Isfahan University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Medications for Blood Pressure, Blood Glucose, Lipids, and Anti-Thrombotic Medications: Relationship With Cardiovascular Disease and Death in Adults From 21 High-, Middle-, and Low-Income Countries With an Elevated Body Mass Index Publisher Pubmed



Leong DP1 ; Rangarajan S1 ; Rosengren A2 ; Oguz A3 ; Alhabib KF4 ; Poirier P5 ; Diaz R6 ; Dans AL7 ; Iqbal R8 ; Yusufali AM9 ; Yeates K10 ; Chifamba J11 ; Seron P12 ; Lopezlopez J13 Show All Authors
Authors
  1. Leong DP1
  2. Rangarajan S1
  3. Rosengren A2
  4. Oguz A3
  5. Alhabib KF4
  6. Poirier P5
  7. Diaz R6
  8. Dans AL7
  9. Iqbal R8
  10. Yusufali AM9
  11. Yeates K10
  12. Chifamba J11
  13. Seron P12
  14. Lopezlopez J13
  15. Bahonar A14
  16. Wei L15
  17. Bo H15
  18. Weida L15
  19. Avezum A16
  20. Gupta R17
  21. Mohan V18
  22. Kruger HS19
  23. Lakshmi PVM20
  24. Yusuf R21
  25. Yusuf S1
Show Affiliations
Authors Affiliations
  1. 1. The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton General Hospital, C2-238 David Braley Building, 237 Barton St East, Hamilton, L8L 2X2, ON, Canada
  2. 2. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
  3. 3. Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
  4. 4. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
  5. 5. Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Universite Laval, Quebec, QC, Canada
  6. 6. Estudios Clinicos Latinamerica, Rosario, Argentina
  7. 7. University of the Philippines, Manila, Philippines
  8. 8. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  9. 9. Dubai Medical University, Dubai, United Arab Emirates
  10. 10. Department of Medicine, Queen’s University, Kingston, ON, Canada
  11. 11. University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  12. 12. Department of Internal Medicine, Universidad de la Frontera, Temuco, Chile
  13. 13. Centro Integral para la Prevencion de Enfermedades Cardiometabolicas, University of Santander, Bucaramanga, Colombia
  14. 14. Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Chamran Hospital, Isfahan, Iran
  15. 15. Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academic of Medical Sciences, Shenzhen, China
  16. 16. Hospital Alemao Oswado Cruz, University Amaro, Sao Paolo, Brazil
  17. 17. Eternal Heart Care Centre and Research Institute, Jaipur, India
  18. 18. Madras Diabetes Research Foundation, Dr Mohan’s Diabetes Specialities Centre, Chennai, India
  19. 19. Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
  20. 20. Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  21. 21. School of Life Sciences, Independent University, Dhaka, Bangladesh

Source: European Journal of Preventive Cardiology Published:2022


Abstract

Aims Elevated body mass index (BMI) is an important cause of cardiovascular disease (CVD). The population-level impact of pharmacologic strategies to mitigate the risk of CVD conferred by the metabolic consequences of an elevated BMI is not well described. Methods We conducted an analysis of 145 986 participants (mean age 50 years, 58% women) from 21 high-, middle-, and low-in- and results come countries in the Prospective Urban and Rural Epidemiology study who had no history of cancer, ischaemic heart disease, heart failure, or stroke. We evaluated whether the hazards of CVD (myocardial infarction, stroke, heart failure, or cardiovascular death) differed among those taking a cardiovascular medication (n = 29 174; including blood pressure-lowering, blood glucose-lowering, cholesterol-lowering, or anti-thrombotic medications) vs. those not taking a cardiovascular medication (n = 116 812) during 10.2 years of follow-up. Cox proportional hazard models with the community as a shared frailty were constructed by adjusting age, sex, education, geographic region, physical activity, tobacco, and alcohol use. We observed 7928 (5.4%) CVD events and 9863 (6.8%) deaths. Cardiovascular medication use was associated with different hazards of CVD (interaction P, 0.0001) and death (interaction P = 0.0020) as compared with no cardiovascular medication use. Among those not taking a cardiovascular medication, as compared with those with BMI 20 to,25 kg/m2, the hazard ratio (HR) [95% confidence interval (95% CI)] for CVD were, respectively, 1.14 (1.06–1.23); 1.45 (1.30–1.61); and 1.53 (1.28–1.82) among those with BMI 25 to,30 kg/m2; 30 to,35 kg/m2; and ≥35 kg/m2. However, among those taking a cardiovascular medication, the HR (95% CI) for CVD were, respectively, 0.79 (0.72–0.87); 0.90 (0.79–1.01); and 1.14 (0.98–1.33). Among those not taking a cardiovascular medication, the respective HR (95% CI) for death were 0.93 (0.87–1.00); 1.03 (0.93–1.15); and 1.44 (1.24–1.67) among those with BMI 25 to,30 kg/m2; 30 to,35 kg/m2; and ≥35 kg/m2. However, among those taking a cardiovascular medication, the respective HR (95% CI) for death were 0.77 (0.69–0.84); 0.88 (0.78–0.99); and 1.12 (0.96–1.30). Blood pressure-lowering medications accounted for the largest population attributable benefit of cardiovascular medications. Conclusion To the extent that CVD risk among those with an elevated BMI is related to hypertension, diabetes, and an elevated thrombotic milieu, targeting these pathways pharmacologically may represent an important complementary means of reducing the CVD burden caused by an elevated BMI. © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved.
