Rodrigo M Carrillo-Larco1, J Jaime Miranda2, Xian Li3, Chendi Cui4, Xiaolin Xu5, Mohammed Ali6, Dewan S Alam7, Thomas A Gaziano8, Rajeev Gupta9, Vilma Irazola10, Naomi S Levitt11, Dorairaj Prabhakaran12, Adolfo Rubinstein10, Krisela Steyn13, Nikhil Tandon6, Denis Xavier14, Yangfeng Wu15, Lijing L Yan16. 1. CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. 2. CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. 3. The George Institute for Global Health at Peking University Health Science Center, Haidian District, Beijing, China. 4. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. 5. Global Heath Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China. 6. Centre for Chronic Disease Control, Gurgaon, Haryana, India. 7. Centre for Control of Chronic Diseases, International Centre for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh. 8. Brigham and Women's Hospital, Harvard School of Public Health, Harvard University, Cambridge, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. 9. Fortis Escorts Hospital, Jaipur, India; Academic and Research Unit, Rajasthan University of Health Sciences, Jaipur, India. 10. Centro de Excelencia en Salud Cardiovascular para el Cono Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. 11. Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 12. Centre for Chronic Disease Control, Gurgaon, Haryana, India; Public Health Foundation of India, Gurgaon, Haryana, India. 13. Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 14. St. John's Medical College and Research Institute, Koramangala Post, Bangalore, India. 15. The George Institute for Global Health at Peking University Health Science Center, Haidian District, Beijing, China; Peking University School of Public Health and Clinical Research Institute, Haidian District, Beijing, China. Electronic address: ywu@george.org.cn. 16. The George Institute for Global Health at Peking University Health Science Center, Haidian District, Beijing, China; Global Heath Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China. Electronic address: lijing.yan@duke.edu.
Abstract
BACKGROUND: Currently available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMIC). There is a need to assess HCR using a pragmatic evidence-based approach. OBJECTIVES: This study sought to report the prevalence of HCR in 10 LMIC areas in Africa, Asia, and South America and to investigate the profiles and correlates of HCR. METHODS: Cross-sectional analysis using data from the National Heart, Lung, and Blood Institute-UnitedHealth Group Centers of Excellence. HCR was defined as history of heart disease/heart attack, history of stroke, older age (≥50 years for men and ≥60 for women) with history of diabetes, or older age with systolic blood pressure ≥160 mm Hg. Prevalence estimates were standardized to the World Health Organization's World Standard Population. RESULTS: A total of 37,067 subjects ages ≥35 years were included; 53.7% were women and mean age was 53.5 ± 12.1 years. The overall age-standardized prevalence of HCR was 15.4% (95% confidence interval: 15.0% to 15.7%), ranging from 8.3% (India, Bangalore) to 23.4% (Bangladesh). Among men, the prevalence was 1.7% for the younger age group (35 to 49 years) and 29.1% for the older group (≥50); among women, 3.8% for the younger group (35 to 59 years) and 40.7% for the older group (≥60). Among the older group, measured systolic blood pressure ≥160 mm Hg (with or without other conditions) was the most common criterion for having HCR, followed by diabetes. The proportion of having met more than 1 criterion was nearly 20%. Age, education, and body mass index were significantly associated with HCR. Cross-site differences existed and were attenuated after adjusting for age, sex, education, smoking, and body mass index. CONCLUSIONS: The prevalence of HCR in 10 LMIC areas was generally high. This study provides a starting point to define targeted populations that may benefit from interventions combining both primary and secondary prevention strategies.
BACKGROUND: Currently available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMIC). There is a need to assess HCR using a pragmatic evidence-based approach. OBJECTIVES: This study sought to report the prevalence of HCR in 10 LMIC areas in Africa, Asia, and South America and to investigate the profiles and correlates of HCR. METHODS: Cross-sectional analysis using data from the National Heart, Lung, and Blood Institute-UnitedHealth Group Centers of Excellence. HCR was defined as history of heart disease/heart attack, history of stroke, older age (≥50 years for men and ≥60 for women) with history of diabetes, or older age with systolic blood pressure ≥160 mm Hg. Prevalence estimates were standardized to the World Health Organization's World Standard Population. RESULTS: A total of 37,067 subjects ages ≥35 years were included; 53.7% were women and mean age was 53.5 ± 12.1 years. The overall age-standardized prevalence of HCR was 15.4% (95% confidence interval: 15.0% to 15.7%), ranging from 8.3% (India, Bangalore) to 23.4% (Bangladesh). Among men, the prevalence was 1.7% for the younger age group (35 to 49 years) and 29.1% for the older group (≥50); among women, 3.8% for the younger group (35 to 59 years) and 40.7% for the older group (≥60). Among the older group, measured systolic blood pressure ≥160 mm Hg (with or without other conditions) was the most common criterion for having HCR, followed by diabetes. The proportion of having met more than 1 criterion was nearly 20%. Age, education, and body mass index were significantly associated with HCR. Cross-site differences existed and were attenuated after adjusting for age, sex, education, smoking, and body mass index. CONCLUSIONS: The prevalence of HCR in 10 LMIC areas was generally high. This study provides a starting point to define targeted populations that may benefit from interventions combining both primary and secondary prevention strategies.
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