Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

• Published in: The Lancet
• Main Authors: Walli-Attaei, Marjan, Joseph, Philip, Rosengren, Annika, Chow, Clara K., Rangarajan, Sumathy, Lear, Scott A., AlHabib, Khalid F., Davletov, Kairat, Dans, Antonio, Lanas, Fernando, Yeates, Karen, Poirier, Paul, Teo, Koon K., Bahonar, Ahmad, Camilo, Felix, Chifamba, Jephat, Diaz, Rafael, Didkowska, Joanna A., Irazola, Vilma, Ismail, Rosnah, Kaur, Manmeet, Khatib, Rasha, Liu, Xiaoyun, Mańczuk, Marta, Miranda, J. Jaime, Oguz, Aytekin, Perez-Mayorga, Maritza, Szuba, Andrzej, Tsolekile, Lungiswa P., Prasad Varma, Ravi, Yusufali, Afzalhussein, Yusuf, Rita
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2020
• Subjects: Advocate Aurora Research Institute; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/pop/32; https://doi.org/10.1016/S0140-6736(20)30543-2; https://xk8bg6rv9a.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Variations+between+women+and+men+in+risk+factors,+treatments,+cardiovascular+disease+incidence,+and+death+in+27+high-income,+middle-income,+and+low-income+countries+%28PURE%29%3A+a+prospective+cohort+study&rft.jtitle=The+Lancet+%28British+edition%29&rft.au=Walli-Attaei,+Marjan&rft.au=Joseph,+Philip&rft.au=Rosengren,+Annika&rft.au=Chow,+Clara+K&rft.date=2020-07-11&rft.pub=Elsevier+Ltd&rft.issn=0140-6736&rft.eissn=1474-547X&rft.volume=396&rft.issue=10244&rft.spage=97&rft.epage=109&rft_id=info:doi/10.1016%2FS0140-6736%2820%2930543-2&rft.externalDocID=S0140673620305432&paramdict=en-US

Background: Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. Methods: In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death. Findings: From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were ...