Salim Yusuf’s research while affiliated with Population Health Research Institute and other places

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Publications (768)


Predictors of Functional Outcome at 1 Year After Stroke: Analysis of INTERSTROKE Data from Pakistan
  • Article

February 2025

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3 Reads

Journal of Stroke Medicine

Safia Awan

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Mohammad Wasay

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Romaina Iqbal

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[...]

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Martin O. Donnell

Background and Objective Identification of early and long-term outcomes after stroke is important in stroke management strategies. The aim of this study was to analyse predictors of independence and functional outcome at 1 and 12 months post-stroke. Methods This was a prospective study of patients with first stroke who were enrolled between April 2013 and July 2015 from a single-centre tertiary care hospital in Pakistan. Patients were followed up at 1 and 12 months and assessed using the modified Rankin scale (mRs). Results A total of 395 patients with acute first strokes were enrolled. Stroke dependency (mRs score 3-5) was higher in our site at 1 month. At 1 month, 137 (34.6%) of the participants were independent (mRs 0-2), 54.1% ( n = 214) were dependent (mRs 3-5) and 11.1% ( n = 44) died. At 12 months, 86% ( n = 303/351) completed the follow-up. Of 303 participants, 35.3% ( n = 107) were independent (mRs 0-2), 35.6% ( n = 108) were dependent (mRs 3-5) and 29% ( n = 88) had died. Forty-eight patients (14%) were lost to follow-up. Overall mortality was 33% (132/395) in 1 year. At 12 months, no comorbidities (OR 3.26; 95% CI: 1.48-7.21) and normal level of consciousness at onset (OR 3.44; 95% CI: 1.93-6.12) were associated with greater post-stroke independence (mRs 0-2). Out of 395, 111 (28.1%) patients with no or minimal disability at 1 month (mRs 0-2), 32.4% showed worsening of disability (mRs 3-5) at 12 months. Conclusion At 1 year, 33% died and 36% were dependent. A large number (60%) of patients with minimal disability at 30 days worsened or died at 1 year.


Risk of primary outcome during follow-up by splines of ankle blood pressure indices at baseline in people with and without type 2 diabetes. Multivariable-adjusted hazard ratios (HR, solid line) and 95% confidence intervals (shaded region) for expanded major adverse cardiovascular events (MACE) during follow-up according to splines of ankle BP indices at baseline (as continuous variables) compared to a reference value (diamond) as described in Methods. Y axes are log scaled. Hazard ratios were adjusted for baseline age, sex, study membership, ethnic group, history of hypertension, CVD, and peripheral artery disease, current and former smoking, LDL cholesterol, HDL cholesterol, estimated glomerular filtration rate, the number of used antihypertensive drugs, the use of statin, acetylsalicylic acid or antiplatelet treatments, and arm SBP (for ankle SBP)
Risk of primary outcome during follow-up by categories of ankle blood pressure indices at baseline in people with and without type 2 diabetes. Data presented as number of participants without and with (%) expanded major adverse cardiovascular events (MACE). Hazard ratio (HR, 95% CI) for expanded MACE during follow-up according to fourths of ankle BP indices (expressed as mmHg, except for ankle-brachial index). HRs were adjusted for baseline age, sex, study membership, ethnic group, history of hypertension, CVD, and peripheral artery disease, current and former smoking, LDL cholesterol, HDL cholesterol, estimated glomerular filtration rate, the number of used antihypertensive drugs, the use of statin, acetylsalicylic acid or antiplatelet treatments, and arm SBP (for ankle SBP). Interaction tested between history of type 2 diabetes and ankle BP indices in their associations with the primary outcome. SBP, systolic blood pressure; ABI, ankle-brachial index; APPD, ankle-pulse pressure difference
Risk of secondary outcomes during follow-up by categories of ankle blood pressure indices at baseline in people with and without type 2 diabetes. Data presented as number of participants without and with (%) secondary outcomes. Hazard ratio (HR, 95% CI) for cardiovascular mortality (Panels A and B), total myocardial infarction (Panels C and D), hospitalisation for heart failure (Panels E and F), and total stroke (Panels G and H) during follow-up according to fourths of ankle BP indices (expressed as mmHg, except for ankle-brachial index). HRs were adjusted for baseline age, sex, study membership, ethnic group, history of hypertension, CVD, and peripheral artery disease, current and former smoking, LDL cholesterol, HDL cholesterol, estimated glomerular filtration rate, the number of used antihypertensive drugs, the use of statin, acetylsalicylic acid or antiplatelet treatments, and arm SBP (for ankle SBP). Interaction tested between history of diabetes and ankle BP indices in their associations with the secondary outcomes. SBP, systolic blood pressure; ABI, ankle-brachial index; APPD, ankle-pulse pressure difference; HHF, hospitalisation for heart failure
Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes
  • Article
  • Full-text available

