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.
<h4>Background</h4>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 c...
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doaj-3720a98390ea4e2ab5b019850593de232021-07-29T04:31:39ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762021-03-01183e100348510.1371/journal.pmed.1003485Cardiovascular 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.David PeirisArpita GhoshJennifer Manne-GoehlerLindsay M JaacksMichaela TheilmannMaja E MarcusZhaxybay ZhumadilovLindiwe TsabedzeAdil SupiyevBahendeka K SilverAbla M SibaiBolormaa NorovMary T MayigeJoao S MartinsNuno LunetDemetre LabadariosJutta M A JorgensenCorine HouehanouDavid GuwatuddeMongal S GurungAlbertino DamascenoKrishna K AryalGlennis Andall-BreretonKokou AgoudaviBriar McKenzieJacqui WebsterRifat AtunTill BärnighausenSebastian VollmerJustine I DaviesPascal Geldsetzer<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pmed.1003485 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
David Peiris Arpita Ghosh Jennifer Manne-Goehler Lindsay M Jaacks Michaela Theilmann Maja E Marcus Zhaxybay Zhumadilov Lindiwe Tsabedze Adil Supiyev Bahendeka K Silver Abla M Sibai Bolormaa Norov Mary T Mayige Joao S Martins Nuno Lunet Demetre Labadarios Jutta M A Jorgensen Corine Houehanou David Guwatudde Mongal S Gurung Albertino Damasceno Krishna K Aryal Glennis Andall-Brereton Kokou Agoudavi Briar McKenzie Jacqui Webster Rifat Atun Till Bärnighausen Sebastian Vollmer Justine I Davies Pascal Geldsetzer |
spellingShingle |
David Peiris Arpita Ghosh Jennifer Manne-Goehler Lindsay M Jaacks Michaela Theilmann Maja E Marcus Zhaxybay Zhumadilov Lindiwe Tsabedze Adil Supiyev Bahendeka K Silver Abla M Sibai Bolormaa Norov Mary T Mayige Joao S Martins Nuno Lunet Demetre Labadarios Jutta M A Jorgensen Corine Houehanou David Guwatudde Mongal S Gurung Albertino Damasceno Krishna K Aryal Glennis Andall-Brereton Kokou Agoudavi Briar McKenzie Jacqui Webster Rifat Atun Till Bärnighausen Sebastian Vollmer Justine I Davies Pascal Geldsetzer 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. PLoS Medicine |
author_facet |
David Peiris Arpita Ghosh Jennifer Manne-Goehler Lindsay M Jaacks Michaela Theilmann Maja E Marcus Zhaxybay Zhumadilov Lindiwe Tsabedze Adil Supiyev Bahendeka K Silver Abla M Sibai Bolormaa Norov Mary T Mayige Joao S Martins Nuno Lunet Demetre Labadarios Jutta M A Jorgensen Corine Houehanou David Guwatudde Mongal S Gurung Albertino Damasceno Krishna K Aryal Glennis Andall-Brereton Kokou Agoudavi Briar McKenzie Jacqui Webster Rifat Atun Till Bärnighausen Sebastian Vollmer Justine I Davies Pascal Geldsetzer |
author_sort |
David Peiris |
title |
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. |
title_short |
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. |
title_full |
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. |
title_fullStr |
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. |
title_full_unstemmed |
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. |
title_sort |
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. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS Medicine |
issn |
1549-1277 1549-1676 |
publishDate |
2021-03-01 |
description |
<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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. |
url |
https://doi.org/10.1371/journal.pmed.1003485 |
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