Only 14 common but modifiable risk factors such as hypertension and smoking account for more than 70 percent of all cardiovascular disease (CVD) deaths worldwide.

This was the finding of a large international study involving more than 155,000 people in 21 countries, presented Tuesday at the ongoing European Society of Cardiology Congress in France. This eye-opening study was published in the peer-reviewed medical journal, The Lancet.

The study, which followed participants for an average of nine years and a half, found some of the risks are the same around the world. On the other hand, other risks vary by a country's level of economic development.

The 14 modifiable risk factors can be divided into metabolic factors, behavioral factors, psychosocial factors and environmental factors.

Metabolic factors include hypertension, blood lipids and abdominal obesity. Behavioral factors consist of smoking, diet, physical activity, alcohol consumption, salt intake and strength as shown by hand grip.

Psychosocial factors comprise of education and depression. Environmental factors include indoor and outdoor air pollution.

The study found hypertension as the largest factor among the metabolic factors. Low education level was the single largest risk factor while air pollution was the most important community-level risk factor.

"It's clear the majority of cardiovascular disease cases and deaths are accounted for by a small number of common and modifiable risk factors, these could be improved," Philip Joseph, who is among the lead authors of the study, said.

"What is notable is that several risk factors that have a large effect such as strength, low education and indoor and outdoor air pollution have been underappreciated in the past have turned out to be more important than others that we have paid much attention to such as obesity or salt," Joseph added.

The study is a roadmap for global improvements in prevention, according to Salim Yusuf, principal study investigator.

"Health policies should focus on risk factors that have the greatest impact on averting CVD and death globally, with additional emphasis on the risk factors of greatest importance in different countries," Yusuf said.

The study was led by researchers of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences in Hamilton, Canada.

More than 38 researchers from 21 countries are authors of the research paper from the Prospective Urban Rural Epidemiology (PURE) study led by the PHRI.

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