与高收入国家相比,尽管低收入国家的心血管疾病的风险是最低的;但主要心血管疾病和死亡的发生率却明显增高。在高收入国家,心血管疾病的高危因素导致的疾病负担可通过更好的控制危险因素、更多的使用药物治疗和血运重建技术而得到减轻。

-2014年8月30日《新英格兰医学杂志》

 中文翻译

 


 

 

 

题目】17个低、中、高收入国家的心血管疾病风险和事件

 

译文

背景:因心血管疾病死亡的人数,超过80%发生在低、中收入国家,但原因尚不清楚。

方法:我们纳入了来自17个国家(3个高收入、10个中收入、4个低收入国家)628个城市和农村社区共156,424人,采用INTERHEART风险评分方法对其进行心血管疾病危险评价。该方法不是采用实验检测的手段而是对疾病危险因素的负担进行定量化的评分,分数越高表示危险因素负担越重。对参与者的平均随访时间为4.1年,追踪其心血管疾病和死亡的发生情况。

结果:INTERHEART风险平均得分最高的是高收入国家,其次是中等收入国家,最低是低收入国家(P<0.001). 然而,主要心血管事件(心血管原因导致的死亡、心肌梗塞、卒中或心衰)发生率在高收入国家明显低于中等和低收入国家(高、中、低收入国家分别是3.99 /1000 vs. 5.38 /1000 vs. 6.43/1000; P<0.001)。病死率在高收入国家也是最低的(高、中、低收入国家分别是6.5%, 15.9%和 17.3%;P<0.01)。与农村人群相比,城市人群有更高的疾病风险负担,但心血管事件(4.83 vs. 6.25/1000, P<0.001)和病死率(13.52% vs. 17.25%, P<0.001)却较低。与中、低收入国家相比,预防性用药和血运重建技术在高收入国家更为普遍(P<0.001)。

结论:与高收入国家相比,尽管低收入国家的心血管疾病的风险是最低的;但主要心血管疾病和死亡的发生率却明显增高。在高收入国家,心血管疾病的高危因素导致的疾病负担可通过更好的控制危险因素、更多的使用药物治疗和血运重建技术而得到减轻。

 

英文原稿

 


 

 

 

[Title] Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries

 

[Authors]

Salim Yusuf, Sumathy Rangarajan, Koon Teo, Shofiqul Islam, Wei Li, Lisheng Liu, Jian Bo,

Qinglin Lou, Fanghong Lu , Tianlu Liu, Liu Yu, Shiying Zhang, Prem Mony, Sumathi Swaminathan,

Viswanathan Mohan, Rajeev Gupta, Rajesh Kumar, Krishnapillai Vijayakumar, , Scott Lear, Sonia Anand,

Andreas Wielgosz, Rafael Diaz, Alvaro Avezum, Patricio Lopez-

Jaramillo, Fernando Lanas, Khalid Yusoff, Noorhassim Ismail, Romaina Iqbal, Omar Rahman,

Annika Rosengren, Afzalhussein Yusufali, Roya Kelishadi, Annamarie Kruger, Thandi Puoane,

Andrzej Szuba, Jephat Chifamba, M.Phil., Aytekin Oguz, Matthew McQueen, Ch.B., Martin McKee,

Gilles Dagenais

 

[Abstract]

BACKGROUND
More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown.

METHODS
We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries)
and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing
(with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years.

RESULTS
The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001).
However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries
than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality
rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had
a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates
(13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in
middle- or low-income countries (P<0.001).

CONCLUSIONS
Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income
countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more
frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.)

 

原文地址

 

http://www.nejm.org/doi/full/10.1056/NEJMoa1311890

 

 

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