42. Preventing Heart Disease: What the Global Heart Study Tells Us About Life time Risk Factors
NEJM Study, March 30, 2025...
It was in the afternoon, between the patients sipping coffee; I was scrolling and found the study that caught my eye. It was the New England Journal of Medicine(NEJM) article, which was published on March 30, 2025. It was about the risk factors that determine heart disease. We will go into the details of the study. Some critical take from the studies: sit back and get your coffee(sound effects) and find out what's about this study, guiding us into doing simple things that can help us prevent and manage heart health.
Cardiovascular disease is the leading cause of death all around the world. They create significant problems for society, the economy, and public health. The study comprised five main risk factors, High blood pressure, high Cholesterol, Smoking, Obesity, and diabetes, which contribute to more than half the cardiovascular diseases.
The Global Cardiovascular Risk Consortium (GCVRC) aimed to estimate lifetime heart disease risk for both men and women, examining how key risk factors like high blood pressure, diabetes, smoking, cholesterol, and obesity impact life expectancy. The study also compared individuals who have made lifestyle improvements, such as managing their risk factors, with those who haven't, highlighting the benefits of these changes.
South Asian heart disease is the highest in the World. In the previous blog, I listed these populations' essential risk factors for premature heart disease.
The study design combined health data from over 2 million people aged 18 and older from eight different regions around the world: North America, Latin America, Western Europe, Eastern Europe and Russia, North Africa and the Middle East, sub-Saharan Africa, Asia, and Australia. The goal was to study cardiovascular disease conditions like heart attacks and heart-related procedures.
The PURE study (Prospective Urban Rural Epidemiology) found that lifestyle factors like diet, physical activity, and socioeconomic status significantly impact cardiovascular disease (CVD) risk worldwide. It showed that higher intake of fruits, vegetables, and whole grains reduces CVD risk, while refined grains and sugars increase it. Regular physical activity and modest fat intake were linked to better heart health. The study highlighted regional disparities, with low-income countries facing infections and malnutrition, while high-income countries had more obesity and lifestyle-related diseases. It also reinforced the importance of controlling blood pressure, cholesterol, and smoking for reducing heart disease risk globally.
This large observational study analyzed data from 133 cohort studies across 39 countries, involving over 2 million participants. The researchers assessed cardiovascular risk factors—including high blood pressure (systolic ≥130 mm Hg), high cholesterol (non-HDL ≥130 mg/dL), abnormal BMI (underweight <20 or overweight/obese ≥25), diabetes (diagnosed or elevated blood sugar), and smoking (daily or occasional)—at an index age, typically 50. Participants were then grouped by the number of risk factors and followed over time to monitor the development of cardiovascular diseases (like heart attacks, strokes, angina, procedures, and heart-related deaths) and overall mortality. Although it wasn’t a randomized trial, the long-term follow-up and large, globally diverse sample offered strong evidence on how these five key risk factors significantly influence lifetime risk, cardiovascular health, and life expectancy.
1. Systolic Blood Pressure >130 mm Hg
2. NON HDL >130mg/dl
3. Obesity/Overweight ( BMI >25, BMI<20 )
4. Diabetes Mellitus
5. Smoking
The results showed that individuals without these risk factors at age 50 had a lower lifetime risk of CVD (13% for women, 21% for men) compared to those with all risk factors (24% for women, 38% for men).
The results showed that individuals without these risk factors at age 50 had a lower lifetime risk of CVD (13% for women, 21% for men) compared to those with all risk factors (24% for women, 38% for men). Additionally, the absence of these risk factors resulted in more years free from cardiovascular disease and death, with the greatest differences observed for smoking cessation and hypertension control. The study also highlighted regional variations in these lifetime differences, particularly showing the largest benefits in Latin America for CVD and in North America for death reduction. Modifying risk factors between ages 50 and 60, especially hypertension and smoking, was linked to the most significant improvements in life expectancy.
Overall, modifying multiple risk factors, particularly hypertension, contributed to the greatest additional years of life free from cardiovascular disease and death.
Heart disease is the leading cause of mortality all around the globe. This study suggests that 13 % and 21% are at age 50, even without risk factors. This is the observational study, which doesn't give a causal relationship but is given among the most diverse populations worldwide for more than 2 million people actively studied. There are other similar studies, like the inter-heart studies, showing that Hypertension, diabetes, and elevated cholesterol have shown an increased risk for heart disease. The Pure Heart study reinforced the importance of controlling blood pressure, cholesterol, and smoking globally to reduce heart disease risk.
The INTERHEART study was a global, case-control study that aimed to identify the major risk factors for heart disease across diverse populations. It involved over 27,000 participants from 52 countries and focused on understanding how factors like smoking, diet, alcohol, physical activity, and cholesterol levels contribute to heart disease. The study found that nine risk factors—such as hypertension, diabetes, and high cholesterol—accounted for over 90% of the risk for heart attacks worldwide, highlighting the importance of managing these modifiable factors in preventing cardiovascular events.
I have written extensively about preventing heart disease and maintaining optimal health and Longevity attached below.
In summary, the research emphasizes that small steps in lifestyle can reap many benefits, including decreasing cardiovascular risk and overall mortality. Elevated blood pressure appears to be the number one leading cause of heart disease; I would request everyone to keep an eye on their blood pressure and other modifiable risk factors, which can prevent heart disease.
Suman Manchireddy MD, FACP
Internal Medicine,
Leesburg, VA.
Email: Care@ReliantMD.com
Disclaimer: This is for purely informational and educational purposes only. Seek medical advice before starting any testing or treatment regimen. The data presented here has been extensively researched and condensed for a broader audience, and it should be viewed for educational purposes only. The blogger or blog has no affiliation with any pharmaceutical company.
References
1. Global Effect of Cardiovascular Risk Factors on Lifetime Estimates, NEJM 2025
2. Pure Study (Prospective Urban Rural Epidemiology)
3. Interheart study
4. https://spyderdoc.substack.com/p/doctors-heart-series-chapter-9-blueprint
5. https://spyderdoc.substack.com/p/chapter-12-heart-attacks-in-south