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dc.contributor.author
Walli Attaei, Marjan
dc.contributor.author
Joseph, Philip
dc.contributor.author
Rosengren, Annika
dc.contributor.author
Chow, Clara K.
dc.contributor.author
Rangarajan, Sumathy
dc.contributor.author
Lear, Scott A
dc.contributor.author
AlHabib, Khalid F.
dc.contributor.author
Davletov, Kairat
dc.contributor.author
Dans, Antonio
dc.contributor.author
Irazola, Vilma
dc.contributor.author
Yeates, Karen
dc.contributor.author
Poirier, Paul
dc.contributor.author
Teo, Koon K.
dc.contributor.author
Camilo, Felix
dc.contributor.author
Chifamba, Jephat
dc.contributor.author
Diaz, Rafael
dc.contributor.author
Didkowska, Joanna A.
dc.contributor.author
Irazola, Vilma
dc.contributor.author
Kaur, Manmeet
dc.contributor.author
Khatib, Rasha
dc.contributor.author
Liu, Xiaoyun
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Mańczuk, Marta
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Miranda, J. Jaime
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Oguz, Aytekin
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Perez Mayorga, Maritza
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Szuba, Andrzej
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Prasad Varma, Ravi
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Yusufali, Afzalhussein
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Yusuf, Rita
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Wei, Li
dc.contributor.author
Anand, Sonia S.
dc.contributor.author
Yusuf, Salim
dc.date.available
2021-10-05T15:38:25Z
dc.date.issued
2020-07
dc.identifier.citation
Walli Attaei, Marjan; Joseph, Philip; Rosengren, Annika; Chow, Clara K.; Rangarajan, Sumathy; et al.; Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study; Elsevier Science Inc.; Lancet; 396; 10244; 7-2020; 97-109
dc.identifier.issn
0140-6736
dc.identifier.uri
http://hdl.handle.net/11336/142693
dc.description.abstract
Background: Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. Methods: In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35–70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death. Findings: From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5–10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0–4·2] for women vs 6·4 [6·2–6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72–0·79]) and all-cause death (4·5 [95% CI 4·4–4·7] for women vs 7·4 [7·2–7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60–0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2–21·7] versus 27·7 [95% CI 25·6–29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease. Interpretation: Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
Elsevier Science Inc.
dc.rights
info:eu-repo/semantics/restrictedAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.subject
risk factors
dc.subject
Women
dc.subject
Men
dc.subject
cardiovascular disease incidence
dc.subject.classification
Otras Ciencias de la Salud
dc.subject.classification
Ciencias de la Salud
dc.subject.classification
CIENCIAS MÉDICAS Y DE LA SALUD
dc.title
Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2021-09-07T15:00:18Z
dc.journal.volume
396
dc.journal.number
10244
dc.journal.pagination
97-109
dc.journal.pais
Estados Unidos
dc.description.fil
Fil: Walli Attaei, Marjan. No especifíca;
dc.description.fil
Fil: Joseph, Philip. No especifíca;
dc.description.fil
Fil: Rosengren, Annika. No especifíca;
dc.description.fil
Fil: Chow, Clara K.. No especifíca;
dc.description.fil
Fil: Rangarajan, Sumathy. No especifíca;
dc.description.fil
Fil: Lear, Scott A. No especifíca;
dc.description.fil
Fil: AlHabib, Khalid F.. No especifíca;
dc.description.fil
Fil: Davletov, Kairat. No especifíca;
dc.description.fil
Fil: Dans, Antonio. No especifíca;
dc.description.fil
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
dc.description.fil
Fil: Yeates, Karen. No especifíca;
dc.description.fil
Fil: Poirier, Paul. No especifíca;
dc.description.fil
Fil: Teo, Koon K.. No especifíca;
dc.description.fil
Fil: Camilo, Felix. No especifíca;
dc.description.fil
Fil: Chifamba, Jephat. No especifíca;
dc.description.fil
Fil: Diaz, Rafael. No especifíca;
dc.description.fil
Fil: Didkowska, Joanna A.. No especifíca;
dc.description.fil
Fil: Irazola, Vilma. No especifíca;
dc.description.fil
Fil: Kaur, Manmeet. No especifíca;
dc.description.fil
Fil: Khatib, Rasha. No especifíca;
dc.description.fil
Fil: Liu, Xiaoyun. No especifíca;
dc.description.fil
Fil: Mańczuk, Marta. No especifíca;
dc.description.fil
Fil: Miranda, J. Jaime. No especifíca;
dc.description.fil
Fil: Oguz, Aytekin. No especifíca;
dc.description.fil
Fil: Perez Mayorga, Maritza. No especifíca;
dc.description.fil
Fil: Szuba, Andrzej. No especifíca;
dc.description.fil
Fil: Prasad Varma, Ravi. No especifíca;
dc.description.fil
Fil: Yusufali, Afzalhussein. No especifíca;
dc.description.fil
Fil: Yusuf, Rita. No especifíca;
dc.description.fil
Fil: Wei, Li. No especifíca;
dc.description.fil
Fil: Anand, Sonia S.. No especifíca;
dc.description.fil
Fil: Yusuf, Salim. No especifíca;
dc.journal.title
Lancet
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S0140673620305432
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/http://dx.doi.org/10.1016/S0140-6736(20)30543-2
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