Comparison of Cardiovascular Risk-Factor Burden in Low-, Middle-, and High-Income Countries

The incidence of cardiovascular disease is increasing rapidly in low- and middle-income countries, with these countries accounting for an estimated 80% of the global burden. To understand the cardiovascular risk-factor burden worldwide, the PURE investigators studied cardiovascular risk-factor burden (according to INTERHEART risk score), incident cardiovascular disease, and death in more than 150,000 adult residents of 17 high-, middle-, and low-income countries.

The mean cardiovascular risk-factor burden was highest in high-income countries and lowest in low-income countries. Compared with urban areas, rural areas had higher risk-factor burden in high-income countries but lower burden in middle-income and low-income countries. For primary prevention, the use of antiplatelet drugs was highest in high-income countries and lowest in low-income countries. A similar pattern was observed for beta-blockers, renin-angiotensin system blockers, and statins. Overall and cardiovascular death rates were highest in low-income countries and lowest in high-income countries. Nonmajor cardiovascular events, in contrast, were higher in high-income countries. Among individuals with a cardiovascular event, death rates were highest in low-income countries.