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

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.

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