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

• Main Authors: Anand, S. (Author), Avezum, A. (Author), Bo, J. (Author), Chifamba, J. (Author), Dagenais, G. (Author), Diaz, R. (Author), Gupta, R. (Author), Iqbal, R. (Author), Islam, S. (Author), Ismail, N. (Author), Kelishadi, R. (Author), Kruger, A. (Author), Kumar, R. (Author), Lanas, F. (Author), Lear, S. (Author), Li, W. (Author), Liu, L. (Author), Liu, T. (Author), Lopez-Jaramillo, P. (Author), Lou, Q. (Author), Lu, F. (Author), McKee, M. (Author), McQueen, M. (Author), Mohan, V. (Author), Mony, P. (Author), Oguz, A. (Author), Puoane, T. (Author), Rahman, O. (Author), Rangarajan, S. (Author), Rosengren, A. (Author), Swaminathan, S. (Author), Szuba, A. (Author), Teo, K. (Author), Vijayakumar, K. (Author), Wielgosz, A. (Author), Yu, L. (Author), Yusoff, K. (Author), Yusuf, S. (Author), Yusufali, A. (Author), Zhang, S. (Author)
• Format: Article
• Language: English
• Published: Massachussetts Medical Society 2014
• Subjects: adolescent; angiotensin receptor antagonist; antithrombocytic agent; article; beta adrenergic receptor blocking agent; cardiovascular disease; Cardiovascular Diseases; cardiovascular mortality; cardiovascular risk; cerebrovascular accident; coronary artery bypass graft; fatality; female; Female; follow up; health care utilization; heart death; heart failure; heart infarction; heart muscle revascularization; high income country; human; Humans; incidence; Income; INTERHEART Risk Score; low income country; lowest income group; major clinical study; male; Male; Middle Aged; middle income country; percutaneous coronary intervention; priority journal; risk assessment; Risk Assessment; Risk Factors; Rural Health; scoring system; social status; statin (protein); Urban Health; urban rural difference; World Health
• Online Access: View Fulltext in Publisher; View in Scopus
• ISBN: 00284793 (ISSN)
• DOI: 10.1056/NEJMoa1311890

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. Copyright © 2014 Massachusetts Medical Society.