Cardiovascular diseases in Latin America and the Caribbean: The present situation

"Cardiovascular diseases in Latin America and the Caribbean: The present situation"

Prevention and Control 2007; Available online 9 May 2007

http://www.precon-journal.com/article/PIIS1573208807000049/abstractThe review below compiles information from the Pan American Health Organization (PAHO) and studies published in peer-reviewed journals.


HEALTH DISPARITIES AND DIFFERENCES IN DEVELOPMENT

People in urban areas have easy access to hospitals, but poverty and education inequities limit optimal health care.

Those in rural areas face the inability to afford user charges for health care, financial barriers for necessary prescription drugs and lack of transportation to reach health services.
Highly Indebted Poor Countries" have little national income for investments in health and other social needs.

Data to monitor gender disparities and progress in gender equity in health have not been readily available.


SOME CONSIDERATIONS ABOUT CVD MORTALITY DATA

Coronary heart disease mortality rates among men were highest in Venezuela (137.3/100,000) and lowest in Argentina (63.5/100,000) in 2000.

For women the rates were highest in Cuba and lowest in Argentina.

Stroke mortality was highest in Brazil and lowest in Puerto Rico in 2000.

Ischemic heart disease was the leading cause of death in 16 countries in the 45-64 age group.

Stroke ranked first in five countries in the 45-64 age group.

Ischemic heart disease ranked first in 15 countries and stroke in nine countries in the >=65 age group.

In Costa Rica from 1970-2001, mortality from CVD dropped by an average of 33%, while ischemic heart disease mortality rose by an average of 18.4%.

In Guatemala the CVD death rate was 65.9/100,000 in 1969, 80/100,000 in 1986 and between 1986-1999 the percentage doubled from 7% to 13%.


CARDIOVASCULAR RISK FACTORS AND THEIR IMPLICATIONS

Latin America and the Caribbean are seeing a decreased consumption of fruit, vegetables, whole grains, cereals, and legumes and parallel increases in consumption of food rich in saturated fat, sugar, and salt, as well as milk, meat, refined cereals, and processed food.

Several national surveys show that between 50-60% of adults and 7-12% of children <5 years old are overweight and obese.

In Chile and Mexico, recent national surveys show that 15% of adolescents are obese.35 million people in the region are currently affected by diabetes, and the WHO forecast an increase to 64 million by 2025.

Medical expenditures for people with diabetes are 2-3 times higher than for those not affected by diabetes.

Diabetes prevalence in Barbados is 16.4%, 18% in Jamaica, between 6-8% in Central and South America and in Mexico has increased from 7.2% in 1993 to 10.7% in 2003 in those aged 20-69 years.

Data for Mexico indicate that the hypertension prevalence increased from 26% in 1993 to 30% in 2000.

A survey part of the Central American Initiative of Diabetes (CAMDI) of PAHO, showed a high prevalence of risk factors in the adult population of Villa Nueva, Guatemala: 54% overweight, 13% hypertension, 35% hypercholesterolemia, 8% diabetes, 15% metabolic syndrome and 16% current smoking.

Diabetes prevalence was 9% among men and 7% among women, while non-diagnosed diabetes was 56% among men and 39% among women.

Hypertension prevalence was 12% among men and 14% among women, while non-diagnosed hypertension was 63% among men and 28% among women.

Adult smoking prevalence is as high as 40% in Chile and Argentina, while it remains below 20% in Colombia, Costa Rica and Panama.

In the Caribbean, it is estimated that 5600 deaths annually are attributable to smoking.

In Guatemala, 21% of men and 2% of women from the rural highlands were current smokers.

A tobacco study among physicians working at public hospitals in Guatemala City found that 18% of medical residents were current smokers, and that 35% were former smokers.

Rural and urban women had similar prevalence of overweight, elevated body fat and low physical activity in a study of rural-to-urban migration and cardiovascular disease risk factors in young Guatemalan adults.

Compared to rural men, more urban men were sedentary (79% vs. 27%), with higher body fat (15.3 +-5.3% vs. 13.3 +-5.7%), and serum cholesterol (165 +-29 vs.151 +-27mg/dl).

Women had higher serum cholesterol than men in both rural and urban areas. Urban residents consumed more saturated fats, red meat and sweetened beverages, and fewer legumes.

