A Secondary-Prevention Alarm Bell for Lower-Income Countries

Among survivors of coronary heart disease and stroke, those in lower-income countries were even less likely to observe key elements of a healthy lifestyle than survivors in wealthier countries.

How well do survivors of coronary heart disease (CHD) and stroke in a variety of countries adhere to a healthy lifestyle? To find out, investigators prospectively assessed the prevalence of smoking, healthy eating, and regular physical activity among 153,996 adults (age range, 35–70) in 628 urban and rural communities in 17 countries from January 2003 through December 2009. Three of the countries were identified as high-income, 7 as upper-middle-income, 3 as lower-middle-income, and 4 as low-income.

Of the 7519 participants with self-reported CHD or stroke, 81.5% had never smoked or had quit smoking, 35.1% participated in high levels of work- or leisure-related physical activity, and 39.0% ate a healthy diet. Notably, only 4.3% of this group observed all three healthy lifestyle habits. Income level by country correlated significantly with the prevalence of smoking cessation (ranging from 38% in low-income countries to 75% in high-income countries) and eating a healthy diet (ranging from 26% to more than 40%, respectively) — but not with engaging in regular physical activity.

CITATION(S):

Teo K et al. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) Study. JAMA 2013 Apr 17; 309:1613.