Repositorio
Institucional

Teo, Koon

Lear, Scott

Islam, Shofiqul

Mony, Prem

Dehghan, Mahshid

Li, Wei

Rosengren, Annika

Lopez-Jaramillo, Patricio

Diaz, Rafael

Oliveira, Gustavo

Miskan, Maizatullifah

Rangarajan, Sumathy

Iqbal, Romaina

Ilow, Rafal

Puone, Thandi

Bahonar, Ahmad

Gulec, Sadi

Darwish, Ebtihal A.

Lanas, Fernando

Vijaykumar, Krishnapillai

Rahman, Omar

Chifamba, Jephat

Hou, Yan

Li, Ning

Yusuf, Salim

Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income Countries The Prospective Urban Rural Epidemiology (PURE) Study

AMER MEDICAL ASSOC

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

en

Importance Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide. Objective To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event. Design, Setting, and Participants Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153 996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009. Main Outcome Measures Smoking status (current, former, never), level of exercise (low, <600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, >3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index). Results Among 7519 individuals with self-reported CHD (past event: median, 5.0 [interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median, 4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke; only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work-or leisure-related physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets; 14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI, 50.7%-54.3%) quit smoking (by income country classification: 74.9% [95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6% [95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%-57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%-68.7%). Conclusion and Relevance Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries. JAMA. 2013;309(15):1613-1621 www.jama.com

Artículo original

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Lear reported that the Population Health Research Institute (Hamilton, Ontario, Canada) provided funding support for travel to meetings for the Prospective Urban Rural Epidemiology (PURE) study. Dr Lopez-Jaramillo reported receiving speakers fees from Boehringer and Merck. Dr Ilow reported receiving research funding from the Polish Minstry of Science and Higher Education and the Population Health Research Institute. Dr Bahonar reported receiving institutional funding from the Population Health Research Institute for the costs of the study. Dr Gulec reported serving on the board of Pfizer, Novartis, AstraZeneca, and Boehringer Ingelheim

receiving speakers fees from sanofi-aventis, AstraZeneca, Novartis, Pfizer, Bayer, and Boehringer Ingelheim

receiving payment for the development of educational presentations from Abdi Ibrahim (Turkey)

and receiving travel reimbursement from Boehringer Ingelheim and sanofi-aventis. Dr Lanas reported receiving a grant from the Universidad de La Frontera

and receiving travel reimbursement from the Population Health Research Institute. No other author reported disclosures.Dr Yusuf is supported by the Mary W. Burke endowed chair of the Heart and Stroke Foundation of Ontario. Dr Chow is supported by a fellowship co-funded by the National Heart and Medical Research Council of Australia, the National Heart Foundation of Australia, and the Sydney Medical Foundation. The PURE study is funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca in Sweden and Canada, Novartis, sanofi-aventis in France and Canada, Boehringer Ingelheim in Germany and Canada, Servier, King Pharma, and GlaxoSmithKline), and additionally by contributions from various national or local organizations in the following countries: Bangladesh: Independent University, Bangladesh, Mitra and Associates. Brazil: Unilever Health Institute, Brazil. Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network. Chile: Universidad de la Frontera. China: National Center for Cardiovascular Diseases. Colombia: Colciencias grant 6566-04-18062. India: Indian Council of Medical Research. Malaysia: Ministry of Science, Technology, and Innovation of Malaysia grant 07-05-IFN-MEB010, Universiti Teknologi MARA, and Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010). Poland: Polish Ministry of Science and Higher Education grant Nr 290/W-PURE/2008/0, and Wroclaw Medical University. South Africa: North-West University, SANPAD (South Africa and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of South Africa, South Africa Sugar Association, and Faculty of Community and Health Sciences (University of Western Cape). Sweden: Swedish Council for Working Life and Social Research, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, Swedish Heart and Lung Foundation, Swedish Research Council, grant from the Swedish State under LakarUtbildningsAvtalet agreement, and grant from the Vastra Gotaland Region. Turkey: Metabolic Syndrome Society, AstraZeneca, and sanofi-aventis. United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, and Dubai Health Authority.

