Repositorio
Institucional

Leong, Darryl P.

Rangarajan, Sumathy

Rosengren, Annika

Oguz, Aytekin

Alhabib, Khalid F.

Poirier, Paul

Diaz, Rafael

Dans, Antonio L.

Iqbal, Romaina

Yusufali, Afzalhussein M.

Yeates, Karen

Chifamba, Jephat

Seron, Pamela

Lopez-Lopez, Jose

Bahonar, Ahmad

Wei, Li

Bo, Hu

Weida, Liu

Avezum, Alvaro

Gupta, Rajeev

Mohan, Viswanathan

Kruger, Herculina S.

Lakshmi, P. V. M.

Yusuf, Rita

Yusuf, Salim

Medications for blood pressure, blood glucose, lipids, and anti-thrombotic medications: relationship with cardiovascular disease and death in adults from 21 high-, middle-, and low-income countries with an elevated body mass index

OXFORD UNIV PRESS

EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY

en

Aims Elevated body mass index (BMI) is an important cause of cardiovascular disease (CVD). The population-level impact of pharmacologic strategies to mitigate the risk of CVD conferred by the metabolic consequences of an elevated BMI is not well described. Methods and results We conducted an analysis of 145 986 participants (mean age 50 years, 58% women) from 21 high-, middle-, and low-income countries in the Prospective Urban and Rural Epidemiology study who had no history of cancer, ischaemic heart disease, heart failure, or stroke. We evaluated whether the hazards of CVD (myocardial infarction, stroke, heart failure, or cardiovascular death) differed among those taking a cardiovascular medication (n = 29 174, including blood pressure-lowering, blood glucose-lowering, cholesterol-lowering, or anti-thrombotic medications) vs. those not taking a cardiovascular medication (n = 116 812) during 10.2 years of follow-up. Cox proportional hazard models with the community as a shared frailty were constructed by adjusting age, sex, education, geographic region, physical activity, tobacco, and alcohol use. We observed 7928 (5.4%) CVD events and 9863 (6.8%) deaths. Cardiovascular medication use was associated with different hazards of CVD (interaction P < 0.0001) and death (interaction P = 0.0020) as compared with no cardiovascular medication use. Among those not taking a cardiovascular medication, as compared with those with BMI 20 to <25 kg/m(2), the hazard ratio (HR) [95% confidence interval (95% CI)] for CVD were, respectively, 1.14 (1.06-1.23), 1.45 (1.30-1.61), and 1.53 (1.28-1.82) among those with BMI 25 to <30 kg/m(2), 30 to <35 kg/m(2), and >= 35 kg/m(2). However, among those taking a cardiovascular medication, the HR (95% CI) for CVD were, respectively, 0.79 (0.72-0.87), 0.90 (0.79-1.01), and 1.14 (0.98-1.33). Among those not taking a cardiovascular medication, the respective HR (95% CI) for death were 0.93 (0.87-1.00), 1.03 (0.93-1.15), and 1.44 (1.24-1.67) among those with BMI 25 to <30 kg/m(2), 30 to <35 kg/m(2), and >= 35 kg/m(2). However, among those taking a cardiovascular medication, the respective HR (95% CI) for death were 0.77 (0.69-0.84), 0.88 (0.78-0.99), and 1.12 (0.96-1.30). Blood pressure-lowering medications accounted for the largest population attributable benefit of cardiovascular medications. Conclusion To the extent that CVD risk among those with an elevated BMI is related to hypertension, diabetes, and an elevated thrombotic milieu, targeting these pathways pharmacologically may represent an important complementary means of reducing the CVD burden caused by an elevated BMI.

artículo original

10.1093/eurjpc/zwac069

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Obesity

Cardiovascular

Risk factor

Blood pressure

Lipid-lowering

ASSOCIATION

RISK

Sistemas cardíacos y cardiovasculares

Obesidad

Cardiovascular

Factor de riesgo

Presión arterial

Reductor de lípidos

ASOCIACIÓN

RIESGO

Sistema Cardiovascular y Cardiaco

Medicina General e Interna

Epidemiología

Medications for blood pressure, blood glucose, lipids, and anti-thrombotic medications: relationship with cardiovascular disease and death in adults from 21 high-, middle-, and low-income countries with an elevated body mass index

1817

1826

artículo original

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