Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

• Published in: The Lancet
• Main Authors: Yusuf, Salim, Joseph, Philip, Rangarajan, Sumathy, Islam, Shofiqul, Mente, Andrew, Hystad, Perry, Brauer, Michael, Kutty, Vellappillil Raman, Gupta, Rajeev, Wielgosz, Andreas, AlHabib, Khalid F., Dans, Antonio, Lopez-Jaramillo, Patricio, Avezum, Alvaro, Lanas, Fernando, Oguz, Aytekin, Kruger, Iolanthe M., Diaz, Rafael, Yusoff, Khalid, Mony, Prem, Chifamba, Jephat, Yeates, Karen, Kelishadi, Roya, Yusufali, Afzalhussein, Khatib, Rasha, Rahman, Omar, Zatonska, Katarzyna, Iqbal, Romaina, Wei, Li, Bo, Hu, Rosengren, Annika, Kaur, Manmeet
• 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/34; https://doi.org/10.1016/S0140-6736(19)32008-2; 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=Modifiable+risk+factors,+cardiovascular+disease,+and+mortality+in+155%E2%80%88722+individuals+from+21+high-income,+middle-income,+and+low-income+countries+%28PURE%29%3A+a+prospective+cohort+study&rft.jtitle=The+Lancet+%28British+edition%29&rft.au=Yusuf,+Salim&rft.au=Joseph,+Philip&rft.au=Rangarajan,+Sumathy&rft.au=Islam,+Shofiqul&rft.date=2020-03-07&rft.pub=Elsevier+Ltd&rft.issn=0140-6736&rft.eissn=1474-547X&rft.volume=395&rft.issue=10226&rft.spage=795&rft.epage=808&rft_id=info:doi/10.1016%2FS0140-6736%2819%2932008-2&rft.externalDocID=S0140673619320082&paramdict=en-US

Background: Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels. Methods: In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs. Findings: Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were ...