Long-term incidence and risk factors of cardiovascular events in Asian populations: systematic review and meta-analysis of population-based cohort studies

Abstract

Background: Scientific studies on cardiovascular disease (CVD) burden and risk factors are predominantly based on short-term risk in Westerner populations, and such information may not be applicable to Asian populations, especially over the longer term. This review aims to estimate the long-term (>10 years) CVD burden, including coronary heart disease (CHD) and stroke, as well as associated risk factors in Asian populations.

Methods: PubMed, Embase and Web of Science were systematically searched, and hits screened on: Asian adults, free of CVD at baseline; cohort study design (follow-up >10 years). Primary outcomes were fatal and non-fatal CVD events. Pooled estimates and between-study heterogeneity were calculated using random effects models, Q and I² statistics.

Results: Overall, 32 studies were eligible for inclusion (follow-up: 11–29 years). The average long-term rate of fatal CVD is 3.68 per 1000 person-years (95% CI 2.84–4.53), the long-term cumulative risk 6.35% (95% CI 4.69%–8.01%, mean 20.13 years) and the cumulative fatal stroke/CHD risk ratio 1.5:1. Important risk factors for long-term fatal CVD (RR, 95% CI) were male gender (1.49, 1.36–1.64), age over 60/65 years (7.55, 5.59–10.19) and current smoking (1.68, 1.26–2.24). High non-HDL-c, and β- and γ-tocopherol serum were associated only with CHD (HR 2.46 [95% CI 1.29–4.71] and 2.47 [1.10–5.61] respectively), while stage 1 and 2 hypertensions were associated only with fatal stroke (2.02 [1.19–3.44] and 2.89 [1.68–4.96] respectively).

Conclusions: Over a 10 year + follow-up period Asian subjects had a higher risk of stroke than CHD. Contrary to CVD prevention in Western countries, strategies should also consider stroke instead of CHD only.

Keywords:

• Asia
• cardiovascular disease
• coronary heart disease
• long-term risk
• risk factor
• stroke

Transparency

Declaration of funding

This work was supported by LPDP and DIKTI scholarships from the Ministry of Finance and the Ministry of Research, Technology and Higher Education of the Republic of Indonesia, respectively. The LPDP and DIKTI had no direct role in research design, data collection, analysis and interpretation, or manuscript writing and publication.

Author contributions: All authors were involved in study design, interpretation, review and final approval of the manuscript. Additionally, S.I. conducted search and study selection, data extraction, risk of bias assessment, data analysis, and prepared the first draft of the manuscript. R.W. conducted study selection, confirmed the correctness of data extraction and risk of bias assessment. A.F.S. provided advice in the data interpretation and important intellectual content in the draft of the manuscript. A.I. confirmed the correctness of data extraction and provided statistical advice. T.F. provided advice in the data analysis and important intellectual content in the draft of the manuscript. E.B. provided important intellectual content in the draft of the manuscript. B.W. resolved disagreements in study selection and provided important intellectual content in the draft of the manuscript. E.H. resolved disagreements in study selection and risk of bias assessment, and provided important intellectual content in the data analysis and the draft of the manuscript.

Declaration of financial/other relationships

S.I., R.W., A.F.S., A.I., T.F., E.B., B.W. and E.H. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We would like to thank Karin Sijtsma for her contribution to developing the search strategy and Sjoukje van der Werf for her contribution to checking the appropriateness of the search strategy. We also would like to thank several authors of the included studies (Pao-Hwa Lin, Woon-Puay Koh and Ying Wang) for their contribution to providing complementary data for the meta-analysis.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Sylvi Irawati, upon reasonable request.