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The Emerging Epidemic of Cardiovascular Risk Factors and Atherosclerotic Disease in Developing Countries
Koon K Teo1, Hisham Dokainish1
1Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Insights
Cardiovascular disease (CVD) is rising in developing nations. Effective interventions targeting common risk factors are crucial to combat this growing global health burden.
Area of Science:
- Global Health
- Epidemiology
- Cardiology
Background:
- Cardiovascular disease (CVD) poses a significant health burden globally, increasingly affecting developing countries.
- Major studies like INTERHEART and INTERSTROKE identified key risk factors for acute myocardial infarction and stroke.
- The Prospective Urban and Rural Epidemiological (PURE) study investigated CVD prevalence and risk factors across diverse income settings.
Purpose of the Study:
- To analyze the global epidemiology of cardiovascular disease (CVD) and its risk factors.
- To compare CVD incidence, risk, and case-fatality rates across different income-level countries.
- To assess the utilization of cardiovascular medicines and adherence to lifestyle modifications in various global regions.
Main Methods:
- Utilized data from large-scale epidemiological studies, including the Prospective Urban and Rural Epidemiological (PURE) study (>150,000 participants).
- Included case-control studies (INTERHEART, INTERSTROKE) with a majority of participants from developing countries.
- Analyzed cardiovascular risk factors, CVD incidence, case-fatality rates, medication use, and lifestyle adherence across income levels.
Main Results:
- High-income countries exhibit the highest cardiovascular risk but the lowest CVD incidence and case-fatality rates.
- Low-income countries show the lowest cardiovascular risk but paradoxically the highest CVD incidence and case-fatality rates.
- Cardiovascular medicine use and risk factor control/lifestyle modification adherence are poorest in low-income countries, with medicines often unavailable or unaffordable.
Conclusions:
- Common cardiovascular risk factors require targeted, systematic, and sustained interventions in developing countries.
- Addressing the emerging epidemic of CVD in developing nations necessitates improved access to and affordability of cardiovascular medicines.
- Enhanced control of risk factors and adherence to lifestyle modifications are critical for mitigating CVD burden in low-income settings.
Abstract:
Cardiovascular disease (CVD) and its risk factors, which are major health burdens in high-income countries, are a growing problem in developing or lower-income countries, where the vast majority of CVD now occurs. Two case-control studies, INTERHEART and INTERSTROKE, which included a majority of patients from developing countries, were seminal in identifying common risk factors explaining the vast majority of risk for acute myocardial infarction and stroke, respectively. The population-based Prospective Urban and Rural Epidemiological (PURE) study, which included > 150,000 participants, also with a majority from developing countries, found that although high-income countries were at highest cardiovascular (CV) risk, they had the lowest incidence of CVD and associated case-fatality rates, whereas patients in low-income countries had the lowest CV risk and yet the highest CVD and case-fatality rates. The PURE study also demonstrated relatively low rates of CV medicine use in high- and middle-income countries, but even lower rates in low-income countries, where these medicines were often either unavailable or unaffordable. The PURE study also demonstrated that control of CV risk factors and adherence to lifestyle modifications, although suboptimal globally, were poorest in low-income countries. Taken together, these data identify common CV risk factors requiring targeted, systematic, sustained, and effective interventions in developing countries to mitigate the emerging epidemic of CVD in these regions of the world.
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