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Comparison of Cardiovascular Risk-Factor Burden in Low-, Middle-, and High-Income Countries

Summary and Comment |
August 27, 2014

Comparison of Cardiovascular Risk-Factor Burden in Low-, Middle-, and High-Income Countries

  1. Harlan M. Krumholz, MD, SM

Paradoxically, risk factors were lowest but the incidence of cardiovascular events was highest in low-income countries.

  1. Harlan M. Krumholz, MD, SM

The incidence of cardiovascular disease is increasing rapidly in low- and middle-income countries, with these countries accounting for an estimated 80% of the global burden. To understand the cardiovascular risk-factor burden worldwide, the PURE investigators studied cardiovascular risk-factor burden (according to INTERHEART risk score), incident cardiovascular disease, and death in more than 150,000 adult residents of 17 high-, middle-, and low-income countries.

The mean cardiovascular risk-factor burden was highest in high-income countries and lowest in low-income countries. Compared with urban areas, rural areas had higher risk-factor burden in high-income countries but lower burden in middle-income and low-income countries. For primary prevention, the use of antiplatelet drugs was highest in high-income countries and lowest in low-income countries. A similar pattern was observed for beta-blockers, renin-angiotensin system blockers, and statins. Overall and cardiovascular death rates were highest in low-income countries and lowest in high-income countries. Nonmajor cardiovascular events, in contrast, were higher in high-income countries. Among individuals with a cardiovascular event, death rates were highest in low-income countries.

Comment

The main finding in this study is paradoxical: In low-income countries, the risk-factor burden was lowest but the incidence of cardiovascular events was highest. The rate of death after a cardiovascular event was also highest in low-income countries. These results suggest that improved healthcare delivery and access to high-quality care in low- and middle-income countries could save many lives.

  • Disclosures for Harlan M. Krumholz, MD, SM at time of publication Consultant / Advisory board United Healthcare; VHA, Inc.; Premier, Inc. Equity ImageCor Grant / Research support FDA; NIH-NHLBI; Commonwealth Fund; The Catherine and Patrick Weldon Donaghue Medical Research Foundation; Robert Wood Johnson Foundation; Medtronic Editorial boards BMJ.com/us; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Central European Journal of Medicine; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Journal of Cardiovascular Medicine; Circulation: Cardiovascular Quality and Outcomes Leadership positions in professional societies American Board of Internal Medicine (Chair, Assessment 2020 Task Force)

Citation(s):

Reader Comments (2)

MB,ChB, MD Physician, Internal Medicine, Retired. Emeritus, Adjunct

Is it not at last time to question the relevance of the risk factors we have long held as if in sacred trust?
Louis Krut

Ravi BATHINA . M.D. Physician, Cardiology, Citizens Hospital. Hyderabad. India

Excellent study with relevant observations.
The Socio-economic is much more crippling in the developing countries than in the Developed countries.

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