Risk factors for incident cardiovascular events among adults in low- and middle-income countries: A systematic review and meta-analysis of prospective cohort studies.

Autor: Birhanu MM; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Zaman SB; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Thrift AG; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. Electronic address: amanda.thrift@monash.edu., Evans RG; Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia., Zengin A; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. Electronic address: ayse.zengin@monash.edu.
Jazyk: angličtina
Zdroj: Preventive medicine [Prev Med] 2022 May; Vol. 158, pp. 107036. Date of Electronic Publication: 2022 Mar 28.
DOI: 10.1016/j.ypmed.2022.107036
Abstrakt: The relative contributions of risk factors for cardiovascular events at a population level has received little attention in low- and middle-income countries (LMICs). We estimated the population attributable fraction (PAF) of risk factors associated with incident cardiovascular events in LMICs. We searched six databases for relevant articles, supplemented with a manual search of reference lists. Articles included in the meta-analyses were those based on prospective community-based cohorts and incorporating adjusted hazard ratios (HR) or relative risks with 95% confidence intervals (95% CI) for associations between risk factors and a composite cardiovascular and/or stroke endpoint. Pooled HRs and 95% CI were calculated using the random effects model. We assessed heterogeneity using the I 2 test and study quality using the Newcastle-Ottawa Scale. We calculated the PAF of each associated risk factor. The protocol was registered in PROSPERO (CRD42019122741). We identified 18 cohorts from LMICs with 1,125,846 participants, 77,045 composite cardiovascular events and 42,216 strokes. Substantial proportions of incident cardiovascular events were attributable to hypertension (HR [95% CI], 2.23 [2.01-2.48], PAF = 28%); current smoking (1.44 [1.31-1.58], PAF = 10%); and diabetes mellitus (1.93 [1.67-2.23], PAF = 8%). Other risk factors identified included number of children, depression, bone mineral density, and air pollution. A substantial proportion of incident cardiovascular events were linked to traditional metabolic and behavioural modifiable risk factors. However, other novel risk factors also appear to contribute. Targeting of these established and novel risk factors has the potential to reduce the burden of CVD in LMICs.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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