Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries

Yusuf, Salim; Rangarajan, Sumathy; Teo, Koon; Islam, Shofiqul; Li, Wei; Liu, Lisheng; Jiang, Bo; Lou, Qinglin; Lu, Fanghong; Liu, Tianlu; Liu, Yu; Zhang, Shiying; Mony, Prem; Swaminathan, Sumathi; Mohan, Viswanathan; Gupta, Rajeev; Kumar, Rajesh; Vijayakumar, Krishnapillai; Lear, Scott A.; Anand, Sonia S.; Wielgosz, Andreas; Dı́az, Rafael; Avezum, Álvaro; López‐Jaramillo, Patricio; Lanas, Fernando; Yusoff, Khalid; Ismail, Noorhassim; Iqbal, Romaina; Rahman, Omar; Rosengren, Annika; Yusufali, Afzalhussein; Kelishadi, Roya; Kruger, Annamarie; Puoane, Thandi; Szuba, Andrzej; Chifamba, Jephat; Oğuz, Aytekin; McQueen, Matthew; McKee, Martin; Dagenais, Gilles R.

doi:10.1056/nejmoa1311890

Cited by 779 publications

(654 citation statements)

References 17 publications

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“…The morbidity and mortality from cardiovascular disease in the developing world is high 4. Healthcare systems need to be cost appropriate, accessible, and capable of making a diagnosis, implementing appropriate therapy and monitoring that therapy.…”

Section: Discussionmentioning

confidence: 99%

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INCA (Peru) Study: Impact of Non‐Invasive Cardiac Magnetic Resonance Assessment in the Developing World

Menacho

Ramírez²,

Segura³

et al. 2018

JAHA

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BackgroundAdvanced cardiac imaging permits optimal targeting of cardiac treatment but needs to be faster, cheaper, and easier for global delivery. We aimed to pilot rapid cardiac magnetic resonance (CMR) with contrast in a developing nation, embedding it within clinical care along with training and mentoring.Methods and ResultsA cross‐sectional study of CMR delivery and clinical impact assessment performed 2016–2017 in an upper middle‐income country. An International partnership (clinicians in Peru and collaborators from the United Kingdom, United States, Brazil, and Colombia) developed and tested a 15‐minute CMR protocol in the United Kingdom, for cardiac volumes, function and scar, and delivered it with reporting combined with training, education and mentoring in 2 centers in the capital city, Lima, Peru, 100 patients referred by local doctors from 6 centers. Management changes related to the CMR were reviewed at 12 months. One‐hundred scans were conducted in 98 patients with no complications. Final diagnoses were cardiomyopathy (hypertrophic, 26%; dilated, 22%; ischemic, 15%) and 12 other pathologies including tumors, congenital heart disease, iron overload, amyloidosis, genetic syndromes, vasculitis, thrombi, and valve disease. Scan cost was $150 USD, and the average scan duration was 18±7 minutes. Findings impacted management in 56% of patients, including previously unsuspected diagnoses in 19% and therapeutic management changes in 37%.ConclusionsAdvanced cardiac diagnostics, here CMR with contrast, is possible using existing infrastructure in the developing world in 18 minutes for $150, resulting in important changes in patient care.

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Section: Discussionmentioning

confidence: 99%

“…However, CVD disease and death rates are highest in low‐ and middle‐income countries, despite there being a lower burden of classical risk factors 2, 3, 4. For example, in Peru, CVD affects 3.2 million (16% of the adult population), leading to a significant loss of well‐being, estimated at 281 829 Disability Adjusted Life Years.…”

Section: Introductionmentioning

confidence: 99%

INCA (Peru) Study: Impact of Non‐Invasive Cardiac Magnetic Resonance Assessment in the Developing World

Menacho

Ramírez²,

Segura³

et al. 2018

JAHA

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“…As part of China's epidemiologic transition to higher rates of noncommunicable diseases, women, like men, are experiencing a rapid increase in the incidence of acute myocardial infarction (AMI) and AMI‐related mortality,1 as seen in other low‐ and middle‐income countries 2. In addition, the China Patient‐centered Evaluative Assessment of Cardiac Events (PEACE) study demonstrated sex differences in mortality with women at higher risk of death in younger age groups 3.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST‐Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)‐Retrospective Study

Du¹,

Spatz²,

Dreyer

et al. 2016

JAHA

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BackgroundChina is experiencing a marked increase in ST‐segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in‐hospital death in relatively younger age groups (<70). Yet, little is known about sex differences in ST‐segment elevation myocardial infarction presentation and management.Methods and ResultsIn a nationally representative sample of patients with ST‐segment elevation myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006, and 2011, we examined sex differences in hospitalization rates, clinical profiles, and quality of care. Among 11 986 patients, the proportion of women was unchanged between 2001 and 2011. The estimated national rates of hospital admission per 100 000 people increased from 4.6 in 2001 to 18.0 in 2011 among men (3.9‐fold increase) and from 1.9 to 8.0 among women (4.2‐fold increase) (P trend<0.0001). The median age of women increased from 68 years in 2001 to 72 years in 2011 (P trend<0.001); however, there was no age change in men (63 years in 2011) (P trend=0.48). After accounting for age, women had a higher frequency of comorbidities. Although there were significant sex differences in the time interval of >12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence‐based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P<0.001 for all) and the differences were largely unchanged over time.ConclusionsWomen experienced a higher increase in hospitalization rates for ST‐segment elevation myocardial infarction in China between 2001 and 2011 and were less likely to receive evidence‐based therapies, especially reperfusion. In addition to efforts to improve quality of care generally, understanding the reasons for this sex disparity and addressing these differences in care should be a priority.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

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“…Developing regions, such as Latin America, are experiencing a growing burden of cardiovascular disease20 and related risk factors such as type 2 diabetes mellitus 21. These findings may result from deficits in preventive strategies, genetic factors, exposure to Western countries’ high‐fat diets, and increasing prevalence of sedentary behaviors 21.…”

Section: Discussionmentioning

confidence: 99%

“…These findings may result from deficits in preventive strategies, genetic factors, exposure to Western countries’ high‐fat diets, and increasing prevalence of sedentary behaviors 21. The PURE (Prospective Urban and Rural Epidemiological) study, which enrolled 156 424 persons across 17 countries, identified that although the burden of cardiovascular risk factors may be lower in low‐ to middle‐income countries, the risk of cardiovascular events was much higher 20. This may reflect superior control of risk factors and more frequent use of proven pharmacological therapies and revascularization in high‐income countries 20.…”

Section: Discussionmentioning

confidence: 99%

International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial

Santos

Sharma

Sun

et al. 2017

JAHA

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BackgroundRegional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial.Methods and Results NAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P<0.0001) and the composite cardiovascular outcome (hazard ratio 1.48, 95% CI 1.15–1.92; P=0.003). No differential interactions between treatment and geographic location were identified.ConclusionsMajor regional differences regarding the risk of new‐onset diabetes mellitus and cardiovascular outcomes in NAVIGATOR participants were identified. These differences should be taken into account when planning global trials.Clinical Trial RegistrationURL: http://www.ClinicalTrials.gov. Unique identifier: NCT00097786.

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Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries

Cited by 779 publications

References 17 publications

INCA (Peru) Study: Impact of Non‐Invasive Cardiac Magnetic Resonance Assessment in the Developing World

INCA (Peru) Study: Impact of Non‐Invasive Cardiac Magnetic Resonance Assessment in the Developing World

Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST‐Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)‐Retrospective Study

International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial

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