Ferrer Jose Maria E, Boch Johannes, Aerts Ann, Anne Malick, Avezum Alvaro, Barboza Joseph, Baxter Yara, Bortolotto Luiz Aparecido, Cobos Daniel, Des Rosiers Sarah, Mauro Dib Karina, Drager Luciano F, Jones Olivia, Morgan Louise, Picou Kylie, Rajkumar Sarah, Reiker Theresa, Silveira Mariana, Venkitachalam Lakshmi, Steinmann Peter
American Heart Association Dallas Texas USA.
Novartis Foundation Basel Switzerland.
J Am Heart Assoc. 2025 May 6;14(9):e038816. doi: 10.1161/JAHA.124.038816. Epub 2025 Apr 16.
Stroke is one of the major causes of death worldwide, mainly in low- and middle-income countries. The implementation of multifaceted strategies aiming at blood pressure control may change the global burden of stroke.
We evaluated the impact of a multisector urban cardiovascular health initiative (CARDIO4Cities) on stroke outcomes in Dakar, Senegal, and São Paulo, Brazil. Data covered preintervention, intervention, and follow-up periods with ongoing intervention from 2016 to 2021. An interrupted time series analysis and a segmented regression approach were used to evaluate temporal trends. The relative risk of stroke hospitalization was analyzed with a generalized linear model. In São Paulo, data could also be compared between intervention and control districts. A total of 3445 stroke hospitalizations were analyzed in Dakar and 4491 in São Paulo. In both cities, age-standardized stroke hospitalization rates (Dakar: -26%; São Paulo: -54% on average across 2 districts) and the risk of death from stroke declined over the intervention period. In São Paulo, the baseline risk of stroke hospitalization was comparable across the city. In the follow-up period, the risk was 24.5% lower in the intervention districts compared with the rest of the city (<0.05). The COVID-19 situation did not change this dynamic.
The implementation of the multisectoral CARDIO4Cities initiative correlated with positive trends in stroke outcomes. Interventions to reduce cardiovascular risk and improve hypertension management at population level appear to rapidly translate into reduced stroke-related hospitalizations and mortality.
中风是全球主要死因之一，在低收入和中等收入国家尤为突出。实施旨在控制血压的多方面策略可能会改变全球中风负担。
我们评估了一项多部门城市心血管健康倡议（CARDIO4Cities）对塞内加尔达喀尔和巴西圣保罗中风结局的影响。数据涵盖干预前、干预期间和随访期，干预从2016年持续至2021年。采用中断时间序列分析和分段回归方法评估时间趋势。使用广义线性模型分析中风住院的相对风险。在圣保罗，还可以对干预区和对照区的数据进行比较。在达喀尔共分析了3445例中风住院病例，在圣保罗分析了4491例。在这两个城市，年龄标准化中风住院率（达喀尔：-26%；圣保罗：两个区平均为-54%）以及中风死亡风险在干预期间均有所下降。在圣保罗，全市中风住院的基线风险相当。在随访期，干预区的风险比城市其他地区低24.5%（<0.05）。新冠疫情并未改变这一动态。
多部门CARDIO4Cities倡议的实施与中风结局的积极趋势相关。在人群层面降低心血管风险和改善高血压管理的干预措施似乎能迅速转化为中风相关住院率和死亡率的降低。
