非洲和中东不同国家收入类别的心血管危险因素负担：非洲中东心血管流行病学（ACE）横断面研究的事后分析。
Cardiovascular risk factor burden in Africa and the Middle East across country income categories: a post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study.
作者信息
Raal Frederick J, Alsheikh-Ali Alawi A, Omar Mohamed I, Rashed Wafa, Hamoui Omar, Kane Abdoul, Alami Mohamed, Abreu Paula, Mashhoud Walid M
机构信息
Carbohydrate & Lipid Metabolism Research Unit, Division of Endocrinology & Metabolism, Department of Medicine, Faculty of Health Sciences, Johannesburg Hospital, University of the Witwatersrand, Parktown, Johannesburg, 2193 South Africa.
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
出版信息
Arch Public Health. 2018 Feb 12;76:15. doi: 10.1186/s13690-018-0257-5. eCollection 2018.
BACKGROUND
A significant number of cardiovascular disease (CVD)-related deaths occur in developing countries. An increasing prevalence of CVD is associated with a change in the macro-economy of these countries. In this post hoc analysis, CVD risk factor (CVDRF) prevalence is evaluated across countries based on national income in the Africa and Middle East Region (AfME).
METHODS
Data from the Africa Middle East Cardiovascular Epidemiological (ACE) study were used; a cross-sectional study in 14 AfME countries (94 clinics) from July 2011-April 2012, which evaluated CVDRF prevalence in stable adult outpatients. World Bank definitions were used to classify countries as low-income (LI), lower-middle-income (LMI), upper-middle-income (UMI) or high-income (HI) countries. Four thousand three hundred seventy-eight subjects were recruited where 260 (6%), 1324 (30%), 1509 (35%) and 1285 (29%) were from LI, LMI, UMI, and HI countries, respectively.
RESULTS
Of all the CVDRFs evaluated, almost two-thirds of the study population across the national income groups had abdominal obesity and dyslipidemia. Countries in the HI category were associated with a higher prevalence of diabetes (32%), obesity (44%) and smoking (16%). UMI and HI countries were associated with higher clustering of CVDRFs where at least one-third of subjects having four or more CVDRFs. Lower income countries had lower blood pressure control rates and lower percentages of outpatients achieving LDL-cholesterol targets.
CONCLUSION
The burden of CVDRFs in stable outpatients is high across the national income categories in the AfME region, with HI countries showing a higher prevalence of CVDRFs. The high burden in lower income countries is associated with sub-optimal control of dyslipidemia and hypertension. Lowering the CVDRF burden would need specific public health actions in line with positive changes in the macro-economy of these countries.
TRIAL REGISTRATION
The ACE trial is registered under NCT01243138.
背景
大量心血管疾病（CVD）相关死亡发生在发展中国家。CVD患病率的上升与这些国家宏观经济的变化有关。在这项事后分析中，基于非洲和中东地区（AfME）各国的国民收入评估了心血管疾病风险因素（CVDRF）的患病率。
方法
使用了来自非洲中东心血管流行病学（ACE）研究的数据；这是一项于2011年7月至2012年4月在14个AfME国家（94个诊所）开展的横断面研究，评估了稳定成年门诊患者的CVDRF患病率。采用世界银行的定义将国家分类为低收入（LI）、中低收入（LMI）、中高收入（UMI）或高收入（HI）国家。共招募了4378名受试者，其中分别有260名（6%）、1324名（30%）、1509名（35%）和1285名（29%）来自LI、LMI、UMI和HI国家。
结果
在所有评估的CVDRF中，几乎三分之二的不同国民收入组研究人群存在腹型肥胖和血脂异常。HI类别国家的糖尿病（32%）、肥胖（44%）和吸烟（16%）患病率较高。UMI和HI国家的CVDRF聚集性较高，至少三分之一的受试者有四种或更多CVDRF。低收入国家的血压控制率较低，达到低密度脂蛋白胆固醇目标的门诊患者百分比也较低。
结论
在AfME地区，不同国民收入类别的稳定门诊患者中CVDRF负担都很高，HI国家的CVDRF患病率更高。低收入国家的高负担与血脂异常和高血压控制不佳有关。降低CVDRF负担需要采取符合这些国家宏观经济积极变化的具体公共卫生行动。
试验注册
ACE试验已在NCT01243138下注册。
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