Salim Yusuf1, Sumathy Rangarajan, Koon Teo, Shofiqul Islam, Wei Li, Lisheng Liu, Jian Bo, Qinglin Lou, Fanghong Lu, Tianlu Liu, Liu Yu, Shiying Zhang, Prem Mony, Sumathi Swaminathan, Viswanathan Mohan, Rajeev Gupta, Rajesh Kumar, Krishnapillai Vijayakumar, Scott Lear, Sonia Anand, Andreas Wielgosz, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Khalid Yusoff, Noorhassim Ismail, Romaina Iqbal, Omar Rahman, Annika Rosengren, Afzalhussein Yusufali, Roya Kelishadi, Annamarie Kruger, Thandi Puoane, Andrzej Szuba, Jephat Chifamba, Aytekin Oguz, Matthew McQueen, Martin McKee, Gilles Dagenais. 1. From 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 District, Jiefangxi (S.Z.) - all in China; the Division of Epidemiology and Population Health, St. John's Research Institute, Bangalore (P.M., S.S.), Madras Diabetes Research Foundation, Chennai (V.M.), Fortis Escorts Hospitals, JLN Marg, Jaipur (R.G.), Postgraduate Institute of Medical Education and Research School of Public Health, Chandigarh (R. Kumar), and Health Action by People, Trivandrum, Kerala (K.V.) - all in India; Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina (R.D.); Dante Pazzanese Institute of Cardiology, São Paulo (A.A.); Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Floridablanca-Santander, Colombia (P.L.-J.); Universidad de La Frontera, Temuco, Chile (F. Lanas); Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, and UCSI University Kuala Lumpur, Kuala Lumpur (K.Y.), and the Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur (N.I.) - all in Malay
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.).
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.).
Authors: Tae Jin Lee; Xiaoyi Yuan; Keith Kerr; Ji Young Yoo; Dong H Kim; Balveen Kaur; Holger K Eltzschig Journal: Pharmacol Rev Date: 2020-07 Impact factor: 25.468
Authors: Perry Hystad; Andrew Larkin; Sumathy Rangarajan; Khalid F AlHabib; Álvaro Avezum; Kevser Burcu Tumerdem Calik; Jephat Chifamba; Antonio Dans; Rafael Diaz; Johan L du Plessis; Rajeev Gupta; Romaina Iqbal; Rasha Khatib; Roya Kelishadi; Fernando Lanas; Zhiguang Liu; Patricio Lopez-Jaramillo; Sanjeev Nair; Paul Poirier; Omar Rahman; Annika Rosengren; Hany Swidan; Lap Ah Tse; Li Wei; Andreas Wielgosz; Karen Yeates; Khalid Yusoff; Tomasz Zatoński; Rick Burnett; Salim Yusuf; Michael Brauer Journal: Lancet Planet Health Date: 2020-06
Authors: R Bijker; A Jiamsakul; E Uy; N Kumarasamy; R Ditango; R Chaiwarith; W W Wong; A Avihingsanon; L P Sun; E Yunihastuti; S Pujari; C D Do; T P Merati; P Kantipong; K V Nguyen; A Kamarulzaman; F Zhang; M P Lee; J Y Choi; J Tanuma; O T Ng; Blh Sim; J Ross; S Kiertiburanakul Journal: HIV Med Date: 2019-01-08 Impact factor: 3.180
Authors: Miguel Cainzos-Achirica; Ugo Fedeli; Naveed Sattar; Charles Agyemang; Anne K Jenum; John W McEvoy; Jack D Murphy; Carlos Brotons; Roberto Elosua; Usama Bilal; Alka M Kanaya; Namratha R Kandula; Pablo Martinez-Amezcua; Josep Comin-Colet; Xavier Pinto Journal: Atherosclerosis Date: 2019-05-16 Impact factor: 5.162
Authors: Mayowa O Owolabi; Onoja M Akpa; Felix Made; Sally N Adebamowo; Akinlolu Ojo; Dwomoa Adu; Ayesha A Motala; Bongani M Mayosi; Bruce Ovbiagele; Clement Adebamowo; Bamidele Tayo; Charles Rotimi; Rufus Akinyemi; Mulugeta Gebregziabher; Fred Sarfo; Kolawole W Wahab; Rulan S Parekh; Mark E Engel; Chisala Chisala; Emmanuel Peprah; George Mensah; Ken Wiley; Jennifer Troyer; Michèle Ramsay Journal: Int J Epidemiol Date: 2019-04-01 Impact factor: 7.196
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690