Risk-based prevention of heart disease and stroke in Latin America and the Caribbean: a pooled analysis of prospective cohorts and population-based surveys

Abstract

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality in Latin America and the Caribbean (LAC). Decision to start pharmacological treatment for prevention of CVDs is informed by cardiovascular risk prediction equations. There are no cardiovascular risk prediction equations using data from LAC. My PhD research aimed to provide LAC with a cardiovascular risk prediction equation based on regional data to support prevention of CVDs, and to quantify the gap in treatment. Through the Cohorts Consortium of Latin America and the Caribbean, I pooled data from 35 prospective cohorts with cardiometabolic risk factors and cardiovascular fatal/non-fatal outcomes. Data from prospective cohorts were used to quantify the association between cardiometabolic risk factors and cardiovascular outcomes and to derive a cardiovascular risk prediction equation. Data on cardiometabolic risk factors in the national populations in LAC were from health surveys collated through the Non-Communicable Disease Risk Factor Collaboration. In internal validation, my risk prediction equation showed good discrimination and calibration and had better calibration than global equations. Mean levels of cardiometabolic risk factors from surveys were used to recalibrate the equation for 31 countries in LAC. Data on cardiometabolic risk factors in the national populations in LAC were used to quantify the prevalence of high cardiovascular risk and the proportion of high-risk people receiving antihypertensive and lipid-lowering treatment. The prevalence of high cardiovascular risk varied greatly in LAC and was higher in men. The gap to have all high-risk individuals receiving antihypertensive and lipid-lowering medication varied substantially in LAC, treatment rates were lower in men and for lipid-lowering treatment. My research delivered a cardiovascular risk prediction equation to guide prevention of CVDs in LAC; such an equation can be used to monitor the prevalence of high cardiovascular risk and treatment prescription for prevention of CVDs. My research suggests that closing the treatment gap should be prioritized during the expansion of universal health coverage in LAC.