The absence of cardiovascular risk factors at age 50 is associated with more than ten additional years of life expectancy.

A large international study shows that the absence, at age 50, of five major cardiovascular risk factors – high blood pressure, high cholesterol, diabetes, smoking, and abnormal body mass index – is associated with a gain of more than ten years in life expectancy, compared to people with all of these risk factors. Published in The New England Journal of Medicine[1], The results are based on the analysis of more than two million participants followed in 39 countries. In women with none of these risk factors at age 50, life expectancy without cardiovascular disease is extended by 13.3 years and overall life expectancy by 14.5 years. In men, these gains reach 10.6 and 11.8 years, respectively.

The study is based on harmonized data from the Global Cardiovascular Risk Consortium, which includes 2,078,948 individuals from 133 cohorts across six continents. Participants, aged 18 or older at enrollment, were followed up to a maximum age of 90. The analyses focused on the presence or absence, at age 50, of five modifiable cardiovascular risk factors defined according to standardized clinical thresholds: systolic blood pressure greater than or equal to 130 mmHg, non-HDL cholesterol level greater than or equal to 130 mg/dL, body mass index less than 20 or greater than or equal to 25, the presence of diabetes, and current smoking.

A marked reduction in cardiovascular risk over a lifetime

The study highlights a clear association between the absence of cardiovascular risk factors at age 50 and a substantial reduction in the lifetime risk of developing cardiovascular disease. Among individuals with none of the five analyzed risk factors, the cumulative risk of a cardiovascular event before age 90 is estimated at 13 per 100,000 years (%) for women and 21 per 100,000 years (%) for men. Conversely, in individuals with all five risk factors at age 50, this risk reaches 24 per 100,000 years (%) for women and 38 per 100,000 years (%) for men, reflecting a significantly increased exposure to cardiovascular disease over the course of their lives.

Beyond the probability of events occurring, analysis in terms of life expectancy without cardiovascular disease reveals particularly marked differences. Women aged 50 with no risk factors benefit on average from 13.3 additional years lived without cardiovascular disease compared to those exposed to all risk factors, while this gain is estimated at 10.6 years for men. These differences illustrate the cumulative impact of traditional risk factors on cardiovascular-healthy lifespan, regardless of subsequent changes.

Smoking and diabetes are among the most impactful determinants.

Risk factor analysis highlights the particularly significant role of smoking and diabetes in reducing life expectancy and increasing long-term cardiovascular risk. Among all the factors studied, the absence of smoking and the absence of diabetes appear to be the two variables associated with the greatest gains in life years, both in terms of overall survival and cardiovascular disease-free life expectancy.

Not smoking at age 50 is associated with an average gain of 5.5 years of life without cardiovascular disease in women and 4.8 years in men, compared to smokers with other risk factors. Regarding all-cause mortality, the life expectancy gap reaches 5.6 years in women and 5.1 years in men in favor of non-smokers. These results highlight the significant role of tobacco as a cross-cutting factor, influencing both the occurrence of cardiovascular disease and overall mortality, independently of the other determinants analyzed.

Diabetes has a comparable impact. The absence of diabetes at age 50 is associated with an estimated gain of 4.7 years of life without cardiovascular disease in women and 4.2 years in men. In terms of overall survival, this difference increases to 6.4 years in women and 5.8 years in men. These discrepancies reflect the central role of diabetes in accelerating atherosclerotic processes and increasing the risk of cardiovascular and metabolic complications throughout the lifespan.

The study also shows that the effect of smoking and diabetes exceeds that observed for other risk factors taken in isolation, such as hypertension, hypercholesterolemia or abnormalities in body mass index, whose associations with life expectancy appear more modest when considered individually.

The benefits of modifying risk factors in middle age

The study highlights that the trajectory of cardiovascular risk factors is not fixed upon entering middle age and that changes occurring in later life remain associated with significant health and longevity benefits. Analyses show that, in individuals with all risk factors between the ages of 50 and 55, an improvement in their risk profile between 55 and 60 is associated with a measurable gain in years of life, both without cardiovascular disease and from all causes.

Among the various factors studied, controlling high blood pressure appears to be the most associated with a significant gain in years of life without cardiovascular disease. Individuals who normalized their blood pressure during this period benefit from a significant extension of their life expectancy without cardiovascular events, highlighting the central role of hypertension in the development of long-term cardiovascular diseases. This benefit is observed in both women and men, although its magnitude varies according to sex and geographical context.

Regarding all-cause mortality, smoking cessation between the ages of 55 and 60 is the factor most associated with a significant increase in life expectancy among all the factors analyzed. In individuals with all risk factors between the ages of 50 and 55, smoking cessation during this period is associated with an average increase in all-cause life expectancy estimated at 2.1 years for women and 2.4 years for men, compared to those who continue to smoke during the same period.

The study also shows that simultaneously modifying several risk factors is associated with cumulative benefits. Individuals who manage to improve their blood pressure, smoking status, and metabolic control together experience the greatest increases in life expectancy, suggesting a synergistic effect of prevention and management strategies in middle age.

©Generation Without Tobacco

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[1] Global Effect of Cardiovascular Risk Factors on Lifetime Estimates, The Global Cardiovascular Risk Consortium, Published March 30, 2025 N Engl J Med 2025;393:125-138 DOI: 10.1056/NEJMoa2415879 VOL. 393 NO. 2