Body-mass index, blood pressure, diabetes and cardiovascular mortality in Cuba: prospective study of 146,556 participants
| Autor: | Paul Sherliker, Jennifer L Carter, Jonathan Emberson, Elba Lorenzo-Vázquez, Sarah Lewington, Marcy Calderón Martínez, Marelis Cendra Asencio, Monica Soni, Fernando Achiong Estupiñán, Shaquille Charles, M. Sofia Massa, Noel Rosquete Muñoz, Ileydis Iglesias-Marichal, Osvaldo Jesús Hernández López, Sonia Bess Constantén, Mayda Díaz González, Richard Peto, Oscar Díaz-Diaz, Julie Ann Burrett, Patricia Varona-Pérez, Ismell Alonso Alomá, Ben Lacey, Stephanie Ross, Miguel Morales, Nurys B. Armas Rojas, Nazrul Islam, José Manuel Morales Rigau, Hannah Taylor |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Blood Pressure Body-mass index Disease 030204 cardiovascular system & hematology Cardiovascular Body Mass Index 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Epidemiology Diabetes Mellitus medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Aged business.industry Public health Diabetes Public Health Environmental and Occupational Health Cuba Middle Aged medicine.disease Blood pressure Cardiovascular Diseases Female Public aspects of medicine RA1-1270 Biostatistics business Body mass index Research Article |
| Zdroj: | BMC Public Health BMC Public Health, Vol 21, Iss 1, Pp 1-10 (2021) |
| Popis: | Background Cardiovascular disease accounts for about one-third of all premature deaths (ie, age Methods In 1996–2002, 146,556 adults were recruited from the general population in five areas of Cuba. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to national death registries until Jan 1, 2017; in 2006–08, 24,345 participants were resurveyed. After excluding all with missing data, cardiovascular disease at recruitment, and those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate cardiovascular mortality rate ratios (RRs) at ages 35–79 years to SBP, diabetes and BMI; RR were corrected for regression dilution to give associations with long-term average (ie, ‘usual’) levels of SBP and BMI. Results After exclusions, there were 125,939 participants (mean age 53 [SD12]; 55% women). Mean SBP was 124 mmHg (SD15), 5% had diabetes, and mean BMI was 24.2 kg/m2 (SD3.6); mean SBP and diabetes prevalence at recruitment were both strongly related to BMI. During follow-up, there were 4112 cardiovascular deaths (2032 ischaemic heart disease, 832 stroke, and 1248 other). Cardiovascular mortality was positively associated with SBP (>=120 mmHg), diabetes, and BMI (>=22.5 kg/m2): 20 mmHg higher usual SBP about doubled cardiovascular mortality (RR 2.02, 95%CI 1.88–2.18]), as did diabetes (2.15, 1.95–2.37), and 10 kg/m2 higher usual BMI (1.92, 1.64–2.25). RR were similar in men and in women. The association with BMI and cardiovascular mortality was almost completely attenuated following adjustment for the mediating effect of SBP. Elevated SBP (>=120 mmHg), diabetes and raised BMI (>=22.5 kg/m2) accounted for 27%, 14%, and 16% of cardiovascular deaths, respectively. Conclusions This large prospective study provides direct evidence for the effects of these major risk factors on cardiovascular mortality in Cuba. Despite comparatively low levels of these risk factors by international standards, the strength of their association with cardiovascular death means they nevertheless exert a substantial impact on premature mortality in Cuba. |
| Databáze: | OpenAIRE |
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