Artículo de revista
Contrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143,567 individuals in 21 countries in the pure study
Fecha
2020-10-15Autor
Mohan Anjana, Ranjit
Mohan, Viswanathan
Rangarajan, Sumathy
Gerstein, Hertzel C.
Venkatesan, Ulagamadesan
Sheridan, Patrick
Dagenais, Gilles R.
Lear, Scott A.
Teo, Koon
Karsidag, Kubilay
Alhabib, Khalid F.
Yusoff, Khalid
Ismail, Noorhassim
Mony, Prem
Lopez-Jaramillo, Patricio
Chifamba, Jephat
Palileo-Villanueva, Lia M.
Iqbal, Romaina
Yusufali, Afzalhussein
Kruger, Iolanthe M.
Rosengren, Annika
Bahonar, Ahmad
Zatonska, Katarzyna
Yeates, Karen
Gupta, Rajeev
Li, Wei
Hu, Lihua
Rahman, M. Omar
Lakshmi, P.V.M.
Iype, Thomas
Avezum, Alvaro
Diaz, Rafael
Lanas, Fernando
Yusuf, Salim
Institución
Resumen
OBJECTIVE
We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV
mortality rates among adults with and without diabetes in countries with differing
levels of income.
RESEARCH DESIGN AND METHODS
The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults
aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries
(MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 6 3.0 years.
RESULTS
Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 personyears, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 personyears, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years,
P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC,
mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle
10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those
with diabetes in LIC remained unchanged even after adjustment for behavioral risk
factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]).
CONCLUSIONS
CVD rates, all-cause mortality, and CV mortality were markedly higher among those
with diabetes in LIC compared with MIC and HIC with mortality risk remaining
unchanged even after adjustment for risk factors and treatments. There is an urgent
need to improve access to care to those with diabetes in LIC to reduce the excess
mortality rates, particularly among those in the poorer strata of society.