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Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. Publisher Pubmed



Magnussen C1, 2, 3 ; Ojeda FM1, 2 ; Leong DP19 ; Alegrediaz J20 ; Amouyel P22 ; Avilessanta L25 ; De Bacquer D27 ; Ballantyne CM28 ; Bernabeortiz A31 ; Bobak M32 ; Brenner H4 ; Carrillolarco RM36 ; De Lemos J30 ; Dobson A37 Show All Authors
Authors
  1. Magnussen C1, 2, 3
  2. Ojeda FM1, 2
  3. Leong DP19
  4. Alegrediaz J20
  5. Amouyel P22
  6. Avilessanta L25
  7. De Bacquer D27
  8. Ballantyne CM28
  9. Bernabeortiz A31
  10. Bobak M32
  11. Brenner H4
  12. Carrillolarco RM36
  13. De Lemos J30
  14. Dobson A37
  15. Dorr M5
  16. Donfrancesco C45
  17. Drygas W50
  18. Dullaart RP52
  19. Engstrom G55
  20. Ferrario MM46
  21. Ferrieres J23
  22. De Gaetano G47
  23. Goldbourt U59
  24. Gonzalez C21
  25. Grassi G48
  26. Hodge AM38, 39
  27. Hveem K60, 61
  28. Iacoviello L46, 47
  29. Ikram MK53, 54
  30. Irazola V65
  31. Jobe M66
  32. Jousilahti P67
  33. Kaleebu P68
  34. Kavousi M54
  35. Kee F34
  36. Khalili D69
  37. Koenig W6, 7, 9, 16
  38. Kontsevaya A73
  39. Kuulasmaa K67
  40. Lackner KJ10, 13
  41. Leistner DM15
  42. Lind L57
  43. Linneberg A75, 77
  44. Lorenz T1, 2, 3
  45. Lyngbakken MN62, 63
  46. Malekzadeh R70, 71, 72
  47. Malyutina S74
  48. Mathiesen EB64
  49. Melander O55
  50. Metspalu A78
  51. Miranda JJ31, 41
  52. Moitry M24
  53. Mugisha J68
  54. Nalini M26, 72
  55. Nambi V29
  56. Ninomiya T79
  57. Oppermann K81
  58. Dorsi E82
  59. Pajak A51
  60. Palmieri L45
  61. Panagiotakos D83
  62. Perianayagam A84, 85
  63. Peters A6, 8, 17, 18
  64. Poustchi H71, 72
  65. Prentice AM66
  66. Prescott E76
  67. Riserus U56
  68. Salomaa V67
  69. Sans S86
  70. Sakata S79
  71. Schottker B4
  72. Schutte AE42, 43, 87
  73. Sepanlou SG72
  74. Sharma SK89
  75. Shaw JE40
  76. Simons LA44
  77. Soderberg S58
  78. Tamosiunas A90
  79. Thorand B8, 17, 18
  80. Tunstallpedoe H35
  81. Twerenbold R1, 2, 3
  82. Vanuzzo D49
  83. Veronesi G46
  84. Waibel J1, 2, 3
  85. Wannamethee SG33
  86. Watanabe M80
  87. Wild PS11, 12, 13, 14
  88. Yao Y91, 93
  89. Zeng Y92, 94
  90. Ziegler A1, 2, 88, 95, 96
  91. Blankenberg S1, 2, 3, 95
Show Affiliations
Authors Affiliations
  1. 1. Center for Population Health Innovation, University Heart and Vascular Center Hamburg, Germany
  2. 2. University Medical Center Hamburg Eppendorf, Germany
  3. 3. German Center for Cardiovascular Research (DZHK) Partner Site Hamburg Kiel Lubeck, Germany
  4. 4. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, and Network Aging Research, Heidelberg University, Heidelberg, Germany
  5. 5. Department of Internal Medicine B, University Medicine Greifswald, Dzhk Partner Site Greifswald, Greifswald, Germany
  6. 6. Dzhk Partner Site Munich Heart Alliance, Technical University of Munich, Munich, Germany
  7. 7. German Heart Center, Technical University of Munich, Munich, Germany
  8. 8. Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig Maximilians Universitat Munchen, Munich, Germany
  9. 9. Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
  10. 10. Institute of Clinical Chemistry and Laboratory Medicine, Germany
  11. 11. Preventive Cardiology and Preventive Medicine, Mainz, Germany
  12. 12. Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, Mainz, Germany
  13. 13. University Medical Center of the Johannes Gutenberg University Mainz, Dzhk Partner Site Rhine Main, Mainz, Germany
  14. 14. Institute for Molecular Biology, Mainz, Germany
  15. 15. University Heart and Vascular Center Frankfurt, Dzhk Partner Site Rhine Main, Frankfurt, Germany
  16. 16. Institute of Epidemiology, Helmholtz Zentrum Munchen, Neuherberg, Germany
  17. 17. German Research Center for Environmental Health, Neuherberg, Germany
  18. 18. German Center for Diabetes Research (DZD) Partner Site Munich Neuherberg, Neuherberg, Germany
  19. 19. Department of Medicine (Cardiology), McMaster University, Hamilton, Canada
  20. 20. Experimental Medicine Research Unit, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
  21. 21. Centro de Estudios en Diabetes, Centro de Investigacion en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
  22. 22. Universite de Lille, Inserm, Centre Hospitalier University de Lille, Institut Pasteur de Lille, UMR1167 RID-AGE Risk Factors and Molecular Determinants of Aging-Related Diseases, Epidemiology and Public Health Department, Lille, France
  23. 23. Department of Cardiology, Inserm UMR1295, Toulouse Rangueil University Hospital, Toulouse, France
  24. 24. Department of Public Health, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
  25. 25. Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
  26. 26. Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
  27. 27. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  28. 28. Department of Medicine, Baylor College of Medicine, Houston, TX, United States
  29. 29. Michael E. DeBakey Veterans Affairs Hospital, Baylor College of Medicine, Houston, TX, United States
  30. 30. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
  31. 31. Cronicas Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
  32. 32. Department of Epidemiology and Public Health, University College London, London, United Kingdom
  33. 33. Research Department of Primary Care and Population Health, University College London, London, United Kingdom
  34. 34. The Centre for Public Health, Queens University Belfast, Belfast, United Kingdom
