About half of the world's burden of cardiovascular disease is carried by countries in the Asia-Pacific region. This study aimed to quantify the contribution of hypertension to cardiovascular diseases (CVD) at the country level, by calculating the sex-specific, population-attributable fractions (PAFs) for fatal ischaemic heart disease (IHD) and stroke (haemorrhagic and ischaemic) for the World Health Organization Western Pacific and South-east Asian regions.
The most recent sex-specific prevalence data on hypertension were sought. Age-adjusted hazard ratio (HR) estimates for fatal IHD and stroke associated with hypertension were obtained using Cox analyses of individual participant cohort data from 600 000 adult participants in the Asia-Pacific Cohort Studies Collaboration. HR estimates and prevalence were then used to calculate sex-specific PAFs for fatal IHD and stroke, by country.
In 15 countries with available data, the prevalence of hypertension ranged from 5–47% in men and from 7–38% in women. Overall, the fraction of IHD attributable to hypertension ranged from 4–28% in men and from 8–39% in women. Corresponding ranges for haemorrhagic stroke were 18–66% and 15–49%, and for ischaemic stroke were 8–44% and 12–45%.
In the Asia-Pacific region, up to 66% of some subtypes of CVD can be attributed to hypertension, underscoring the immense impact that blood pressure- lowering strategies could have in this populous region.
aThe George Institute for International Health, Sydney, Australia
bUniversity of Auckland, Auckland, New Zealand
cShiga University of Medical Science, Shiga, Japan
dYonsei University College of Medicine, Seoul, Korea
eUniversity of Hong Kong, Hong Kong
fChinese Academy of Medical Sciences, Beijing, China
gUniversity of Queensland, Brisbane, Australia
hTohoku University, Sendai, Japan
*Details of the Asia-Pacific Cohort Studies Collaboration are given in the Appendix.
Received 19 April, 2006
Revised 1 September, 2006
Accepted 4 September, 2006
Correspondence and requests for reprints to Alexandra Martiniuk, The George Institute for International Health at the University of Sydney, PO Box M201 Missenden Road; Camperdown, NSW; 2050, Australia Tel: +61 2 9993 4500; fax: +61 2 9993 4501; e-mail: amartiniuk@george.org.au
Sponsorship: This project was supported through a program grant from the National Health and Medical Research Council of Australia and an unrestricted educational grant from Pfizer Inc. A.L.C.M. received support from a Rotary International Ambassadorial Scholarship. C.M.Y.L. is supported by a postgraduate scholarship from the National Health and Medical Research Council. C.M.M.L. is supported by a National Heart Foundation (New Zealand) Fellowship. The sponsors had no influence on design, analysis or interpretation of results.
Conflict of interest: none.
