Table 1
Definition of risk factor targets.
| RISK FACTOR | TARGET |
|---|---|
| Smoking | No smoking or cessation |
| Physical activity | Moderately vigorous physical activity ≥30 minutes 3–5 times/week |
| BMI | <25 kg/m2 |
| Waist circumference | <94 cm in men (<90 cm in South-East Asian men) and <80 cm in women |
| Blood pressure | <140/90 mmHg (<140/85 mmHg in diabetics) |
| LDL | <1.8 mmol/L. Stricter target: <1.4 mmol/L |
| non-HDL cholesterol | <2.2 mmol/L |
| Triglycerides | <1.7 mmol/L |
| Hba1c (in diabetics) | <7% |
Table 2
Characteristics of the study population by country income group.
| (LMIC N = 2645) | UMIC (N = 3777) | HIC (N = 7462) | (Total N = 13884) | |
|---|---|---|---|---|
| Number of countries | 3 | 9 | 17 | 29 |
| Number of centres | 11 | 29 | 65 | 105 |
| Type of centre attended | ||||
| Private | 1526 (57.7) | 940 (24.9) | 313 (4.55) | 2779 (20.9) |
| Public | 1119 (42.3) | 2837 (75.1) | 6561 (95.4) | 10517 (79.1) |
| Demographics | ||||
| Mean age (SD) | 62.1 (39.9) | 63.0 (10.5) | 66.7 (11.0) | 64.8 (20.0) |
| Sex | ||||
| Female | 502 (19.0) | 1140 (30.2) | 1823 (24.4) | 3465 (25.0) |
| Ethnic Group | ||||
| Arab | 346 (13.1) | 102 (2.7) | 123 (4.3) | 571 (6.1) |
| Asian | 2284 (86.4) | 628 (16.6) | 26 (0.9) | 2938 (31.8) |
| Black | 6 (0.2) | 18 (0.5) | 14 (0.5) | 38 (0.4) |
| Mixed | 5 (0.2) | 41 (1.1) | 9 (0.3) | 55 (0.6) |
| Other | 0 (0.0) | 3 (0.1) | 8 (0.3) | 11 (0.1) |
| White | 4 (0.2) | 2981 (79.0) | 2634 (93.6) | 5619 (60.9) |
| Educational level | ||||
| Primary school | 630 (24.8) | 506 (16.8) | 921 (16.7) | 2057 (18.6) |
| Secondary school | 964 (37.9) | 1403 (46.6) | 1451 (26.3) | 3818 (34.5) |
| Tertiary/University | 950 (37.3) | 1100 (36.6) | 3150 (57.0) | 5200 (47.0) |
| Cardiovascular history | ||||
| Index event | ||||
| CABG | 423 (16.0) | 690 (18.3) | 797 (15.7) | 1910 (16.6) |
| PCI | 1253 (47.4) | 2197 (58.2) | 2875 (56.6) | 6325 (55.0) |
| Acute coronary syndrome | 1034 (39.1) | 1462 (38.7) | 4128 (55.3) | 6624 (47.7) |
| Stable angina pectoris | 855 (32.3) | 1539 (40.7) | 2146 (28.8) | 4540 (32.7) |
| Family history premature CVD | 288 (10.9) | 1184 (31.4) | 819 (29.0) | 2291 (24.8) |
| Risk factor history | ||||
| Hypertension | 1359 (51.4) | 3109 (82.3) | 3162 (65.7) | 7630 (67.9) |
| Dyslipidemia | 1234 (46.7) | 1974 (52.3) | 3163 (67.5) | 6371 (57.4) |
| Diabetes | 1129 (29.2) | 1136 (42.9) | 1294 (34.3) | 3559 (34.6) |
| Smoking | ||||
