Author Contributions: Dr Teo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Teo, Yusuf.
Acquisition of data: Teo, Lear, Mony, Dehghan, W. Li, Rosengren, Lopez-Jaramillo, Diaz, Oliveira, Miskan, Rangarajan, Iqbal, Ilow, Puone, Bahonar, Gulec, Darwish, Lanas, Vijaykumar, Rahman, Chifamba, Hou, N. Li, Yusuf.
Analysis and interpretation of data: Teo, Islam, Dehghan, Yusuf.
Drafting of the manuscript: Teo.
Critical revision of the manuscript for important intellectual content: Teo, Lear, Islam, Mony, Dehghan, Li, Rosengren, Lopez-Jaramillo, Diaz, Oliveira, Miskan, Rangarajan, Iqbal, Ilow, Puone, Bahonar, Gulec, Darwish, Lanas, Vijaykumar, Rahman, Chifamba, Hou, Li, Yusuf.
Statistical analysis: Islam.
Obtained funding: Yusuf.
Administrative, technical, or material support: Teo, Mony, Dehghan, Li, Rosengren, Miskan, Rangarajan, Iqbal, Gulec, Darwish, Lanas, Rahman, Chifamba, Hou.
Study supervision: Teo, Mony, Li, Rangarajan, Iqbal, Puone, Bahonar, Darwish, Hou, Yusuf, and other national lead investigators.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Lear reported that the Population Health Research Institute (Hamilton, Ontario, Canada) provided funding support for travel to meetings for the Prospective Urban Rural Epidemiology (PURE) study. Dr Lopez-Jaramillo reported receiving speakers fees from Boehringer and Merck. Dr Ilow reported receiving research funding from the Polish Minstry of Science and Higher Education and the Population Health Research Institute. Dr Bahonar reported receiving institutional funding from the Population Health Research Institute for the costs of the study. Dr Gulec reported serving on the board of Pfizer, Novartis, AstraZeneca, and Boehringer Ingelheim; receiving speakers fees from sanofi-aventis, AstraZeneca, Novartis, Pfizer, Bayer, and Boehringer Ingelheim; receiving payment for the development of educational presentations from Abdi Ibrahim (Turkey); and receiving travel reimbursement from Boehringer Ingelheim and sanofi-aventis. Dr Lanas reported receiving a grant from the Universidad de La Frontera; and receiving travel reimbursement from the Population Health Research Institute. No other author reported disclosures.
Funding/Support: Dr Yusuf is supported by the Mary W. Burke endowed chair of the Heart and Stroke Foundation of Ontario. Dr Chow is supported by a fellowship co-funded by the National Heart and Medical Research Council of Australia, the National Heart Foundation of Australia, and the Sydney Medical Foundation. The PURE study is funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca in Sweden and Canada, Novartis, sanofi-aventis in France and Canada, Boehringer Ingelheim in Germany and Canada, Servier, King Pharma, and GlaxoSmithKline), and additionally by contributions from various national or local organizations in the following countries: Bangladesh: Independent University, Bangladesh, Mitra and Associates. Brazil: Unilever Health Institute, Brazil. Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network. Chile: Universidad de la Frontera. China: National Center for Cardiovascular Diseases. Colombia: Colciencias grant 6566-04-18062. India: Indian Council of Medical Research. Malaysia: Ministry of Science, Technology, and Innovation of Malaysia grant 07-05-IFN-MEB010, Universiti Teknologi MARA, and Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010). Poland: Polish Ministry of Science and Higher Education grant Nr 290/W-PURE/2008/0, and Wroclaw Medical University. South Africa: North-West University, SANPAD (South Africa and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of South Africa, South Africa Sugar Association, and Faculty of Community and Health Sciences (University of Western Cape). Sweden: Swedish Council for Working Life and Social Research, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, Swedish Heart and Lung Foundation, Swedish Research Council, grant from the Swedish State under LäkarUtbildningsAvtalet agreement, and grant from the Västra Götaland Region. Turkey: Metabolic Syndrome Society, AstraZeneca, and sanofi-aventis. United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, and Dubai Health Authority.
Role of the Sponsor: The funders and sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
PURE Project office staffat Population Health Research Institute: (Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada): S. Rangarajan (project manager); K. K. Teo, C. K. Chow; S. Islam (statistician); M. Zhang (statistician); C. Kabali (statistician); M. Dehghan (nutritionist); J. Xiong, A. Mente, J. DeJesus, P. Mackie, M. Madhavan, D. Corsi, L. Farago, J. Michael, I. Kay, S. Zafar, D. Williams, R. Solano, N. Solano, M. Farago, J. Rimac, S. Trottier, W. ElSheikh, M. Mustaha, J. Kaszyca, R. Hrnic, S. Yusuf (principal investigator).
PURE Core Laboratories: M. McQueen, K. Hall, J. Keys (Hamilton, Ontario, Canada), X. Wang (Beijing, China), J. Keneth (Bangalore, India).