Los autores han completado y enviado el Formulario ICMJE para la Declaración de Posibles Conflictos de Interés. El Dr. Lear informó que el Population Health Research Institute (Hamilton, Ontario, Canadá) proporcionó apoyo financiero para viajes a reuniones para el estudio Prospective Urban Rural Epidemiology (PURE). El Dr. López-Jaramillo informó haber recibido honorarios por ponencias de Boehringer y Merck. El Dr. Ilow informó haber recibido financiación para investigación del Ministerio de Ciencia y Educación Superior de Polonia y del Population Health Research Institute. El Dr. Bahonar informó haber recibido financiación institucional del Population Health Research Institute para los costos del estudio. El Dr. Gulec informó haber formado parte de la junta directiva de Pfizer, Novartis, AstraZeneca y Boehringer Ingelheim

haber recibido honorarios por ponencias de sanofi-aventis, AstraZeneca, Novartis, Pfizer, Bayer y Boehringer Ingelheim

haber recibido pago por el desarrollo de presentaciones educativas de Abdi Ibrahim (Turquía)

y haber recibido reembolso de gastos de viaje de Boehringer Ingelheim y sanofi-aventis. El Dr. Lanas informó haber recibido una beca de la Universidad de La Frontera y un reembolso de gastos de viaje del Population Health Research Institute. Ningún otro autor informó conflictos de interés. El Dr. Yusuf cuenta con el apoyo de la cátedra Mary W. Burke de la Heart and Stroke Foundation of Ontario. El Dr. Chow cuenta con el apoyo de una beca cofinanciada por el National Heart and Medical Research Council of Australia, la National Heart Foundation of Australia y la Sydney Medical Foundation. El estudio PURE está financiado por los Canadian Institutes of Health Research, la Heart and Stroke Foundation of Ontario y mediante subvenciones sin restricciones de varias compañías farmacéuticas (con importantes contribuciones de AstraZeneca en Suecia y Canadá, Novartis, sanofi-aventis en Francia y Canadá, Boehringer Ingelheim en Alemania y Canadá, Servier, King Pharma y GlaxoSmithKline), y adicionalmente por contribuciones de diversas organizaciones nacionales o locales en los siguientes países: Bangladesh: Independent University, Bangladesh, Mitra and Associates. Brasil: Unilever Health Institute, Brasil. Canadá: Public Health Agency of Canada y Champlain Cardiovascular Disease Prevention Network. Chile: Universidad de la Frontera. China: Centro Nacional de Enfermedades Cardiovasculares. Colombia: Subvención Colciencias 6566-04-18062. India: Consejo Indio de Investigación Médica. Malasia: Subvención del Ministerio de Ciencia, Tecnología e Innovación de Malasia 07-05-IFN-MEB010, Universiti Teknologi MARA y Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010). Polonia: Subvención del Ministerio de Ciencia y Educación Superior de Polonia Nr 290/W-PURE/2008/0 y Universidad Médica de Breslavia. Sudáfrica: Universidad del Noroeste, SANPAD (Programa de Sudáfrica y Países Bajos para el Desarrollo Alternativo), Fundación Nacional de Investigación, Consejo de Investigación Médica de Sudáfrica, Asociación Azucarera de Sudáfrica y Facultad de Ciencias Comunitarias y de la Salud (Universidad del Cabo Occidental). Suecia: Consejo Sueco para la Investigación Social y Laboral, Consejo Sueco de Investigación para el Medio Ambiente, las Ciencias Agrícolas y la Planificación Espacial, Fundación Sueca del Corazón y los Pulmones, Consejo Sueco de Investigación, subvención del Estado sueco en virtud del acuerdo LakarUtbildningsAvtalet y subvención de la Región de Västra Götaland. Turquía: Sociedad del Síndrome Metabólico, AstraZeneca y Sanofi-Aventis. Emiratos Árabes Unidos: Premio Sheikh Hamdan Bin Rashid Al Maktoum de Ciencias Médicas y Autoridad Sanitaria de Dubái.

10.1001/jama.2013.3519

pdf

FOOD FREQUENCY QUESTIONNAIRES

MYOCARDIAL-INFARCTION

RISK-FACTORS

SECONDARY PREVENTION

DRUG THERAPIES

TOBACCO USE

INTERHEART

DIET

COMMUNITY

EXERCISE

CUESTIONARIOS DE FRECUENCIA DE CONSUMO DE ALIMENTOS

INFARTO DE MIOCARDIO

FACTORES DE RIESGO

PREVENCIÓN SECUNDARIA

TERAPIAS FARMACOLÓGICAS

CONSUMO DE TABACO

INTERHEART

DIETA

COMUNIDAD

EJERCICIO

FOOD FREQUENCY QUESTIONNAIRES

MYOCARDIAL-INFARCTION

RISK-FACTORS

SECONDARY PREVENTION

DRUG THERAPIES

TOBACCO USE

INTERHEART

DIET

COMMUNITY

EXERCISE

CUESTIONARIOS DE FRECUENCIA DE CONSUMO DE ALIMENTOS

INFARTO DE MIOCARDIO

FACTORES DE RIESGO

PREVENCIÓN SECUNDARIA

TERAPIAS FARMACOLÓGICAS

CONSUMO DE TABACO

INTERHEART

DIETA

COMUNIDAD

EJERCICIO

Epidemiología

Sistema Cardiovascular y Cardiaco

Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income Countries The Prospective Urban Rural Epidemiology (PURE) Study