| Current | 423 (16.3) | 861 (23.7) | 1541 (21.9) | 2825 (21.3) |
| Former | 442 (17.0) | 1112 (30.6) | 3129 (44.4) | 4683 (35.3) |
| Never | 1736 (66.7) | 1661 (45.7) | 2373 (33.7) | 5770 (43.5) |
| Physical activity < 30 minutes 3–5 times/week | 979 (38.0) | 1690 (52.9) | 1640 (43.6) | 4309 (45.2) |
| Moderate | 1259 (48.8) | 1037 (32.5) | 1451 (38.5) | 3747 (39.3) |
| Physical activity > 30 minutes 3–5 times/week | 340 (13.2) | 465 (14.6) | 673 (17.9) | 1478 (15.5) |
| Risk factor levels (mean (SD)) | ||||
| Systolic BP (mmHg) mean (SD) | 128 (20.2) | 134 (20.3) | 132 (17.7) | 132 (19.0) |
| Diastolic BP (mmHg) mean (SD) | 75.8 (11.3) | 80.7 (11.4) | 77.2 (10.6) | 77.9 (11.1) |
| Heart rate (bpm) mean (SD) | 77.8 (13.6) | 73.7 (12.9) | 68.9 (12.2) | 73.1 (13.3) |
| BMI (kg/m2) mean (SD) | 26.5 (4.5) | 28.7 (4.9) | 28.2 (5.0) | 28.0 (4.9) |
| Waist circumference (cm) mean (SD) | 90.5 (15.4) | 99.2 (12.7) | 103 (13.1) | 100 (13.7) |
| Total cholesterol (mmol/l) mean (SD) | 3.86 (1.2) | 4.70 (1.4) | 3.98 (1.4) | 4.19 (1.4) |
| LDL cholesterol (mmol/l) mean (SD) | 2.15 (1.1) | 2.79 (1.2) | 2.06 (1.0) | 2.24 (1.1) |
| HDL cholesterol (mmol/l) mean (SD) | 1.11 (0.4) | 1.19 (0.4) | 1.22 (0.4) | 1.18 (0.4) |
| Tryglicerides (mmol/l) mean (SD) | 3.74 (1.9) | 2.44 (2.0) | 2.76 (1.9) | 2.92 (2.0) |
| Fasting glucose (mmol/l) mean (SD) | 7.63 (3.5) | 6.78 (2.8) | 6.44 (2.2) | 6.88 (2.9) |
| HbA1C (%) | 7.97 (1.7) | 7.74 (1.7) | 8.94 (11.1) | 8.23 (6.5) |
[i] Results are indicated in number of participants (%) unless indicated. HICs: high-income counties, UMICs: upper-middle-income countries, LMICs: lower-middle income countries, CABG: Coronary Artery Bypass Graft, PCI: Percutaneous Coronary Intervention, CVD: cardiovascular disease.
Figure 1
Percentage of participants (A) meeting risk factor targets, (B) with information recorded on risk factors, and (C) reporting to use medication and participate in cardiac rehabilitation. Risk factor targets are defined as: no smoking or smoking cessation, Moderately vigorous physical activity at least 30 minutes 3–5 times/week, BMI <25 kg/m2, waist circumference <94 cm in men (<90 cm in South-East Asian men) and <80 cm in women, blood pressure <140/90 mmHg (<140/85 mmHg in diabetics), LDL <1.8 mmol/L, LDL <1.4 mmol/L, non-HDL cholesterol <2.2 mmol/L, triglycerides <1.7 mmol/L, and Hba1c (in diabetic patients) <7%. Results on Hba1c recording, target attainment, oral hypoglicemics, and insulin are calculated among diabetic patients.
