17 个低收入、中收入和高收入国家的心血管风险和事件。
Cardiovascular risk and events in 17 low-, middle-, and high-income countries.
机构信息
From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., S.R., K.T., S.I., S.A., M. McQueen), Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC (S.L.), the Department of Medicine, University of Ottawa, Ottawa, ON (A.W.), and Laval University Heart and Lungs Institute, Quebec City, QC (G.D.) - all in Canada; the National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing (W.L., L.L., J.B.), Jiangsu Province Institute of Geriatrics, Jiangsu Province, Nanjing City (Q.L.), Shandong Province Academy of Medical Science, Shandong Province, Jinan City (F. Lu), Xi'an Electronic Technology University Hospital, Shanxi Province, Xi'an City (T.L.), Shenyang City 242 Hospital, Liaoning Province, Shenyang City, Huanggu District (L.Y.), Bayannaoer Center for Disease Control and Prevention, Inner Mongolia, Bayannaoer City, Linhe District, Jiefangxi (S.Z.) - all in China; the Division of Epidemiology and Population Health, St. John's Research Institute, Bangalore (P.M., S.S.), Madras Diabetes Research Foundation, Chennai (V.M.), Fortis Escorts Hospitals, JLN Marg, Jaipur (R.G.), Postgraduate Institute of Medical Education and Research School of Public Health, Chandigarh (R. Kumar), and Health Action by People, Trivandrum, Kerala (K.V.) - all in India; Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina (R.D.); Dante Pazzanese Institute of Cardiology, São Paulo (A.A.); Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Floridablanca-Santander, Colombia (P.L.-J.); Universidad de La Frontera, Temuco, Chile (F. Lanas); Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, and UCSI University Kuala Lumpur, Kuala Lumpur (K.Y.), and the Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur (N.I.) - all in Malay
出版信息
N Engl J Med. 2014 Aug 28;371(9):818-27. doi: 10.1056/NEJMoa1311890.
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. (Funded by the Population Health Research Institute and others.).
背景
据估计，80%以上的心血管疾病死亡发生在低收入和中等收入国家，但原因尚不清楚。
方法
我们在 17 个国家的 628 个城乡社区招募了 156424 人（3 个高收入国家、10 个中等收入国家和 4 个低收入国家），使用 INTERHEART 风险评分评估他们的心血管风险，这是一种量化无实验室检测的危险因素负担的有效评分（评分越高，危险因素负担越大）。参与者的心血管疾病发病和死亡中位随访时间为 4.1 年。
结果
高收入国家的 INTERHEART 风险评分最高，中等收入国家居中，低收入国家最低（P<0.001）。然而，高收入国家的主要心血管事件（心血管原因死亡、心肌梗死、卒中和心力衰竭）发生率低于中低收入国家（每 1000 人年分别为 3.99 例、5.38 例和 6.43 例；P<0.001）。高收入国家的病死率也最低（分别为 6.5%、15.9%和 17.3%；P=0.01）。城市社区的危险因素负担高于农村社区，但心血管事件发生率较低（每 1000 人年分别为 4.83 例和 6.25 例；P<0.001）和病死率较低（分别为 13.52%和 17.25%；P<0.001）。高收入国家预防药物和血运重建的使用率明显高于中低收入国家（P<0.001）。
结论
尽管低收入国家的危险因素负担最低，但主要心血管疾病和死亡的发生率明显高于高收入国家。高收入国家的危险因素负担较高，可能是通过更好地控制危险因素以及更频繁地使用已证实的药物治疗和血运重建来减轻的。（由人口健康研究所和其他机构资助）。
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