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Title: Cardiovascular risk and events in 17 low-, middle-, and high-income countries
Authors: Yusuf, Salim
Rangarajan, Sumathy
Teo, Koon
Islam, Shofiqul
Li, Wei
Liu, Lisheng
Bo, Jian
Lou, Qinglin
Lu, Fanghong
Liu, Tianlu
Yu, Liu
Zhang, Shiying
Mony, Prem
Swaminathan, Sumathi
Mohan, Viswanathan
Gupta, Rajeev
Kumar, Rajesh
Vijayakumar, Krishnapillai
Lear, Scott A.
Anand, Sonia S.
Wielgosz, Andreas
Diaz, Rafael
Avezum, Alvaro
López Jaramillo, Patricio
Lanas, Fernando
Yusoff, Khalid
Ismail, Noorhassim
Iqbal, Romaina
Rahman, Omar
Rosengren, Annika
Yusufali, Afzalhussein
Kelishadi, Roya
Kruger, Annamarie
Puoane, Thandi
Szuba, Andrzej
Chifamba, Jephat
Oguz, Aytekin
McQueen, Matthew J.
McKee, Martin
Dagenais, Gilles
The PURE (Prospective Urban Rural Epidemiology) Study investigators
Keywords: Cardiovascular
Issue Date: 28-Aug-2014
Abstract: BACKGROUND More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODS We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years. RESULTS The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001). CONCLUSIONS Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.)
Description: 10 p.
ISBN: 1533-4406
ISSN: 0028-4793
Appears in Collections:DCADA. Artículos de Investigación

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