Premature Cardiovascular Death and its Modifiable Risk Factors: Protocol of a Systematic Review and Meta-Analysis

IntroductionThe burden of cardiovascular disease (CVDs), in the number of premature deaths, continues to increase globally and alarmingly, especially in almost all countries outside high-income countries. An accurate estimate of premature CVD death is of crucial importance for planning, implementing, and evaluating cardiovascular prevention and care interventions. However, existing literature reported the evidence on premature CVD death from selected regions, and there has been less evidence of systematic review with meta-analysis estimating the global premature death. This paper reports the protocol for a systematic review and meta-analysis to derive solid and updated estimates on global and setting-specific premature CVD death prevalence and its associated risk factors. Methods and analysisPUBMED, EMBASE, Web of Science, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) will be used as the literature database. Retrieved records will be independently screened by two authors and relevant data will be extracted from studies that report data on premature mortality (death before the age of 70 years) related to CVD. Study selection and reporting will follow the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline. Pooled estimates of premature CVD mortality (based on standardised mortality ratio and years of life lost) and the effect size of modifiable risk factors will be computed applying random-effects meta-analysis. Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Depending on data availability, we propose to conduct subgroup analyses by geographical area, CVD events, and socio-demographic variables of interest study. The risk of bias for the studies included in the systematic review or meta-analysis will be assessed by the Newcastle-Ottawa Quality Assessment Scale. Ethics and disseminationEthics approval is not required as the data used in this systematic review will be extracted from published studies. The systematic review will focus on the premature CVD mortality rate and its associated factors. The findings of the final report will be disseminated to the scientific community through publication in a peer-reviewed journal and presentation at conferences. PROSPERO registration numberCRD42021288415