THE CHALLENGE OF CONTROLLING CARDIOVASCULAR RISK FACTORS. A PERSPECTIVE FROM THE RESULTS OF THE PURE COHORT

Abstract

To investigate the determinants of cardiovascular diseases, the PURE cohort was established in 2003. It is conducted in 28 countries and includes 212,199 volunteers. All participants un derwent extensive assessments, including lifestyle questionnaires, medical history, therapies, anthropometric measurements, electrocardiography, spirometry, handgrip strength testing, and blood sampling. Five major areas were examined. 1) Hypertension control: Sixty percent of participants were aware of their hypertensive condition; among these, five out of six were receiving treatment, yet only two out of ten achieved adequate blood pressure control. 2) Secondary prevention: Low levels of adherence to lifestyle recommendations and appropriate pharmacotherapy were observed, with greater deficiencies in lower-middle- and low-income countries. 3) Dietary effects on cardiovascular disease: The lowest incidence of cardiovascular events was observed with estimated sodium intakes of 4 to 6 grams per day. Consumption of fruits, vegetables, and legumes was associated with lower event rates. No significant effect of total fat intake was observed, whereas a higher proportion of ultra processed carbohydrates was associated with increased cardiovascular risk. 4) Climate change: Temperatures below and above the optimal mean temperature were associated with increased mortality. 5)Mortality patterns: Overall mortality increased as national income decreased. While cardiovascular disease was the leading cause of death in the cohort, cancer surpassed cardiovascular mortality in high-income countries.