Massive global study looks at ‘paradox’ in fighting heart disease
'There is a real paradox. We have found that richer countries with higher risk factors have less heart disease and once people have a heart attack or stroke, the risk of dying is substantially less compared to poor countries,' said Dr. Salim Yusuf, principal investigator for the study.
Maintaining a healthy heart may have as much to do with the quality of health care one receives as it does with smoking, diet and exercise.
A large international study led by researchers at the Population Health Research Institute at McMaster and Hamilton Health Sciences has found that low-income countries which have people with the lowest risk factors for cardiovascular problems have the highest rates of cardiovascular events and death.
However, high-income countries full of people with the highest risk factors for heart conditions have a lower rate of severe heart problems and deaths.
The paper, published Wednesday in the prestigious New England Journal of Medicine, involved more than 156,000 people in 17 countries worldwide who took part in the Prospective Urban Rural Epidemiologic (PURE) Study.
“There is a real paradox. We have found that richer countries with higher risk factors have less heart disease and once people have a heart attack or stroke, the risk of dying is substantially less compared to poor countries,” said Dr. Salim Yusuf, principal investigator for the study.
Some 80 per cent of the deaths each year from cardiovascular disease happen in low and middle-income countries. Yusuf says the difference lies in the quality of health care.
“We have found that health care is as important, if not more important, than avoiding the risk factors in reducing cardiovascular disease.”
He added that for better heart health, wealthy countries should continue to deliver high quality health care while trying to reduce risk factors, while poor countries need to avoid the rise of risk factors but also substantially improve their health care.
Risk factors for cardiovascular problems include smoking, high cholesterol, high blood pressure, diabetes, obesity, stress and not enough fruits and vegetables or exercise.
Participants came from both urban and rural areas of four low-income countries of Bangladesh, India, Pakistan or Zimbabwe; 10 middle-income countries of Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, Poland, South Africa and Turkey; and three high-income countries of Canada, Sweden and the United Arab Emirates.
Funding for the study came from the Population Health Research Institute, along with many national or local organizations in participating countries and the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario and unrestricted grants from several pharmaceutical companies.
