Khetan Aditya K, Palileo-Villanueva Lia M, Mat-Nasir Nafiza, Ismail Rosnah, Dans Antonio Miguel, Abat Marc Evans M, Islam Shofiqul, Joseph Philip, Leong Darryl P, Teo Koon K, Rangarajan Sumathy, Yusuf Salim
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
UP College of Medicine, University of the Philippines, Manila, Philippines.
JACC Asia. 2024 Jul 30;4(8):624-633. doi: 10.1016/j.jacasi.2024.05.008. eCollection 2024 Aug.
The drivers of cardiovascular disease (CVD) and all-cause mortality may differ around the world. Regional-level prospective data can help guide policies to reduce CVD and all-cause mortality.
This study examined the incidence of CVD and mortality in Malaysia and the Philippines and estimated the population-level risks attributable to common risk factors for each outcome.
This prospective cohort study included 20,272 participants from Malaysia and the Philippines. The mean follow-up was 8.2 years. The incidences of CVD and mortality rates were calculated for the overall cohort and in key subgroups. For each outcome, population-attributable fractions (PAFs) were calculated to compare risks associated with 12 modifiable risk factors.
The mean age of the cohort was 51.8 years (59% women). Leading causes of mortality were CVD (37.9%) and cancer (12.4%). The incidence of CVD (per 1,000 person-years) was higher in the Philippines (11.0) than Malaysia (8.3), and CVD contributed to a higher proportion of deaths in the Philippines (58% vs 36%). By contrast, all-cause mortality rates were higher in Malaysia (14.1) than in the Philippines (10.9). Approximately 78% of the PAF for CVD and 68% of the PAF for all-cause mortality were attributable to 12 modifiable risk factors. For CVD, the largest PAF was from hypertension (24.2%), whereas for all-cause mortality, the largest PAF was from low education (18.4%).
CVD and cancer account for one-half of adult mortality in Malaysia and the Philippines. Hypertension was the largest population driver of CVD, whereas low education was associated with the largest burden of overall mortality.
心血管疾病（CVD）和全因死亡率的驱动因素在世界各地可能有所不同。区域层面的前瞻性数据有助于指导降低CVD和全因死亡率的政策。
本研究调查了马来西亚和菲律宾的CVD发病率和死亡率，并估计了每种结局归因于常见风险因素的人群水平风险。
这项前瞻性队列研究纳入了来自马来西亚和菲律宾的20272名参与者。平均随访时间为8.2年。计算了整个队列以及关键亚组的CVD发病率和死亡率。对于每种结局，计算人群归因分数（PAF）以比较与12种可改变风险因素相关的风险。
队列的平均年龄为51.8岁（59%为女性）。主要死亡原因是CVD（37.9%）和癌症（12.4%）。菲律宾的CVD发病率（每1000人年）高于马来西亚（8.3），且CVD导致的死亡比例在菲律宾更高（58%对36%）。相比之下，马来西亚的全因死亡率（14.1）高于菲律宾（10.9）。CVD的PAF中约78%以及全因死亡率的PAF中约68%可归因于12种可改变风险因素。对于CVD，最大的PAF来自高血压（24.2%），而对于全因死亡率，最大的PAF来自低教育水平（18.4%）。
在马来西亚和菲律宾，CVD和癌症占成人死亡率的一半。高血压是CVD最大的人群驱动因素，而低教育水平与总体死亡率的最大负担相关。
