Key result
≥3 metabolic risk factors linked to ~3.2-fold higher CVD risk in young adults.
Why the study?
Metabolic abnormalities are increasingly prevalent in young adults and commonly cluster in the elderly, but the landscape of metabolic burden and its cardiovascular impact across adulthood in the Chinese population had not been quantified.
How do 6 major metabolic risk factors and their longitudinal transitions impact incident cardiovascular disease risk across different age groups and sexes over the adult lifespan in a Chinese population?
Cohort (n=7,513,828)
Yes
How do 6 major metabolic risk factors and their longitudinal transitions impact incident cardiovascular disease risk across different age groups and sexes over the adult lifespan in a Chinese population?
Answers are grounded in this paper and cite their sources.
This massive life-course cohort of 7.5 million adults demonstrates that metabolic risk factors confer the highest relative cardiovascular risk in young adults (<40 years) and peak population attributable burden in midlife (40–<60 years), with early 1-year metabolic improvement substantially reducing incident CVD risk.
Background Metabolic abnormalities are increasingly prevalent in young adults and commonly cluster in the elderly. We aimed to map the landscape of metabolic burden and quantify the related cardiovascular impact across the adulthood in Chinese population. Methods The prospective cohort included 7,513,828 adults (3,907,602 women and 3,606,226 men) from northwestern China who were free of cardiovascular disease (CVD) at baseline. Participants were grouped by age (18–<40, 40–<60, 60–<80, and ≥80 years). Age-specific distribution and time-series trajectories were depicted for 6 major metabolic risk factors, including obesity, hepatic steatosis, hypertension, hyperlipidemia, diabetes, and renal dysfunction. Their age-specific associations with incident CVD and population attributable fractions (PAFs) were assessed, considering potential sex difference. Findings Metabolic states exhibited obvious age-dependent sexual dimorphism, characterized by an initial female advantage in young adults which reversed around age 45. Over a median follow-up of 4.5 years, the metabolic factors exhibited strong associations with incident CVD in younger adults which gradually attenuated with advancing age. In particular, the HR for hypertension declined from 3.60 in the youngest group to 2.12 in the middle-aged group, 1.41 in the older group, and 1.21 in the very old (≥80 years). Regardless of age or sex, obesity demonstrated the highest PAF to CVD. For combined metabolic burden, the PAF was highest in middle-aged group (37.89%), followed by people aged 18–<40 years (29.78%) and 60–<80 years (25.24%), and lowest in the very old (15.85%). The PAF was higher in men than women only in those under 40 and the sex disparity reversed in the older groups. Among metabolically abnormal participants, transitioning to a healthier metabolic state, within an average of 1 year, was associated with a substantially reduced risk of CVD, particularly in the younger groups. Interpretation The metabolic burden and its cardiovascular effects are heterogeneous across demographic segments, supporting the rationale of implementing age-specific and gender-sensitive strategies for metabolic management and CVD prevention.
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Liu et al. (2026) conducted a cohort in Metabolic burden and primary prevention of cardiovascular disease (n=7,513,828). Metabolic risk factors (obesity, hepatic steatosis, hypertension, hyperlipidemia, diabetes, and renal dysfunction); ≥3 metabolic risk factors in YOUNGEST group (18–<40 years) vs. 0 metabolic risk factors (metabolically normal) was evaluated on Incident major cardiovascular disease (composite of coronary heart disease [ICD-10 I21–I25] and stroke [ICD-10 I60–I64]) (HR 3.16 (for ≥3 vs 0 risk factors in ages 18–<40), 95% CI 3.04-3.28, p=<3.50E-15 for age interaction). Metabolic risk factors were strongly associated with incident CVD in young adults (<40 years; HR 3.16 for ≥3 risk factors) with effects attenuating with age and PAF peaking in midlife (37.89%).
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