Harvard Heart Letter – To live a long life free of heart disease, what habits or conditions matter the most?
According to a major global study, smoking and high blood pressure stand out as the two most important factors driving the risk of developing heart disease.
Together with high cholesterol, excess weight (or being underweight), and diabetes, these five factors account for about 50% of the burden of cardiovascular disease, the leading cause of death worldwide. (Burden refers to all the negative effects — illness, deaths, as well as social and economic costs).
The analysis, published March 30, 2025, in The New England Journal of Medicine, combined data from more than two million people in 39 countries on six continents.
Researchers estimated their lifetime risk of cardiovascular disease and death from any cause up to 90 years of age, based on whether they had or did not have each of the five factors.
Compared to people with all five risk factors at age 50, those who had none of the factors were far less likely to develop cardiovascular disease or die early.
On average, women with none of the risks at midlife lived 13 more years without heart disease, while men lived an additional 11 years. As for overall survival, women without the five risks lived about 14½ years longer, while men gained nearly 12 extra years.
Risk management strategies
All five factors tend to occur together, notes Dr. Eric Rimm, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.
“People with high blood pressure and high cholesterol often have obesity as well, which is why their added risk of heart disease is not surprising,” he says. Apart from smoking (currently a habit among fewer than 9% of Americans age 65 and older), all of the other factors tend to become more prevalent as people age …
