Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data

Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic c...

Full description

Saved in:
Bibliographic Details
Published in:PLoS medicine 2021-03, Vol.18 (3), p.e1003485
Main Authors: Peiris, David, Ghosh, Arpita, Manne-Goehler, Jennifer, Jaacks, Lindsay M, Theilmann, Michaela, Marcus, Maja E, Zhumadilov, Zhaxybay, Tsabedze, Lindiwe, Supiyev, Adil, Silver, Bahendeka K, Sibai, Abla M, Norov, Bolormaa, Mayige, Mary T, Martins, Joao S, Lunet, Nuno, Labadarios, Demetre, Jorgensen, Jutta M A, Houehanou, Corine, Guwatudde, David, Gurung, Mongal S, Damasceno, Albertino, Aryal, Krishna K, Andall-Brereton, Glennis, Agoudavi, Kokou, McKenzie, Briar, Webster, Jacqui, Atun, Rifat, Bärnighausen, Till, Vollmer, Sebastian, Davies, Justine I, Geldsetzer, Pascal
Format: Article
Language:English
Subjects:
Age
Antihypertensive drugs
Blood pressure
Body weight
Cardiovascular disease
Cardiovascular diseases
Care and treatment
Cerebral infarction
Cross-sectional studies
Developing countries
Diabetes
Disease prevention
Earth Sciences
Estimates
Health aspects
Heart attacks
Laboratories
Low income groups
Medicine and Health Sciences
Myocardial infarction
Population
Regulation
Risk factors
Social Sciences
Surveillance
Sustainable development
Working groups
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%-4.2%) and 1.6% (1.3%-2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%-37.2%) for males and 41.6% (23.9%-53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%-58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1003485