Teo Koon K, Dokainish Hisham
Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Can J Cardiol. 2017 Mar;33(3):358-365. doi: 10.1016/j.cjca.2016.12.014. Epub 2016 Dec 24.
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.
心血管疾病（CVD）及其危险因素在高收入国家是主要的健康负担，而在发展中国家或低收入国家，这一问题也日益严重，目前世界上绝大多数心血管疾病都发生在这些国家。两项病例对照研究——INTERHEART和INTERSTROKE，纳入了大多数来自发展中国家的患者，它们在分别确定解释绝大多数急性心肌梗死和中风风险的常见危险因素方面具有开创性意义。基于人群的城乡前瞻性流行病学（PURE）研究纳入了超过15万名参与者，其中大多数也来自发展中国家，该研究发现，尽管高收入国家心血管（CV）风险最高，但它们的心血管疾病发病率和相关病死率最低，而低收入国家的患者CV风险最低，但心血管疾病发病率和病死率却最高。PURE研究还表明，高收入和中等收入国家的心血管药物使用率相对较低，但低收入国家的使用率更低，在这些国家，这些药物往往无法获得或负担不起。PURE研究还表明，尽管全球范围内对心血管危险因素的控制和对生活方式改变的坚持都不理想，但在低收入国家情况最差。综上所述，这些数据确定了在发展中国家需要有针对性、系统、持续和有效的干预措施的常见心血管危险因素，以减轻世界这些地区心血管疾病的新流行。
