Facultad de Ciencias de la Salud, Instituto Masira, Universidad de Santander (UDES), Bloque G, piso 6, Bucaramanga, Santander, Colombia.
Centro para la Prevencion de las Enfermedades Cardiometabolicas (CIPCA), FOSCAL Internacional, Bucaramanga, Colombia.
Eur Heart J. 2022 Aug 7;43(30):2841-2851. doi: 10.1093/eurheartj/ehac113.
In a multinational South American cohort, we examined variations in CVD incidence and mortality rates between subpopulations stratified by country, by sex and by urban or rural location. We also examined the contributions of 12 modifiable risk factors to CVD development and to death.
This prospective cohort study included 24 718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia. The mean follow-up was 10.3 years. The incidence of CVD and mortality rates were calculated for the overall cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and for death were examined for 12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (tobacco, alcohol, diet quality, and physical activity), and others (education, household air pollution, strength, and depression). Leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). The incidence of CVD (per 1000 person-years) only modestly varied between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates (per 1000 person-years) between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07). Men had a higher incidence of CVD (4.48 vs. 2.60 per 1000 person-years) and a higher mortality rate (6.33 vs. 3.96 per 1000 person-years) compared with women. Deaths were higher in rural compared to urban areas. Approximately 72% of the PAF for CVD and 69% of the PAF for deaths were attributable to 12 modifiable risk factors. For CVD, largest PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), tobacco use (13.5%), low strength (5.6%), and diabetes (5.3%). For death, the largest PAFs were from tobacco use (14.4%), hypertension (12.0%), low education (10.5%), abdominal obesity (9.7%), and diabetes (5.5%).
Cardiovascular disease, cancer, and respiratory diseases account for over two-thirds of deaths in South America. Men have consistently higher CVD and mortality rates than women. A large proportion of CVD and premature deaths could be averted by controlling metabolic risk factors and tobacco use, which are common leading risk factors for both outcomes in the region.
在一项多国家的南美洲队列研究中，我们按国家、性别和城乡位置对亚人群进行分层，以评估心血管疾病（CVD）发病率和死亡率的差异。我们还研究了 12 种可改变的危险因素对 CVD 发展和死亡的贡献。
这项前瞻性队列研究纳入了来自阿根廷、巴西、智利和哥伦比亚的 51 个城市和 49 个农村社区的 24718 名参与者。平均随访时间为 10.3 年。我们计算了整个队列和亚人群的 CVD 发病率和死亡率。我们还研究了 12 种常见可改变危险因素（代谢因素[高血压、糖尿病、腹部肥胖和非高密度脂蛋白胆固醇升高]、行为因素[吸烟、饮酒、饮食质量和体力活动]和其他因素[教育、家庭空气污染、力量和抑郁]）与 CVD 和死亡之间的风险比和人群归因分数（PAF）。主要死因是 CVD（31.1%）、癌症（30.6%）和呼吸系统疾病（8.6%）。CVD 的发病率（每 1000 人年）在国家之间仅略有差异，巴西的发病率最高（3.86），阿根廷的发病率最低（3.07）。国家之间的死亡率（每 1000 人年）差异较大，阿根廷的死亡率最高（5.98），智利的死亡率最低（4.07）。与女性相比，男性 CVD 的发病率（4.48 比 2.60 每 1000 人年）和死亡率（6.33 比 3.96 每 1000 人年）更高。农村地区的死亡率高于城市地区。大约 72%的 CVD 的 PAF 和 69%的死亡 PAF 归因于 12 种可改变的危险因素。对于 CVD，最大的 PAF 归因于高血压（18.7%）、腹部肥胖（15.4%）、吸烟（13.5%）、低力量（5.6%）和糖尿病（5.3%）。对于死亡，最大的 PAF 归因于吸烟（14.4%）、高血压（12.0%）、低教育（10.5%）、腹部肥胖（9.7%）和糖尿病（5.5%）。
在南美洲，心血管疾病、癌症和呼吸系统疾病导致三分之二以上的死亡。男性的 CVD 和死亡率一直高于女性。通过控制该地区两种结局的常见主要危险因素（代谢危险因素和吸烟），可预防很大一部分 CVD 和过早死亡。
