Factores Socioeconomicos y riesgo cardiovascular
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Transcript of Factores Socioeconomicos y riesgo cardiovascular
Novartis Aztra Zeneca
Sanofi AventisSchering Plough
AsofarmaPfizer
Merck SeronoMerck Sharp Dohme
BayerAbbottServierRoche
MenariniTakedaFerrer
DISCLOSUREAdvisory Board Research
Economic Growth, Income, Employment and
Cardiovascular Disease
Dr. Fernando Stuardo Wyss Quintana Md, Phd, GCSM, ESHM, ESCM
Vice-president of Interamerican Society of Cardiology Guatemala City, Guatemala, C.A.
Globalization / Urbanization and the Epidemiologic Transition
Our final Conclusion be that from the point of view of Cardiovascular Disease
powerfuls, arrogants and impotents
Vital Basic Basket and Minimum Wage
The National Survey of Living Conditions ENCOVI 2006
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI
VITAL BASIC BASKET
FOOD
AGRICULTURE WAGE NOT AGRICULTURE WAGE
Vital Basic Basket and Minimum Wage
The National Survey of Living Conditions ENCOVI 2006
Wyss; Source: Based on data: Guatemala 2011 government salary
- Agriculture / not Agriculture Q. 2,187.54 per month $ 276.90
- Export and manufacture Q. 2,058.27 per month $ 260.24
- Cardiologist in GH Q. 4,000.00 per month $ 506.32
In accordance with Government Agreement No. 388-2010 published in the Journal of Central America, December 30, 2010, establishes the new minimum wage that
governed from January 1, 2011.
All Poor Extremely Poor Poor Not Poor0
10
20
30
40
50
60
70
80
51
15
36
49
75
27
48
25
36
8
29
64
All PopulationIndigenousNon-Indigenous
N = 12,987,829
Guatemala: Poverty nationwide distribution of poverty by ethnic identity National Survey of Living Conditions 2006 ENCOVI absolute
and relative numbers
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI
%
The National Survey of Living Conditions ENCOVI 2006
Guatemala: Poverty Incidence by Region
Wyss; Source: Based on data from the National Survey of Living Conditions ENCOVI 2006.
All Poor´ 51%Extremely poor 15%Poor 36% Not Poor 49%
The National Survey of Living Conditions ENCOVI 2006
The National Survey of Living Conditions ENCOVI 2006
Incidence of Poverty in each Department
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI
Poor Not Poor
11%1%
Guatemala: Social Spending on Education, Health and Housing% Of GDP (Gross Domestic Product), 2001 -2007.
The National Survey of Living Conditions ENCOVI 2006
Education Health Housing
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI
1.7574 %
Guatemala: Social Spending on Health % Of GDP
(Gross Domestic Product), 2001 -2007.
13
3
36
6
% GDP 2001 - 2007
GuatemalaEl SalvadorHondurasNicaraguaCosta RicaPanama
The National Survey of Living Conditions ENCOVI 2006
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI
Cardiovascular Risk Assessment in Guatemala
• General population
• Bedroom City´s
• Chronically ill population
• High-income population
Data in Pediatric Populations
OBESITY IN ELEMENTARY SCHOOL EDUCATION, UNIVERSITY OF SAN
CARLOS DE GUATEMALA
67%
Dr. Luis Moya MD, PhD; Verbal Information
Cardiometabolic Risk Factors Guatemalan Heart League
N = 111,201
Dr. Wyss, Data Base; Guatemalan Heart League
HypertensionDiabetes MellitusDyslipidemia
HypertensionDiabetes Mellitus
Dyslipidemia
0
5
10
15
20
25
30
35
25
43
35
8
6
34
8
6
200120072008
Cardiometabolic Risk Factors Guatemalan Heart League
Dr. Wyss, Data Base; Guatemalan Heart League
%
N = 111,201
Commuter Town StudyThe Villa Nueva Study, OPS, OMS CDC
OPS, OMS, Villa Nueva Study Paper
OverweigthAbnormal glucouse Hypertension Obesity Abdominal Circunference
Prevalence of Metabolic Syndrome Hypertension Unit, St. Jhon of God General Hospital
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital
Hypertension Obesity
• 398 patients• Routine Cardiovascular Screening• High income• Lifestyle modification• Fitness cardiovascular activity• Play Golf• Balanced diet• They drink wine
Global Cardiovascular Risk Assessment in an apparently healthy population EVRICARDS
Fernando Wyss; in press, 2010
LIPID PROFILE
BLOOD PRESURE
Economic Growth, Income, Employment and
Cardiovascular Disease ??We have a social difference in the appearance of
cardiovascular disease ?
