• Smoking Cessation
• Prevention & Screening
• Cardiology Clinical Trials

Results from the Prospective Urban Rural Epidemiology [PURE] study, presented by Salim Yusuf, MD, McMaster University, Hamilton, Ontario, Canada, indicated that different strategies are needed to influence health behaviors in countries, depending upon their socioeconomic status. In relatively low-income countries, key strategies include making healthy foods accessible and affordable, and promoting smoking cessation. Among relatively more high-income/industrialized countries, efforts should be focused on increasing physical activity and decreasing fat consumption, while continuing to promote smoking cessation.

Diet, physical activity, and smoking account for 50% to 60% of the risk for cardiovascular disease (CVD) [Yusuf S et al. Lancet 2004; Tu JV. Lancet 2010]; however, these factors vary markedly both across and within countries, due to environmental and societal factors. The PURE study was designed to create an understanding of these factors in order to develop contextually appropriate strategies for CVD prevention.

The PURE study was comprised of 153,996 individuals (aged 35 to 70 years; 42.1% men) from 348 urban and 280 rural communities in 17 low-, middle-, and high-income countries for whom data on diet, physical activity, and smoking were collected during 2003–2010. Validated food frequency questionnaires were used to record diet; physical activity (recreational and nonrecreational/obligatory) was collected using the International Physical Activity Questionnaire. These factors, plus smoking prevalence (ever, current, and quitting) were then related to country gross domestic product (GDP; World Bank statistics) and household wealth (wealth index) overall and separately for individuals from urban and rural areas.

Results from the PURE study showed that among those living in low-income countries there is less consumption of fruits, vegetables, proteins and fats, and a higher consumption of carbohydrates, which researchers attributed to the affordability of different foods. Activity levels were higher in low-income countries due to a higher level of obligatory physical activities (mostly work and transportation-related). Smoking was also more prevalent among individuals in low-income countries. As country GDP increased, there was an increased consumption of fruits and vegetables, accompanied by a higher percentage of energy obtained from total (but not saturated) fats and proteins, with a lower percentage of energy from carbohydrates. Physical activity declined with increasing GDP mostly because of a marked decline in obligatory/nonrecreational activity that was not compensated for by an increase in recreational physical activity. In all categories studied, the association of household wealth to diet, physical activity, and quitting smoking were similar to that observed for GDP.

“Policies to prevent CVD need to focus on different aspects of lifestyle among the rich versus the poor and between rich and poor countries,” said Prof. Yusuf. “In particular, healthy foods need to become more affordable.”

• © 2012 MD Conference Express®