  35. 35. Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
  36. 36. Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States
  37. 37. School of Public Health, University of Queensland, Brisbane, Australia
  38. 38. Division of Cancer Epidemiology, Cancer Council Victoria, Australia
  39. 39. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
  40. 40. Baker Heart and Diabetes Institute, Melbourne, Australia
  41. 41. Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
  42. 42. George Institute for Global Health, Sydney, Australia
  43. 43. School of Population Health, Kensington, Australia
  44. 44. University of New South Wales, Kensington, Australia
  45. 45. Department of Cardiovascular and Endocrine Metabolic Diseases and Aging, Istituto Superiore di Sanita, Rome, Italy
  46. 46. Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
  47. 47. Department of Epidemiology and Prevention, Irccs Neuromed, Pozzilli, Italy
  48. 48. Clinica Medica, University of Milano Bicocca, Milan, Italy
  49. 49. Monica (Monitoring Cardiovascular Diseases) Friuli Study Group, Udine, Italy
  50. 50. Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Lazarski University, Warsaw, Poland
  51. 51. Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  52. 52. Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  53. 53. Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
  54. 54. Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
  55. 55. Department of Clinical Sciences Malmo, Lund University, Malmo, Sweden
  56. 56. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Sweden
  57. 57. Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  58. 58. Department of Public Health and Clinical Medicine, University of Umea, Umea, Sweden
  59. 59. Department of Epidemiology, Tel Aviv University School of Public Health, Tel Aviv, Israel
  60. 60. Hunt (Trondelag Health Study) Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
  61. 61. K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Trondheim, Norway
  62. 62. Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
  63. 63. K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  64. 64. Department of Clinical Medicine, University of Tromso the Arctic University of Norway, Tromso, Norway
  65. 65. Department of Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
  66. 66. Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
  67. 67. Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
  68. 68. Medical Research Council Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
  69. 69. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Iran
  70. 70. Liver and Pancreaticobiliary Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  71. 71. Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  72. 72. Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  73. 73. National Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
  74. 74. Research Institute of Internal and Preventive Medicine, Branch of the Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russian Federation
  75. 75. Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
  76. 76. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
  77. 77. Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  78. 78. Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
  79. 79. Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  80. 80. Global Center of Excellence Program Study Group, Yamagata University School of Medicine, Yamagata, Japan
  81. 81. School of Medicine, University of Passo Fundo, Passo Fundo, Brazil
  82. 82. Department of Public Health, Postgraduate Program in Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
  83. 83. School of Health Sciences and Education, Harokopio University, Athens, Greece
  84. 84. National Council of Applied Economic Research, Delhi, India
  85. 85. International Institute for Population Sciences, Mumbai, India
  86. 86. Catalan Department of Health, Barcelona, Spain
  87. 87. Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
  88. 88. School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
  89. 89. Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
  90. 90. Laboratory of Population Studies, Institute of Cardiology, Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
  91. 91. China Center for Health Development Studies, National School of Development, Peking University, China
  92. 92. Center for Healthy Aging and Development Studies, National School of Development, Peking University, China
  93. 93. Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
  94. 94. Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, United States
  95. 95. Cardio-CARE, Davos, Switzerland
  96. 96. Swiss Institute of Bioinformatics, Lausanne, Switzerland

Source: New England Journal of Medicine Published:2023


Abstract

Background Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking. Methods We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified 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. Results Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease 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 cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6). Conclusions Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease 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. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.) © 2023 Massachusetts Medical Society.
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