Risk factors for cardiovascular disease in the developing world. A multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN)

Twelve centres in 7 countries in the Developing World (China, Thailand, the Philippines, Indonesia, Chile, Colombia and Brazil) connected with the International Clinical Epidemiology Network (INCLEN) each measured cardiovascular disease (CVD) risk factors in random samples of approx. 200 men aged between 35 and 65 years. Samples of men aimed to be representative of the population from which they were drawn, but the population in each centre was not designed to be representative of the whole country. Cigarette smoking rates varied from 16 to 78% and mean cholesterol levels varied from 3.8 to 6.4 mmol/l. In Bogota, Colombia, 46% of the men had a cholesterol level > 6.5mmol/l and in another 5 communities 19% or more of the population had these levels. A body mass index (BMI) of > 25 was seen in more than 50% of 4 communities and a blood pressure ? 160mmHg systolic and/or 95 mmHg diastolic was found in more than 20% of 6 countries. BMI was strongly correlated with blood cholesterol and blood pressure levels in almost all population groups. It would appear that many communities in the Developing World have high levels of risk factors for CVD and that steps could well start to be taken now to prevent the emergence of CVD epidemics in the future

Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables. Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35-65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country. For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the 'Developed' World. The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention