Статья

Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries

Salim YusufFrom the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., S.R., K.T., S.I., S.A., M. McQueen), Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC (S.L.), the Department of Medicine, University of Ottawa, Ottawa, ON (A.W.), and Laval University Heart and Lungs Institute, Quebec City, QC (G.D.) - all in Canada; the National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing (W.L., L.L., J.B.), Jiangsu Province Institute of Geriatrics, Jiangsu Province, Nanjing City (Q.L.), Shandong Province Academy of Medical Science, Shandong Province, Jinan City (F. Lu), Xi'an Electronic Technology University Hospital, Shanxi Province, Xi'an City (T.L.), Shenyang City 242 Hospital, Liaoning Province, Shenyang City, Huanggu District (L.Y.), Bayannaoer Center for Disease Control and Prevention, Inner Mongolia, Bayannaoer City, Linhe DSumathy RangarajanMcMaster UniversityKoon TeoPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Shofiqul IslamPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Wei LiPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Lisheng LiuPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Jian BoPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Qinglin LouPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Fanghong LuPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Tianlu LiuPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Yü LiuPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Shiying ZhangPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Prem MonyPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Sumathi SwaminathanPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Viswanathan MohanPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Rajeev GuptaPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Rajesh KumarPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Krishnapillai VijayakumarPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Scott A. LearPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Sonia S. AnandPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Andreas WielgoszPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Rafael DíazPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Álvaro AvezumPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Patricio López‐JaramilloPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Fernando LaņasPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Khalid YusoffPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Noor Hassim IsmailPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Romaina IqbalPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Omar RahmanPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Annika RosengrenPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Afzalhussein YusufaliPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Roya KelishadiPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Annamarie KrugerPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Thandi PuoanePopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Andrzej SzubaPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Jephat ChifambaPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Aytekin OğuzPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Matthew McQueenPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Martin McKeePopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,Gilles R. DagenaisPopulation Health Re-search Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada,

2014en

ABI

Аннотация

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.).

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DOI: 10.1056/nejmoa1311890

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