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Canadian Journal of Cardiology

The Emerging Epidemic of Cardiovascular Risk Factors and Atherosclerotic Disease in Developing Countries

Published:December 23, 2016DOI:https://doi.org/10.1016/j.cjca.2016.12.014

      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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