More than half of all heart attacks and strokes are avoidable by checking and treating the five most common cardiovascular risk factors – high blood pressure, high cholesterol, overweight, smoking, and diabetes – a new global study has found.

Based on the data of 1.5 million individuals in 34 countries, the findings of the Global Cardiovascular Risk Consortium (GCVRC) were published today in The New England Journal of Medicine and simultaneously presented at the ESC Congress in Amsterdam.

Darryl Leong

PHRI Scientist Darryl Leong is one of the authors and on the steering committee of the GCVRC.

“The present work from the GCVRC, driven by [senior author] Stefan Blankenberg, represents a complementary approach to studying cardiovascular risk factors globally. Ambitious studies such as this one are pioneering approaches we must take to address cardiovascular disease worldwide,” says Leong.

At the ESC late-breaking science session today, first author Christina Magnussen, University Heart & Vascular Center Hamburg, presented data from 112 cohort studies in North America, Latin America, Western Europe, Eastern Europe and Russia, North Africa and the Middle East, Sub-Saharan Africa, Asia, and Australia.

The highest rates for being overweight were in Latin America; the highest values for high blood pressure and high cholesterol were in Europe. The risk factor of smoking was particularly decisive in Latin America and Eastern European, and for diabetes in North Africa and the Middle East.

Raising new questions to pursue

The study showed a linear relationship between high blood pressure, high cholesterol and the occurrence of CVD, which applied to all the world regions studied. The scientists also identified that very low, as well as high, cholesterol levels increase overall mortality.

With the exception of high body mass index (BMI), the significance of the other risk factors decreases with age; for example, high blood pressure is more damaging to a 40 year old than an 80 year old person.

“This raises the question: to what extent should the target values for treating cardiovascular risk factors for the most elderly patients be identical with those in middle-age,” says Stefan Blankenberg, University Heart and Vascular Center at the UKE, Germany.

He also notes that “approximately 45% of all cardiovascular cases cannot be explained by these risk factors. That should motivate us, and academic funders, to further research efforts.”

All five risk factors combined amounted to 57.2% of women’s cardiovascular risk; to 52.6% for men. The five risk factors accounted for only about 20% of the risk of mortality.

The study provides an extensive dataset to avoid cardiovascular diseases or reduce their effects for at-risk persons, or patients with cardiovascular diseases, by improving their lifestyle and by lowering blood pressure or cholesterol.

“High systolic blood pressure accounts for the largest share of cardiovascular risk. We should place a particular focus on the therapy of patients with high blood pressure to avoid cardiovascular diseases as much as possible,” says Magnussen.

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