Related Docs
View other Related Docs
1. Metabolic, Behavioural, and Psychosocial Risk Factors and Cardiovascular Disease in Women Compared With Men in 21 High-Income, Middle-Income, and Low-Income Countries: An Analysis of the Pure Study, The Lancet (2022)
2. An Office-Based Cardiovascular Prediction Model Developed and Validated in Cohort Studies of a Middle-Income Country, Journal of Clinical Epidemiology (2022)
3. Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality, New England Journal of Medicine (2021)
4. Developing Non-Laboratory Cardiovascular Risk Assessment Charts and Validating Laboratory and Non-Laboratory-Based Models, Global Heart (2021)
5. Cardiovascular Disease Risk Assessment: Triglyceride/High-Density Lipoprotein Versus Metabolic Syndrome Criteria, Journal of Research in Health Sciences (2019)
6. Availability and Affordability of Medicines and Cardiovascular Outcomes in 21 High-Income, Middle-Income and Low-Income Countries, BMJ Global Health (2020)
7. 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, The Lancet (2020)
8. Modifiable Risk Factors, Cardiovascular Disease, and Mortality in 155 722 Individuals From 21 High-Income, Middle-Income, and Low-Income Countries (Pure): A Prospective Cohort Study, The Lancet (2020)
Experts (# of related papers)
View all Related Experts
Nizal Sarrafzadegan (125)
Masoumeh Sadeghi (97)
Other Related Docs
9. Ultra-Processed Foods and Mortality: Analysis From the Prospective Urban and Rural Epidemiology Study, American Journal of Clinical Nutrition (2023)
10. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries, JAMA Cardiology (2022)
11. Association of Dairy Intake With Cardiovascular Disease and Mortality in 21 Countries From Five Continents (Pure): A Prospective Cohort Study, The Lancet (2018)
12. Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries, JAMA Psychiatry (2020)
13. Associations of Cereal Grains Intake With Cardiovascular Disease and Mortality Across 21 Countries in Prospective Urban and Rural Epidemiology Study: Prospective Cohort Study, The BMJ (2021)
14. Secondary Prevention Medications in 17 Countries Grouped by Income Level (Pure): A Prospective Cohort Study, Journal of the American College of Cardiology (2025)
15. Associations of Outdoor Fine Particulate Air Pollution and Cardiovascular Disease in 157 436 Individuals From 21 High-Income, Middle-Income, and Low-Income Countries (Pure): A Prospective Cohort Study, The Lancet Planetary Health (2020)
16. Variations in the Association of Height With Mortality, Cardiovascular Disease and Cancer in Low-, Middle-And High-Income Countries, International Journal of Epidemiology (2022)
17. Use of Secondary Prevention Drugs for Cardiovascular Disease in the Community in High-Income, Middle-Income, and Low-Income Countries (The Pure Study): A Prospective Epidemiological Survey, The Lancet (2011)
18. The Effect of Physical Activity on Mortality and Cardiovascular Disease in 130 000 People From 17 High-Income, Middle-Income, and Low-Income Countries: The Pure Study, The Lancet (2017)
19. Effect of Obesity Duration and Bmi Trajectories on Cardiovascular Disease: A Narrative Review, Cardiology and Therapy (2023)
20. The Influence of Gender and Place of Residence on Cardiovascular Diseases and Their Risk Factors. the Isfahan Cohort Study, Saudi Medical Journal (2012)
21. Temporal Trend of Short-Term Mortality in Acute Myocardial Between 2000-2017: A Multi-Centric Iranian Registry, ARYA Atherosclerosis (2024)
22. The Prevalence of the Risk Factors Associated With Cardiovascular Diseases Among Iranian Adults: Findings of a Cross‑Sectional Study, Journal of Education and Health Promotion (2024)
23. Cardiovascular Mortality in a Western Asian Country: Results From the Iran Cohort Consortium, BMJ Open (2018)
24. 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)
25. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the Gbd 2019 Study, Journal of the American College of Cardiology (2020)