PURE National Coordinators (indicated with an asterisk), Investigators, and Key Staff by Country:Argentina: R. Diaz*, A. Orlandini, C. Bahit, B. Linetsky, S. Toscanelli, G. Casaccia, J. M. Maini Cuneo. Bangladesh: O. Rahman*, R. Yusuf, A. K. Azad, K. A. Rabbani, H. M. Cherry, A. Mannan, I. Hassan, A. T. Talukdar, R. B. Tooheen, M. U. Khan. Brazil: A. Avezum*, G. B. Oliveira, C. S. Marcilio, A. C. Mattos. Canada: K. Teo*, S Yusuf*, J. Dejesus, S. Zafar, D. Williams, J. Rimac, G. Dagenais, P. Poirier, G. Turbide, D. Auger, A. LeBlanc De Bluts, M. C. Proulx, M. Cayer, N. Bonneville, S. Lear, A. Chockalingam, D. Gasevic, S. Gyawali, S. Hage-Moussa, G. Mah, M. MacLeod, I. Vukmirovich, A. Wielgosz, G. Fodor, A. Pipe, S. Papadakis, I. Moroz, S. Muthuri. Chile: F. Lanas*, P. Seron, S. Martinez. China: Liu Lisheng*, Li Wei*, Chen Chunming, Wang Xingyu, Zhao Wenhua, Bo Jian, Chang Xiaohong, Chen Tao, Chen Hui, Cheng Xiaoru, Deng Qing, He Xinye, Hu Bo, Jia Xuan, Li Jian, Li Juan, Liu Xu, Ren Bing, Sun Yi, Wang Wei, Wang Yang, Yang Jun, Zhai Yi, Zhang Hongye, Zhao Xiuwen, Zhu Manlu, Lu Fanghong, Wu Jianfang, Li Yindong, Hou Yan, Zhang Liangqing, Guo Baoxia, Liao Xiaoyang, Zhang Shiying, Bian Rongwen, Tian Xiuzhen, Li Dong, Chen Di, Wu Jianguo, Xiao Yize, Liu Tianlu, Zhang Peng, Dong Changlin, Li Ning, Ma Xiaolan,Yang Yuqing, Lei Rensheng, Fu Minfan, He Jing, Liu Yu, Xing Xiaojie, Zhou Qiang. Colombia: P. Lopez-Jaramillo*, R. Garcia, J. F. Arguello, R. Dueñas, S. Silva, L. P. Pradilla, F. Ramirez, D. I. Molina, C. Cure-Cure, M. Perez, E. Hernandez, E. Arcos, S. Fernandez, C. Narvaez, J. Paez, A. Sotomayor, H. Garcia, G. Sanchez, T. David, D. Gómez-Arbeláez, A. Rico. India: M. Vaz*, A. V. Bharathi, S. Swaminathan, P. Mony, K. Shankar, A. V. Kurpad, K. G. Jayachitra, N. Kumar, V. Mohan, M. Deepa, K. Parthiban, M. Anitha, S. Hemavathy, T. Rahulashankiruthiyayan, D. Anitha, K. Sridevi, R. Gupta, R. B. Panwar, I. Mohan, P. Rastogi, S. Rastogi, R. Bhargava, R. Kumar, J. S. Thakur, B. Patro, R. Mahajan, P. Chaudary, V. Raman Kutty, K. Vijayakumar, K. Ajayan, G. Rajasree, A. R. Renjini, A. Deepu, B. Sandhya, S. Asha, H. S. Soumya. Iran: R. Kelishadi*, A. Bahonar, N. Mohammadifard, H. Heidari. Malaysia: K. Yusoff*, H. M. Nawawi, T. S. Ismail, A. S. Ramli, R. Razali, N. Khan, N. M. Nasir, R. Ahmad, T. Winn, F. A. Majid, I. Noorhassim, M. J. Hasni, M. T. Azmi, M. I. Zaleha, K. Y. Hazdi, A. R. Rizam, W. Sazman, A. Azman. Pakistan: R. Iqbal*, A. Afridi, R. Khawaja, K. Kazmi. Poland: W. Zatonski*, R. Andrzejak, A. Szuba, K. Zatonska, R. Ilow, M. Ferus, B. Regulska-Ilow, D. Różańska, M. Wolyniec. South Africa: A. Kruger*, H. H. Voster, A. E. Schutte, E. Wentzel-Viljoen, F. C. Eloff, H. de Ridder, H. Moss, J. Potgieter, A. A. Roux, M. Watson, G. de Wet, A. Olckers, J. C. Jerling, M. Pieters, T. Hoekstra, T. Puoane, E. Igumbor, L. Tsolekile, D. Sanders, P. Naidoo, N. Steyn, N. Peer, B. Mayosi, B. Rayner, V. Lambert, N. Levitt, T. Kolbe-Alexander, L. Ntyintyane, G. Hughes, R. Swart, J. Fourie, M. Muzigaba, S. Xapa, N. Gobile, K. Ndayi, B. Jwili, K. Ndibaza, B. Egbujie, T. de Lima, M. Petersen, S. Govender. Sweden: A. Rosengren*, K. Bengtsson Boström, U. Lindblad, P. Langkilde, A. Gustavsson, M. Andreasson, M. Snällman, L. Wirdemann, K. Pettersson, E. Moberg. Turkey: A. Oguz*, A. A. K. Akalin, K. B. T. Calik, N. Imeryuz, A. Temizhan, E. Alphan, E. Gunes, H. Sur, K. Karsidag, S. Gulec, Y. Altuntas. United Arab Emirates: A. M. Yusufali*, W. Almahmeed, H. Swidan, E. A. Darwish, A. R. A. Hashemi, N. Al-Khaja, J. M. Muscat-Baron, S. H. Ahmed, T. M. Mamdouh, W. M. Darwish, M. H. S. Abdelmotagali, S. A. Omer Awed, G. A. Movahedi, F. Hussain, H. Al Shaibani, R. I. M. Gharabou, D. F. Youssef, A. Z. S. Nawati, Z. A. R. Abu Salah, R. F. E. Abdalla, S. M. Al Shuwaihi, M. A. Al Omairi, O. D. Cadigal, R. S. Alejandrino. Zimbabwe: J. Chifamba*, L. Gwaunza, G. Terera, C. Mahachi, P. Mrambiwa, T. Machiweni, R. Mapanga.
Online-Only Material: The Author Video Interview is available .