Examinando por Autor "Iype, Thomas"

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  • Publicación
    Acceso abierto
    Contrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143,567 individuals in 21 countries in the pure study
    (American Diabetes Association, 2020-10-15) Mohan Anjana, Ranjit; Mohan, Viswanathan; Rangarajan, Sumathy; Gerstein, Hertzel C.; Venkatesan, Ulagamadesan; Sheridan, Patrick; Dagenais, Gilles R.; Lear, Scott A.; Teo, Koon; Karsidag, Kubilay; Alhabib, Khalid F.; Yusoff, Khalid; Ismail, Noorhassim; Mony, Prem; Lopez-Jaramillo, Patricio; Chifamba, Jephat; Palileo-Villanueva, Lia M.; Iqbal, Romaina; Yusufali, Afzalhussein; Kruger, Iolanthe M.; Rosengren, Annika; Bahonar, Ahmad; Zatonska, Katarzyna; Yeates, Karen; Gupta, Rajeev; Li, Wei; Hu, Lihua; Rahman, M. Omar; Lakshmi, P.V.M.; Iype, Thomas; Avezum, Alvaro; Diaz, Rafael; Lanas, Fernando; Yusuf, Salim; Masira
    OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 6 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 personyears, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 personyears, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
  • Publicación
    Acceso abierto
    Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals
    (Oxford Academic, 2021-06-05) Joseph, Philip; Healey, Jeffrey S.; Raina, Parminder; Connolly, Stuart J.; Ibrahim, Quazi; Gupta, Rajeev; Avezum, Alvaro; Dans, Antonio; Lopez-Jaramillo, Patricio; Yeates, Karen; Teo, Koon; Douma, Reuben; Bahonar, Ahmad; Chifamba, Jephat; Lanas, Fernando; Dagenais, Gilles R.; Lear, Scott; Kumar, Rajesh; Kengne, Andre P.; Keskinler, Mirac; Mohan, Viswanathan; Mony, Prem; Alhabib, Khalid F.; Huisman, Hugo; Iype, Thomas; Zatonska, Katarzyna; Ismail, Rosnah; Kazmi, Khawar; Rosengren, Annika; Rahman, Omar; Yusufali, Afzalhussein; Wei, Li; Orlandini, Andres; Islam, Shofiqul; Rangarajan, Sumathy; Yusuf, Salim; The PURE Investigators; Masira
    Aims To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results Baseline ECGs were collected in 153 152 middle-aged participants (ages 35–70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270–360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30–60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49–3.52] and death (HR 2.97; 95% CI 2.25–3.93); with similar rates in different countries grouped by income level. Conclusions Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.