Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control

Abstract

The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD.

Public hospital management in times of crisis: Lessons learned from Cienfuegos, Cuba (1996–2008)

“…Case fatality rate for coronary hearth disease declined by 40-50% between 1990 and 2003. While over the same period admission rates for stroke doubled in Cienfuegos hospital, case fatality rates fell with 48% [25,32,33]. These results might suggest that less severe cases were admitted, explaining at least part of the mortality reduction.…”

“…Like in most countries, also in Cuba cardiovascular disease is a peaking cause of death [25]. In Cienfuegos province, the number of hospital admissions for AMI doubled over the period 1990-2003.…”

“…Following the lessons learnt from the approach to AMI, in 2001 a comparable approach was also implemented for stroke, the third cause of death in Cuba [25]. The 'fast track' approach for stroke can be summarized into 10 components all starting with the word "early": awareness of the warning signs, medical contact, life support, referral, treatment in the emergency department, brain imaging, admission to the stroke unit, rehabilitation, education for patients and carers, and secondary prevention.…”

Which factors confound or modify the relationship between body weight and mortality?

“…Consequently, weight loss of 15 pounds was observed, which was consistent across the population. [16][17][18] As shown in Figure 4, the BMI of the population in 1995 (at the height of the special period), was shifted uniformly downward across the entire distribution compared to 1991 (during the special period); by 2000, after the economy had recovered, the curve had shifted back to the right. Mortality attributable to diabetes dropped precipitously during the latter half of the special period, although it had been trending upward in the 1980s ( Figure 5).…”

“…Declines were also seen in the death rates from coronary heart disease and stroke and all causes. 16 This period of privation also had negative health consequences, with a small upward rise in infant mortality, presumably because some pregnant women were receiving suboptimal nutrition. 15 An increase in mortality was also observed in people over 65 years of age, as a result of excess deaths due to infectious diseases and recrudescence of latent tuberculosis; no change was seen in cancer mortality.…”