26. Integration of Diabetes Mellitus and Hypertension on Major Cardiovascular Events: An Experience From a 15-Year Follow-Up Cohort Study in Emr, Current Diabetes Reviews (2024)
27. Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries, New England Journal of Medicine (2014)
28. A Healthy Diet, Physical Activity, or Either in Relation to Cardiovascular and All-Cause Mortality: A Prospective Cohort Study, Nutrition (2023)
29. Meta-Analysis of Cardiovascular Events and Related Biomarkers Comparing Survivors Versus Non-Survivors in Patients With Covid-19, American Journal of Cardiology (2020)
30. Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting, Global Heart (2024)
31. Heart Rate and Cardiovascular Events: A Nested Case-Control in Isfahan Cohort Study, Archives of Iranian Medicine (2014)
32. Metabolic Syndrome Components and Long-Term Incidence of Cardiovascular Disease in Eastern Mediterranean Region: A 13-Year Population-Based Cohort Study, Metabolic Syndrome and Related Disorders (2019)
33. Trends in Adult Body-Mass Index in 200 Countries From 1975 to 2014: A Pooled Analysis of 1698 Population-Based Measurement Studies With 19.2 Million Participants, The Lancet (2016)
34. Activity Limitations, Use of Assistive Devices, and Mortality and Clinical Events in 25 High-Income, Middle-Income, and Low-Income Countries: An Analysis of the Pure Study, The Lancet (2024)
35. Cardiovascular Disease Burden in the North Africa and Middle East Region: An Analysis of the Global Burden of Disease Study 1990–2021, BMC Cardiovascular Disorders (2024)
36. Impact of Diabesity Phenotype on Cardiovascular Diseases, Major Cardiovascular Events and All-Cause Mortality, Scientific Reports (2023)
37. Pathways Leading to Prevention of Fatal and Non-Fatal Cardiovascular Disease: An Interaction Model on 15 Years Population-Based Cohort Study, Lipids in Health and Disease (2020)
38. High-Sensitivity C-Reactive Protein and Low-Density Lipoprotein Cholesterol Association With Incident of Cardiovascular Events: Isfahan Cohort Study, BMC Cardiovascular Disorders (2022)
39. Assessing the Built Environment Through Photographs and Its Association With Obesity in 21 Countries: The Pure Study, The Lancet Global Health (2024)
40. Association of Adult Height With Cardiovascular Mortality: A Systematic Review and Meta-Analysis of Cohort Studies, International Journal of Clinical Practice (2022)
41. Association of the Triglyceride Glucose Index With All-Cause and Cardiovascular Mortality in a General Population of Iranian Adults, Cardiovascular Diabetology (2024)
42. The Association Between Dietary Inflammatory Index (Dii) and Risk of Hypertension: A Case–Control Study, High Blood Pressure and Cardiovascular Prevention (2022)
43. Variations in Risks From Smoking Between High-Income, Middle-Income, and Low-Income Countries: An Analysis of Data From 179 000 Participants From 63 Countries, The Lancet Global Health (2022)
44. Glucose and the Risk of Hypertension in First-Degree Relatives of Patients With Type 2 Diabetes, Hypertension Research (2015)
45. Isfahan Healthy Heart Program, Sample Size and Sampling Structure: A Comprehensive Report, Journal of Isfahan Medical School (2016)
46. Prevalence of Total Cholesterol in Iran: Systematic Review and Meta-Analysis, Journal of Mazandaran University of Medical Sciences (2015)
47. The Association Between Platelet-To-Lymphocyte Ratio With Mortality Among Patients Suffering From Acute Decompensated Heart Failure, BMC Cardiovascular Disorders (2021)
48. Association Between Diabetes Risk Reduction Diet Score and Risk of Breast Cancer: A Case–Control Study, Clinical Nutrition ESPEN (2023)
49. Burden of Ischemic Heart Disease Attributable to Low Omega-3 Fatty Acids Intake in Iran: Findings From the Global Burden of Disease Study 2010, Journal of Tehran University Heart Center (2016)
50. Is Cardiac Rehabilitation After Pci As Effective As Cabg? the First Experience From the Eastern Mediterranean Region Cardiac Rehabilitation Registry, ARYA Atherosclerosis (2024)