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Long-term incidence and risk factors of cardiovascular events in Asian populations: systematic review and meta-analysis of population-based cohort studies |
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| Authors: | Sylvi Irawati Riswandy Wasir Amand Floriaan Schmidt Atiqul Islam Talitha Feenstra Erik Buskens |
| Affiliation: | 1. Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology &2. Economics, University of Groningen, Groningen, the Netherlands;3. Center for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia;4. Faculty of Medical Sciences, Epidemiology, University Medical Center Groningen, Groningen, the Netherlands;5. Sekolah Tinggi Ilmu Farmasi, Makassar, Indonesia;6. University College London, Institute of Cardiovascular Science, London, UK;7. Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands;8. Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh |
| Abstract: | Background: Scientific studies on cardiovascular disease (CVD) burden and risk factors are predominantly based on short-term risk in Westerner populations, and such information may not be applicable to Asian populations, especially over the longer term. This review aims to estimate the long-term (>10 years) CVD burden, including coronary heart disease (CHD) and stroke, as well as associated risk factors in Asian populations. Methods: PubMed, Embase and Web of Science were systematically searched, and hits screened on: Asian adults, free of CVD at baseline; cohort study design (follow-up >10 years). Primary outcomes were fatal and non-fatal CVD events. Pooled estimates and between-study heterogeneity were calculated using random effects models, Q and I2 statistics. Results: Overall, 32 studies were eligible for inclusion (follow-up: 11–29 years). The average long-term rate of fatal CVD is 3.68 per 1000 person-years (95% CI 2.84–4.53), the long-term cumulative risk 6.35% (95% CI 4.69%–8.01%, mean 20.13 years) and the cumulative fatal stroke/CHD risk ratio 1.5:1. Important risk factors for long-term fatal CVD (RR, 95% CI) were male gender (1.49, 1.36–1.64), age over 60/65 years (7.55, 5.59–10.19) and current smoking (1.68, 1.26–2.24). High non-HDL-c, and β- and γ-tocopherol serum were associated only with CHD (HR 2.46 [95% CI 1.29–4.71] and 2.47 [1.10–5.61] respectively), while stage 1 and 2 hypertensions were associated only with fatal stroke (2.02 [1.19–3.44] and 2.89 [1.68–4.96] respectively). Conclusions: Over a 10 year?+?follow-up period Asian subjects had a higher risk of stroke than CHD. Contrary to CVD prevention in Western countries, strategies should also consider stroke instead of CHD only. |
| Keywords: | Asia cardiovascular disease coronary heart disease long-term risk risk factor stroke |