September 2024

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18 Reads

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1 Citation

Cardiovascular Diabetology

Background The relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes. Methods We used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke. Results Among 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98–1.12), 1.17 (1.08–1.25), and 1.54 (1.54–1.65) for ankle SBP; HR 1.06 (0.99–1.14), 1.26 (1.17–1.35), and 1.48 (1.38–1.58) for ABI; and HR 1.02 (0.95–1.10), 1.15 (1.07–1.23), and 1.48 (1.38–1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90–1.21], 1.21 [1.05–1.40], and 1.93 [1.68–2.22]), and APPD (HRs 1.08 [0.93–1.26], 1.30 [1.12–1.50], and 1.97 [1.72–2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05). Conclusions Inverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes. Graphical abstract Ankle blood pressure indices and incidence of major cardiovascular outcomes. Expanded MACE, a composite of death from cardiovascular causes, myocardial infarction,hospitalization for heart failure, or stroke. BP, blood pressure; CV, cardiovascular; HHF, hospitalization for heart failure; HR, Hazard ratio (for the lowest fourth of blood pressure indice compared to the highest); MACE, major adverse cardiovascular events; MI, myocardial infarction; Total, fatal and non-fatal MI or stroke.

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Cost effectiveness analysis of a fixed dose combination pill for primary prevention of cardiovascular disease from an individual participant data meta-analysis

May 2024

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47 Reads

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1 Citation

EClinicalMedicine

Background Cardiovascular disease (CVD) continues to impart a large burden on the global population, especially in lower income countries where affordability limits the use of cardiovascular medicines. A fixed dose combination strategy of at least 2 blood pressure lowering medications and a statin with aspirin in a single pill has been shown to reduce the risk of incident CVD by 38% in primary prevention in a recent meta-analysis. We report the in-trial (median follow-up: 5 years) cost-effectiveness of a fixed dose combination (FDC) pill in different income groups based on data from that meta-analysis. Methods Countries were categorized using World Bank economic groups: Lower Middle Income Countries (LMIC), Upper Middle Income Countries (UMIC) and High Income Countries (HIC). Country specific costs were obtained for hospitalized events, procedures, and non-study medications (2020 USD). FDC price was based on the cheapest equivalent substitute (CES) for each component. Findings For the CES-FDC pill versus control the difference in cost was 346(95346 (95% CI: 294–398)perparticipantinLowerMiddleIncomeCountries,398) per participant in Lower Middle Income Countries, 838 (95% CI: 781–895) in Upper Middle Income Countries and 42(9542 (95% CI: −155 to 239)(costneutral)inHighIncomeCountries.DuringthestudyperiodtheCESFDCpillwasassociatedwithincrementalgaininqualityadjustedlifeyearsof0.06(95239) (cost-neutral) in High Income Countries. During the study period the CES-FDC pill was associated with incremental gain in quality-adjusted life years of 0.06 (95% CI: 0.04–0.08) resulting in an incremental cost-effectiveness ratio (ICER) of 5767 (95% CI: 5735–5799), 13,937 (95% CI: 13,893–14,041) and 700(95700 (95% CI: 662–738)respectively.Insubgroupsanalyses,thehighest10yearsCVDrisksubgrouphadICERsof738) respectively. In subgroups analyses, the highest 10 years CVD risk subgroup had ICERs of 2033, 7322and7322 and −6000/QALY. Interpretation A FDC pill produced at CES costs is cost-neutral in HIC. Governments of LMI and UMI countries should assess these results based on the ICER threshold accepted in their own country and own specific health care priorities but should consider prioritizing this strategy for patients with high 10 years CVD risk as a first step. Funding Population Health Research Institute.


