Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
Background Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar meth...
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Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Everest 2021-11-23T22:19:58Z 2021-11-23T22:19:58Z 2019-09-03 Digital Background Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels. Methods In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs. Findings Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs. Interpretation Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries. Funding Full funding sources are listed at the end of the paper (see Acknowledgments). Ciencias Médicas y de la Salud 14 p application/pdf https://doi.org/10.1016/S0140-6736(19)32008-2 https://repositorio.udes.edu.co/handle/001/5726 eng Elsevier Reino Unido 808 10226 795 395 Scopus The Lancet © 2019 Elsevier Ltd. All rights reserved. info:eu-repo/semantics/closedAccess Atribución-NoComercial 4.0 Internacional (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/ https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32008-2/fulltext#%20 Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) A a prospective cohort study Artículo de revista http://purl.org/coar/resource_type/c_6501 Text info:eu-repo/semantics/article http://purl.org/redcol/resource_type/ART info:eu-repo/semantics/publishedVersion Todas las Audiencias Publication http://purl.org/coar/access_right/c_14cb http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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Universidad EIA |
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d_repositorio.udes.edu.co-DSPACE |
| title |
Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) |
| spellingShingle |
Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Everest |
| title_short |
Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) |
| title_full |
Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) |
| title_fullStr |
Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) |
| title_full_unstemmed |
Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE) |
| title_sort |
modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (pure) |
| author |
Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Everest |
| author_facet |
Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles Everest |
| building |
Repositorio digital |
| publishDate |
2019-09-03 |
| language |
English |
| publisher |
Elsevier |
| physical |
14 p |
| format |
Artículo de revista |
| title_alt |
A a prospective cohort study |
| description |
Background
Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels.
Methods
In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs.
Findings
Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs.
Interpretation
Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries.
Funding
Full funding sources are listed at the end of the paper (see Acknowledgments).
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