Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study

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Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study Publisher Pubmed

Anjana RM¹ ; Mohan V¹ ; Rangarajan S² ; Gerstein HC² ; Venkatesan U¹ ; Sheridan P² ; Dagenais GR³ ; Lear SA^{4, 5, 6} ; Teo K² ; Karsidag K⁷ ; Alhabib KF⁸ ; Yusoff K^{9, 10} ; Ismail N¹¹ ; Mony PK¹² Show All Authors

Anjana RM¹
Mohan V¹
Rangarajan S²
Gerstein HC²
Venkatesan U¹
Sheridan P²
Dagenais GR³
Lear SA^{4, 5, 6}
Teo K²
Karsidag K⁷
Alhabib KF⁸
Yusoff K^{9, 10}
Ismail N¹¹
Mony PK¹²
Lopezjaramillo P¹³
Chifamba J¹⁴
Palileovillanueva LM¹⁵
Iqbal R¹⁶
Yusufali A¹⁷
Kruger IM¹⁸
Rosengren A^{19, 20}
Bahonar A²¹
Zatonska K²²
Yeates K²³
Gupta R²⁴
Li W²⁵
Hu L²⁶
Rahman MO²⁷
Lakshmi PVM²⁸
Iype T²⁹
Avezum A³⁰
Diaz R³¹
Lanas F³²
Yusuf S²

Show Affiliations

1. Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, India
2. Population Health Research Institute, McMaster University, Hamilton, ON, Canada
3. Institut universitaire de Cardiologie et Pneumo-logie de Quebec-Universite Laval, Quebec, QC, Canada
4. Department of Biomedical Physiology and Kine-siology, Simon Fraser University, Burnaby, BC, Canada
5. Faculty of Health Sciences, Simon Fraser Uni-versity, Burnaby, BC, Canada
6. Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
7. Department of Internal Medicine, Division of Endocrinology, Istanbul, Turkey
8. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
9. Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
10. Department of Medicine, UCSI University, Cheras, Selangor, Malaysia
11. Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
12. Division of Epidemiology and Population Health, St. John’s Medical College and Research Institute, Bangalore, India
13. Masira Research Institute, Universidad de Santander (UDES), Bucaramanga, Colombia
14. College of Health Sciences, Physiology Depart-ment, University of Zimbabwe, Harare, Zimbabwe
15. UP College of Medicine, University of the Philippines Manila, Manila, Philippines
16. Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
17. Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
18. Africa Unit for Transdisciplinary Health Re-search, Department of Medicine, Faculty of Health Sciences, North-West University, Mma-batho, South Africa
19. Department of Molecular and Clinical Medi-cine, Sahlgrenska Academy, University of Goth-enburg, Gothenburg, Sweden
20. Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
21. Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
22. Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
23. Department of Medicine, Queen’s University, Kingston, ON, Canada
24. Eternal Heart Care Centre and Research In-stitute, Jaipur, India
25. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
26. Nanchang County Center for Disease Prevention and Control, Nanchang, Jiangxi Province, China
27. Independent University, Dhaka, Bangladesh
28. School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
29. Health Action by People and Government Medical College, Thiruvanthapuram, Kerala, India
30. Hospital Alemao Oswaldo Cruz and UNISA, Sao Paulo, Brazil
31. Estudios Clinicos Latino America, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
32. Universidad de La Frontera, Temuco, Chile

Source: Diabetes Care Published:2020

Abstract

OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. © 2020 by the American Diabetes Association.

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Style	Citing Format
MLA	Anjana RM, et al.. "Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study." Diabetes Care, vol. 43, no. 12, 2020, pp. 3094-3101.
APA	Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, Dagenais GR, Lear SA, Teo K, Karsidag K, Alhabib KF, Yusoff K, Ismail N, Mony PK, Lopezjaramillo P, Chifamba J, Palileovillanueva LM, Iqbal R, Yusufali A, ... Yusuf S (2020). Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study. Diabetes Care, 43(12), 3094-3101.
Chicago	Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, Dagenais GR, et al.. "Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study." Diabetes Care 43, no. 12 (2020): 3094-3101.
Harvard	Anjana RM et al. (2020) 'Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study', Diabetes Care, 43(12), pp. 3094-3101.
Vancouver	Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, et al.. Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study. Diabetes Care. 2020;43(12):3094-3101.
BibTex	@article{ author = {Anjana RM and Mohan V and Rangarajan S and Gerstein HC and Venkatesan U and Sheridan P and Dagenais GR and Lear SA and Teo K and Karsidag K and Alhabib KF and Yusoff K and Ismail N and Mony PK and Lopezjaramillo P and Chifamba J and Palileovillanueva LM and Iqbal R and Yusufali A and Kruger IM and Rosengren A and Bahonar A and Zatonska K and Yeates K and Gupta R and Li W and Hu L and Rahman MO and Lakshmi PVM and Iype T and Avezum A and Diaz R and Lanas F and Yusuf S}, title = {Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study}, journal = {Diabetes Care}, volume = {43}, number = {12}, pages = {3094-3101}, year = {2020} }
RIS	TY - JOUR AU - Anjana RM AU - Mohan V AU - Rangarajan S AU - Gerstein HC AU - Venkatesan U AU - Sheridan P AU - Dagenais GR AU - Lear SA AU - Teo K AU - Karsidag K AU - Alhabib KF AU - Yusoff K AU - Ismail N AU - Mony PK AU - Lopezjaramillo P AU - Chifamba J AU - Palileovillanueva LM AU - Iqbal R AU - Yusufali A AU - Kruger IM AU - Rosengren A AU - Bahonar A AU - Zatonska K AU - Yeates K AU - Gupta R AU - Li W AU - Hu L AU - Rahman MO AU - Lakshmi PVM AU - Iype T AU - Avezum A AU - Diaz R AU - Lanas F AU - Yusuf S TI - Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the Pure Study JO - Diabetes Care VL - 43 IS - 12 SP - 3094 EP - 3101 PY - 2020 ER -

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