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

hibrida

verde

acceso abierto

acceso abierto

PMID 23592106

en

Artículo original

versión publicada

Population Health Research Institute (Hamilton, Ontario, Canada)#Boehringer#Merck#Polish Minstry of Science and Higher Education#Population Health Research Institute#sanofi-aventis#AstraZeneca#Novartis#Pfizer#Bayer#Boehringer Ingelheim#Abdi Ibrahim (Turkey)#Universidad de La Frontera#Mary W. Burke endowed chair of the Heart and Stroke Foundation of Ontario#National Heart and Medical Research Council of Australia#National Heart Foundation of Australia#Sydney Medical Foundation#Canadian Institutes of Health Research#Heart and Stroke Foundation of Ontario#AstraZeneca in Sweden#AstraZeneca in Canada#sanofi-aventis in France#sanofi-aventis in Canada#Boehringer Ingelheim in Germany#Boehringer Ingelheim in Canada#Servier#King Pharma#GlaxoSmithKline#Independent University, Bangladesh#Mitra and Associates#Unilever Health Institute, Brazil#Public Health Agency of Canada#Champlain Cardiovascular Disease Prevention Network#National Center for Cardiovascular Diseases#Colciencias 6566-04-18062#Indian Council of Medical Research#Ministry of Science, Technology, and Innovation of Malaysia 07-05-IFN-MEB010#Universiti Teknologi MARA#Universiti Kebangsaan Malaysia UKM-Hejim-Komuniti-15-2010#Polish Ministry of Science and Higher Education 290/W-PURE/2008/0#Wroclaw Medical University#North-West University, SANPAD (South Africa and Netherlands Programme for Alternative Development)#National Research Foundation#Medical Research Council of South Africa#South Africa Sugar Association#Faculty of Community and Health Sciences (University of Western Cape)#Swedish Council for Working Life and Social Research#Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning#Swedish Heart and Lung Foundation#Swedish Research Council#Swedish State under LakarUtbildningsAvtalet#Vastra Gotaland Region#Metabolic Syndrome Society#Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences#Dubai Health Authority

Population Health Research Institute (Hamilton, Ontario, Canada)

Boehringer

Merck

Polish Minstry of Science and Higher Education

Population Health Research Institute

sanofi-aventis

AstraZeneca

Novartis

Pfizer

Bayer

Boehringer Ingelheim

Abdi Ibrahim (Turkey)

Universidad de La Frontera

Mary W. Burke endowed chair of the Heart and Stroke Foundation of Ontario

National Heart and Medical Research Council of Australia

National Heart Foundation of Australia

Sydney Medical Foundation

Canadian Institutes of Health Research

Heart and Stroke Foundation of Ontario

AstraZeneca in Sweden

AstraZeneca in Canada

sanofi-aventis in France

sanofi-aventis in Canada

Boehringer Ingelheim in Germany

Boehringer Ingelheim in Canada

Servier

King Pharma

GlaxoSmithKline

Independent University, Bangladesh

Mitra and Associates

Unilever Health Institute, Brazil

Public Health Agency of Canada

Champlain Cardiovascular Disease Prevention Network

National Center for Cardiovascular Diseases

Colciencias 6566-04-18062

Indian Council of Medical Research

Ministry of Science, Technology, and Innovation of Malaysia 07-05-IFN-MEB010

Universiti Teknologi MARA

Universiti Kebangsaan Malaysia UKM-Hejim-Komuniti-15-2010

Polish Ministry of Science and Higher Education 290/W-PURE/2008/0

Wroclaw Medical University

North-West University, SANPAD (South Africa and Netherlands Programme for Alternative Development)

National Research Foundation

Medical Research Council of South Africa

South Africa Sugar Association

Faculty of Community and Health Sciences (University of Western Cape)

Swedish Council for Working Life and Social Research

Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning

Swedish Heart and Lung Foundation

Swedish Research Council

Swedish State under LakarUtbildningsAvtalet

Vastra Gotaland Region

Metabolic Syndrome Society

Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences

Dubai Health Authority

AMER MEDICAL ASSOC

0098-7484

1613

1621

Medicina general e interna

Medicine, General & Internal

pdf

WOS:000317599500025