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Prospective Urban and Rural Epidemiological (PURE) Study

Official Title

Prospective Urban and Rural Epidemiological Study

Status

Ongoing

Overview

To examine the impact of urbanization on the development of primordial risk factors (for example: physical activity and nutrition changes), primary risk factors (for example: obesity, hypertension, dysglycemia and dyslipidemia, smoking), and CVD.

Complete list of PURE lead investigators in countries and territories participating in the PURE study.

PURE study – contact us.

Study Design

Prospective Cohort

Primary Endpoint

Adjudicated locally within each country. Each country will follow a similar protocol decided by the adjudicating committee.

Number of Patients

225000

Number of Sites

23

Number of Countries

25

Study Period

2002–TBA

Principal Investigator

Salim Yusuf

Program Manager

Sumathy Rangarajan

Research Coordinator

Maha Mushtaha, Pam Mackie, Shameena Ramacham, SiuLim Chin, Dawn Agapay, Roxanna Solano, Divya Pattah

Collaborators

London School of Hygiene and Tropical Medicine – Prof. Martin McKee, Dr. Ben Palafox, Dr. Adrianna Murphy, and Dr. Dina Balabanova
Harvard University – Prof. S (Subu) V Subramanian
The George Institute for Global Health, Australia – Dr. Clara Chow
The University of British Columbia, School of Population and Public Health – Prof. Michael Brauer
Oregon State University, College of Public Health and Human Sciences – Dr. Perry Hystad

Key Publications

Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, Avezum A, Bengtsson Boström K, Chifamba J, Gulec S, Gupta R, Igumbor EU, Iqbal R, Ismail N, Joseph P, Kaur M, Khatib R, Kruger IM, Lamelas P, Lanas F, Lear SA, Li W, Wang C, Quiang D, Wang Y, Lopez-Jaramillo P, Mohammadifard N, Mohan V, Mony PK, Poirier P, Srilatha S, Szuba A, Teo K, Wielgosz A, Yeates KE, Yusoff K, Yusuf R, Yusufali AH, Attaei MW, McKee M, Yusuf S. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. Lancet Glob Health. 2019 Jun; 7(6):e748-e760. doi: 10.1016/S2214-109X(19)30045-2.

Duong M, Islam S, Rangarajan S, Leong D, Kurmi O, Teo K, Killian K, Dagenais G, Lear S4, Wielgosz A, Nair S, Mohan V, Mony P, Gupta R, Kumar R, Rahman O, Yusoff K, du Plessis JL, Igumbor EU, Chifamba J, Li W, Lu Y, Zhi F, Yan R, Iqbal R, Ismail N, Zatonska K, Karsidag K, Rosengren A, Bahonar A, Yusufali A, Lamelas PM, Avezum A, Lopez-Jaramillo P, Lanas F, O’Byrne PM, Yusuf S; PURE investigators. Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community-based cohort study. Lancet Glob Health. 2019 May;7(5):e613-e623. doi: 10.1016/S2214-109X(19)30070-1.

Chow CK, Ramasundarahettige C, Hu W, AlHabib KF, Avezum A Jr, Cheng X, Chifamba J, Dagenais G, Dans A, Egbujie BA, Gupta R, Iqbal R, Ismail N, Keskinler MV, Khatib R, Kruger L, Kumar R, Lanas F, Lear S, Lopez-Jaramillo P, McKee M, Mohammadifard N, Mohan V, Mony P, Orlandini A, Rosengren A, Vijayakumar K, Wei L, Yeates K, Yusoff K, Yusuf R, Yusufali A, Zatonska K, Zhou Y, Islam S, Corsi D, Rangarajan S, Teo K, Gerstein HC, Yusuf S; PURE investigators. Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study.Lancet Diabetes Endocrinol. 2018 Oct;6(10):798-808. doi: 10.1016/S2213-8587(18)30233-X.

Mente A, O’Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, Lear S, Ah STL, Wei L, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Mony P, Szuba A, Iqbal R, Yusuf R, Mohammadifard N, Khatib R, Yusoff K, Ismail N, Gulec S, Rosengren A, Yusufali A, Kruger L, Tsolekile LP, Chifamba J, Dans A, Alhabib KF, Yeates K, Teo K, Yusuf S. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet. 2018 Aug 11;392(10146):496-506. doi: 10.1016/S0140-6736(18)31376-X.

