Effect of modifiable risk factors on cardiovascular and cancer mortality across European and Asian regions: a multicohort study

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.

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The Lancet Regional Health - Europe
Published
2026-11-09
DOI
https://doi.org/10.1016/j.lanepe.2026.101918
Primary Topic
Cardiovascular Health and Risk Factors
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article
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article

Effect of modifiable risk factors on cardiovascular and cancer mortality across European and Asian regions: a multicohort study

Концевая Анна Васильевна, Ben Schöttker, Farzad Hadaegh, H Brenner et al.
The Lancet Regional Health - Europe
Cardiovascular Health and Risk Factors
article

Effect of modifiable risk factors on cardiovascular and cancer mortality across European and Asian regions: a multicohort study

Концевая Анна Васильевна, Ben Schöttker, Farzad Hadaegh, H Brenner, Gunnar Engström, Raphael Twerenbold, Peter M. Nilsson, Christina Magnussen, Yariv Gerber, Uri Goldbourt, Simona Costanzo, Stefan Blankenberg, Arokiasamy Perianayagam, Dirk De Bacquer, Kristian Hveem, Licia Iacoviello, Thiess Lorenz, Chean Lin Chong, Stephan J. L. Bakker, Robin P. F. Dullaart, Stefan Groß, Satoko Sakata, Lubna A. Alnasser, Hossein Poustchi, Hossein Molavi Vardanjani, Sok King Ong, Bamba Gaye, Francisco Ojeda, Andrzej Pająk, Torbjørn Omland, Yoichiro Otaki, Sadaf Ghajarieh Sepanlou, Darryl P. Leong, Martin Bobák, Magnus Nakrem Lyngbakken, Gorm Boje Jensen, Fereidoun Azizi, Manami Inoue, Olle Melander, Toshiharu Ninomiya, Eva Prescott, Giovanni de Gaetano, Pasquale Maffia, Till Ittermann, Davood Khalili, Mohamed B. Jalloh, Masafumi Watanabe, JOHANN ALEXANDRE CHAFA EDJIMBI, Paolo Boffetta, Reza Malekzadeh, Victoria Gauthier, Julia Munzinger, Elisa Grossmann, Philippe Amouyel, Sanjib Kumar Sharma, Linlin Guo, Tetsu Watanabe, Mahshid Ghasempour Moghaddam, Marie Neumann
article en

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.

The Lancet Regional Health - EuropeVol. 72
Yamagata University (JP), University of Insubria (IT), Jagiellonian University (PL), University Medical Center Groningen (NL), Kyushu University (JP), Inserm (FR), Universität Hamburg (DE), Tel Aviv University (IL), University of Groningen (NL), German Cancer Research Center (DE), University of Oslo (NO), King Saud bin Abdulaziz University for Health Sciences (SA), Lund University (SE), Universiti Brunei Darussalam (BN), Shiraz University of Medical Sciences (IR), Université Paris Cité (FR), Norwegian University of Science and Technology (NO), Masaryk University (CZ), Heidelberg University (DE), Université de Lille (FR), Universitätsmedizin Greifswald (DE), Akershus University Hospital (NO), Institut Pasteur de Lille (FR), Bispebjerg Hospital (DK), Istituto Neurologico Mediterraneo (IT), Ghent University (BE), Universität Greifswald (DE), University of Oxford (GB), King Abdullah International Medical Research Center (SA), St Olav's University Hospital (NO), Research Institute for Endocrine Sciences (IR), Shariati Hospital (IR), University Medical Center Hamburg-Eppendorf (DE), National Research Center for Preventive Medicine (RU), RECETOX (CZ), German Centre for Cardiovascular Research (DE), Paris Cardiovascular Research Center (FR), LUM Jean Monnet University (IT), Yamagata University Hospital (JP), Approches épidémiologiques et moléculaires intégratives visant à améliorer la compréhension des maladies chroniques liées au vieillissement (FR), Digestive Disease Research Institute (IR), National Cancer Center Institute for Cancer Control (JP), University College London (GB), Shahid Beheshti University (IR), Shahid Beheshti University of Medical Sciences (IR), Stony Brook University (US), Qatar University (QA), B.P. Koirala Institute of Health Sciences (NP), Tehran University of Medical Sciences (IR), University of Naples Federico II (IT), University of Glasgow (GB), University of Bologna (IT), McMaster University (CA)
Cardiovascular Health and Risk Factors
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