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

BACKGROUNDMore than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODSWe enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income coun... Full description

Journal Title: The New England journal of medicine August 28, 2014, Vol.371(9), pp.818-827
Main Author: Yusuf, Salim
Other Authors: Rangarajan, Sumathy , Teo, Koon , Islam, Shofiqul , Li, Wei , Liu, Lisheng , Bo, Jian , Lou, Qinglin , Lu, Fanghong , Liu, Tianlu , Yu, Liu , Zhang, Shiying , Mony, Prem , Swaminathan, Sumathi , Mohan, Viswanathan , Gupta, Rajeev , Kumar, Rajesh , Vijayakumar, Krishnapillai , Lear, Scott , Anand, Sonia , Wielgosz, Andreas , Diaz, Rafael , Avezum, Alvaro , Lopez-Jaramillo, Patricio , Lanas, Fernando , Yusoff, Khalid , Ismail, Noorhassim , Iqbal, Romaina , Rahman, Omar , Rosengren, Annika , Yusufali, Afzalhussein , Kelishadi, Roya , Kruger, Annamarie , Puoane, Thandi , Szuba, Andrzej , Chifamba, Jephat , Oguz, Aytekin , Mcqueen, Matthew , Mckee, Martin , Dagenais, Gilles , Yusuf, Salim
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: E-ISSN: 1533-4406 ; DOI: 10.1056/NEJMoa1311890
Link: http://search.proquest.com/docview/1558519612/?pq-origsite=primo
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title: Cardiovascular risk and events in 17 low-, middle-, and high-income countries.
format: Article
creator:
  • Yusuf, Salim
  • Rangarajan, Sumathy
  • Teo, Koon
  • Islam, Shofiqul
  • Li, Wei
  • Liu, Lisheng
  • Bo, Jian
  • Lou, Qinglin
  • Lu, Fanghong
  • Liu, Tianlu
  • Yu, Liu
  • Zhang, Shiying
  • Mony, Prem
  • Swaminathan, Sumathi
  • Mohan, Viswanathan
  • Gupta, Rajeev
  • Kumar, Rajesh
  • Vijayakumar, Krishnapillai
  • Lear, Scott
  • Anand, Sonia
  • Wielgosz, Andreas
  • Diaz, Rafael
  • Avezum, Alvaro
  • Lopez-Jaramillo, Patricio
  • Lanas, Fernando
  • Yusoff, Khalid
  • Ismail, Noorhassim
  • Iqbal, Romaina
  • Rahman, Omar
  • Rosengren, Annika
  • Yusufali, Afzalhussein
  • Kelishadi, Roya
  • Kruger, Annamarie
  • Puoane, Thandi
  • Szuba, Andrzej
  • Chifamba, Jephat
  • Oguz, Aytekin
  • Mcqueen, Matthew
  • Mckee, Martin
  • Dagenais, Gilles
  • Yusuf, Salim
subjects:
  • Cardiovascular Diseases–Epidemiology
  • Female–Mortality
  • Global Health–Mortality
  • Humans–Mortality
  • Income–Mortality
  • Male–Mortality
  • Middle Aged–Mortality
  • Risk Assessment–Mortality
  • Risk Factors–Mortality
  • Rural Health–Mortality
  • Urban Health–Mortality
  • Abridged
ispartof: The New England journal of medicine, August 28, 2014, Vol.371(9), pp.818-827
description: BACKGROUNDMore than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODSWe 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. RESULTSThe mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P
language: eng
source:
identifier: E-ISSN: 1533-4406 ; DOI: 10.1056/NEJMoa1311890
fulltext: fulltext
issn:
  • 15334406
  • 1533-4406
url: Link


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titleCardiovascular risk and events in 17 low-, middle-, and high-income countries.
