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

• Published in: New England Journal of Medicine
• Main Author: 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.
• Format: Article
• Language: English
• Published: Massachussetts Medical Society 2014
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84907320446&doi=10.1056%2fNEJMoa1311890&partnerID=40&md5=5e95b45d4538790b41e073d6074942c8

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.