Global Effect of Cardiovascular Risk Factors on Lifetime Estimates
The Global Cardiovascular Risk Consortium
N Engl J Med 2025;393:125-138
DOI: 10.1056/NEJMoa2415879
Abstract
BACKGROUND
Five risk factors account for approximately 50% of the global burden of cardiovascular disease. How the presence or absence of classic risk factors affects lifetime estimates of cardiovascular disease and death from any cause remains unclear.
五项危险因素约占全球心血管疾病负担的50%。典型危险因素存在与否如何影响患心血管疾病和全因死亡的终生估计值，目前仍不清楚。
METHODS
We harmonized individual-level data from 2,078,948 participants across 133 cohorts, 39 countries, and 6 continents. Lifetime risk of cardiovascular disease and death from any cause was estimated up to 90 years of age according to the presence or absence of arterial hypertension, hyperlipidemia, underweight and overweight or obesity, diabetes, and smoking at 50 years of age. Differences in life span (in terms of additional life-years free of cardiovascular disease or death from any cause) according to the presence or absence of these risk factors were also estimated. Risk-factor trajectories were analyzed to predict lifetime differences according to risk-factor variation.
我们整合了来自39个国家和6大洲133个队列2,078,948名参与者的个体数据。根据参与者50岁时是否患动脉高血压、高脂血症、体重过轻、超重或肥胖、糖尿病和吸烟，估算90岁前患心血管疾病和全因死亡的终生风险。此外，我们还根据参与者是否存在这些危险因素估算寿命差异（以免于心血管疾病或全因死亡的额外寿命[年数]计算）。我们对危险因素轨迹进行了分析，从而根据危险因素的变化预测寿命差异。
RESULTS
The lifetime risk of cardiovascular disease was 24% (95% confidence interval [CI], 21 to 30) among women and 38% (95% CI, 30 to 45) among men for whom all five risk factors were present. In the comparison between participants with none of the risk factors and those with all the risk factors, the estimated number of additional life-years free of cardiovascular disease was 13.3 (95% CI, 11.2 to 15.7) for women and 10.6 (95% CI, 9.2 to 12.9) for men; the estimated number of additional life-years free of death was 14.5 (95% CI, 9.1 to 15.3) for women and 11.8 (95% CI, 10.1 to 13.6) for men. As compared with no changes in the presence of all risk factors, modification of hypertension at an age of 55 to less than 60 years was associated with the most additional life-years free of cardiovascular disease, and modification of smoking at an age of 55 to less than 60 years was associated with the most additional life-years free of death.
存在全部五项危险因素的情况下，女性患心血管疾病的终生风险为24%（95%置信区间[CI]，21~30），男性为38%（95% CI，30~45）。对不存在任何危险因素的参与者和存在所有危险因素的参与者进行比较时，女性和男性免于心血管疾病的额外寿命估计分别为13.3（95% CI，11.2~15.7）年和10.6（95% CI，9.2~12.9）年；女性和男性免于死亡的额外寿命估计分别为14.5（95% CI，9.1~15.3）年和11.8（95% CI，10.1~13.6）年。与存在所有危险因素且不做出改变的情况相比，在55~<60岁改变高血压的情况下，免于心血管疾病的额外寿命最多，在55~<60岁改变吸烟的情况下，免于死亡的额外寿命最多。
CONCLUSIONS
The absence of five classic risk factors at 50 years of age was associated with more than a decade greater life expectancy than the presence of all five risk factors, in both sexes. Persons who modified hypertension and smoking in midlife had the most additional life-years free of cardiovascular disease and death from any cause, respectively. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov number, NCT05466825.)
在男女两性中，50岁时不存在五项典型危险因素的人比存在所有五项危险因素的人预期寿命长10年以上。中年改变高血压和吸烟的人，免于心血管疾病的额外寿命和免于全因死亡的额外寿命分别最多。（由德国心血管研究中心[DZHK，German Center for Cardiovascular Research]资助；在ClinicalTrials.gov注册号为NCT05466825）。