creatorYusuf, Salim ; Rangarajan, Sumathy ; Teo, Koon ; Islam, Shofiqul ; Li, Wei ; Liu, Lisheng ; Bo, Jian ; Lou, Qinglin ; Lu, Fanghong ; Liu, Tianlu ; Yu, Liu ; Zhang, Shiying ; Mony, Prem ; Swaminathan, Sumathi ; Mohan, Viswanathan ; Gupta, Rajeev ; Kumar, Rajesh ; Vijayakumar, Krishnapillai ; Lear, Scott ; Anand, Sonia ; Wielgosz, Andreas ; Diaz, Rafael ; Avezum, Alvaro ; Lopez-Jaramillo, Patricio ; Lanas, Fernando ; Yusoff, Khalid ; Ismail, Noorhassim ; Iqbal, Romaina ; Rahman, Omar ; Rosengren, Annika ; Yusufali, Afzalhussein ; Kelishadi, Roya ; Kruger, Annamarie ; Puoane, Thandi ; Szuba, Andrzej ; Chifamba, Jephat ; Oguz, Aytekin ; Mcqueen, Matthew ; Mckee, Martin ; Dagenais, Gilles ; Yusuf, Salim
contributorYusuf, S (correspondence author) ; Rangarajan, S (record owner) ; Teo, K K ; Chow, C K ; O'Donnell, M ; Mente, A ; Leong, D ; Smyth, A ; Joseph, P ; Islam, S ; Zhang, M ; Hu, W ; Wong, G ; Manandhar, N ; Dehghan, M ; Royerr, M ; Dejesus, J ; Lewis, G ; Mackie, P ; Farago, L ; Kay, I ; Agapay, D ; Solano, R ; Ramacham, S ; Kandy, N ; Rimac, J ; Trottier, S ; Elsheikh, W ; Mustaha, M ; Tongana, T ; Aoucheva, N ; Swallow, J ; Ramezani, E ; Lindeman, J ; Mcqueen, M ; Hall, K ; Keys, J ; Wang, X ; Keneth, J ; Devanath, A ; Diaz, R ; Orlandini, A ; Linetsky, B ; Toscanelli, S ; Casaccia, G ; Cuneo, J M Maini ; Rahman, O ; Yusuf, R ; Azad, A K ; Rabbani, K A ; Cherry, H M ; Mannan, A ; Hassan, I ; Talukdar, A T ; Tooheen, R B ; Khan, M U ; Sintaha, M ; Choudhury, T ; Haque, R ; Parvin, S ; Avezum, A ; Oliveira, G B ; Marcilio, C S ; Mattos, A C ; Teo, K ; Yusuf, S ; Dejesus, J ; Agapay, D ; Tongana, T ; Solano, R ; Kay, I ; Trottier, S ; Rimac, J ; Elsheikh, W ; Heldman, L ; Ramezani, E ; Dagenais, G ; Poirier, P ; Turbide, G ; Auger, D ; De Bluts, A Leblanc ; Proulx, M C ; Cayer, M ; Bonneville, N ; Lear, S ; Gasevic, D ; Corber, E ; de Jong, V ; Vukmirovich, I ; Wielgosz, A ; Fodor, G ; Pipe, A ; Shane, A ; Lanas, F ; Seron, P ; Martinez, S ; Valdebenito, A ; Oliveros, M ; Li, Wei ; Liu, Lisheng ; Chen, Chunming ; Wang, Xingyu ; Zhao, Wenhua ; Zhang, Hongye ; Jiaxuan, Bo ; Hu, Yi ; Sun, Jian ; Bo, Xiuwen ; Zhao, Xiaohong ; Chang, Tao ; Chen, Hui ; Chen, Xiaohong ; Chang, Qing ; Deng, Xiaoru ; Cheng, Qing ; Deng, Xinye ; He, Bo ; Hu, Jian ; Jiaxuan, Juan ; Li, Xu ; Li, Bing ; Liu, Yi ; Ren, Wei ; Sun, Yang ; Wang, Jun ; Wang, Yi ; Yang, Hongye ; Zhai, Xiuwen ; Zhang, Manlu ; Zhao, Fanghong ; Zhu, Jianfang ; Lu, Yindong ; Wu, Yan ; Li, Liangqing ; Hou, Baoxia ; Zhang, Xiaoyang ; Guo, Shiying ; Liao, Dong ; Zhang, Di ; Bianrongwen, Jianguo ; Tianxiuzhen, Yize ; Li, Tianlu ; Chen, Peng ; Wu, Changlin ; Xiao, Ning ; Liu, Xiaolan ; Zhang, Yuqing ; Dong, Rensheng ; Li, Minfan ; Ma, Jing ; Yang, Yu ; Lei, Xiaojie ; Fu, Qiang ; He, P ; Liu, P A Camacho ; Xing, R ; Zhou, L J A ; Lopez-Jaramillo, D ; Lopez, J F ; Garcia, R ; Jurado, S ; Gómez-Arbeláez, L P ; Arguello, F ; Dueñas, D I ; Silva, C ; Pradilla, M ; Ramirez, E ; Molina, E ; Cure-Cure, S ; Perez, C ; Hernandez, J ; Arcos, A ; Fernandez, H ; Narvaez, G ; Paez, T ; Sotomayor, A ; Garcia, P ; Sanchez, M ; David, A V ; Rico, S ; Mony, K ; Vaz, A V ; Bharathi, K G ; Swaminathan, N ; Shankar, H A L ; Kurpad, V ; Jayachitra, M ; Kumar, K ; Hospital, M ; Mohan, S ; Deepa, T ; Parthiban, D ; Anitha, K ; Hemavathy, R ; Rahulashankiruthiyayan, R B ; Anitha, I ; Sridevi, P ; Gupta, S ; Panwar, R ; Mohan, R ; Rastogi, J S ; Rastogi, B ; Bhargava, P V M ; Kumar, R ; Thakur, P ; Patro, V Raman ; Lakshmi, K ; Mahajan, K ; Chaudary, G
ispartofThe New England journal of medicine, August 28, 2014, Vol.371(9), pp.818-827
identifierE-ISSN: 1533-4406 ; DOI: 10.1056/NEJMoa1311890
subjectCardiovascular Diseases–Epidemiology ; Female–Mortality ; Global Health–Mortality ; Humans–Mortality ; Income–Mortality ; Male–Mortality ; Middle Aged–Mortality ; Risk Assessment–Mortality ; Risk Factors–Mortality ; Rural Health–Mortality ; Urban Health–Mortality ; Abridged
descriptionBACKGROUNDMore than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODSWe 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. RESULTSThe 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). CONCLUSIONSAlthough 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. (Funded by the Population Health Research Institute and others.).
