Half of the cardiovascular deaths in U.S. adults in 2009 and 2010 were due to modifiable risk factors such as elevated cholesterol, diabetes, hypertension, obesity and smoking, according to a cross-sectional analysis of a large survey.

For men, 54 percent of cardiovascular deaths could be prevented through eliminating all of the risk factors, while 39.6 percent of cardiovascular deaths could be prevented by eliminating components of the metabolic syndrome. For women, the rates were 49.6 percent and 56.5 percent, respectively, according to Shivani A. Patel, PhD, of Emory University in Atlanta, and colleagues, who published their findings online in Annals of Internal Medicine on June 30.

The most important risk factor for cardiovascular mortality was smoking for men and hypertension for women.

Patel and colleagues said that the risk factors correlated across states and could be modified through programs such as tobacco taxation, smoke-free environments and places that promote physical activity.

“I’m not a policy expert, but what I do hope is that this will set a precedent for how we measure these things in the country,” Patel told Cardiovascular Business. “We’ve tried to be really transparent about how we did it. We hope that we can keep on monitoring progress by looking at these things over time.”

In addition to analyzing elimination of all risk factors, the authors also evaluated what would happen if each risk factor could be decreased to the best performing state. Under that scenario, they found they could reduce cardiovascular mortality by up to 5 percent in men and 7 percent in women.

Findings were based on cardiovascular risk factor data from more than 500,000 adults in the BRFSS (Behavioral Risk Factor Surveillance System) from 2009 to 2010. The BRFSS measures state-level health-related risk factors, treatment and outcomes and is conducted by the Centers for Disease Control and Prevention in conjunction with states. They also examined data from NHANES (National Health and Nutrition Examination Survey), which is a sample of adults and children designed to represent the U.S. population.

“A big strength of this study is it’s very generalizable to the national population and state populations because of the data sources we used,” Patel said.

The final evaluation included 2,651 respondents who were between 45 and 79 years old. The researchers defined elevated cholesterol as a total blood cholesterol of 240 mg/dL or higher or use of cholesterol-lowering medications; diabetes as HbA1c of at least 6.5 percent or use of diabetes medications; hypertension as average systolic blood pressure of at least 140 mm Hg, average diastolic blood pressure of at least 90 mm Hg or use of hypertension medications; and obesity as a body mass index of at least 30 kg/m².

Patel and colleagues found that 81.7 percent of men and 80.0 percent of women had at least one cardiovascular risk factor. For men and women, elevated cholesterol and hypertension were the most prevalent risk factors. Although cardiovascular mortality has decreased significantly in the past three decades, the authors noted that cardiovascular disease accounted for more than 780,000 deaths in 2010. They added that the U.S. lags behind other developed countries in cardiovascular mortality, overall mortality and disability levels.

In a state-by-state analysis, the proportion of people with at least one cardiovascular risk factor ranged from 75.7 percent to 86.6 percent.

“That was a bit surprising,” Patel said. “We were expecting that healthier states would be doing much better. It turned out they weren’t that much better off than the worst states.”