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N Engl J Med. 2014 Aug 28;371(9):818-27. doi: 10.1056/NEJMoa1311890.

Cardiovascular risk and events in 17 low-, middle-, and high-income countries.

Collaborators (371)

Yusuf S, Rangarajan S, Teo KK, Chow CK, O'Donnell M, Mente A, Leong D, Smyth A, Joseph P, Islam S, Zhang M, Hu W, Wong G, Manandhar N, Dehghan M, Royerr M, DeJesus J, Lewis G, Mackie P, Farago L, Kay I, Agapay D, Solano R, Ramacham S, Kandy N, Rimac J, Trottier S, ElSheikh W, Mustaha M, Tongana T, Aoucheva N, Swallow J, Ramezani E, Lindeman J, McQueen M, Hall K, Keys J, Wang X, Keneth J, Devanath A, Diaz R, Orlandini A, Linetsky B, Toscanelli S, Casaccia G, Cuneo JM, Rahman O, Yusuf R, Azad AK, Rabbani KA, Cherry HM, Mannan A, Hassan I, Talukdar AT, Tooheen RB, Khan MU, Sintaha M, Choudhury T, Haque R, Parvin S, Avezum A, Oliveira GB, Marcilio CS, Mattos AC, Teo K, Yusuf S, Dejesus J, Agapay D, Tongana T, Solano R, Kay I, Trottier S, Rimac J, Elsheikh W, Heldman L, Ramezani E, Dagenais G, Poirier P, Turbide G, Auger D, De Bluts AL, Proulx MC, Cayer M, Bonneville N, Lear S, Gasevic D, Corber E, de Jong V, Vukmirovich I, Wielgosz A, Fodor G, Pipe A, Shane A, Lanas F, Seron P, Martinez S, Valdebenito A, Oliveros M, Li W, Liu L, Chen C, Wang X, Zhao W, Zhang H, JiaXuan, Hu B, Sun Y, Bo J, Zhao X, Chang X, Chen T, Chen H, Chang X, Deng Q, Cheng X, Deng Q, He X, Hu B, JiaXuan, Li J, Li J, Liu X, Ren B, Sun Y, Wang W, Wang Y, Yang J, Zhai Y, Zhang H, Zhao X, Zhu M, Lu F, Wu J, Li Y, Hou Y, Zhang L, Guo B, Liao X, Zhang S, BianRongwen, TianXiuzhen, Li D, Chen D, Wu J, Xiao Y, Liu T, Zhang P, Dong C, Li N, Ma X, Yang Y, Lei R, Fu M, He J, Liu Y, Xing X, Zhou Q, Lopez-Jaramillo P, Lopez PA, Garcia R, Jurado LJ, Gómez-Arbeláez D, Arguello JF, Dueñas R, Silva S, Pradilla LP, Ramirez F, Molina DI, Cure-Cure C, Perez M, Hernandez E, Arcos E, Fernandez S, Narvaez C, Paez J, Sotomayor A, Garcia H, Sanchez G, David T, Rico A, Mony P, Vaz M, Bharathi AV, Swaminathan S, Shankar K, Kurpad AV, Jayachitra KG, Kumar N, Hospital HA, Mohan V, Deepa M, Parthiban K, Anitha M, Hemavathy S, Rahulashankiruthiyayan T, Anitha D, Sridevi K, Gupta R, Panwar RB, Mohan I, Rastogi P, Rastogi S, Bhargava R, Kumar R, Thakur JS, Patro B, Lakshmi PV, Mahajan R, Chaudary P, Kutty VR, Vijayakumar K, Ajayan K, Rajasree G, Renjini AR, Deepu A, Sandhya B, Asha S, Soumya HS, Kelishadi R, Bahonar A, Mohammadifard N, Heidari H, Yusoff K, Ismail TS, Ng KK, Devi A, Nasir NM, Yasin MM, Miskan M, Rahman EA, Arsad MK, Ariffin F, Razak SA, Majid FA, Bakar NA, Yacob MY, Zainon N, Salleh R, Ramli MK, Halim NA, Norlizan SR, Ghazali NM, Arshad MN, Razali R, Ali S, Othman HR, Hafar CW, Pit A, Danuri N, Basir F, Zahari SN, Abdullah H, Arippin MA, Zakaria NA, Noorhassim I, Hasni MJ, Azmi MT, Zaleha MI, Hazdi KY, Rizam AR, Sazman W, Azman A, Khatib R, Khammash U, Giacaman R, Husseini A, Abu-Diab K, Warrad M, Iqbal R, Afridi A, Khawaja R, Raza A, Kazmi K, Zatonski W, Szuba A, Zatonska K, Ilow R, Ferus M, Regulska-Ilow B, Różańska D, Wolyniec M, Kruger A, Voster HH, Schutte AE, Wentzel-Viljoen E, Eloff FC, de Ridder H, Moss H, Potgieter J, Roux AA, Watson M, de Wet G, Olckers A, Jerling JC, Pieters M, Hoekstra T, Puoane T, Igumbor E, Tsolekile L, Sanders D, Naidoo P, Steyn N, Peer N, Mayosi B, Rayner B, Lambert V, Levitt N, Kolbe-Alexander T, Ntyintyane L, Hughes G, Swart R, Fourie J, Muzigaba M, Xapa S, Gobile N, Ndayi K, Jwili B, Ndibaza K, Egbujie B, Rosengren A, Boström KB, Lindblad U, Langkilde P, Gustavsson A, Andreasson M, Snällman M, Wirdemann L, Pettersson K, Moberg E, Oguz A, Akalin AA, Calik KB, Imeryuz N, Temizhan A, Alphan E, Gunes E, Sur H, Karsidag K, Gulec S, Altuntas Y, Yusufali AM, Almahmeed W, Swidan H, Darwish EA, Hashemi AR, Al-Khaja N, Muscat-Baron JM, Ahmed SH, Mamdouh TM, Darwish WM, Abdelmotagali MH, Awed SA, Movahedi GA, Hussain F, Al Shaibani H, Gharabou RI, Youssef DF, Nawati AZ, Abu Salah ZA, Abdalla RF, Al Shuwaihi SM, Al Omairi MA, Cadigal OD, Alejandrino RS, Chifamba J, Gwaunza L, Terera G, Mahachi C, Mrambiwa P, Machiweni T, Mapanga R.

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.).

PMID:
25162888
[PubMed - indexed for MEDLINE]
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