Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study
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Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
American Medical Association
Abstract
Importance: Little is known about adoption of healthy lifestyle behaviors among individuals
with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide.
Objective: To examine the prevalence of avoidance or cessation of smoking, eating
a healthy diet, and undertaking regular physical activities by individuals with a CHD
or stroke event.
Design, Setting, and Participants Prospective Urban Rural Epidemiology (PURE)
was a large, prospective cohort study that used an epidemiological survey of 153 996
adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income
countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries
(LMIC), and 4 low-income countries (LIC), who were enrolled between January
2003 and December 2009.
Main Outcome: Measures smoking status (current, former, never), level of exercise
(low, 600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000
MET-min/wk; high, 3000 MET-min/wk), and diet (classified by the Food Frequency
Questionnaire and defined using the Alternative Healthy Eating Index).
Results: Among 7519 individuals with self-reported CHD (past event: median, 5.0
[interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median,
4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke;
only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work- or leisure related
physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets;
14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle
behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI,
50.7%-54.3%) quit smoking (by income country classification: 74.9%
[95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6%
[95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels
of physical activity increased with increasing country income but this trend was
not statistically significant. The lowest prevalence of eating healthy diets was in LIC
(25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%-
57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%-
68.7%).
Conclusion and Relevance: Among a sample of patients with a CHD or stroke event
from countries with varying income levels, the prevalence of healthy lifestyle behaviors
was low, with even lower levels in poorer countries.
Description
Keywords
Healthy lifestyle, Cardiovascular disease, Communities
Citation
Teo, K. et al. (2013). 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, 309(15): 1613 - 1621