Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)

Digital

Autores:: Yusuf, Salim
Joseph, Philip
Rangarajan, Sumathy
Islam, Shofiqul
Mente, Andrew
Hystad, Perry
Brauer, Michael
Raman Kutty, Vellappillil
Gupta, Rajeev
Wielgosz, Andreas
AlHabib, Khalid F.
Dans, Antonio
Lopez-Jaramillo, Patricio
Avezum, Alvaro
Lanas, Fernando
Oguz, Aytekin
Kruger, Iolanthe M.
Diaz, Rafael
Yusoff, Khalid
Mony, Prem
Chifamba, Jephat
Yeates, Karen
Kelishadi, Roya
Yusufali, Afzalhussein
Khatib, Rasha
Rahman, Omar
Zatonska, Katarzyna
Iqbal, Romaina
Wei, Li
Bo, Hu
Rosengren, Annika
Kaur, Manmeet
Mohan, Viswanathan
Lear, Scott A.
Teo, Koon K.
Leong, Darryl
O'Donnell, Martin
McKee, Martin
Dagenais, Gilles

Tipo de recurso:: Article of journal

Fecha de publicación:: 2019

Institución:: Universidad de Santander

Repositorio:: Repositorio Universidad de Santander

Idioma:: eng

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dc.title.spa.fl_str_mv	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
dc.title.alternative.spa.fl_str_mv	A a prospective cohort study
title	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
spellingShingle	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
title_short	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
title_full	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
title_fullStr	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
title_full_unstemmed	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
title_sort	Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)
dc.creator.fl_str_mv	Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles
dc.contributor.author.none.fl_str_mv	Yusuf, Salim Joseph, Philip Rangarajan, Sumathy Islam, Shofiqul Mente, Andrew Hystad, Perry Brauer, Michael Raman Kutty, Vellappillil Gupta, Rajeev Wielgosz, Andreas AlHabib, Khalid F. Dans, Antonio Lopez-Jaramillo, Patricio Avezum, Alvaro Lanas, Fernando Oguz, Aytekin Kruger, Iolanthe M. Diaz, Rafael Yusoff, Khalid Mony, Prem Chifamba, Jephat Yeates, Karen Kelishadi, Roya Yusufali, Afzalhussein Khatib, Rasha Rahman, Omar Zatonska, Katarzyna Iqbal, Romaina Wei, Li Bo, Hu Rosengren, Annika Kaur, Manmeet Mohan, Viswanathan Lear, Scott A. Teo, Koon K. Leong, Darryl O'Donnell, Martin McKee, Martin Dagenais, Gilles
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publishDate	2019
dc.date.issued.none.fl_str_mv	2019-09-03
dc.date.accessioned.none.fl_str_mv	2021-11-23T22:19:58Z
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dc.language.iso.spa.fl_str_mv	eng
language	eng
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dc.relation.citationvolume.spa.fl_str_mv	395
dc.relation.indexed.spa.fl_str_mv	Scopus
dc.relation.ispartofjournal.spa.fl_str_mv	The Lancet
dc.rights.spa.fl_str_mv	© 2019 Elsevier Ltd. All rights reserved.
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dc.format.extent.spa.fl_str_mv	14 p
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dc.publisher.spa.fl_str_mv	Elsevier
dc.publisher.place.spa.fl_str_mv	Reino Unido
dc.source.spa.fl_str_mv	https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32008-2/fulltext#%20
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spelling	Yusuf, Salim06a836b5-f5e3-41d9-a516-9cc46e5d7948-1Joseph, Philip35ddb523-bb0e-4c55-9a59-b24968824fbf-1Rangarajan, Sumathy5466c363-e515-4bd2-8537-eb839320f385-1Islam, Shofiqule02df6ce-a317-49c4-8ebd-72d82c266011-1Mente, Andrew9a80b664-b49e-4fce-961e-b7dd6e07a3ab-1Hystad, Perryab041ed3-f9b8-4a72-ad0c-2f4f7bd41522-1Brauer, Michael8f4c3a9c-b3e1-4546-a7fa-d04aec76dde3-1Raman Kutty, Vellappillil096a62d9-a241-4aa1-9566-75ce7e7095e0-1Gupta, Rajeevde1826df-aac8-4d9f-9b84-f21ba704686c-1Wielgosz, Andreasd9d25746-66c4-498e-a328-286412ab8782-1AlHabib, Khalid