title: Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Smoking status (current, former, never), level of exercise (low, <600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, >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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Koon
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authors.lastname: Teo
authors.forename: Scott
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authors.lastname: Lear
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.forename: Prem
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authors.lastname: Mony
authors.forename: Mahshid
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authors.lastname: Dehghan
authors.forename: Wei
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authors.lastname: Li
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.forename: Gustavo
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authors.lastname: Oliveira
authors.forename: Maizatullifah
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authors.lastname: Miskan
authors.forename: Sumathy
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authors.lastname: Rangarajan
authors.forename: Romaina
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authors.lastname: Iqbal
authors.forename: Rafal
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authors.forename: Thandi
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authors.lastname: Puone
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authors.lastname: Bahonar
authors.forename: Sadi
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authors.lastname: Gulec
authors.forename: Ebtihal A
authors.initials: EA
authors.lastname: Darwish
authors.forename: Fernando
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authors.lastname: Lanas
authors.forename: Krishnapillai
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authors.lastname: Vijaykumar
authors.forename: Omar
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authors.lastname: Rahman
authors.forename: Jephat
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authors.lastname: Chifamba
authors.forename: Yan
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authors.lastname: Hou
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mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019049:Developed Countries; D003906:Developing Countries; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D007182:Income; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D016540:Smoking Cessation; D020521:Stroke / Q000517:prevention & control*; D014505:Urban Population