AIM To examine the incidence of cardiovascular disease (CVD), of death, and the comparative effects of 12 common modifiable risk factors for both outcomes in South Asia. METHODS AND RESULTS Prospective study of 33 583 individuals 35-70 years of age from India, Bangladesh, or Pakistan. Mean follow-up period was 11 years. Age and sex adjusted incidence of a CVD event and mortality rates were calculated for the overall cohort, by urban or rural location, by sex, and by country. For each outcome, mutually adjusted population attributable fractions (PAFs) were calculated in 32 611 individuals without prior CVD to compare risks associated with four metabolic risk factors (hypertension, diabetes, abdominal obesity, high non-HDL cholesterol), four behavioural risk factors (tobacco use, alcohol use, diet quality, physical activity), education, household air pollution, strength, and depression. Hazard ratios were calculated using Cox regression models, and average PAFs were calculated for each risk factor or groups of risk factors. Cardiovascular disease was the most common cause of death (35.5%) in South Asia. Rural areas had a higher incidence of CVD (5.41 vs. 4.73 per 1000 person-years) and a higher mortality rate (10.27 vs. 6.56 per 1000 person-years) compared with urban areas. Males had a higher incidence of CVD (6.42 vs. 3.91 per 1000 person-years) and a higher mortality rate (10.66 vs. 6.85 per 1000 person-years) compared with females. Between countries, CVD incidence was highest in Bangladesh, while the mortality rate was highest in Pakistan. The modifiable risk factors studied contributed to approximately 64% of the PAF for CVD and 69% of the PAF for death. Largest PAFs for CVD were attributable to hypertension (13.1%), high non-HDL cholesterol (11.1%), diabetes (8.9%), low education (7.7%), abdominal obesity (6.9%), and household air pollution (6.1%). Largest PAFs for death were attributable to low education (18.9%), low strength (14.6%), poor diet (6.4%), diabetes (5.8%), tobacco use (5.8%), and hypertension (5.5%). CONCLUSION In South Asia, both CVD and deaths are highest in rural areas and among men. Reducing CVD and premature mortality in the region will require investment in policies that target a broad range of health determinants.

中文翻译：

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南亚多国队列中的心血管疾病、死亡率及其与可改变风险因素的关联：一项 PURE 子研究。

目的 研究南亚心血管疾病 (CVD) 的发病率、死亡以及 12 种常见的可改变危险因素对这两种结局的比较影响。方法和结果 对来自印度、孟加拉国或巴基斯坦的 33 583 名 35-70 岁个体的前瞻性研究。平均随访期为 11 年。根据城市或农村地区、性别和国家，计算了整个队列的年龄和性别调整后的 CVD 事件发生率和死亡率。对于每项结果，计算了 32611 名既往无 CVD 的个体的相互调整的人群归因分数 (PAF)，以比较与四种代谢危险因素（高血压、糖尿病、腹部肥胖、高非 HDL 胆固醇）、四种行为危险因素相关的风险。烟草使用、酒精使用、饮食质量、身体活动）、教育、家庭空气污染、力量和抑郁。使用 Cox 回归模型计算风险比，并计算每个风险因素或风险因素组的平均 PAF。心血管疾病是南亚最常见的死因（35.5%）。与城市地区相比，农村地区的 CVD 发病率（5.41 对 4.73/1000 人年）和死亡率更高（10.27 对 6.56/1000 人年）。与女性相比，男性的 CVD 发病率（6.42 对 3.91/1000 人年）和死亡率更高（10.66 对 6.85/1000 人年）。在国家之间，孟加拉的心血管疾病发病率最高，而巴基斯坦的死亡率最高。研究的可改变风险因素导致约 64% 的心血管疾病 PAF 和 69% 的死亡 PAF。CVD 的最大 PAF 归因于高血压 (13.1%)、高非 HDL 胆固醇 (11.1%)、糖尿病 (8.9%)、教育程度低 (7.7%)、腹部肥胖 (6.9%) 和家庭空气污染 (6.1%) ）。死亡的最大 PAF 归因于教育程度低 (18.9%)、强度低 (14.6%)、饮食不良 (6.4%)、糖尿病 (5.8%)、烟草使用 (5.8%) 和高血压 (5.5%)。结论 在南亚，农村地区和男性的心血管疾病和死亡人数均最高。减少该地区的心血管疾病和过早死亡将需要对针对广泛健康决定因素的政策进行投资。不良饮食（6.4%）、糖尿病（5.8%）、烟草使用（5.8%）和高血压（5.5%）。结论 在南亚，农村地区和男性的心血管疾病和死亡人数均最高。减少该地区的心血管疾病和过早死亡将需要对针对广泛健康决定因素的政策进行投资。不良饮食（6.4%）、糖尿病（5.8%）、烟草使用（5.8%）和高血压（5.5%）。结论 在南亚，农村地区和男性的心血管疾病和死亡人数均最高。减少该地区的心血管疾病和过早死亡将需要对针对广泛健康决定因素的政策进行投资。