F.49cf9a4d-2bdf-4356-b613-9ef98a77f4c3-1Dans, Antoniof365ef5a-7610-4022-8485-31d6d3879cd6-1Lopez-Jaramillo, Patricio9a71267b-dcb0-4d31-b37d-2d30be58d4d2-1Avezum, Alvaro8b920360-abb2-4ec8-b5ee-4e3f4e0b11eb-1Lanas, Fernandod22b7fe4-9f1f-4028-a22b-be782ef03d3c-1Oguz, Aytekince3e3101-01ec-4709-ad5f-2ba54357481e-1Kruger, Iolanthe M.3cbeccb6-af61-49b4-a95f-2c6cf4aa7985-1Diaz, Rafaelf2be4a74-501a-4e63-8bbd-965cbcf8c57b-1Yusoff, Khalid933db13d-f5bb-4ea6-91a5-68eea1ca9ffc-1Mony, Premab6dbf82-20a0-4744-abfd-8a723db46c4d-1Chifamba, Jephatf2496279-e934-40b8-8f61-0039a09f03f8-1Yeates, Karen79418492-ec06-4cc6-831a-4bf5b245b584-1Kelishadi, Roya4cdb25d6-6e41-4905-a399-c9d53f250b42-1Yusufali, Afzalhussein2c177fd9-b761-4f07-b754-1e05fe659a48-1Khatib, Rasha7beae0a6-cfd5-4272-bf8c-1b5896fed8e5-1Rahman, Omar2fdf224c-97c9-4fb0-b7a9-ea79427bc631-1Zatonska, Katarzyna6d84170f-b69c-462b-9d93-3f363491580a-1Iqbal, Romaina015cbc16-dd01-4e26-adff-257bb8827f50-1Wei, Li615354ee-b1c5-4dab-b9f2-64e8bcad90e8-1Bo, Hufac47230-40af-4a68-aa8a-f40c8912f599-1Rosengren, Annika923779f9-3a92-4086-b3d9-9d78974926d9-1Kaur, Manmeet857257e4-cebb-4bea-8d9b-e134b46dc72b-1Mohan, Viswanathane7246d73-7de3-4d86-9c7b-b9ca011e618b-1Lear, Scott A.dc924e5a-246b-40a8-b08f-59610fa89be1-1Teo, Koon K.10190d66-4f2e-4a41-8a15-bc2d4ba9d1f8-1Leong, Darryleb30b053-331a-4c98-a1eb-47fa40728418-1O'Donnell, Martinb8e18a05-4b9e-40ba-871f-7084e8e8f70f-1McKee, Martin5258b372-6b7d-4e6f-aaa6-0e81538245af-1Dagenais, Gillesc865f015-4dc7-483d-9dae-132288d901f8-1Everest2021-11-23T22:19:58Z2021-11-23T22:19:58Z2019-09-03DigitalBackground Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels. Methods In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs. Findings Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs. Interpretation Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).Ciencias Médicas y de la Salud14 papplication/pdfhttps://doi.org/10.1016/S0140-6736(19)32008-2https://repositorio.udes.edu.co/handle/001/5726engElsevierReino Unido80810226795395ScopusThe Lancet© 2019 Elsevier Ltd. All rights reserved.info:eu-repo/semantics/closedAccessAtribución-NoComercial 4.0 Internacional (CC BY-NC 4.0)https://creativecommons.org/licenses/by-nc/4.0/http://purl.org/coar/access_right/c_14cbhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32008-2/fulltext#%20Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)A a prospective cohort studyArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a85Todas las AudienciasPublicationORIGINALModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE). A prospective cohort study.pdfModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE). A prospective cohort study.pdfapplication/pdf196112https://repositorio.udes.edu.co/bitstreams/f3045e06-9afb-4969-abfc-188e25181c78/downloadb858baedec07397da1915a133b89b541MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-859https://repositorio.udes.edu.co/bitstreams/aa8a6a16-c04a-4aca-be01-7a52162809b2/download38d94cf55aa1bf2dac1a736ac45c881cMD52TEXTModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE). A prospective cohort study.pdf.txtModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE). A prospective cohort study.pdf.txtExtracted texttext/plain5https://repositorio.udes.edu.co/bitstreams/3f176feb-db08-4606-82ed-4f2ceaa141c7/download5dbe86c1111d64f45ba435df98fdc825MD53THUMBNAILModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE). A prospective cohort study.pdf.jpgModifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE). A prospective cohort study.pdf.jpgGenerated Thumbnailimage/jpeg6540https://repositorio.udes.edu.co/bitstreams/14ce8dc5-e644-48b4-8915-7625ecd908c5/download39b4698c95a0ada7fc61e7ec355ebcb8MD54001/5726oai:repositorio.udes.edu.co:001/57262023-10-10 08:29:07.994https://creativecommons.org/licenses/by-nc/4.0/© 2019 Elsevier Ltd. 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Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE)

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