-years free of CVD in both women (+2.4 years) and men (+1.2 years).
- Compared with no change in all five risk factors, the greatest improvement in additional life-years free from death was observed after modifying smoking between the age of 55 and <60 years (+2.1 years in women and +2.4 years in men).
Conclusion
Individual-level data from the Global Cardiovascular Risk Consortium demonstrated that lifetime risk for CVD remains substantial in both women and men, even among persons with none of the five classical risk factors. “Our results call for targeted interventions on specific risk factors, especially in the critical midlife decade,” says Christina Magnussen.
- Our reporting is based on the information provided at the ACC.25 Scientific Session -