Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income CountriesThe Prospective Urban Rural Epidemiology (PURE) Study Author Interview with Dr. Koon Teo, MB, PhD

Population Health Research Institute, Hamilton Health Sciences,
McMaster University, Hamilton, Ontario, Canada What are the main findings of the study?

Dr. Teo: In this study we examined the prevalence of smoking cessation or avoidance, eating a healthy diet and undertaking regular physical activities in nearly 8000 individuals who had previously experienced a coronary heart disease event or stroke, on average 5 years after their events. The individuals were recruited from over 600 communities in 17 countries with varying incomes and economic development.  We found that although these healthy lifestyle activities could reduce the risk of further heart or stroke events, about one fifth of individuals continued to smoke, only one third undertook regular leisure or work related physical activities and about two fifths ate a healthy diet.

There were differences between countries of different incomes, with high income countries having higher prevalence of quitting smoking and more doing regular physical activities but the prevalence of those eating healthy diets was lower compared to some countries with lower incomes. Low income countries had low prevalence of smoking cessation, regular physical activities and eating healthy diets. Overall the prevalence of healthy lifestyle behaviours was low. This requires development of simple, effective and low cost strategies for secondary prevention that is applicable worldwide. Were any of the findings unexpected?

Dr. Teo: We were disappointed but not too surprised at the findings and the persistent gap in healthy lifestyle behaviors. What should clinicians and patients take away from your report?

Dr. Teo: Although most of us, clinicians and patients, are aware of healthy lifestyles we must consciously follow these lifestyle all the time. Often enough, people slip back into their previous behaviors when they feel “normal” after they recover from the acute attacks. Clinicians should reinforce this message every time they see their patients. What recommendations do you have for future research as a result of this study?

Dr. Teo: We should work on strategies on improving lifestyle behaviours as secondary prevention and test them in the various populations to determine which ones work best in each of the countries which vary in the health resources available.


Teo K, Lear S, Islam S, et al. Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle- and Low-Income Countries: The Prospective Urban Rural Epidemiology (PURE) Study. JAMA. 2013;309(15):1613-1621. doi:10.1001/jama.2013.3519.

Last Updated on September 19, 2013 by Marie Benz MD FAAD