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Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries
Open accessAbstract
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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“Data from the international Prospective Urban and Rural Epidemiological Study (PURE; 138,926 individuals in 628 communities 17 countries) suggest a need to consider the context and availability of specific foods before making food choice recommendations (114).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [114]
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Metadata
- Authors
- Yusuf, S., Rangarajan, S., Teo, K., Islam, S., Li, W., Liu, L., Bo, J., Lou, Q., Lu, F., Liu, T., Yu, L., Zhang, S., Mony, P., Swaminathan, S., Mohan, V., Gupta, R., Kumar, R., Vijayakumar, K., Lear, S., Anand, S., Wielgosz, A., Diaz, R., Avezum, A., Lopez-Jaramillo, P., Lanas, F., Yusoff, K., Ismail, N., Iqbal, R., Rahman, O., Rosengren, A., Yusufali, A., Kelishadi, R., Kruger, A., Puoane, T., Szuba, A., Chifamba, J., Oguz, A., McQueen, M., McKee, M., & Dagenais, G.
- Affiliations
- University of Ottawa (CA)
- Population Health Research Institute (CA)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Shandong First Medical University (CN)
- St. John's Research Institute (IN)
- Madras Diabetes Research Foundation (IN)
- Fortis Escorts Hospital (IN)
- Post Graduate Institute of Medical Education and Research (IN)
- Health Action by People (IN)
- Simon Fraser University (CA)
- Universidad de La Frontera (CL)
- UCSI University (MY)
- Aga Khan University (PK)
- Independent University, Bangladesh (BD)
- University of Gothenburg (SE)
- Dubai Health Authority (AE)
- Isfahan University of Medical Sciences (IR)
- North-West University (ZA)
- University of the Western Cape (ZA)
- Wroclaw Medical University (PL)
- University of Zimbabwe (ZW)
- London School of Hygiene & Tropical Medicine (GB)
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- ORCID
- Yusuf, Salim
- Rangarajan, Sumathy
- Teo, Koon
- Islam, Shofiqul
- Li, Wei
- Liu, Lisheng
- Liu, Tianlu
- Mony, Prem
- Swaminathan, Sumathi
- Mohan, Viswanathan
- Gupta, Rajeev
- Kumar, Rajesh
- Lear, Scott
- Anand, Sonia
- Wielgosz, Andreas
- Lanas, Fernando
- Yusoff, Khalid
- Iqbal, Romaina
- Rahman, Omar
- Rosengren, Annika
- Yusufali, Afzalhussein
- Kelishadi, Roya
- Puoane, Thandi
- Szuba, Andrzej
- Chifamba, Jephat
- McKee, Martin
- Dagenais, Gilles
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-08-28
- Volume
- 371
- Issue
- 9
- Pages
- 818-827
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2151739272
- Cited by
- 983
- References
- 17
- Citations by year
- 2026: 48 · 2025: 64 · 2024: 123 · 2023: 84 · 2022: 73 · 2021: 87 · 2020: 109 · 2019: 78 · 2018: 75 · 2017: 79 · 2016: 80 · 2015: 70 · 2014: 12
- FWCI
- 55.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Repositorio Universidad de Santander (submittedVersion, cc-by-nc)
- Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
- Boloka Institutional Repository (North-west University) (submittedVersion)
- 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 › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- cardiovascular disease, cardiovascular risk, risk factor burden, low-income countries, middle-income countries, high-income countries, cardiovascular mortality, myocardial infarction, stroke, heart failure, case fatality, urban-rural differences, revascularization, global health disparities
- MeSH terms
- Cardiovascular Diseases, Female, Humans, Income, Male, Middle Aged, Risk Factors, Rural Health, Urban Health, Global Health, Risk Assessment
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