Cardiovascular prevention: more than ten years of life gained without risk factors

A large international study, published in the New England Journal of Medicine[1] shows that the absence of five cardiovascular risk factors at age 50 is associated with a gain in life expectancy of more than ten years, both in terms of overall survival and life without cardiovascular disease. These results, from a globally harmonized analysis, highlight the decisive role of prevention in cardiovascular health. They also confirm that it is never too late to intervene: targeted modificationsées, meven afterfrom the age of 55, can significantly improve the prognosis.

The study was based on the analysis of individual data from 2,078,948 people aged 18 and over, from 133 cohorts spread across 39 countries and 6 continents. Conducted by the Global Cardiovascular Risk Consortium, it aimed to estimate the long-term risks of cardiovascular disease and death, based on the presence or absence of five modifiable risk factors, at age 50: high blood pressure, hyperlipidemia, diabetes, smoking, and an abnormal body mass index (less than 20 or greater than or equal to 25).

The data were harmonized according to the definitions of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) cohorts. Risks were modeled up to age 90 using sex-adjusted Weibull survival models, allowing for the estimation of differences in life expectancy with or without cardiovascular disease, as well as overall survival. These models also took into account changes in certain factors over time, particularly between ages 55 and 60, to assess the potential benefits of behavioral change during life.

Absence of risk factors at age 50: a gain of more than ten years of life

The study results show that the absence of the five classic risk factors—high blood pressure, hyperlipidemia, overweight or underweight, diabetes, and smoking—at age 50 is associated with a significant increase in life expectancy, both in terms of overall survival and life without cardiovascular disease.

In women aged 50 years without any of these factors, life expectancy without cardiovascular events is extended by an average of 13.3 years compared to those with all five factors. This difference is also marked in men, for whom the absence of risk factors is associated with an additional 10.6 years of life without cardiovascular disease.

The gaps are even wider when it comes to overall survival, from all causes of death combined. Women without risk factors at age 50 live an average of 14.5 years longer than those with all of them; for men, this gain reaches 11.8 years. These figures are derived from statistical models based on follow-up data up to age 90, and incorporate the cumulative probabilities of a cardiovascular event or death.

Beyond these overall estimates, the study also highlights a strong correlation between the number of factors present and the reduction in life expectancy. Each additional risk factor contributes to a progressive decrease in the number of years of life without cardiovascular disease, illustrating a cumulative effect that is particularly unfavorable when several factors are combined.

Finally, even in the total absence of factors at this age, the risk of developing cardiovascular disease during life remains non-zero: 13 % in women and 21 % in men, which reminds us that other determinants (genetic, environmental or social) also intervene. Nevertheless, the differences observed between the groups underline the decisive importance of controlling modifiable risk factors from a public health perspective.

Acting after 55: still significant benefits

One of the major contributions of the study lies in the analysis of the effect of the modification of risk factors after the age of 55. Contrary to a widespread idea that preventive interventions are not very effective beyond a certain age, the results demonstrate that it is still possible to significantly reduce cardiovascular risks and extend life expectancy by taking action from the second half of the fifties.

Among participants who had all five risk factors between ages 50 and 55, those who managed to normalize their blood pressure between ages 55 and 60 experienced the greatest gain in cardiovascular event-free life. This improvement in hypertension control was associated with an increase of 2.4 years of cardiovascular disease-free life in women and 1.2 years in men. These figures were derived from models that accounted for individual changes in risk profiles, giving these estimates high predictive value.

Regarding overall survival, smoking cessation is associated with the greatest benefit. Quitting smoking between the ages of 55 and 60 years would allow women to live an average of 2.1 years longer and men 2.4 years longer, regardless of all causes of death. This finding underscores that smoking cessation, even late, remains a high priority in public health.

Furthermore, the study shows that beneficial effects accumulate when multiple factors are modified simultaneously. For example, participants who acted on hypertension, hyperlipidemia, and diabetes at the same time between the ages of 55 and 60 had a combined gain of up to 3.3 years of life without cardiovascular disease in women, and 1.5 years in men, compared to those who did not modify their risk profile. When smoking cessation is also included, the gain can exceed 5 additional years of survival.

These results highlight that an effective cardiovascular prevention strategy is not limited to young adults or populations at high risk identified early. It must also address individuals in midlife, with interventions targeted at modifiable factors, for which the beneficial effects remain significant, measurable, and relevant in terms of public health.

A major contribution to global cardiovascular prevention

The study's findings strengthen the case for a structured, two-pronged prevention policy: on the one hand, targeting young, healthy people to prevent the development of risk factors; on the other, supporting people in mid-life with concrete changes, particularly in smoking, blood pressure control and weight management.

This study also highlights the need to break down age-specific barriers to public health policies and to promote continuous cardiovascular prevention that can be adapted to different stages of life. It provides robust data that can be leveraged across governments, healthcare institutions, and awareness campaigns to clearly and measurably illustrate the impact of risk factor reduction.

Finally, by providing a globally harmonized baseline, the consortium paves the way for future research aimed at integrating other health determinants (social, environmental, behavioral) into cardiovascular risk trajectories. This work therefore provides a solid foundation for building evidence-based clinical recommendations and public health interventions.

©Generation Without Tobacco

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[1] Global Cardiovascular Risk Consortium;  Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. N Engl J Med. 2023 Oct 5;389(14):1273-1285. doi:10.1056/NEJMoa2206916. Epub 2023 Aug 26. PMID: 37632466; PMCID: PMC10589462.