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Original research article
Low prevalence of ideal cardiovascular health in Peru
  1. Catherine P Benziger1,2,
  2. José Alfredo Zavala-Loayza1,
  3. Antonio Bernabe-Ortiz1,3,
  4. Robert H Gilman4,5,
  5. William Checkley4,6,
  6. Liam Smeeth3,
  7. German Malaga1,7,
  8. Juan Jaime Miranda1,7
  9. CRONICAS Cohort Study group
  1. 1 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
  2. 2 Division of Cardiology, University of Washington, Seattle, WA, USA
  3. 3 Faculty of Epidemiology and Population Health, London School of Hygiene andTropical Medicine, London, UK
  4. 4 Department of International Health, Johns Hopkins University, Baltimore, MD, USA
  5. 5 Research Division, Asociación Benéfica PRISMA, Lima, Peru
  6. 6 Division of Pulmonary and Critical Care, School of Medicine Johns Hopkins University, Baltimore, MD, USA
  7. 7 Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
  1. Correspondence to Dr Juan Jaime Miranda, CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru; jaime.miranda{at}


Background The prevalence of and factors associated with ideal cardiovascular health (ICH) by sociodemographic characteristics in Peru is not well known.

Methods The American Heart Association’s ICH score comprised 3 ideal health factors (blood pressure, untreated total cholesterol and glucose) and 4 ideal health behaviours (smoking, body mass index, high physical activity and fruit and vegetable consumption). ICH was having 5 to 7 of the ideal health metrics. Baseline data from the Center of Excellence in Chronic Diseases, a prospective cohort study in adults aged ≥35 years in 4 Peruvian settings, was used (n=3058).

Results No one met all 7 of ICH metrics while 322 (10.5%) had ≤1 metric. Fasting plasma glucose was the most prevalent health factor (72%). Overall, compared with ages 35–44 years, the 55–64 years age group was associated with a lower prevalence of ICH (prevalence ratio 0.54, 95% CI 0.40 to 0.74, P<0.001). Compared with those in the lowest tertile of socioeconomic status, those in the middle and highest tertiles were less likely to have ICH after adjusting for sex, age and education (P<0.001).

Conclusion There is a low prevalence of ICH. This is a benchmark for the prevalence of ICH factors and behaviours in a resource-poor setting.

  • cardiac risk factors and prevention
  • obesity
  • epidemiology
  • global disease patterns

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors CPB and JJM conceived the idea of the manuscript. CPB drafted the first version of the manuscript and led the statistical analysis with support of JZL and AB-O. JJM, RHG, WC and LS conceived, designed and supervised the overall study. JJM, AB-O and WC coordinated and supervised fieldwork activities in Lima, Tumbes and Puno. All authors participated in writing of manuscript, provided important intellectual content and gave their final approval of the version submitted for publication.

  • Funding This CRONICAS Cohort Study was established with federal funds from the US National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract no HHSN268200900033C. AB-O is a Research Training Fellow in Public Health and Tropical Medicine (103994/Z/14/Z) and LS is a Senior Clinical Fellow (098504/Z/12/Z), both funded by Wellcome Trust. WC was further supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute. JJM acknowledges receiving additional support from the Alliance for Health Policy and Systems Research (HQHSR1206660), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877), Grand Challenges Canada (0335-04), International Development Research Center Canada (106887, 108167), Inter-American Institute for Global Change Research (IAI CRN3036), Medical Research Council (MR/P008984/1, MR/P024408/1, MR/P02386X/1), National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), Wellcome Trust (074833/Z/04/Z, 093541/Z/10/Z, 107435/Z/15/Z, 103994/Z/14/Z, 205177/Z/16/Z) and the World Diabetes Foundation (WDF15-1224).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics approval for this study protocol was obtained from the Institutional Review Boards at Universidad Peruana Cayetano Heredia and A.B. PRISMA in Lima, Peru, and at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Technical appendix, statistical code and dataset available on request from the corresponding author at Applications will only be granted and data provided after agreement from our contributing providers.

  • Correction notice Since this paper was first published online the funding statement has been updated. Reference citations in the text have also been updated.

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