RESUMO
Background: Implementation of guideline recommendations for cardiovascular disease (CVD) prevention in people with diabetes in low- and middle-income countries (LMICs) is unclear. We assessed the achievement of CVD prevention targets among patients with diabetes in LMICs. Methods: We pooled nationally representative cross-sectional surveys from 38 LMICs. We evaluated three targets according to the World Health Organization's (WHO) recommendations: treatment (glucose-lowering drugs, statins, antihypertensive drugs, and aspirin); metabolism (blood glucose, body mass index, blood pressure, and cholesterol); and lifestyle (non-smoking, non-drinking, physical activity, and diet). We used multivariable Poisson regression models to assess sociodemographic factors influencing adherence to guideline recommendations. Results: The study included 110 083 participants, of whom 6789 (6.0%) had self-reported diabetes. The prevalence of achieving the treatment, metabolic and lifestyle targets for all components were 9.9%, 8.1%, and 7.2%, respectively. The components with the lowest prevalence of the three targets were 11.1% for statin use, 27.3% for body mass index control, and 19.5% for sufficient consumption of fruit and vegetables, respectively. Upper-middle-income countries were better at achieving the treatment, non-drinking, and dietary targets than lower-middle-income countries. Women, middle-aged and older patients, and highly educated patients had a lower prevalence of metabolic adherence. Conclusions: In LMICs, the prevalence of patients with diabetes meeting WHO-recommended treatment, metabolic and lifestyle targets for CVD prevention was low. Our findings highlighted the need to strengthen the prevention of CVD in patients with diabetes in LMICs.
Assuntos
Doenças Cardiovasculares , Países em Desenvolvimento , Diabetes Mellitus , Humanos , Doenças Cardiovasculares/prevenção & controle , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Adulto , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/epidemiologia , Idoso , Guias de Prática Clínica como Assunto , Fidelidade a Diretrizes/estatística & dados numéricosRESUMO
BACKGROUND: This study aimed to estimate the prevalence of achieving the secondary prevention targets recommended in the World Health Organization (WHO) guidelines for cardiovascular disease (CVD) in 38 low-income and middle-income countries (LMICs). METHODS: We pooled nationally representative cross-sectional surveys from 38 LMICs between 2013 and 2020. Treatment, metabolic and lifestyle targets were assessed for individuals with a self-reported history of CVD according to WHO's recommendations. Associations between the prevalence of guideline adherence and sociodemographic characteristics were assessed using multivariate Poisson regression models. RESULTS: The pooled sample included 126 106 participants, of whom 9821 (6.8% [95% CI 6.4-7.2]) reported a history of CVD. Overall, the prevalence of achieving treatment targets in patients with CVD was 22.7% (95% CI, 21.0-24.5%) for antihypertensive drugs, 19.6% (17.9-21.4%) for aspirin, and 13.6% (12.0-15.44%) for statins. The prevalence of achieving metabolic targets was 54.9% (52.5-57.3%) for BMI, 39.9% (37.7-42.2%) for blood pressure, 46.1% (43.6-48.6%) for total cholesterol, and 84.9% (83.1-86.5%) for fasting blood glucose. The prevalence of achieving lifestyle targets was 83.2% (81.5-84.7%) for not smoking, 83.1% (81.2-84.9%) for not drinking, 65.5% (63.1-67.7%) for sufficient physical activity and 16.2% (14.5-18.0%) for healthy diet. Only 6.1% (5.1-7.4%) achieved three treatment targets, 16.0% (14.3-17.9%) achieved four metabolic targets, and 6.9% (5.8-8.0%) achieved four lifestyle targets. Upper-middle income countries were better than low-income countries at achieving the treatment, non-drinking and dietary targets. Being younger and female were associated with poorer achievement of metabolic targets. CONCLUSION: In LMICs, achieving the targets recommended in the guideline for treatment, metabolism and healthy lifestyles for patients with CVD is notably low. This highlights an urgent need for effective, systematic secondary prevention strategies to improve CVD management.
Assuntos
Doenças Cardiovasculares , Países em Desenvolvimento , Prevenção Secundária , Humanos , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Feminino , Masculino , Prevenção Secundária/métodos , Prevenção Secundária/estatística & dados numéricos , Prevenção Secundária/normas , Pessoa de Meia-Idade , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Adulto , Idoso , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Organização Mundial da Saúde , Estilo de VidaRESUMO
BACKGROUND: Given the substantial prevalence of cardiovascular disease (CVD) in low-income and middle-income countries (LMICs), evaluation of behavioral counseling for prevention of CVD is important. METHODS: We pooled nationally representative cross-sectional surveys from 36 LMICs between 2013 and 2020. The population was divided into three groups according to CVD risk: the potential risk group, the risk group and the CVD group. We estimated the prevalence of six types of behavioral counseling among the three groups separately: smoking, salt reduction, fruit and vegetable intake, dietary fat reduction, physical activity and body weight. RESULTS: There were 16,057 (25.4%) in the potential risk group, 43,113 (49.9%) in the risk group, and 7796 (8.6%) in the CVD group. The prevalence of receiving at least four types of counseling in the three groups was 15.6% (95% CI 13.9 to 17.5), 14.9% (95% CI 14.0 to 15.9), and 19.8% (95% CI 17.7 to 22.2), respectively. The lowest prevalence was for tobacco use counseling: 24.5% (95% CI 22.5 to 26.4), 23.2% (95% CI 22.1 to 24.3), and 32.1% (95% CI 29.5 to 34.8), respectively. The prevalence of counseling was higher in upper-middle-income countries than in lower-middle-income countries. Women, older people, those with more education, and those living in urban areas were more likely to receive counseling. CONCLUSION: The prevalence of behavioral counseling for CVD is low in LMICs, especially among potentially at-risk populations and in low-income countries. These findings highlight the current urgent need to improve CVD prevention and management systems to enhance behavioral counseling and intervention.