Murphy A, Palafox B, O’Donnell O, Stuckler D, Perel P2, AlHabib KF5, Avezum A6, Bai X7, Chifamba J8, Chow CK9, Corsi DJ10, Dagenais GR11, Dans AL12, Diaz R13, Erbakan AN14, Ismail N15, Iqbal R16, Kelishadi R17, Khatib R18, Lanas F19, Lear SA20, Li W7, Liu J7, Lopez-Jaramillo P21, Mohan V22, Monsef N23, Mony PK24, Puoane T25, Rangarajan S26, Rosengren A27, Schutte AE28, Sintaha M29, Teo KK26, Wielgosz A30, Yeates K31, Yin L7, Yusoff K32, Zatońska K33, Yusuf S26, McKee M. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. Lancet Glob Health. 2018 Mar;6(3):e292-e301. doi: 10.1016/S2214-109X(18)30031-7.

Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S, Dagenais G, Gupta R, Mohan V, Lear S, Bangdiwala SI, Schutte AE, Wentzel-Viljoen E, Avezum A, Altuntas Y, Yusoff K, Ismail N, Peer N, Chifamba J, Diaz R, Rahman O, Mohammadifard N, Lana F, Zatonska K, Wielgosz A, Yusufali A, Iqbal R, Lopez-Jaramillo P, Khatib R, Rosengren A, Kutty VR, Li W, Liu J, Liu X, Yin L, Teo K, Anand S, Yusuf S; Prospective Urban Rural Epidemiology (PURE) study investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017; 390(10107):2037-2049.

Mente A, Dehghan M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, Lear S, Li W, Chen H, Yi S, Wang Y, Diaz R, Avezum A, Lopez-Jaramillo P, Seron P, Kumar R, Gupta R, Mohan V, Swaminathan S, Kutty R, Zatonska K, Iqbal R, Yusuf R, Mohammadifard N, Khatib R, Nasir NM, Ismail N, Oguz A, Rosengren A, Yusufali A, Wentzel-Viljoen E, Puoane T, Chifamba J, Teo K, Anand SS, Yusuf S; Prospective Urban Rural Epidemiology (PURE) study investigators. Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study. Lancet Diabetes Endocrinol. 2017;5(10):774-787.

Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, Iqbal R, Kumar R, Wentzel-Viljoen E, Rosengren A, Amma LI, Avezum A, Chifamba J, Diaz R, Khatib R, Lear S, Lopez-Jaramillo P, Liu X, Gupta R, Mohammadifard N, Gao N, Oguz A, Ramli AS, Seron P, Sun Y, Szuba A, Tsolekile L, Wielgosz A, Yusuf R, Hussein Yusufali A, Teo KK, Rangarajan S, Dagenais G, Bangdiwala SI, Islam S, Anand SS, Yusuf S; Prospective Urban Rural Epidemiology (PURE) study investigators. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017; 390(10107):2050-2062.

Duong M, Rangarajan S, Zhang X, Killian K, Mony P, Swaminathan S, Bharathi AV, Nair S, Vijayakumar K, Mohan I, Gupta R, Mohan D, Rani S, Mohan V, Iqbal R, Kazmi K, Rahman O, Yusuf R, Pinnaka LV, Kumar R, O’Byrne P, Yusuf S. Effects of bidi smoking on all-cause mortality and cardiorespiratory outcomes in men from south Asia: an observational community-based substudy of the Prospective Urban Rural Epidemiology Study (PURE). Lancet Glob Health. 2017; 5(2):e168-e176.

Miller V, Yusuf S, Chow CK, Dehghan M, Corsi DJ, Lock K, Popkin B, Rangarajan S, Khatib R, Lear SA, Mony P, Kaur M, Mohan V, Vijayakumar K, Gupta R, Kruger A, Tsolekile L, Mohammadifard N, Rahman O, Rosengren A, Avezum A, Orlandini A, Ismail N, Lopez-Jaramillo P, Yusufali A, Karsidag K, Iqbal R, Chifamba J, Oakley SM, Ariffin F, Zatonska K, Poirier P, Wei L, Jian B, Hui C, Xu L, Xiulin B, Teo K, Mente A. Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet Glob Health. 2016; 4(10):e695-703.

Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, Wei L, Mony P, Mohan V, Gupta R, Kumar R, Vijayakumar K, Lear SA, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Yusoff K, Ismail N, Kazmi K, Rahman O, Rosengren A, Monsef N, Kelishadi R, Kruger A, Puoane T, Szuba A, Chifamba J, Temizhan A, Dagenais G, Gafni A, Yusuf S; PURE study investigators. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016;387(10013):61-9.

Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S; Prospective Urban Rural Epidemiology (PURE) Study investigators. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015; 386(9990): 266-73.