Overview of the study design
This study involved European (N = 3514), Latin (N = 4309), and Persian (N = 1332) PURE participants for whom genetic and plasma proteomic data were available. Observational analyses to detect plasma biomarkers of cognitive function were performed in the subset of these participants who were enrolled in the PURE-MIND sub-study (N = 1198), for whom plasma protein (N = 1060 proteins) and MRI measurements were available. Mediation analyses were performed to assess whether any observed associations between protein levels and cognitive function were mediated by structural brain phenotypes ascertained by MRI. Finally, two-sample Mendelian randomisation analyses were performed to assess potentially causal effects of genetically-predicted cognition-associated protein levels on genetically-predicted neurological outcomes. For these analyses, genetic instrumental variables for protein levels were identified in the European, Latin, and Persian PURE participants, and associations with neurological outcomes were assessed using external (non-PURE) datasets. Created with BioRender.com.
Manhattan plot indicating associations between the levels of plasma proteins and performance on the DSST in participants from the PURE-MIND cohort (N = 1198)
Each protein is represented by a triangle with upwards-facing triangles indicating a positive association with DSST performance and downwards-facing triangles indicating a negative association with DSST performance. The position of each protein on the x-axis is determined by the genomic location of its corresponding gene and the position on the y-axis is determined by the –log10p-value. The dashed horizontal line indicates the Bonferroni-corrected significance threshold (p = 4.31 × 10⁻⁵) required to maintain a 5% type I error rate.
Forest plot indicating the association between protein levels and DSST performance for significantly associated proteins
For each protein, the difference in DSST score associated with a standard deviation higher level of protein is shown, together with the 95% confidence interval. Abbreviations: BCAN brevican, CA14 carbonic anhydrase 14, CDCP1 CUB-domain containing protein 1, CI confidence interval, GS Generation Scotland imaging subsample, MOG myelin oligodendrocyte glycoprotein, NCAN neurocan, PURE Prospective Urban and Rural Epidemiology study.
Forest plots indicating the association between the levels of DSST-associated proteins and DSST-associated structural brain phenotype
For each protein, the effect estimate (change in brain volume (cm³ or %) per standard deviation increase in protein expression) is shown, together with the 95% confidence interval. Abbreviations: BCAN brevican; CA14 carbonic anhydrase 14, CDCP1 CUB-domain containing protein 1, CI confidence interval, GS Generation Scotland imaging subsample, MOG myelin oligodendrocyte glycoprotein, NCAN neurocan, PURE Prospective Urban and Rural Epidemiology study, WMH white matter hyperintensity.
The circulating proteome and brain health: Mendelian randomisation and cross-sectional analyses

May 2024

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48 Reads

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1 Citation

Translational Psychiatry

Decline in cognitive function is the most feared aspect of ageing. Poorer midlife cognitive function is associated with increased dementia and stroke risk. The mechanisms underlying variation in cognitive function are uncertain. Here, we assessed associations between 1160 proteins’ plasma levels and two measures of cognitive function, the digit symbol substitution test (DSST) and the Montreal Cognitive Assessment in 1198 PURE-MIND participants. We identified five DSST performance-associated proteins (NCAN, BCAN, CA14, MOG, CDCP1), with NCAN and CDCP1 showing replicated association in an independent cohort, GS (N = 1053). MRI-assessed structural brain phenotypes partially mediated (8–19%) associations between NCAN, BCAN, and MOG, and DSST performance. Mendelian randomisation analyses suggested higher CA14 levels might cause larger hippocampal volume and increased stroke risk, whilst higher CDCP1 levels might increase intracranial aneurysm risk. Our findings highlight candidates for further study and the potential for drug repurposing to reduce the risk of stroke and cognitive decline.


Association of estimated 24‐h sodium and potassium excretion (Tanaka) with risk of blood pressure variability. All plots were adjusted for age, sex, country. The grey ribbons indicate 95% confidence interval. The black lines represent the median value. DBP, diastolic blood pressure; SBP, systolic blood pressure.
Spline of association of systolic blood pressure standard deviation (four level mRS). Association of systolic blood pressure variability (SD) with functional outcome (mRS at 1 month). (a)–(c) Restricted cubic splines of the associations between systolic blood pressure variability (SD) with functional outcome (mRS at 1 month) in all stroke types, in ischaemic stroke and in intracerebral haemorrhage (ICH) stroke subtypes. All plots were adjusted for age, sex, centre, mRS score at admission. The grey ribbons indicate 95% confidence interval. The black lines represent the median value. mRS, modified Rankin Scale.
Spline of association of systolic blood pressure coefficient of variance with function outcomes (four level mRS at 1 month). Association of systolic blood pressure variability (CoV) with functional outcome (mRS at 1 month). (a)–(c) Restricted cubic splines of the associations between systolic blood pressure variability (CoV) with functional outcome (mRS at 1 month) in all stroke types, in ischaemic stroke and in intracerebral haemorrhage (ICH) stroke subtypes. All plots were adjusted for age, sex, centre, mRS score at admission. The grey ribbons indicate 95% confidence interval. The black lines represent the median value. mRS, modified Rankin Scale.
Blood pressure variability in acute stroke: Risk factors and association with functional outcomes at 1 month

