Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Background: Global estimates of the impact of common modifiable risk factors on cardiovascular disease (CVD) and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methodology to prospectively evaluate the impact of modifiable risk factors on CVD and mortality across 21 countries (spanning five continents) at different economic levels. Methods: In a multi-national, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and major CVD in 155,722 community-dwelling participants (ages 35–70 years at enrollment) from 21 high-, middle-, or low-income countries (HIC, MIC or LIC) followed for a median of 9·5 years. We describe the prevalence, hazard ratios, and…