Current Status and Future Strategies for Cardiovascular Disease in Argentina
2019; Lippincott Williams & Wilkins; Volume: 140; Issue: 14 Linguagem: Inglês
10.1161/circulationaha.119.038898
ISSN1524-4539
Autores Tópico(s)Public Health and Social Inequalities
ResumoHomeCirculationVol. 140, No. 14Current Status and Future Strategies for Cardiovascular Disease in Argentina Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBCurrent Status and Future Strategies for Cardiovascular Disease in Argentina Rafael Diaz, MD and Carlos Tajer, MD Rafael DiazRafael Diaz Rafael Diaz, MD, Estudios Clínicos Latinoamérica, Paraguay 160, 2000, Rosario, Argentina. Email E-mail Address: [email protected] Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.). Instituto Cardiovascular de Rosario, Argentina (R.D.). and Carlos TajerCarlos Tajer Hospital El Cruce, Provincia de Buenos Aires, Argentina (C.T.). Originally published30 Sep 2019https://doi.org/10.1161/CIRCULATIONAHA.119.038898Circulation. 2019;140:1137–1139Cardiovascular disease (CVD) is the leading cause of death and disability in Argentina. Approximately 30% of all deaths in the country are caused by CVD, and ischemic heart disease is the cardiovascular condition with the highest rates of morbidity and mortality. Deaths resulting from CVD have decreased gradually in recent decades. A 2014 publication by the Pan American Health Organization/World Health Organization1 reported a steady decrease in the age-standardized premature death rate and suggested that the World Heart Federation "25 by 25" target to reduce premature deaths from CVD will be reached. However, this favorable trend has flattened recently (Figure),2 challenging the expected 25% by year 2025 reduction. Cardiovascular mortality in individuals 50 to 69 years of age was identical from 2014 to 2017: 436 deaths for every 100 000 people.Download figureDownload PowerPointFigure. Evolution of cardiovascular mortality between 1990 and 2017. Developed with freely available data from the Global Burden of Disease.2The rate of cardiovascular mortality varies throughout Argentina and is higher in people in the lower socioeconomic quintiles.3 The standardized cardiovascular mortality rate in 2011 was 10.09 overall, decreasing to 9.39 in the highest quintile and increasing to 12.54 in the lowest quintile. Approximately one-third of the population receives free public health services, and two-thirds are covered by private or institutional insurance healthcare providers. There are ≈5800 cardiologists in the country, a rate of 140 per 1 million inhabitants for a population of 44 million, one of the highest internationally. Cardiologists are trained through a nationwide network of public and private residences.Overall, the prevalence of cardiovascular risk factors is rising in Argentina. Comparing 2005 with 2013 shows that overweight has increased from 34.4% to 37.1%, obesity from 14.6% to 20.8%, and diabetes mellitus from 8.4% to 9.8%. The prevalence of hypertension has remained stable over this period (34.5% versus 34.1%), whereas smoking has decreased from 29.7% to 25.1%.4The high prevalence and poor control of risk factors, the absence of a unique countrywide sustainable program to tackle CVD, and, in low socioeconomic groups, inadequate access to treatments offer a framework for the development of more efficient health policies to reduce cardiovascular deaths and disabilities. Although the health authorities have implemented free provision of generic medications for the prevention of CVD through "Plan Remediar," its success has been far from optimal as a result of budgetary restrictions.Individual efforts and well-designed prospective cohort studies such as PURE (Prospective Urban Rural Epidemiology)5 initiated in the past 10 years have provided reliable data to leverage public and private sector initiatives in an effort to decrease cardiovascular morbidity and mortality. Hypertension is a major cause of death and disability. Given its high prevalence, its ease of detection, and the availability of simple and inexpensive treatments, efficient systems for the management of hypertension are a public health priority. Data from the PURE study5 showed that approximately half of unselected people in Argentina between 35 and 70 years of age have hypertension. The rate of awareness (of a medical diagnosis of hypertension) is low, at 50% to 60%. The overall treatment rate is only 52% but increases to 91% among people who are aware of their diagnosis. Of note, the control rate among hypertensive patients is extremely low (16.6%), as well as among those who are on treatment (32%). The figures are worse in rural compared with urban communities. Most treated patients (69.7%) receive only 1 drug. Several conclusions can be drawn from these observations. First is the high prevalence of hypertension, with