Preventable CVD risk factors, what we know and what is yet to be done

The Global Cardiovascular Risk Consortium has recently published the estimated effects of modifiable risk factors for CVDs burden globally (1). Using individual-level data from 112 cohort studies in 34 countries and 8 geographic regions, the authors estimated the CVD-specific population-fractions attributed to otherwise modifiable risk factors, namely, total body mass index, systolic blood pressure, diabetes, current smoking and non-high-density lipoprotein cholesterol. The population-attributable fraction of the 10-year incidence of CVDs attributed to all these factors combined was 57% (95% confidence interval, 52.4- 62.1) among women and 53% (49.0-56.1) among men, globally, The larger estimates were in North Africa and the Middle East (64% in women and 60% in men, respectively) and in Eastern Europe and Russia (60 % in women and 58% in men, respectively), and the lower estimates were in Sub-Saharan Africa (31 % in women and 33% in men, respectively). Conservative average estimates of the risk-factor specific global CVD-attributable-fractions ranged from 25% for blood pressure to 16% for non-HDL cholesterol, and from 12% for diabetes to 8%-9% for body-mass and smoking, respectively.

Once again, these estimates highlight great opportunities for preventive cardiology, inviting continued efforts for better management and reduction of these well-known determinants for CVD incidence. The regional and risk-specific variations highlighted could help national stakeholders prioritise public-health efforts.

Nonetheless, while heterogeneity in the levels of those specific risk factors or treatments may explain some of the geographical differences described, understanding what drives the remaining excess risk for CVDs through genetic and precision prevention studies, may further advance our understanding of what would be preventable, perhaps in the context of gene-environment risk stratification models and novel pathways discovery.