Modifiable risk factors
This week, I've focused on an article from the New England Journal of Medicine titled "Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality". The article highlighted five risk factors, which are associated with cardiovascular disease and overall mortality. The risk factors were chosen because they are modifiable - things that we can do something about.
The study aimed to address the lack of regional and sex-specific evaluations of these risk factors' effects on outcomes by gathering and analysing data from 112 population studies across 34 countries and 8 regions. The selected risk factors were BMI, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes.
Conducted between 1963 and 2020, the baseline examinations included 1,518,028 participants with an average age of 54 years. Risk factors varied greatly across regions. BMI, for example, is an issue for being high in North America, while it's an issue for being low in sub-Saharan Africa.
The research used modelling exercises to estimate something called "population attributable fraction." This means the proportion of a condition that might be avoidable if risk factors were modified. This led to the researchers to conclude that over 50% of cardiovascular incidents among both women and men, and approximately 20% of deaths from any cause, could be prevented by modifying the specified risk factors.
The paper reported a number of results but there were other conclusions that could be reached from the main paper and supplemental material. One of the findings I found most interesting was that low BMI was a greater risk than high BMI. That held for men and women in all 8 regions.
Overall, the research showed that, of the five risk factors examined, two were far bigger issues than the other three. The two big issues were smoking and diabetes - diabetes being the single most important issue. Cholesterol and blood pressure were inconsequential in comparison.
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