Mortality, Cardiovascular Disease, and Their Associations With Risk Factors in Southeast Asia A PURE Substudy

BACKGROUND The drivers of cardiovascular disease (CVD) and all-cause mortality may differ around the world. Regional-level prospective data can help guide policies to reduce CVD and all-cause mortality. OBJECTIVES This study examined the incidence of CVD and mortality in Malaysia and the Philippines and estimated the population-level risks attributable to common risk factors for each outcome. METHODS This prospective cohort study included 20,272 participants from Malaysia and the Philippines. The mean follow-up was 8.2 years. The incidences of CVD and mortality rates were calculated for the overall cohort and in key subgroups. For each outcome, population-attributable fractions (PAFs) were calculated to compare risks associated with 12 modifiable risk factors. RESULTS The mean age of the cohort was 51.8 years (59% women). Leading causes of mortality were CVD (37.9%) and cancer (12.4%). The incidence of CVD (per 1,000 person-years) was higher in the Philippines (11.0) than Malaysia (8.3), and CVD contributed to a higher proportion of deaths in the Philippines (58% vs 36%). By contrast, all-cause mortality rates were higher in Malaysia (14.1) than in the Philippines (10.9). Approximately 78% of the PAF for CVD and 68% of the PAF for all-cause mortality were attributable to 12 modifiable risk factors. For CVD, the largest PAF was from hypertension (24.2%), whereas for all-cause mortality, the largest PAF was from low education (18.4%). CONCLUSIONS CVD and cancer account for one-half of adult mortality in Malaysia and the Philippines. Hypertension was the largest population driver of CVD, whereas low education was associated with the largest burden of overall mortality. (JACC Asia 2024;4:624-633) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).