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Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)

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dc.contributor.authorYusuf, Salim
dc.contributor.authorJoseph, Philip
dc.contributor.authorRangarajan, Sumathy
dc.contributor.authorIslam, Shofiqul
dc.contributor.authorMente, Andrew
dc.contributor.authorHystad, Perry
dc.contributor.authorBrauer, Michael
dc.contributor.authorRaman Kutty, Vellappillil
dc.contributor.authorGupta, Rajeev
dc.contributor.authorWielgosz, Andreas
dc.contributor.authorAlHabib, Khalid F.
dc.contributor.authorDans, Antonio
dc.contributor.authorLopez-Jaramillo, Patricio
dc.contributor.authorAvezum, Alvaro
dc.contributor.authorLanas, Fernando
dc.contributor.authorOguz, Aytekin
dc.contributor.authorKruger, Iolanthe M.
dc.contributor.authorDiaz, Rafael
dc.contributor.authorYusoff, Khalid
dc.contributor.authorMony, Prem
dc.contributor.authorChifamba, Jephat
dc.contributor.authorYeates, Karen
dc.contributor.authorKelishadi, Roya
dc.contributor.authorYusufali, Afzalhussein
dc.contributor.authorKhatib, Rasha
dc.contributor.authorRahman, Omar
dc.contributor.authorZatonska, Katarzyna
dc.contributor.authorIqbal, Romaina
dc.contributor.authorWei, Li
dc.contributor.authorBo, Hu
dc.contributor.authorRosengren, Annika
dc.contributor.authorKaur, Manmeet
dc.contributor.authorMohan, Viswanathan
dc.contributor.authorLear, Scott A.
dc.contributor.authorTeo, Koon K.
dc.contributor.authorLeong, Darryl
dc.contributor.authorO'Donnell, Martin
dc.contributor.authorMcKee, Martin
dc.contributor.authorDagenais, Gilles
dc.contributor.researchgroupEverestspa
dc.date.accessioned2021-11-23T22:19:58Z
dc.date.available2021-11-23T22:19:58Z
dc.date.issued2019-09-03
dc.descriptionDigitalspa
dc.description.abstractBackground Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels. Methods In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs. Findings Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs. Interpretation Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).spa
dc.description.researchareaCiencias Médicas y de la Saludspa
dc.format.extent14 pspa
dc.format.mimetypeapplication/pdfspa
dc.identifier.doihttps://doi.org/10.1016/S0140-6736(19)32008-2
dc.identifier.urihttps://repositorio.udes.edu.co/handle/001/5726
dc.language.isoengspa
dc.publisherElsevierspa
dc.publisher.placeReino Unidospa
dc.relation.citationendpage808spa
dc.relation.citationissue10226spa
dc.relation.citationstartpage795spa
dc.relation.citationvolume395spa
dc.relation.indexedScopusspa
dc.relation.ispartofjournalThe Lancetspa
dc.rights© 2019 Elsevier Ltd. All rights reserved.spa
dc.rights.accessrightsinfo:eu-repo/semantics/closedAccessspa
dc.rights.creativecommonsAtribución-NoComercial 4.0 Internacional (CC BY-NC 4.0)spa
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/spa
dc.sourcehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32008-2/fulltext#%20spa
dc.titleModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)spa
dc.title.alternativeA a prospective cohort studyspa
dc.typeArtículo de revistaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_6501spa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/articlespa
dc.type.redcolhttp://purl.org/redcol/resource_type/ARTspa
dc.type.versioninfo:eu-repo/semantics/publishedVersionspa
dcterms.audienceTodas las Audienciasspa
dspace.entity.typePublication
oaire.accessrightshttp://purl.org/coar/access_right/c_14cbspa
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85spa
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