Tuesday, September 03, 2013


PURE stands for Prospective Urban Rural Epidermiologic Study. This was an epidermiologic study initiated by Dr Salim Yusuff of McMaster University, Hamilton Ontario. He led a team that looked into the coronary risk factors of cardiovascular disease like cigarette smoking, obesity, hypertension, diabetes etc in a community and also the incidence of strokes, MI and heart failure in that community. All in all, they studied 155,000 subjects in >600 communities, across 17 countries. The study began in 2003 and is still ongoing. At the current, ongoing European Society of Cardiology meeting in Amsterdam, he presented the follow up results up till 2010.

The study revealed that high income economies have many more of the CV risk factors but much lower mortality and much better outcome. Low income economies have much lower CV risk factors but much higher mortality and worse outcome. Middle income economies have intermediate risk and intermediate outcomes. I believe Malaysia is somewhere in the middle income economy. For example, high income economies have a risk factor score of 13, middle income economy 10.5 and low income economy of 8.

Incidence of CVD per 1000 person-years in PURE by country income level, 3.9 years follow-up

End point High Middle Low p 
Any fatal CVD 14.867.25<0 .0001="" br="">
Major CVD (MI, stroke, HF) 11.201.43<0 .0001="" br="">
Any other hospitalized CVD 10.470.26<0 .0001="" br="">
Total CVD 10.860.88<0 .05="" br="">

In the current analysis, Yusuf said, high-income countries included Canada, Sweden, and the United Arab Emirates; among the middle-income countries were Argentina, Brazil, Chile, Poland, Turkey, South Africa, Colombia, China, and Iran; and low-income countries included India, Pakistan, Bangladesh, and Zimbabwe.

One way to account for this must be the better healthcare facilities in high income economies allowing for earlier detection of CVD, better treatment methods and so better outcomes.

Interesting. So factors affecting the outcomes in NCD also includes healthcare facilities. It may mitigate some of the CV risk factors that we have. It may be just the disease itself. Such studies are very useful to us as we plan our healthcare facilities.

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