Abstract
Cardiovascular disease (CVD) and its risk factors, which are major health burdens
in high-income countries, are a growing problem in developing or lower-income countries,
where the vast majority of CVD now occurs. Two case-control studies, INTERHEART and
INTERSTROKE, which included a majority of patients from developing countries, were
seminal in identifying common risk factors explaining the vast majority of risk for
acute myocardial infarction and stroke, respectively. The population-based Prospective
Urban and Rural Epidemiological (PURE) study, which included > 150,000 participants,
also with a majority from developing countries, found that although high-income countries
were at highest cardiovascular (CV) risk, they had the lowest incidence of CVD and
associated case-fatality rates, whereas patients in low-income countries had the lowest
CV risk and yet the highest CVD and case-fatality rates. The PURE study also demonstrated
relatively low rates of CV medicine use in high- and middle-income countries, but
even lower rates in low-income countries, where these medicines were often either
unavailable or unaffordable. The PURE study also demonstrated that control of CV risk
factors and adherence to lifestyle modifications, although suboptimal globally, were
poorest in low-income countries. Taken together, these data identify common CV risk
factors requiring targeted, systematic, sustained, and effective interventions in
developing countries to mitigate the emerging epidemic of CVD in these regions of
the world.
Résumé
Les maladies cardiovasculaires (MCV) et leurs facteurs de risque, qui constituent
un des plus importants fardeaux pour la santé dans les pays à revenu élevé, posent
désormais des problèmes grandissants dans les pays en développement ou à revenu relativement
faible puisque c’est désormais là que leurs méfaits sont les plus prévalents. Les
études cas-témoins INTERHEART et INTERSTROKE, qui comptaient une majorité de patients
en provenance de pays en développement, ont permis de déterminer les facteurs de risque
courants expliquant en majeure partie le risque d’infarctus aigu du myocarde et d’accident
vasculaire cérébral (AVC), respectivement. L’étude prospective sur les populations
PURE (Prospective Urban and Rural Epidemiological), qui portait sur plus de 150 000 participants dont la majorité provenait de pays
en développement, a pour sa part permis de déterminer que les pays à revenu élevé
présentent les facteurs de risque cardiovasculaire les plus importants, mais l’incidence
de MCV et de décès associés la plus faible, tandis que les pays à faible revenu présentent
les risques cardiovasculaires les plus faibles et l’incidence de MCV et de décès associés
la plus forte. L’étude PURE a également révélé un taux d’ordonnances pour le traitement
des MCV relativement faible dans les pays à revenu élevé et à revenu moyen, taux qui
était encore plus bas dans les pays à faible revenu où les médicaments en question
sont soit non disponibles, soit hors de prix. Enfin, l’étude PURE indiquait aussi
que la maîtrise des facteurs de risque cardiovasculaire et la modification durable
du mode de vie étaient sous-optimales à l’échelle mondiale, mais encore plus problématiques
dans les pays à faible revenu. Prises globalement, ces données ont permis de déterminer
quels étaient les facteurs de risque cardiovasculaire courants qui devaient faire
l’objet d’interventions à la fois ciblées, systématiques, soutenues et efficaces dans
les pays en développement de manière à endiguer l’épidémie de MCV émergente dans ces
régions du monde.
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Article info
Publication history
Published online: December 23, 2016
Accepted:
December 21,
2016
Received:
December 13,
2016
Footnotes
See page 364 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
