The Lancet Regional Health. Americas (Dec 2021)

Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies

  • Rodrigo M. Carrillo-Larco,
  • Dalia Stern,
  • Ian R. Hambleton,
  • Anselm Hennis,
  • Mariachiara Di Cesare,
  • Paulo Lotufo,
  • Catterina Ferreccio,
  • Vilma Irazola,
  • Pablo Perel,
  • Edward W Gregg,
  • J. Jaime Miranda,
  • Majid Ezzati,
  • Goodarz Danaei,
  • Carlos A Aguilar-Salinas,
  • Ramón Alvarez-Váz,
  • Marselle B Amadio,
  • Cecilia Baccino,
  • Claudia Bambs,
  • João Luiz Bastos,
  • Gloria Beckles,
  • Antonio Bernabe-Ortiz,
  • Carla DO Bernardo,
  • Katia V. Bloch,
  • Juan E. Blümel,
  • Jose G. Boggia,
  • Pollyanna K. Borges,
  • Miguel Bravo,
  • Gilbert Brenes-Camacho,
  • Horacio A Carbajal,
  • Maria S. Castillo Rascon,
  • Blanca H. Ceballos,
  • Veronica Colpani,
  • Jackie A Cooper,
  • Sandra Cortes,
  • Adrian Cortes-Valencia,
  • Roberto S Cunha,
  • Eleonora d'Orsi,
  • William H Dow,
  • Walter G Espeche,
  • Flavio D. Fuchs,
  • Sandra C. Fuchs,
  • Suely GA Gimeno,
  • Donaji Gomez-Velasco,
  • David A Gonzalez-Chica,
  • Clicerio Gonzalez-Villalpando,
  • María-Elena Gonzalez-Villalpando,
  • Gonzalo Grazioli,
  • Ricardo O. Guerra,
  • Laura Gutierrez,
  • Fernando L Herkenhoff,
  • Andrea RVR Horimoto,
  • Andrea Huidobro,
  • Elard Koch,
  • Martin Lajous,
  • Maria Fernanda Lima-Costa,
  • Ruy Lopez-Ridaura,
  • Alvaro CC Maciel,
  • Betty S Manrique-Espinoza,
  • Larissa P Marques,
  • Jose G Mill,
  • Leila B Moreira,
  • Oscar M Muñoz,
  • Lariane M Ono,
  • Karen Oppermann,
  • Karina M. Paiva,
  • Sergio V. Peixoto,
  • Alexandre C. Pereira,
  • Karen G. Peres,
  • Marco A. Peres,
  • Paula Ramírez-Palacios,
  • Cassiano R Rech,
  • Berenice Rivera-Paredez,
  • Nohora I Rodriguez,
  • Rosalba Rojas-Martinez,
  • Luis Rosero-Bixby,
  • Adolfo Rubinstein,
  • Alvaro Ruiz-Morales,
  • Martin R Salazar,
  • Aaron Salinas-Rodriguez,
  • Jorge Salmerón,
  • Ramon A Sanchez,
  • Nelson AS Silva,
  • Thiago LN Silva,
  • Liam Smeeth,
  • Poli M Spritzer,
  • Fiorella Tartaglione,
  • Jorge Tartaglione,
  • Rafael Velázquez-Cruz

Journal volume & issue
Vol. 4
p. 100068

Abstract

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ABSTRACT: Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding: Wellcome Trust (214185/Z/18/Z)