Table 3
Results multivariable analysis showing odds ratios for achieving risk factor targets, being on medication or participating in cardiac rehabilitation, and secondary or tertiary educational level compared to primary education.
| HIC | UMIC | LMIC | |
|---|---|---|---|
| Target attainmenta | |||
| Never or former smoking | 1.71 (1.43–2.04) | 1.14 (0.88–1.47) | 1.99 (1.53–2.59) |
| Physical activity | 1.94 (1.59–2.35) | 2.48 (1.96–3.14) | 1.75 (1.41–2.13) |
| BMI | 1.06 (0.84–1.34) | 1.10 (0.81–1.51) | 0.89 (0.71–1.11) |
| Waist circumference | 1.30 (0.82–2.12) | 0.63 (0.37–1.10) | 0.86 (0.53–1.40) |
| Blood pressure | 0.64 (0.53–0.77) | 1.02 (0.83–1.27) | 0.92 (0.75–1.14) |
| non-HDL Cholesterol | 1.01 (0.79–1.30) | 0.92 (0.64–1.35) | 1.19 (0.94–1.49) |
| LDL 1.8 | 1.23 (1.05–1.45) | 0.74 (0.55–1.01) | 1.30 (1.04–1.63) |
| LDL 1.4 | 0.94 (0.78–1.13) | 0.65 (0.44–1.00)c | 1.21 (0.93–1.58) |
| Triglycerides | 0.85 (0.66–1.09) | 1.32 (1.01–1.72) | 1.14 (0.91–1.44) |
| Hba1cb | 0.82 (0.45–1.36) | 0.89 (0.53–1.50) | 1.20 (0.80–1.82) |
| Treatment | |||
| Antiplatelets | 1.66 (1.22–2.23) | 1.285 (0.97–1.69) | 1.5 (0.94–2.35) |
| Antihypertensives | 1.995 (1.32–2.96) | 0.72 (0.48–1.05) | 1.03 (0.64–1.63) |
| Lipid-lowering | 1.424 (1.05–1.90) | 0.62 (0.48–0.79 | 1.75 (1.20–2.55) |
| Oral hypoglicemics | 1.43 (0.94–2.16) | 1.08 (0.78–1.49) | 1.26 (0.92–1.72) |
| Insulinb | 1.10 (0.70–1.73) | 0.43 (0.30–0.61) | 0.88 (0.59–1.34) |
| Cardiac rehabilitationb | 2.47 (2.10–2.91) | 4.89 (3.44–7.18) | 1.24 (0.99–1.56) |
[i] Results are expressed in odds ratios (95% confidence intervals) of achieving risk factor targets and being on medication or participating in cardiac rehabilitation, if having secondary or tertiary education compared to primary education, adjusted by age, sex, and type of center (public or private). a Risk factor targets are defined as: no smoking or smoking cessation, Moderately vigorous physical activity at least 30 minutes 3–5 times/week, BMI <25 kg/m2, waist circumference <94 cm in men (<90 cm in South-East Asian men) and <80 cm in women, blood pressure <140/90 mmHg (<140/85 mmHg in diabetics), LDL <1.8 mmol/L, LDL <1.4 mmol/L, non-HDL cholesterol <2.2 mmol/L, triglycerides <1.7 mmol/L, and Hba1c (in diabetic patients) <7%. b Estimates are calculated among diabetic patients. c 97.5% CI = 0.999.