approximately half of the adult population having the condition. Second, the low rate of awareness and the absence of improvement over the past 20 years highlight the lack of an efficient systematic population approach for the detection of hypertension. Because most of the patients who are aware of their diagnosis were receiving medications, increasing the rate of awareness would immediately translate into a higher rate of treated patients and, most likely, better rates of hypertension control. A simple approach would be the mandatory assessment of blood pressure during governmental procedures. One such example, from the Rosario District, is the proposed law to assess blood pressure during the routine medical examination required to obtain a driving license and is expected to be approved later this year.A simple program for the detection and treatment of hypertension was set up by ECLA Foundation in Rosario in 2014; kiosks to measure blood pressure (stands) were established in popular locations throughout the city. Approximately 7500 subjects were screened, and 1200 agreed to receive free treatment provided by medical students and nurses under the direction of cardiologists, comprising risk factor counseling and generic medications. At 3 years, the rate of blood pressure control was high (82%), and patients were receiving 2.5 antihypertension drugs on average (unpublished data, 2018). This type of initiative serves as an example of a simple and inexpensive population measure that can be easily and widely implemented.The incidence of ST-segment elevation myocardial infarction is estimated at 30 000 to 40 000 cases per year. In surveys, the rate of reperfusion is ≈85% (two-thirds with primary percutaneous coronary intervention and one-third with streptokinase).6 However, according to the recorded rates of use of streptokinase and primary percutaneous coronary intervention, the actual rate of reperfusion is likely to be lower in practice. An international plan to provide support for the treatment of heart attacks through coronary care units is about to start. The World Heart Federation 25 by 25 campaign to reduce premature mortality from CVD by 25% by the year 2025 will require appropriate and reasonable coordination among the different sectors involved to cover our country. Despite an adequate availability of technical resources and adequate number of well-trained professionals, comprehensive, centrally developed programs involving public and private sectors are required to control risk factors for CVD.DisclosuresNone.Footnoteshttps://www.ahajournals.org/journal/circRafael Diaz, MD, Estudios Clínicos Latinoamérica, Paraguay 160, 2000, Rosario, Argentina. Email[email protected]orgReferences1. Pan American Health Organization and World Health Organization. Argentina: cardiovascular diseases profile.https://www.paho.org/hq/dmdocuments/2014/ARGENTINA-CVD-PROFILE-2014.pdf. Accessed March 25, 2019.Google Scholar2. GHDx. GBD results tool.http://ghdx.healthdata.org/gbd-results-tool. Accessed March 25, 2019.Google Scholar3. Macchia A, Mariani J, Ferrante D, Nul D, Grancelli H, Doval H. Premature cardiovascular death and socioeconomic status in Argentina: on the opportunities and challenges of representing vulnerable populations.Rev Argent Cardiol. 2015; 83:506–511.Google Scholar4. Galante M, Konfino J, Ondarsuhu D, Goldberg L, O'Donnell V, Begue C, Gaudio M, King A, Sciarretta V, Laspiur S, Ferrante D. Main results of the Third National Non-Communicable Disease Risk Factor Survey in Argentina.Rev Argent Salud Pública. 2015; 6:22–29.Google Scholar5. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, Kazmi K, Lanas F, Wei L, Lopez-Jaramillo P, Fanghong L, Ismail NH, Puoane T, Rosengren A, Szuba A, Temizhan A, Wielgosz A, Yusuf R, Yusufali A, McKee M, Liu L, Mony P, Yusuf S; PURE (Prospective Urban Rural Epidemiology) Study Investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries.JAMA. 2013; 310:959–968. doi: 10.1001/jama.2013.184182CrossrefMedlineGoogle Scholar6. Gagliardi J, Charask A; Perna E, D'Imperio H, Bono J, Castillo Costa Y, Cerezo G; Tajer C. National Survey of ST-Segment Elevation Acute Myocardial Infarction in Argentina (ARGEN-IAM-ST).Rev Argent Cardiol. 2016; 84:548–557. doi: 10.7775/rac.v84.i6.9508CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yao S, Zheng P, Liang Y, Wan Y, Sun N, Luo Y, Yang J and Wang H (2020) Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease, BMC Geriatrics, 10.1186/s12877-020-01606-8, 20:1, Online publication date: 1-Dec-2020. October 1, 2019Vol 140, Issue 14 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.038898PMID: 31567016 Originally publishedSeptember 30, 2019 KeywordsArgentinacardiovascular diseasesPDF download Advertisement SubjectsCardiovascular DiseaseEpidemiology
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