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1Rangarajan, Sumathy
2Teo, Koon
3Islam, Shofiqul
4Li, Wei
5Liu, Lisheng
6Bo, Jian
7Lou, Qinglin
8Lu, Fanghong
9Liu, Tianlu
10Yu, Liu
11Zhang, Shiying
12Mony, Prem
13Swaminathan, Sumathi
14Mohan, Viswanathan
15Gupta, Rajeev
16Kumar, Rajesh
17Vijayakumar, Krishnapillai
18Lear, Scott
19Anand, Sonia
20Wielgosz, Andreas
21Diaz, Rafael
22Avezum, Alvaro
23Lopez-Jaramillo, Patricio
24Lanas, Fernando
25Yusoff, Khalid
26Ismail, Noorhassim
27Iqbal, Romaina
28Rahman, Omar
29Rosengren, Annika
30Yusufali, Afzalhussein
31Kelishadi, Roya
32Kruger, Annamarie
33Puoane, Thandi
34Szuba, Andrzej
35Chifamba, Jephat
36Oguz, Aytekin
37Mcqueen, Matthew
38Mckee, Martin
39Dagenais, Gilles
titleCardiovascular risk and events in 17 low-, middle-, and high-income countries.
descriptionBACKGROUNDMore than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODSWe 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. RESULTSThe 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). CONCLUSIONSAlthough 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. (Funded by the Population Health Research Institute and others.).
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1Female–Mortality
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18Mackie, P
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21Agapay, D
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25Rimac, J
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28Mustaha, M
29Tongana, T
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31Swallow, J
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35Hall, K
36Keys, J
37Wang, X
38Keneth, J
39Devanath, A
40Diaz, R
41Orlandini, A
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44Casaccia, G
45Cuneo, J M Maini
46Rahman, O
47Yusuf, R
48Azad, A K
49Rabbani, K A
50Cherry, H M
51Mannan, A
52Hassan, I
53Talukdar, A T
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60Avezum, A
61Oliveira, G B
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92Zhao, Wenhua
93Zhang, Hongye
94Jiaxuan, Bo
95Hu, Yi
96Sun, Jian
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98Zhao, Xiaohong
99Chang, Tao
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titleCardiovascular risk and events in 17 low-, middle-, and high-income countries.
authorYusuf, Salim ; Rangarajan, Sumathy ; Teo, Koon ; Islam, Shofiqul ; Li, Wei ; Liu, Lisheng ; Bo, Jian ; Lou, Qinglin ; Lu, Fanghong ; Liu, Tianlu ; Yu, Liu ; Zhang, Shiying ; Mony, Prem ; Swaminathan, Sumathi ; Mohan, Viswanathan ; Gupta, Rajeev ; Kumar, Rajesh ; Vijayakumar, Krishnapillai ; Lear, Scott ; Anand, Sonia ; Wielgosz, Andreas ; Diaz, Rafael ; Avezum, Alvaro ; Lopez-Jaramillo, Patricio ; Lanas, Fernando ; Yusoff, Khalid ; Ismail, Noorhassim ; Iqbal, Romaina ; Rahman, Omar ; Rosengren, Annika ; Yusufali, Afzalhussein ; Kelishadi, Roya ; Kruger, Annamarie ; Puoane, Thandi ; Szuba, Andrzej ; Chifamba, Jephat ; Oguz, Aytekin ; Mcqueen, Matthew ; Mckee, Martin ; Dagenais, Gilles ; Yusuf, Salim
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21Agapay, D
22Solano, R
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atitleCardiovascular risk and events in 17 low-, middle-, and high-income countries.
jtitleThe New England journal of medicine
risdate20140828
volume371
issue9
spage818
epage827
pages818-827
eissn1533-4406
formatjournal
genrearticle
ristypeJOUR
abstractBACKGROUNDMore than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODSWe 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. RESULTSThe 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). CONCLUSIONSAlthough 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. (Funded by the Population Health Research Institute and others.).
doi10.1056/NEJMoa1311890
urlhttp://search.proquest.com/docview/1558519612/
issn00284793
date2014-08-28