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Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income Countries: The Prospective Urban Rural Epidemiology (Pure) Study Publisher Pubmed



Teo K1 ; Lear S2, 3 ; Islam S1 ; Mony P4 ; Dehghan M1 ; Li W5 ; Rosengren A6 ; Lopezjaramillo P7 ; Diaz R8 ; Oliveira G9 ; Miskan M10 ; Rangarajan S1 ; Iqbal R11 ; Ilow R12 Show All Authors
Authors
  1. Teo K1
  2. Lear S2, 3
  3. Islam S1
  4. Mony P4
  5. Dehghan M1
  6. Li W5
  7. Rosengren A6
  8. Lopezjaramillo P7
  9. Diaz R8
  10. Oliveira G9
  11. Miskan M10
  12. Rangarajan S1
  13. Iqbal R11
  14. Ilow R12
  15. Puone T13
  16. Bahonar A14
  17. Gulec S15
  18. Darwish EA16
  19. Lanas F17
  20. Vijaykumar K18
  21. Rahman O19
  22. Chifamba J20
  23. Hou Y21
  24. Li N22
  25. Yusuf S1
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
  2. 2. Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, BC, Canada
  3. 3. Providence Health Care, Vancouver, BC, Canada
  4. 4. St. John's Medical College and Research Institute, Bangalore, India
  5. 5. National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
  6. 6. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  7. 7. Desarrollo e Innovacion Tecnologica, Clinica de Sindrome Metabolico, Prediabetes Y Diabetes Y Fundacion Oftalmologica de Sandander, Santander, Colombia
  8. 8. Estudios Clinicos, Latinoamerica ECLA, Rosario, Santa Fe, Argentina
  9. 9. Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
  10. 10. Faculty of Medicine, Universiti Teknologi MARA, Sungai Boloh, Malaysia
  11. 11. Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  12. 12. Department of Food Sciences and Dietetics, Wroclaw Medical University, Wroclaw, Poland
  13. 13. School of Public Health, University of Western Cape, Cape Town, South Africa
  14. 14. Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  15. 15. Cardiology Department, Ankara University, Ankara, Turkey
  16. 16. Family Medicine Department, Dubai Medical College, Dubai, United Arab Emirates
  17. 17. Universidad de la Frontera, Temuco, Chile
  18. 18. Health Action by People, Trivandrum, India
  19. 19. Independent University Bangladesh, Dhaka, Bangladesh
  20. 20. Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  21. 21. Beilingbridge Community Health Service Center, Taiyuan, Shanxi Province, China
  22. 22. Qingshanhu Community Health Service Station, Nanchang, Jiangxi Province, China

Source: JAMA Published:2013


Abstract

Importance: Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide. Objective: To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event. Design, Setting, and Participants: Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153 996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009. Main Outcome Measures: Smoking status (current, former, never), level of exercise (low, ≤600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, ≥3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index). Results: Among 7519 individuals with self-reported CHD (past event: median, 5.0 [interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median, 4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke; only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work- or leisure-related physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets; 14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI, 50.7%-54.3%) quit smoking (by income country classification: 74.9% [95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6% [95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%-57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%-68.7%). Conclusion and Relevance: Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries. ©2013 American Medical Association. All rights reserved.
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