Weekly Journal Scan: A global observational study shows how modifying five cardiovascular risk factors at midlife may affect lifespan and healthspan

This comment refers to ‘Global Effect of Cardiovascular Risk Factors on Lifetime Estimates’ which was published in N Engl J Med. https://doi.org/10.1056/NEJMoa2415879. CVD Represents the leading cause of morbidity and mortality worldwide.3 Despite a significant improvement in CV outcomes over recent decades, the growing prevalence of certain risk factors (e.g. obesity and diabetes), together with the ageing populations, has reinforced the potential key role of preventive strategies. According to a previous study from the GCVRC, five modifiable CV risk factors account for approximately 50% of the global burden of CVD, meaning that their management through preventive strategies could halve cases of CVD.1,4 Lifetime risk of CVD increases with accumulated risk factor load,5 exceeding 55% when considering severe, uncontrolled risk factor levels. Current evidence in this field has been derived largely from US and European populations.6–9 With a multifactorial analysis of lifetime estimates of CVD and all-cause mortality, the present study provides a more thorough appraisal of the impact of modifiable CV risk factors. Among the main strengths of this analysis is the large and diverse study population, which includes data from about 2 million participants spanning 39 countries and 6 continents.2 This extensive sample size enhances the generalizability of the findings to various populations. The inclusion of different geographic areas allows for the identification of regional variations in the prevalence of CV risk factors and associated health outcomes, informing tailored public health interventions. Besides the information on the influence of risk factors on lifespan, the study provides a comprehensive perspective on their impact on CV healthspan which is of paramount importance for both individuals and healthcare systems.10,11 Moreover, by examining data separately for men and women, the study pointed out sex-specific differences in lifetime risk estimates, offering insights into gender-related CV health disparities. Moreover, the study emphasizes that even among participants who had none of the traditional risk factors, the lifetime risk of CVD remained substantial, meaning that factors other than those commonly used in risk scores may account for residual CVD risk and that further efforts are needed to characterize the impact of non-traditional risk factors on CVD. Overall, the harmonized dataset and the employment of standardized definitions strengthen the validity of the results, minimizing variability and providing sufficient consistency across different cohorts.