May 2024

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88 Reads

Background and purpose Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. Patients and methods INTERSTROKE is an international case–control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1‐month follow‐up, and logistic regression was used to identify risk factors for blood pressure variability. Results Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03–1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04–1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. Conclusion Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinary sodium excretion.



Modified Rankin Scale at onset and 1 month by sleep disturbance indices.
Odds of severe stroke at initial assessment for Sleep Disturbance Symptom Burden categories.
Pre‐morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study

March 2024

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56 Reads

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1 Citation

Background and purpose Whilst sleep disturbances are associated with stroke, their association with stroke severity is less certain. In the INTERSTROKE study, the association of pre‐morbid sleep disturbance with stroke severity and functional outcome following stroke was evaluated. Methods INTERSTROKE is an international case–control study of first acute stroke. This analysis included cases who completed a standardized questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration, quality, nocturnal awakening, napping duration, whether a nap was planned, snoring, snorting and breathing cessation) in the month prior to stroke (n = 2361). Two indices were derived representing sleep disturbance (range 0–9) and obstructive sleep apnoea (range 0–3) symptoms. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity defined by the modified Rankin Score. Results The mean age of participants was 62.9 years, and 42% were female. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2–3, odds ratio [OR] 1.44, 95% confidence interval [CI] 1.07–1.94; 4–5, OR 1.66, 95% CI 1.23–2.25; >5, OR 2.58, 95% CI 1.83–3.66). Having >5 sleep disturbance symptoms was associated with significantly increased odds of functional deterioration at 1 month (OR 1.54, 95% CI 1.01–2.34). A higher obstructive sleep apnoea score was also associated with significantly increased odds of initially severe stroke (2–3, OR 1.48; 95% CI 1.20–1.83) but not functional deterioration at 1 month (OR 1.19, 95% CI 0.93–1.52). Conclusions Sleep disturbance symptoms were common and associated with an increased odds of severe stroke and functional deterioration. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcomes and should be the subject of future research.


Fig. 2: Risk of stroke associated with smoke in income regions. The magnitude of odds ratio (A) and PAR (B) of all stroke and Ischemic stroke associated with current smoking varied by income countries (C) Odds ratios of all stroke with increasing number of cigarettes smoked per day in different income countries. HIC = High income country; UMIC = Upper middle income country; LMIC = Low middle income country; LIC = Low income country. Young = female ≤65 years, male ≤55 years; Older = female >65 years, male >55 years. IS = Ischemic stroke; All age-IS, Young-IS and Older-IS mean corresponding age groups in IS subtype. Form = former smokers. Current 1-9 = currently smoking 1-9 cigarettes per day. Current 10-19 = currently smoking 10-19 cigarettes per day. Current ≥20 = currently smoking 20 or more cigarettes per day.
Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case-control study

March 2024

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169 Reads

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2 Citations

EClinicalMedicine

Background Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels. Methods The INTERSTROKE study is a case–control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined). Findings Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46–1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61–2.11) than ICH (OR 1.19 95% CI 1.00–1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24–4.10) and PAR (18.6%, 15.1–22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63–2.87) and undetermined cause (OR 1.97, 95% CI 1.55–2.50). Both filtered (OR 1.73, 95% CI 1.50–1.99) and non-filtered (OR 2.59, 95% CI 1.79–3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69–2.27), ischemic stroke (OR 1.89, 95% CI 1.59–2.24) and ICH (OR 2.00, 95% CI 1.60–2.50). Interpretation There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke. Funding The 10.13039/501100000024Canadian Institutes of Health Research, 10.13039/100004411Heart and Stroke Foundation of Canada, 10.13039/100015098Canadian Stroke Network, 10.13039/501100004359Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, 10.13039/100007212Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from 10.13039/100004325Astra Zeneca, 10.13039/100008349Boehringer Ingelheim (Canada), 10.13039/100004319Pfizer (Canada), 10.13039/100009947MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.


