Carrillo-Larco Rodrigo M, Miranda J Jaime, Li Xian, Cui Chendi, Xu Xiaolin, Ali Mohammed, Alam Dewan S, Gaziano Thomas A, Gupta Rajeev, Irazola Vilma, Levitt Naomi S, Prabhakaran Dorairaj, Rubinstein Adolfo, Steyn Krisela, Tandon Nikhil, Xavier Denis, Wu Yangfeng, Yan Lijing L
CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
Glob Heart. 2016 Mar;11(1):27-36. doi: 10.1016/j.gheart.2015.12.004.
Currently available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMIC). There is a need to assess HCR using a pragmatic evidence-based approach.
This study sought to report the prevalence of HCR in 10 LMIC areas in Africa, Asia, and South America and to investigate the profiles and correlates of HCR.
Cross-sectional analysis using data from the National Heart, Lung, and Blood Institute-UnitedHealth Group Centers of Excellence. HCR was defined as history of heart disease/heart attack, history of stroke, older age (≥50 years for men and ≥60 for women) with history of diabetes, or older age with systolic blood pressure ≥160 mm Hg. Prevalence estimates were standardized to the World Health Organization's World Standard Population.
A total of 37,067 subjects ages ≥35 years were included; 53.7% were women and mean age was 53.5 ± 12.1 years. The overall age-standardized prevalence of HCR was 15.4% (95% confidence interval: 15.0% to 15.7%), ranging from 8.3% (India, Bangalore) to 23.4% (Bangladesh). Among men, the prevalence was 1.7% for the younger age group (35 to 49 years) and 29.1% for the older group (≥50); among women, 3.8% for the younger group (35 to 59 years) and 40.7% for the older group (≥60). Among the older group, measured systolic blood pressure ≥160 mm Hg (with or without other conditions) was the most common criterion for having HCR, followed by diabetes. The proportion of having met more than 1 criterion was nearly 20%. Age, education, and body mass index were significantly associated with HCR. Cross-site differences existed and were attenuated after adjusting for age, sex, education, smoking, and body mass index.
The prevalence of HCR in 10 LMIC areas was generally high. This study provides a starting point to define targeted populations that may benefit from interventions combining both primary and secondary prevention strategies.
目前用于评估高心血管疾病风险（HCR）的工具通常需要在低收入和中等收入国家（LMIC）资源有限的环境中无法获得的测量数据。因此，需要采用一种基于实用证据的方法来评估HCR。
本研究旨在报告非洲、亚洲和南美洲10个LMIC地区的HCR患病率，并调查HCR的特征和相关因素。
使用美国国立心肺血液研究所-联合健康集团卓越中心的数据进行横断面分析。HCR定义为有心脏病/心脏病发作史、中风史、年龄较大（男性≥50岁，女性≥60岁）且有糖尿病史，或年龄较大且收缩压≥160mmHg。患病率估计值根据世界卫生组织的世界标准人口进行标准化。
共纳入37067名年龄≥35岁的受试者；53.7%为女性，平均年龄为53.5±12.1岁。HCR的总体年龄标准化患病率为15.4%（95%置信区间：15.0%至15.7%），范围从8.3%（印度班加罗尔）到23.4%（孟加拉国）。在男性中，较年轻年龄组（35至49岁）的患病率为1.7%，较年长年龄组（≥50岁）为29.1%；在女性中，较年轻年龄组（35至59岁）为3.8%，较年长年龄组（≥60岁）为40.7%。在较年长年龄组中，测量的收缩压≥160mmHg（无论是否有其他疾病）是患有HCR最常见的标准，其次是糖尿病。符合多个标准的比例接近20%。年龄、教育程度和体重指数与HCR显著相关。存在跨站点差异，在调整年龄、性别、教育程度、吸烟和体重指数后差异减弱。
10个LMIC地区的HCR患病率普遍较高。本研究为确定可能受益于初级和二级预防策略相结合干预措施的目标人群提供了一个起点。
