Discover how managing five key cardiovascular risk factors before age 50 can dramatically extend your healthy years—this global study reveals how small changes now can have life-changing effects later.
Study: Global Effect of Cardiovascular Risk Factors on Lifetime Estimates. Image Credit: Orawan Pattarawimonchai / Shutterstock
In a recent study published in the New England Journal of Medicine, a group of researchers estimated the lifetime risk and benefit of cardiovascular risk factor absence or modification on cardiovascular disease and all-cause mortality globally.
Background
What if five modifiable risk factors you manage by age 50 could buy you ten extra years of life? Cardiovascular disease is the world’s leading cause of death, accounting for one in three global fatalities. Remarkably, five modifiable risk factors—arterial hypertension (high blood pressure), hyperlipidemia (high cholesterol), diabetes, smoking, and abnormal body weight (BMI <20 (underweight) or ≥25 (overweight or obesity))—are responsible for nearly half of this burden. Prior studies have shown a rising lifetime risk with increasing risk-factor load; however, these often rely on static profiles or regional data. Little is known about how these risk factors influence global life expectancy when modified over time, highlighting the need for further research.
About the study
Researchers from the Global Cardiovascular Risk Consortium (GCVRC) harmonized data from 2,078,948 individuals aged 18 or older across 133 cohort studies in 39 countries on six continents. Participants were followed for up to 47 years. Those with cardiovascular disease at baseline were excluded from disease-specific analyses. Risk factors were assessed at age 50, and lifetime risk estimates were projected up to age 90.
Risk factors included systolic blood pressure ≥130 mm Hg (arterial hypertension), non-high-density lipoprotein (HDL) cholesterol ≥130 mg/dL (hyperlipidemia), diabetes (via diagnosis or reported history), body mass index (BMI <20 (underweight) or ≥25 (overweight or obesity)), and current smoking. Cardiovascular outcomes included myocardial infarction, stroke, or death from cardiovascular or unknown causes.
Sex-specific Weibull survival models were used to estimate cardiovascular disease-free and overall life expectancy, considering the presence or absence of these risk factors. Additional analyses explored the modification of risk factors between the ages of 55 and 60 and how this affected life expectancy. All models accounted for regional variations using standard deviation thresholds and were recalibrated using global mortality data from the World Health Organization. Statistical analysis was conducted using R software.
Study results
Participants with all five risk factors at age 50 faced a lifetime cardiovascular disease risk of 24% in women and 38% in men. In contrast, individuals with none of these risk factors had significantly lower risks, with 13% for women and 21% for men. Regarding overall mortality, women with all five risk factors had an 88% chance of dying before 90, compared to 53% among those with none. For men, the risk increased from 68% (with no risk factors) to 94% (with all risk factors).
Women free from all five risk factors at 50 lived 13.3 additional years without cardiovascular disease and 14.5 more years free of death compared to those with all five. Men gained 10.6 and 11.8 extra years, respectively. The most impactful single risk factors were diabetes and smoking. Women without diabetes lived 4.7 years longer free of cardiovascular disease and 6.4 years longer free of death; for men, the gains were 4.2 and 5.8 years, respectively. Not smoking added about 5–6 years of life for both sexes.
Even modest improvements helped, as reducing systolic blood pressure to below 130 mmHg added 1.3 years (for women) and 1.8 years (for men) of cardiovascular disease-free life. Improving BMI to 20-24.9 (normal range) resulted in an additional 2.6 years in women and 1.9 years in men, depending on the region.
Changing risk factors midlife mattered, too. Individuals who modified arterial hypertension from present to absent between the ages of 55 and 60 gained the most cardiovascular disease-free years: 2.4 years for women and 1.2 years for men. Smoking cessation in that same window added the most death-free years, with 2.1 for women and 2.4 for men. The more risk factors modified, the greater the gains. Participants who improved four risk factors between the ages of 55 and 60 experienced over five additional years of freedom from both cardiovascular disease and death.
Regional differences were notable. In Latin America, women who reduced their blood pressure saw gains of nearly five years free from cardiovascular disease. North American women gained over five additional years of life by avoiding hypertension. These findings underscore both global commonalities and local priorities in preventive care.
Importantly, even those with no risk factors faced non-negligible lifetime cardiovascular disease risk, with 13% for women and 21% for men, suggesting that additional unidentified factors also contribute to disease.
Conclusions
To summarize, the absence of five classic cardiovascular risk factors—arterial hypertension, hyperlipidemia, diabetes, smoking, and abnormal BMI—by age 50 was linked to over a decade of extra life free from disease and death. Real-world relevance is high: middle-aged individuals who manage to quit smoking or control blood pressure can expect meaningful gains in healthy years. These results offer a compelling argument for earlier, global investment in cardiovascular prevention. They also encourage individuals to modify risk factors even in midlife. While not all risk is avoidable, reducing common modifiable risks can greatly extend both lifespan and quality of life worldwide.