Prevalence of Pragmatically Defined High CV Risk and its Correlates in LMIC: A Report From 10 LMIC Areas in Africa, Asia, and South America

Abstract

Background Current available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMICs). There is a need to assess HCR using a pragmatic evidence-based approach. Objective To report the prevalence of HCR in ten LMIC areas in Africa, Asia and South America, and to investigate the profiles and correlates of HCR. Methods Cross-sectional analysis using data from the NHLBI-UHG Centers of Excellence. HCR was defined as history of heart disease/heart attack, history of stroke, older age (≥50 years for men and ≥60 for women) with history of diabetes, or older age with systolic blood pressure ≥160 mmHg. Prevalence estimates were standardized to the WHO World Standard Population. Results A total of 37,067 subjects aged ≥35 years were included; 53.7% were women and mean age was 53.5 (±12.1) years. The overall age-standardized prevalence of HCR was 15.4% (95% CI: 15.0-15.7), ranging from 8.3% (India, Bangalore) to 23.4% (Bangladesh). Among men, the prevalence was 1.7% for the younger age group (35-49 years) and 29.1% for the older group (≥50); among women, 3.8% for the younger group (35-59 years) and 40.7% for the older group (≥60). Among the older group, measured systolic blood pressure ≥160 mmHg (with or without other conditions) was the most common criterion for having HCR, followed by diabetes. The proportion of having met more than one criterion was nearly 20%. Age, education, and body mass index were significantly associated with HCR. Cross-site differences existed and were attenuated after adjusting for age, sex, education, smoking, and body mass index. Conclusions The prevalence of HCR in ten LMIC areas was generally high. This study provides a starting point to define targeted populations that may benefit from interventions combining both primary and secondary prevention strategies.

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