| SURF CHD Collaborators | |
|---|---|
| Marina Joseph, Yanina Castillo Costa | Socieded Argentina de Cardiología, Buenos Aires |
| Nicolás Esteybar Enrique | Counsel of Cardioecology and Healthy Habits Sociedad Argentina de Cardiología, Mar del Plata, Argentina |
| Rahima Gabulova | Azerbaijan Medical University, Educational Therapeutic Clinic, Baku, Azerbaijan |
| Mahluga Isaveva | Scientific Research Institute for Cardiology, Baku, Azerbaijan |
| Farid Alivev | Baku Health Centre, Baku, Azerbaijan |
| Uzeyir Rahimov | Baku Medical Plaza, Baku, Azerbaijan |
| Galib Imanov | Azerbaijan Medical University, Educational Surgical Clinic, Baku, Azerbaijan |
| Firdovsi Ibrahimov | Central Clinic Hospital, Baku, Azerbaijan |
| Zarbaliyeva Naila | Ganja City United Hospital, Ganja, Azerbaijan |
| Rashad Abasov | ER Medical, Khachmaz, Azerbaijan |
| Paul Dendale, Anre Jassen | Jessa Hospital-Hartcentrum, Hasselt, Belgium |
| Johan De Sutter | AZ Maria Middelares Cardiologie, Gent, Belgium |
| Sofie Cuypers | Hartcentrum OLV ziekenhuis, Aalst, Belgium |
| Dalton Precoma | Sociedade Hospitalar Angelina Caron, Campina Grande do Sul, Brazil |
| Luiz Ritt | Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil |
| Mario Claudio Soares Sturzeneker | Wallace Thadeu de Mello e Silva Regional University Hospital, Brazil |
| Conrado Roberto Hoffmann Filho | Street Blumenau, 294 Centro, Joinville SC, Brazil |
| Maria Teresa Lira | Hospital Clínico Fuerza Aérea de Chile, Santiago, Chile |
| Michal Varablik, Eva Tumova | Centre of Preventive Cardiology, 3th Department of internal medicine, 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic |
| Jaromir Ozana | Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Czech Republic |
| Ann Bovin | Danish Society of Cardiology, Copenhagen, Denmark |
| Margus Viigimaa | North Estonia Medical Centre, Tallinn University of Technology, Tallin, Estonia |
| Konstantinos Tsioufis, Ageliki Laina | Cardiology Department, Hippokration General Hospital, Athens, Greece |
| Zacharoulis Achilles, Fotios Toulgaridis | General Hospital of Athens “Evangelismos”, Athens, Greece |
| Elias Sanidas | LAIKO General Hospital, Athens, Greece |
| Zeljko Reiner | Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland & University Hospital Center, Zagreb, Croatia |
| Marijana Gulin, Antonijo BejúiĆ | County Hospital Sibenik, Croatia |
| Darko Duplančić | University Hospital, Split, Croatia |
| Jozica Šikić | University Hospital Sveti Duh, Croatia |
| Eszter Szabados | Ist Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pécs, Medical School, Pécs, Hungary |
| Badai Bhatara Tiksnadi | Hasan Sadikin General Hospital, Bandung, West Java, Indonesia |
| Bill McEvoy | University Hospital Galway, Galway, Ireland |
| Anne Reynolds, David Moore | Tallaght University, Hospital Cardiology clinic, Dublin, Ireland |
| Declan Spelman | South Tipperary General Hospital, Tipperary, Ireland |
| Raman Puri, Rashmi Nanda | Cardiac Care Centre, New Delhi, India |
| Nagaraj Desai | Namana Medical Centre, Bengaluru, India |
| Prabhakar Dorairaj | Ashwin Clinic, Annanagar, India |
| S. S. Iyengar, Sumitra Lakshmana | Manipal Hospital, Bangalore, India |
| Ajay Kumar Pandey | Galaxy Hospital, Mahmoorganj, India |
| Akshyaya Pradhan | King George’s Medical University, Lucknow, India |
| Kunal Mahajan | Himachal Heart Institute, Chhanwari, India |
| Pompilio Faggiano | Ospedali Riuniti, Brescia, Italy |
| P. Zarcone | Policlinico P. Giccone, Palermo, Italy |
| Maurizio G Abrignani | S Antonio Abate Hospital of Trapani, O.U. of Cardiology, Trapani, Italy |
| Makhanov Daniyar | Central Clinical Hospital, Almaty, Kazakhstan |
| Kairat Davletov | Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan |
| Kuatbek Toleubekov, Olga Visternichan | Cardiorehabilitation Center “Tulpar”, Karaganda Medical University, Karaganda, Kazakhstan |
| Alibek Mereke | City Policlinic № 32, Al Farabi Kazakh National University, Almaty, Kazakhstan |
| Anar Dushpanova | City Policlinic № 32, Al Farabi Kazakh National University, Almaty, Kazakhstan; Scuola Superiore Sant’Anna, Pisa, Italy |
| Bekbolat Zholdin, Zhanat Timirbayev | Medical Center of West Kazakhstan Marat Ospanov Medical University, Zhanakonys, Kazakhstan |
| Gulmira Derbissalina | Astana Medical University, University hospital, Astana, Kazakhstan |
| Daulet K. Aldyngurov | Department of Science and Human resource, Ministry of Healthcare, Kazakhstan |
| Ayan Myssayev | Cardiological Center of Pavlodar region, Department of Science and Human resourse, Ministry of Healthcare, Kazakhstan |
| Alma Nurtazina | Cardiological Center of Pavlodar region, Semey Medical University, Semey, Kazakhstan |
| Zhanna Romanova, Sundetgali Kalmakhanov | City polyclinic № 5, Al Farabi Kazakh National University, Almaty, Kazakhstan |
| Iveta Mintale | Latvian Center of Cardiology, Riga, Latvia |
| Omar Msalam | Libyan Cardiac Society, Tripoli, Libya |
| Emhemed Ehemmali | Misrata Heart & Cardiovascular Center, Misrata, Libya |
| Alami Mohamed | Cabinet Cardiologie ALAMI, Casablanca, Morocco |
| Najat Mouine | Cardiology Centre, Mohammed V Military Hospital, Rabat, Morocco |
| Tazi Mezalek Amale | Hopital Universitaire Cheikh Zaid, Rabat, Morocco |
| Aida Soufiani, Zineb Agoumy, Houda Bachri, Imad Massri | Ligue Nationale de cardiologie, Rabat, Morocco |
| Irena Mitevska | University Cardiology Clinic, Skopje, North Macedonia |
| Saskia Haitjema, Mark de Groot | Utrecht Patient Oriented Database (UPOD), Central Diagnostic Laboratory, Division of Laboratory, Pharmacy, and Biogenetics, University Medical Center Utrecht, Utrecht University, Utrecht |
| Ana Abreu | Hospital Universitário Santa Maria, IMPSP, ISAMB, Faculty of Medicine of University of Lisbon, Lisbon |
| Svetlana Mosterou, Dan Gaita | Institute for Cardiovascular Diseases, Timisoara, Romania |
| Nana Pogosova | National Medical Research Center of Cardiology, Preventive Cardiology Laboratory, Moscow, Russia |
| Marat V. Ezhov | Federal State Budget Institution, National Cardiology Research Centre of Ministry of Healthcare of Russian Federation, Moscow, Russia |
| Abdulhalim Kinsara | Ministry of National Guard health affairs. King Saud bin Abdulaziz University for Health Sciences, COM-WR. King Abdullah International Research Center, Jeddah, Saudi Arabia |
| Ivana Burazor | Cardiology, Institute for rehabilitation; Cardiology, Institute for rehabilitation, and University of Belgrade – Faculty of Medicine, Institute for Cardiovascular Diseases ‘Dedinje’, Belgrade, Serbia |
| Vojislav Giga | Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia |
| Hector Bueno | Hospital 12 de Octubre, Madrid, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain |
| Regina Dalmau | University Hospital la Paz, Madrid, Spain |
| Ana García-Barrios | Hospital General Universitario Dr. Balmis, Alicante, Spain |
| Jose Antonio Alarcon Duque, Joana Reparaz Mendinueta | Hospital Universitario Donostia/OSI Donostialdea, Donostia, Spain |
| Meral Kayikcioglu | Ege University Medical School Cardiology Department, Ege University Tip Fak Kardivoloii AD Bornova Izmir, Turkey |
| Lale Tokgozoglu | Hacettepe University, Department of Cardiology, Ankara, Turkey |
| Emre Aslanger | Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey |
| Ayca Turer Cabbar | Yeditepe Univerisity Hospital, Istanbul, Turkey |
| Samuel Kim, Caleb Self, Dolores Reynolds, Sabrina Rose, Pretti Singh | Weil Cornell Medicine, New York, United States |