Repositorio
Institucional

Lopez-Jaramillo, Patricio,

Joseph, Philip

Lopez-Lopez, Jose P.

Lanas, Fernando

Avezum, Alvaro

Diaz, Rafael

Camacho, Paul A.

Seron, Pamela

Oliveira, Gustavo

Orlandini, Andres

Rangarajan, Sumathy

Islam, Shofiqul

Yusuf, Salim

Risk factors, cardiovascular disease, and mortality in South America: a PURE substudy

OXFORD UNIV PRESS

EUROPEAN HEART JOURNAL

en

Aims In a multinational South American cohort, we examined variations in CVD incidence and mortality rates between sub- populations stratified by country, by sex and by urban or rural location. We also examined the contributions of 12 modifiable risk factors to CVD development and to death. Methods and results This prospective cohort study included 24 718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia. The mean follow-up was 10.3 years. The incidence of CVD and mortality rates were calculated for the overall cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and for death were examined for 12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (tobacco, alcohol, diet quality, and physical activity), and others (education, household air pollution, strength, and depression). Leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). The incidence of CVD (per 1000 person-years) only modestly varied between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates (per 1000 person-years) between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07). Men had a higher incidence of CVD (4.48 vs. 2.60 per 1000 person-years) and a higher mortality rate (6.33 vs. 3.96 per 1000 person-years) compared with women. Deaths were higher in rural compared to urban areas. Approximately 72% of the PAF for CVD and 69% of the PAF for deaths were attributable to 12 modifiable risk factors. For CVD, largest PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), tobacco use (13.5%), low strength (5.6%), and diabetes (5.3%). For death, the largest PAFs were from tobacco use (14.4%), hypertension (12.0%), low education (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). Conclusions Cardiovascular disease, cancer, and respiratory diseases account for over two-thirds of deaths in South America. Men have consistently higher CVD and mortality rates than women. A large proportion of CVD and premature deaths could be averted by controlling metabolic risk factors and tobacco use, which are common leading risk factors for both outcomes in the region. Key questions How do the rates of cardiovascular disease (CVD) and death vary within South America, and what are the predominant risk factors for each? Key findings Cardiovascular disease and death rates were both higher in men compared with women. Death rates were higher in rural compared with urban areas. Hypertension, obesity, diabetes, and tobacco use were leading risk factors for both CVD and death. Take-home message A large proportion of CVD and premature deaths in South America could be averted by policies aimed at controlling metabolic risk factors and tobacco use. [GRAPHICS] .

artículo original

10.1093/eurheartj/ehac113

PDF

Cardiovascular disease

Mortality

South America

INCOME COUNTRIES PURE

MIDDLE-INCOME

RELIABILITY

Sistemas cardíacos y cardiovasculares

Enfermedad cardiovascular

Mortalidad

América del Sur

PAÍSES DE INGRESOS PUROS

INGRESOS MEDIOS

CONFIABILIDAD

Epidemiología

Sistema Cardiovascular y Cardiaco

Salud Pública y Ambiental

Risk factors, cardiovascular disease, and mortality in South America: a PURE substudy

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