The Burden of Cardiovascular Events According to Cardiovascular Risk Profile in Adults from High-, Middle- and Low-Income Countries

Background: Current strategies to prevent adverse cardiovascular outcomes focus on secondary prevention and primary prevention in high-risk groups. The proportion of events occurring in lower-risk groups globally is unknown. Methods We prospectively documented fatal or non-fatal myocardial infarction, stroke, heart failure, or any other fatal cardiovascular event stratified by history of cardiovascular disease (CVD), and by the INTERHEART and the Framingham risk score in those without prior CVD, in 189,097 adults from 26 high-, middle- and low-income countries. Results Participants mean±SD age was 51±10 years and 59% were women. We observed 14,829 outcome events affecting 8% of the cohort during a median 12.4 years follow-up. Overall, 44% of outcome events occurred in CVD-naive participants at low or intermediate INTERHEART risk and 56% occurred in in CVD-naive participants at non-high Framingham risk. The proportion of adverse cardiovascular outcomes occurring in these lower risk groups was inversely related to country income level and was higher in women (55%) than in men (35%). Conclusions To achieve a substantial population-level reduction in CVD, preventive strategies for CVD are essential in those considered low- or intermediate-risk.