INTRODUCTION Over the last decade, total cardiovascular risk assessment and management has been recommended by cardiovascular prevention guidelines in most high-income countries and by WHO. Cardiovascular risk prediction charts have been developed based on multivariate equations of values of some well-known risk factors such as age, sex, smoking, systolic blood pressure and diabetes, including or omitting total blood cholesterol. OBJECTIVEThe objectives of this study were: to determine the distribution of cardiovascular risk in a Cuban population using the WHO/ International Society of Hypertension risk prediction charts with and without cholesterol; and to assess applicability of the risk prediction tool without cholesterol in a middle-income country, by evaluating concordance between the two approaches and comparing projected drug requirements resulting from each (at risk thresholds of ≥20% and ≥30%) and for the single-risk-factor approach.METHODS From April through December 2008, a cross-sectional study was conducted in 1287 persons (85.8% of the sample selected), aged 40-80 years living in a polyclinic catchment area of Havana, Cuba, based on the protocol and data from a WHO multinational study. The study used the two sets of the WHO and the International Society of Hypertension (WHO/ISH) risk prediction charts, with and without cholesterol. Percentages and means were calculated, as well as prevalence (%) of risk factors. The chi-square test was used to compare means (p ≤0.05). Concordance between the two prediction charts was calculated for different risk levels, using the chart with cholesterol as a reference. RESULTSUsing the risk assessment tools with and without cholesterol, 97.1% and 95.4% respectively of the study population were in the ten-year cardiovascular risk category of <20%, while 2.9% and 4.6% respectively were in the category of ≥20%. Risk categories were concordant in 88.1% of the population; overestimation was higher among the nonconcordant (136/153). When risk assessment did not include cholesterol, there was 2.6% (34/1287) overestimation of drug requirements and 0.5% (6/1287) underestimation, compared to estimates including cholesterol.CONCLUSION Total cardiovascular risk assessment using the WHO/ ISH charts without cholesterol could be a useful approach to predict cardiovascular risk in settings where cholesterol cannot be measured. This does not introduce overconsumption of drugs, but does enable better targeting of resources to those who are more likely to develop cardiovascular disease.

INTRODUCTION Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years.OBJECTIVE Describe acute myocardial infarction mortality in Cuba from 1999 through 2008.METHODS A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age-and sex-specifi c rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two fi ve-year time frames within the study period.RESULTS A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51. 8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the fi rst fi ve-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both fi ve-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively).CONCLUSIONS Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care assessments for these patients.

Background: Cardiovascular disease (CVD) is a leading cause of premature death in Cuba. Although raised blood pressure (BP) is an established risk factor for CVD, there is limited evidence on the prevalence and management of hypertension in Cuba. Purpose: To describe the prevalence, awareness, treatment and control of hypertension, and assess the CVD mortality attributable to hypertension in Cuba. Methods: In this prospective study (Cuba Prospective Study), 150 000 adults aged 30 years and over were recruited from the general population in five areas (urban and rural) of Cuba between 1996-2002. BP was measured at recruitment and participants were followed up for certified causes of death to 1.1.2015. Hypertension was defined as systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or self-reported history of hypertension. We calculated the prevalence of hypertension at recruitment and the proportion of hypertensives that were diagnosed, treated and controlled (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), overall and in various population subgroups. Cox regression analysis was used to calculate age-specific rate ratios for deaths due to CVD comparing participants with and without uncontrolled hypertension, which were used to estimate the number of CVD deaths attributable to hypertension. Results: Mean age at recruitment was 52 years and 56% were women. Overall, about onethird of participants were hypertensive (38%). Of those with hypertension, about two-thirds were diagnosed (70%); of those diagnosed, about two-thirds were treated (64%); and, of those treated, about one-third had controlled BP (36%). The overall control rate among all hypertensives was 16%. Uncontrolled hypertension was associated with relative risks of CVD mortality of 2.14 (95% CI 1.85-2.47), 1.83 (1.66-2.04) and 1.39 (1.29-1.51) at ages 35-59, 60-69 and 70-79 years, respectively. Uncontrolled hypertension accounted for about 3000 CVD deaths at ages 35-79 years in Cuba in 2013. Conclusion: About one-third of Cuban adults in this large study had hypertension. Levels of diagnosis and treatment were commensurate to some high-income countries, but levels of BP control were low. Our findings suggest that, in addition to public health measures to reduce the prevalence of hypertension, greater BP control among treated hypertensives is required (especially among adults at high absolute risk, such as those with prior vascular disease).

No abstract

No abstract