Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income Countries

IMPORTANCE: Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide. OBJECTIVE: To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event. DESIGN, SETTING, AND PARTICIPANTS: Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153, 996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009. MAIN OUTCOME MEASURES: Smoking status (current, former, never), level of exercise (low, 3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index). RESULTS: Among 7519 individuals with self-reported CHD (past event: median, 5. 0 interquartile range IQR, 2. 0-10. 0 years ago) or stroke (past event: median, 4. 0 IQR, 2. 0-8. 0 years ago), 18. 5% (95% CI, 17. 6%-19. 4%) continued to smoke; only 35. 1% (95% CI, 29. 6%-41. 0%) undertook high levels of work- or leisure-related physical activity, and 39. 0% (95% CI, 30. 0%-48. 7%) had healthy diets; 14. 3% (95% CI, 11. 7%-17. 3%) did not undertake any of the 3 healthy lifestyle behaviors and 4. 3% (95% CI, 3. 1%-5. 8%) had all 3. Overall, 52. 5% (95% CI, 50. 7%-54. 3%) quit smoking (by income country classification: 74. 9% 95% CI, 71. 1%-78. 6% in HIC; 56. 5% 95% CI, 53. 4%-58. 6% in UMIC; 42. 6% 95% CI, 39. 6%-45. 6% in LMIC; and 38. 1% 95% CI, 33. 1%-43. 2% in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25. 8%; 95% CI, 13. 0%-44. 8%) compared with LMIC (43. 2%; 95% CI, 30. 0%-57. 4%), UMIC (45. 1%, 95% CI, 30. 9%-60. 1%), and HIC (43. 4%, 95% CI, 21. 0%-68. 7%). CONCLUSION AND RELEVANCE: Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries.