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Cited by 305Cardiovascular Health and Risk FactorsHealth and Lifestyle StudiesCardiac Health and Mental Health

Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income Countries: The Prospective Urban Rural Epidemiology (PURE) Study

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Teo, Koon, Lear, Scott, Islam, Shofiqul, Mony, Prem, Dehghan, Mahshid, Li, Wei, Rosengren, Annika, Lopez-Jaramillo, Patricio +18 more·2013·JAMA
DOI 10.1001/jama.2013.3519
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Abstract

IMPORTANCE: Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide. OBJECTIVE: To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event. DESIGN, SETTING, AND PARTICIPANTS: Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153,996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009. MAIN OUTCOME MEASURES: Smoking status (current, former, never), level of exercise (low, <600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, >3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index). RESULTS: Among 7519 individuals with self-reported CHD (past event: median, 5.0 [interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median, 4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke; only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work- or leisure-related physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets; 14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI, 50.7%-54.3%) quit smoking (by income country classification: 74.9% [95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6% [95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%-57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%-68.7%). CONCLUSION AND RELEVANCE: Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries.

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Authors
Teo, K., Lear, S., Islam, S., Mony, P., Dehghan, M., Li, W., Rosengren, A., Lopez-Jaramillo, P., Diaz, R., Oliveira, G., Miskan, M., Rangarajan, S., Iqbal, R., Ilow, R., Puone, T., Bahonar, A., Gulec, S., Darwish, E. A., Lanas, F., Vijaykumar, K., Rahman, O., Chifamba, J., Hou, Y., Li, N., Yusuf, S., & PURE Investigators, O. B. O. T.
Affiliations
Hamilton General Hospital (CA)
Corresponding author
Teo, Koon
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2013-04-17
Volume
309
Issue
15
Pages
1613
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2013.3519
OpenAlex
W2160440586
Cited by
305
References
23
Citations by year
2026: 7 · 2025: 18 · 2024: 18 · 2023: 20 · 2022: 17 · 2021: 22 · 2020: 11 · 2019: 25 · 2018: 28 · 2017: 26 · 2016: 34 · 2015: 32 · 2014: 27 · 2013: 18 · 2012: 1
FWCI
25.26
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
  • UWC Research Repository (University of the Western Cape) (submittedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
healthy lifestyle behaviors, cardiovascular disease, coronary artery disease, stroke, smoking cessation, physical activity, healthy eating, Alternative Healthy Eating Index, income level
MeSH terms
Adult, Aged, Cardiovascular Diseases, Developing Countries, Diet, Female, Humans, Income, Life Style, Male, Middle Aged, Prospective Studies, Urban Population, Health Behavior, Exercise, Prevalence, Smoking Cessation, Developed Countries, Stroke

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