Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries

作者：Salim Yusuf, Sumathy Rangarajan, Koon Kang Teo, Shofiqul Islam, Wei Li, Lisheng Liu, Jian Bo, Qinglin Lou, Fanghong Lu, Tianlu Liu, Yu Shih Liu, Shiying Zhang, Prem Kumar Mony, Sumathi Swaminathan, Viswanathan Mohan, Rajeev Gupta, Rajesh Kumar, Krishnapillai Vijayakumar, Scott Alexander Lear, Sonia Savitri Anand, Andreas T. Wielgosz, Rafael Díaz, Álvaro Avezum, Patricio López‐Jaramillo, Fernando Tomas Lanas, Khalid Yusoff, Noor Hassim Ismail, Romaina Iqbal, Omar M. Rahman, Annika Rosengren, Afzalhussein Yusufali, Roya Kelishadi, Annamarie Kruger, Thandi Rose Puoane, Andrzej Szuba, Jephat Chifamba, Aytekin Oğuz, Matthew McQueen, Martin McKee, Gilles R. Dagenais · 发表于：New England Journal of Medicine · 年份：2014 · DOI：10.1056/nejmoa1311890 · 被引用次数：1013 · 研究领域：Health Promotion and Cardiovascular Prevention、Acute Myocardial Infarction Research、Diabetes, Cardiovascular Risks, and Lipoproteins

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 o...