Figure 3 Associations between cardiovascular risk factors and MACE in women and men. Note: HR = hazard ratio. *1 SD increase in waist-to-hip ratio is 0.09. § 1 SD increase in fasting blood glucose is (27.94 mg/ dL). ¥ 1 SD increase in AHEI score is 7.32. ¢ 1 SD increase in triglycerides glucose index is 0.57.
Sex Differences in Cardiovascular Disease Risk Factor Prevalence, Morbidity, and Mortality in Colombia: Findings from the Prospective Urban Rural Epidemiology (PURE) Study

January 2024

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87 Reads

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1 Citation

Global Heart

Background Controversies exist on whether the presence of cardiovascular risk factors and their association with major cardiovascular events (MACE) is different between men and women. Most of the evidence comes from high-income countries, hindering extrapolation of sociocultural and demographic factors of other regions. Objective To evaluate sex differences in the prevalence of cardiovascular risk factors and the incidence of MACE and diabetes in Colombian adults. Methods We performed a survival analysis from women and men aged 35–70 belonging to the Prospective Urban Rural Epidemiology-Colombia prospective study. Incidence rates for MACE composite (myocardial infarction, stroke, heart failure, death) and each outcome and diabetes were calculated. Kaplan-Meier curves and log-rank tests were performed. The association between demographic, behavioral, and metabolic variables with MACE and diabetes were evaluated with Cox proportional hazards models. Results 7,552 participants (50±9.7 years) were included; 64% were women. Women had higher hypertension prevalence, body mass index, levels of total cholesterol, LDL-c, and HDL-c but lower triglycerides levels. Women were more sedentary but fewer smokers or active alcohol consumers and had higher educational levels. After 12-year mean follow-up (SD 2.3), the incidence rate of MACE composite was higher in men [4.2 (3.6–4.9) vs. 3.2 (2.8–3.7) cases per 1000 person-years]. Diabetes had the greatest association with MACE (HR = 2.63 95%CI:1.85;3.76), followed by hypertension (HR = 1.75 95%CI:1.30;2.35), low relative grip strength (HR = 1.53 95%CI:1.15;2.02), smoking (HR = 1.47 95%CI: 1.11;1.93), low physical activity (HR = 1.42 95%CI: 1.03;1.96). When evaluating risk factors by sex, only an increased waist-to-hip ratio was more strongly associated with MACE in men (p-interaction <0.05). Conclusions The composite MACE outcome was higher in men despite having a lower overall burden of risk factors. The risk factors contribution was similar, leading us to reconsider the need to carrying out differentiated cardiovascular risk prevention and management campaigns, at least in our region.


Citations (88)


... Hyperglycemia may be an independent risk factor that predicts poor outcomes in diabetic patients with Stroke. 15,16 Many studies suggest that hyperglycemia increases the oxidative stress and responses of inflammation which can further damage the tissues of brain thus further complicating the recovery processes. This physiological process highlights the need for monitoring that should be careful and blood glucose level management in the acute phase of stroke to minimize or diminish the outcomes that are adverse. ...

Reference:

Incidence Of Acute Ischemic Stroke Among Type 2 Diabetic Patients In A Tertiary Care Setting
Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes

Cardiovascular Diabetology

... The DSST assesses executive function, attention span, and processing speed. The DSST is a useful instrument for evaluating cognitive decline associated with CVH since processing speed is one of the cognitive areas that is typically affected by the condition (Walker et al., 2024). The CERAD Word List Learning Test tests both short-term and delayed memory by having participants learn and then recall a list of words. ...

The circulating proteome and brain health: Mendelian randomisation and cross-sectional analyses

Translational Psychiatry

... Отмечается [21], что связь нарушений с риском ЦИ более характерна для лиц в возрасте до 55 лет. Кроме этого, нарушения сна, предшествовавшие инсульту, ухудшают его течение и функциональное восстановление [22]. ...

Pre‐morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study

... A recent study from Colombia has demonstrated that isometric exercise in hypertensive patients has a considerable BP-lowering effect with an average reduction of 9 mmHg in SBP with only 20 min of exercise three times a week [25]. This is important because individuals with lower strength have adverse cardiometabolic characteristics and increased all-cause mortality, cardiovascular death, and higher fatality rates after an acute illness independently of demographic, anthropometric, or classic CVRF [26][27][28]. LATAM is a large region with great disparities regarding climate, altitude of residence, diet, ethnicity, socioeconomic characteristics, and life expectancy. A study carried out in Brazil showed that BP values may be dependent on environmental temperature, with higher rates of sustained hypertension in colder regions, and higher rates of normotension and in warmer regions [29]. ...

