GLOBAL HEALTH | GLOBAL PARTNERSHIPS | GLOBAL IMPACT

PURE – Modifiable risk factors in Lancet

In Population Health Research Institute (PHRI) research published in The Lancet on September 3, 2019, and presented the same day by Salim Yusuf at the European Society of Cardiology (ESC) Congress, more than 70 per cent of cardiovascular disease and deaths around the world were found to be attributable to a small number of common but modifiable risk factors.

Using data from the Prospective Urban and Rural Epidemiological (PURE) study – involving more than 155,000 people in 21 countries – researchers found that some of the risks are common around the world, such as hypertension or low education, while other risks vary by a country’s level of economic development.

The 14 modifiable risk factors making up 70 per cent are metabolic factors such as hypertension, blood lipids, abdominal obesity; behavioural factors including smoking, diet, physical activity, alcohol consumption, salt intake; strength as shown by hand grip; psychosocial factors such as education and depression, and environmental factors of indoor and outdoor air pollution.

In middle- and low-income countries, the risk factors of low education, poor diet, indoor air pollution from solid fuel use, and low strength were most important.

Hypertension was found to be the largest factor among the metabolic factors. Low education level was the single largest risk factor, and air pollution was the most important community-level risk factor.

More than 38 researchers from 21 countries around the world, including five from Canada, are authors of the research paper from the PURE study led by the PHRI – the first study to measure the same information the same way across five continents. For this research, people were followed for an average of 9.5 years.

“It’s clear the majority of cardiovascular disease cases and deaths are accounted for by a small number of common and modifiable risk factors; these could be improved,” said Philip Joseph, a joint lead author of the paper, and a PHRI investigator.

“What is notable is that several risk factors that have a large effect such as strength, low education and indoor and outdoor air pollution have been underappreciated in the past have turned out to be more important than others that we have paid much attention to such as obesity or salt,” Joseph said.

The study clearly lays out direction for global improvements in prevention, said Salim Yusuf, principal investigator of the PURE study and Executive Director of PHRI. “Health policies should focus on risk factors that have the greatest impact on averting CVD and death globally, with additional emphasis on the risk factors of greatest importance in different countries.”