CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Universidad Científica del Sur, Lima, Peru.
Glob Heart. 2022 Jun 21;17(1):42. doi: 10.5334/gh.1130. eCollection 2022.
There is limited information regarding the variation of the cardiovascular (CV) risk, that combines multiple risk factors in one metric, according to urbanization and altitude.
To assess and disentangle the potential association between urbanization and altitude with absolute CV risk using Peruvian nationally representative surveys.
Pooled analysis of Peruvian Demographic Health Surveys (from 2014 to 2020), including subjects aged between 40 and 74 years, was conducted. The outcome of interest was the 10-year predicted absolute CV risk based on the non-laboratory version of the World Health Organization (WHO) and split into <10% and ≥10%. The exposures were urbanization (rural or urban) and altitude (<500 meters above the sea level [m.a.s.l.], between 500 and 2,499 m.a.s.l, between 2,500 and 3,499 m.a.s.l., and ≥3,500 m.a.s.l.). Crude and adjusted Poisson regression models were built to assess the associations of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95% CI).
Data of 80,409 subjects, mean age 54.3 (SD: 8.8) and 42,640 (54.4%) females were analyzed. Regarding urbanization, 30,722 (25.4%) subjects were from rural areas, and 60.6% lives at <500 m.a.s.l., whereas only 9.3% lives at ≥3500 m.a.s.l. The 10-year predicted absolute CV risk mean was 4.5% (SD: 3.1), and 7.8% had a CV risk ≥10%. In multivariable model, urbanization, mainly rurality (PR = 0.89; 95%CI: 0.81-0.97) and altitude (PR = 0.82; 95%CI: 0.75-0.90 for those living between 2,500-3,490 m.a.s.l. and PR = 0.68; 95%CI: 0.60-0.76 for those living ≥3,500 m.a.s.l) were factors independently associated with CV risk. Urbanization was an effect modifier of the association between altitude and CV risk with a greater effect in urban settings.
Urbanization, specifically rurality, and high-altitude, mainly ≥2,500 m.a.s.l., were factors independently associated with lower predicted CV risk.
根据城市化和海拔高度，将多种风险因素综合在一个指标中计算心血管（CV）风险的相关信息有限。
使用来自秘鲁全国代表性调查的数据评估和厘清城市化和海拔高度与绝对 CV 风险之间的潜在关联。
对 2014 年至 2020 年期间的秘鲁人口健康调查进行了汇总分析，包括年龄在 40 至 74 岁之间的受试者。主要结局为基于世界卫生组织（WHO）非实验室版本的 10 年预测绝对 CV 风险，分为<10%和≥10%。暴露因素为城市化（农村或城市）和海拔高度（<500 米海平面以上[masl]，500 至 2499 masl，2500 至 3499 masl，和≥3500 masl）。建立了粗和调整后的泊松回归模型来评估相关关联，报告患病率比（PR）和 95%置信区间（95%CI）。
分析了 80409 名受试者的数据，平均年龄为 54.3（标准差：8.8），其中 42640 名（54.4%）为女性。关于城市化，30722 名（25.4%）受试者来自农村地区，60.6%居住在<500 masl，而只有 9.3%居住在≥3500 masl。10 年预测的绝对 CV 风险平均值为 4.5%（标准差：3.1），有 7.8%的人 CV 风险≥10%。在多变量模型中，城市化，主要是农村地区（PR=0.89；95%CI：0.81-0.97）和海拔（居住在 2500-3499 masl 之间的 PR=0.82；95%CI：0.75-0.90，居住在≥3500 masl 的 PR=0.68；95%CI：0.60-0.76）是与 CV 风险独立相关的因素。城市化是海拔与 CV 风险之间关联的一个效应修饰因素，在城市环境中具有更大的影响。
城市化，特别是农村化，以及高海拔地区，主要是≥2500 masl，是与较低预测 CV 风险独立相关的因素。