Smyth A, Teo KK, Rangarajan S, O’Donnell M, Zhang X, Rana P, Leong DP, Dagenais G, Seron P, Rosengren A, Schutte AE, Lopez-Jaramillo P, Oguz A, Chifamba J, Diaz R, Lear S, Avezum A, Kumar R, Mohan V, Szuba A, Wei L, Yang W, Jian B, McKee M, Yusuf S; PURE Investigators. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet. 2015;386(10007):1945-54.

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, Bo J, Lou Q, Lu F, Liu T, Yu L, Zhang S, Mony P, Swaminathan S, Mohan V, Gupta R, Kumar R, Vijayakumar K, Lear S, Anand S, Wielgosz A, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Yusoff K, Ismail N, Iqbal R, Rahman O, Rosengren A, Yusufali A, Kelishadi R, Kruger A, Puoane T, Szuba A, Chifamba J, Oguz A, McQueen M, McKee M, Dagenais G; PURE Investigators. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371(9):818-27

O’Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, Yan H, Lee SF, Mony P, Devanath A, Rosengren A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Yusoff K, Iqbal R, Ilow R, Mohammadifard N, Gulec S, Yusufali AH, Kruger L, Yusuf R, Chifamba J, Kabali C, Dagenais G, Lear SA, Teo K, Yusuf S; PURE Investigators. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014; 371(7):612-23>/P>

Mente A, O’Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A, Morrison H, Li W, Wang X, Di C, Mony P, Devanath A, Rosengren A, Oguz A, Zatonska K, Yusufali AH, Lopez-Jaramillo P, Avezum A, Ismail N, Lanas F, Puoane T, Diaz R, Kelishadi R, Iqbal R, Yusuf R, Chifamba J, Khatib R, Teo K, Yusuf S; PURE Investigators. Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med 2014; 371(7): 601-11.

Duong M, Islam S, Rangarajan S, Teo K, O’Byrne PM, Schünemann HJ, Igumbor E, Chifamba J, Liu L, Li W, Ismail T, Shankar K, Shahid M, Vijayakumar K, Yusuf R, Zatonska K, Oguz A, Rosengren A, Heidari H, Almahmeed W, Diaz R, Oliveira G, Lopez-Jaramillo P, Seron P, Killian K, Yusuf S; PURE-BREATH Study Investigators. Global differences in lung function by region (PURE): an international, community-based prospective study. Lancet Respir Med. 2013; 1(8):599-609.

Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, Kazmi K, Lanas F, Wei L, Lopez-Jaramillo P, Fanghong L, Ismail NH, Puoane T, Rosengren A, Szuba A, Temizhan A, Wielgosz A, Yusuf R, Yusufali A, McKee M, Liu L, Mony P, Yusuf S; PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013;310(9):959-68.>/p>

Teo K, Lear S, Islam S, Mony P, Dehghan M, Li W, Rosengren A, Lopez-Jaramillo P, Diaz R, Oliveira G, Miskan M, Rangarajan S, Iqbal R, Ilow R, Puone T, Bahonar A, Gulec S, Darwish EA, Lanas F, Vijaykumar K, Rahman O, Chifamba J, Hou Y, Li N, Yusuf S; PURE Investigators. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. JAMA 2013; 309(15):1613-21.

Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, Gupta R, Kelishadi R, Iqbal R, Avezum A, Kruger A, Kutty R, Lanas F, Lisheng L, Wei L, Lopez-Jaramillo P, Oguz A, Rahman O, Swidan H, Yusoff K, Zatonski W, Rosengren A, Teo KK; Prospective Urban Rural Epidemiology (PURE) Study Investigators. 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. Lancet 2011; 378(9798): 1231-43.

EPOCH Pilot – Cigarette pack labelling in 12 countries at different levels of economic development: J Public Health Policy. 2011 May;32(2):146-64

Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, Casanova A, Swaminathan S, Anjana RM, Kumar R, Rosengren A, Wei L, Yang W, Chuangshi W, Huaxing L, Nair S, Diaz R, Swidon H, Gupta R, Mohammadifard N, Lopez-Jaramillo P, Oguz A, Zatonska K, Seron P, Avezum A, Poirier P, Teo K, Yusuf S. 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. Lancet. 2017;390(10113):2643-2654.

EPOCH Pilot paper – PLoS One. 2010 Dec 10;5(12):e14294

For more studies dating before this, back to 2005, visit: phri.ca/pure/pure-study-publications/

For more information, please visit http://www.phri.ca/pure