Sex Differences in Cardiovascular Disease Risk Factor Prevalence, Morbidity, and Mortality in Colombia: Findings from the Prospective Urban Rural Epidemiology (PURE) Study

Global Heart

... Due to a relatively small sample size of the NCARI group, we did not further pursue stratification of this group by the causative agents identified via multiplex PCR. The utility of MALDI-TOF MS/ML in differentiating various NCARIs and unrecognized SARS-CoV-2 infections would be important to examine in the context of the changing post-pandemic ARI landscape (21)(22)(23). Temporal variation, spanning samples collected over 2 years (2020-2022), and demographic differences across groups might have contributed to a high heterogeneity of our results. To address these constraints within a clinical laboratory setting, it would be necessary to integrate the MALDI-TOF MS/ML pipeline into a comprehensive ARI testing strategy and train the pipeline on a sufficiently large pool of samples (2). ...

Risk factors for recognized and unrecognized SARS-CoV-2 infection: a seroepidemiologic analysis of the Prospective Urban Rural Epidemiology (PURE) study

Microbiology Spectrum

... En cuanto al elevado porcentaje de mujeres con IC no especificada podría estar indicando este menor esfuerzo diagnóstico en población femenina, tal y como se ha descrito en algunos estudios 24,29,38 . La literatura también sugiere que las causas de IC y los fenotipos según FEVI difieren entre hombres y mujeres, al igual que la sintomatología 14 . ...

Characteristics, management, and outcomes in women and men with congestive heart failure in 40 countries at different economic levels: an analysis from the Global Congestive Heart Failure (G-CHF) registry
  • Citing Article
  • January 2024

The Lancet Global Health

... The selection process is visually represented in the PRISMA flowchart shown in Fig. 1. Table 1 provides a summary of the studies included in this analysis, which were carried out between 2018 and 2024 across various locations, including Canada, France, and Germany [16], Netherlands [12,17], the UK [18], Finland [19], Italy [20], Australia [21,22], China [23], Taiwan [24], and the USA [25]. The perspective analyzed in the research varied, encompassing an examination of the health system [16,18,[21][22][23], health care payer [19,24,25], and societal perspective [12,17]. ...

The Cost-Effectiveness of Rivaroxaban Plus Aspirin Compared with Aspirin Alone in the COMPASS Trial: A US Perspective

American Journal of Cardiovascular Drugs

... There were women with PCOS that more often reported on vitamin and other food supplement consumption, presumably to improve their health status, but the question remains as to what extent the consumption of dietary supplements contributed to negative correlations with Mo-SG levels in women with PCOS and with Cu-S levels in the control group of women. The positive correlation of Cu-S levels with beef consumption, observed in women with PCOS, acknowledges that beef is an important dietary source of Cu [86]. It remains debatable as to what extent higher Cu intake might affect Mo metabolism by forming the aforementioned non-absorbable Cu-Mo complexes in the gastrointestinal tract [66]. ...

Associations of dietary copper intake with cardiovascular disease and mortality: findings from the Chinese Perspective Urban and Rural Epidemiology (PURE-China) Study

BMC Public Health

... Serum K + values kept between 4.0 and 5.0 mmol/L seem safe and likely to offer stability in various cardiovascular processes (Sica et al., 2002). Increased consumption of potassium-rich foods is linked to a decreased incidence of stroke and may also lessen the risk of congenital cardiac conditions and overall cardiovascular disease (O'Donnell et al., 2023). These findings corroborate with suggestions to increase the intake of food high in potassium to prevent vascular disorders (D'Elia et al., 2011). ...

Potassium intake: the Cinderella electrolyte
  • Citing Article
  • November 2023

European Heart Journal

... Data of 116 individuals of the original cohort were retrieved from the studied population, maintaining similar proportions of sex (60 males and 56 females), age range [62]. Demographics, weight, height, waist circumference, body fat percentage, systolic (SBP) and diastolic (DBP) blood pressures, and blood chemistry parameters (HDL cholesterol, LDL cholesterol, very low-density lipoprotein (VLDL) cholesterol, oxidized LDL, triglycerides, fasting insulin, fasting glucose, leptin, and total adiponectin) were retrieved from published records [25,26,63]. ...

Waist circumference cut-off points to identify major cardiovascular events and incident diabetes in Latin America: findings from the prospective Urban rural epidemiology study Colombia