According to the FRICAS study (Factores de Riesgo Coronario Argentina), the findings for women compared to men in terms of risk factor prevalence and risk for developing an AMI were as follows: hypertension 68% vs. 46%; diabetes 25% vs. 12%; serum cholesterol >220mg/dl: 21% vs. 18%.

Although women smoked less than men, 22% vs. 51%, the risk was greater.

According to the FRICAL study (Factores de Riesgo Coronario en America
Latina), attributable risk for diabetes in the development of an AMI was 10% in Venezuela, 15% in Mexico, 5% in Cuba and 7% in Argentina.

Attributable risk for hypercholesterolemia was 27% in Venezuela, 3% in Mexico, 30% in Cuba and 36% in Argentina.


CARDIOVASCULAR DISEASE PREVENTION INITIATIVES IN LATIN AMERICA AND THE CARIBBEAN

Sustainable program activities aimed at the individual and at entire communities are needed in combination with initiatives to improve the environmental support for active lifestyles.

The CARMEN Initiative (Conjunto de Acciones para Reducción Multifactorial de Enfermedades No Transmisibles), based on the implementation of integrated community-based preventive projects, seeks to effectively prevent and control non-communicable diseases (NCDs) in the Americas. The general objective of CARMEN is to improve the health status of target populations by reducing common risk factors associated with NCDs and CVDs. Several Latin American and Caribbean countries are already involved in this initiative.

"In Brazil, the 'Agita São Paulo Program' and in Chile the 'Vida Chile Program' are models for the use of physical activity to promote health in the general population. Starting as a local, grassroots initiative, the Agita São Paulo Program alliance went on to become an inclusive, statewide coalition of public and private institutions. The contagious effect of Agita São Paulo has already seen an impact on the rest of Brazil as well as many other countries in the Americas."

PAHO is launching a media communication campaign 'Let's eat healthy, live well and get moving, America!' to encourage and move countries into action on healthy habits. The purpose of the campaign is to raise public awareness about the negative health consequences of obesity, to try to promote healthy dietary patterns and to improve physical activity levels.


The city of Bogotá, Colombia has provided an example of how urban planning can impact positively on public health by promoting and facilitating physical activity in the population. Changes in the city include 250km of bike trails, good pedestrian infrastructure and efforts to improve road safety. Awareness of the urban changes taking place in Bogotá is spreading throughout the Americas and they are being adopted in several cities.

The PROPIA Program (Programa de Prevencin del Infarto en Argentina) from La Plata University, Argentina, in association with other governmental and non-governmental organizations, aims to diminish the mortality and morbidity from atherosclerotic diseases in the general population. It focuses on healthy food, promotion of physical activity and tobacco control.

The Caribbean Food and Nutrition Institute (CFNI) and the PAHO/WHO Office of Caribbean Program Coordination released in 2004 a protocol intended to serve as a resource for nutrition and dietetic personnel and other health professionals involved in the management of subjects with obesity, diabetes and hypertension in the primary health care setting.

Brazil is one of the control leaders in the region, with prohibition on tobacco advertisement from 2000. It has developed a policy of smoke free public places and it facilitates access to treatment for smokers who want to quit. In Uruguay, multiple alliances among civilians and medical and NGO organizations have engaged in 'Alianza Nacional para el Control del Tabaco.' As a result of the joint efforts, Uruguay has become the first country among Latin American and Caribbean countries to pass a law banning smoking indoors. Venezuela has a long history of tobacco control from 1992 banning advertising from media and in some states declaring all public places smoke free. The Caribbean Standards Bureau, based in Jamaica, is developing recommendations about warning labels and these recommendations will apply to all English-speaking Caribbean countries. CLACCTA (Comite LatinoAmericano Coordinador para el Control del Tabaco) joined InterAmerican Heart Foundation and together initiated a movement to facilitate tobacco control policies in the Region.


CONCLUSION

"In our vision the challenge for governments, health authorities, non-governmental organizations and all the people involved in prevention, is to close the gap between the existing reality and the desired CV health of the population. Numerous local or regional studies published on CVD and CV risk factors provide solid information upon which to base action and implement health policies in the region. Many of the approaches are affordable. Now is the time for these efforts to be made, before the impending CVD epidemic becomes overwhelming. Foundations and Scientific Societies have to make a great effort to inform the authorities and to provide them the cooperation to reduce the growing epidemic of CVD in Latin America