Effect of modifiable risk factors on cardiovascular and cancer mortality across European and Asian regions: a multicohort study
Year: 2026
Type: article
Abstract: Background Cardiovascular disease and cancer are the leading causes of death worldwide, and a substantial proportion of mortality is attributable to modifiable risk factors. This study aimed to assess the associations of modifiable risk factors with cardiovascular and cancer mortality across European and Asian populations. Methods We analysed harmonized data from 798,867 adults in 25 cohorts across Europe, Western Asia and North Africa, and Central, East and South Asia, using two-stage random-effects individual-participant-data meta-analysis Cox and Weibull models to estimate hazard ratios and population-attributable fractions (PAFs). PAFs were estimated for each individual risk factor and jointly for all risk factors. Risk factors included body mass index, systolic blood pressure, non–HDL cholesterol, current smoking, and diabetes. The main outcomes were 10-year risks for cardiovascular and cancer mortality. Findings During a median follow-up of 8.2 years, 12,429 cardiovascular and 19,674 cancer deaths occurred. Deaths per 1000 person-years were higher among men for cardiovascular mortality (2.4, 95% CI 2.3–2.4) than women (1.4, 95% CI 1.4–1.5), as was cancer mortality (for men 3.6, 95% CI 3.5–3.7; for women 2.3, 95% CI 2.4–2.5). Joint PAFs were larger for cardiovascular than cancer mortality for women (52.3%, 95% CI 41.9–62.7, vs. 16.3%, 6.0–26.6) and men (44.4%, 95% CI 33.8–54.9, vs. 29.3%, 20.0–38.7) across regions. Systolic blood pressure and diabetes contributed most to cardiovascular mortality, while smoking was the main driver of cancer mortality, particularly in men. For cardiovascular mortality, joint PAFs were lowest in European men (37.5%, 95% CI 24.1–50.9) and highest in Western Asian and North African women (61.0%, 95% CI 51.7–70.3). For cancer mortality, joint PAFs were lowest in European women (14.7%, 95% CI 3.8–25.6) and highest in Central, East and South Asian men (34.5%, 95% CI 25.7–43.3). Interpretation Modifiable risk factors accounted for a larger proportion of cardiovascular than cancer deaths, with variations by sex and region. Prioritizing interventions for blood pressure, diabetes, and tobacco cessation could reduce mortality and improve region-specific prevention. Funding None.
Authors: Mahshid Ghasempour Moghaddam, Elisa Großmann, Linlin Guo, Davood Khalili, Marie Neumann, Tetsu Watanabe, Thiess Lorenz, Bamba Gaye, Lubna A. Alnasser, Philippe Amouyel, Fereidoun Azizi, Dirk De Bacquer, Stephan J.L. Bakker, Martin Bobak, Paolo Boffetta, Hermann Brenner, Chean Lin Chong, Simona Costanzo, Giovanni de Gaetano, Robin P.F. Dullaart, Johann A.C. Edjimbi, Gunnar Engström, Victoria Gauthier, Yariv Gerber, Uri Goldbourt, Stefan Groß, Farzad Hadaegh, Kristian Hveem, Licia Iacoviello, Manami Inoue, Till Ittermann, Mohamed B. Jalloh, Gorm Boje Jensen, Anna Kontsevaya, Magnus Nakrem Lyngbakken, Darryl P. Leong, Pasquale Maffia, Reza Malekzadeh, Olle Melander, Hossein Molavi Vardanjani, Julia Munzinger, Toshiharu Ninomiya, Torbjørn Omland, Sok King Ong, Yoichiro Otaki, Andrzej Pająk, Arokiasamy Perianayagam, Peter M. Nilsson, Hossein Poustchi, Eva Prescott, Satoko Sakata, Ben Schöttker, Sadaf G. Sepanlou, Sanjib Kumar Sharma, Raphael Twerenbold, Masafumi Watanabe, Stefan Blankenberg, Francisco M. Ojeda, Christina Magnussen
Institutions: Universität Hamburg, University Medical Center Hamburg-Eppendorf, German Centre for Cardiovascular Research, Inserm, Université Paris Cité, University of Oxford, Paris Cardiovascular Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Université de Lille, Institut Pasteur de Lille, Approches épidémiologiques et moléculaires intégratives visant à améliorer la compréhension des maladies chroniques liées au vieillissement, Research Institute for Endocrine Sciences, Shahid Beheshti University, Shahid Beheshti University of Medical Sciences, Ghent University, University Medical Center Groningen, University of Groningen, Masaryk University, RECETOX, University College London, Stony Brook University, University of Bologna, German Cancer Research Center, Heidelberg University, Universiti Brunei Darussalam, University of Insubria, Istituto Neurologico Mediterraneo, Lund University, Tel Aviv University, Universitätsmedizin Greifswald, Universität Greifswald, Norwegian University of Science and Technology, St Olav's University Hospital, LUM Jean Monnet University, National Cancer Center Institute for Cancer Control, Bispebjerg Hospital, National Research Center for Preventive Medicine, University of Oslo, Akershus University Hospital, McMaster University, University of Naples Federico II, University of Glasgow, Shariati Hospital, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shiraz University of Medical Sciences, Kyushu University, Yamagata University, Yamagata University Hospital, Jagiellonian University, Qatar University, B.P. Koirala Institute of Health Sciences
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,930
OpenAlex ID: W7225613686