Stroke. 2012; 43 /doi: 10.1161/ STROKEAHA.111.632158
This study demonstrated an association between low GDP of a country:
1. A 32% increase stroke risk
2. An increase in the rate of death at 30 days post-stroke by 43%
3. An excess of 43% in intracerebral hemorrhage
4. An increase of almost double the incidence of stroke in young individuals.
Gross Domestic Product and Health Expenditure Associated With Incidence, 30-Day Fatality, and Age at Stroke Onset, A Systematic ReviewLuciano A. Sposato, MD, MBA; Gustavo Saposnik, MD, MSc, FAHA
Also, a low total health expenditure was correlated with a proportional increase in the rate of death at 30 days and:
1. A 26% increase stroke risk
2. An increase of 45% death rate at 30 days post-stroke
3. An excess of 32% in intracerebral hemorrhage
4. A 36% increase in the incidence of stroke in young individuals.
Gross Domestic Product and Health Expenditure Associated With Incidence, 30-Day Fatality, and Age at Stroke Onset, A Systematic ReviewLuciano A. Sposato, MD, MBA; Gustavo Saposnik, MD, MSc, FAHA
Stroke. 2012; 43 /doi: 10.1161/ STROKEAHA.111.632158
Intervention ModelHigh Income and compare the Relative Risk Reduction of Low-Income
POOR male NOT POOR male
POOR female NOT POOR female
74 80 65 66
161 169 151 157
29 28 29 26
BMIHEIGHT cmWEIGTH kg
Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations
N = 1403
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital
100
90
80
70
60
50
40
30
20
10
0
Obesity
RRR 4% RRR 11%
POOR
NOT POOR
94
96
94
90
MALEFEMALE
0 20 40 60 80 100
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital
N = 1403
Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations
Abdominal Circunference
RRR 5%
TOTAL CHOLESTEROL HDL
TRIGLICERIDESLDL
0
10
20
30
40
50
60
70
48
65 70
5544 4858
51
POORNOT POOR
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital
N = 1403
%
Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations
LIPID PROFILE´S
RRR 9% 27% 18% 32%
Diabetes MellitusInsulin Resistence
0
5
10
15
20
25
30
35
21 24
7
34
POORNOT POOR
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital
Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations
Insulin Resistence and Diabetes Mellitus
RRR 67%
(Glucosa > 100 / < 126 mg7dl )
Prevalence of Hypertension in the Central American and the Caribbean
Wyss et al, CLCC, from Central America and Caribbean Board, march 2008
Prevalence of Dyslipidemia in the Central American and the Caribbean
Wyss et al, CLCC, from Central America and Caribbean Board, march 2008
Wyss et al, CLCC, from Central America and Caribbean Board, march 2008
Prevalence of Diabetes in the Central Americanand the Caribbean
Wyss et al, CLCC, from Central America and Caribbean Board, march 2008
Prevalence of obesity in the Central Americanand the Caribbean
CONCLUSIONS
National Statistics Institute INE - Guatemala, 2006
Rich People Middle Class Poor People
1. Overweight2. Prehypertension3. Mild dyslipidemia4. Smoking
1. Overweight / Obesity2. Hypertension I - II3. Mixed Dyslipidemia4. Smoking5. IR / Diabetes
1. Obesity2. Hypertension II - I3. Mixed Dyslipidemia4. Diabetes / IR
CENTRAL AMERICA AND CARIBBEANIn some countries of the Region, out-of-pocket expenditures account for up
to 78% of spending on medicines, and this can be catastrophic for low-income families and populations.
1. Money makes the difference in CVD and MACCE
2. The provision of human resources and training materials in adequate number if necessary
3. Access to primary prevention for POOR PEOPLE
4. Improved accessibility and availability of medicines
5. The impact of social, demographic, epidemiological and technological advances in CVD requires reorienting periodically plans of study, undergraduate and graduate, in each country to adapt to their training needs.
Pan American Health Organization.“Regional Consultation: Priorities for Cardiovascular Health in the Americas. Key Messages for Policymakers”
Washington, D.C.: PAHO, © 2011-
Cost-Effectiveness of Community-Based Strategies for Blood Pressure Control in a Low-Income Developing Country: Findings From a Cluster-Randomized, Factorial-Controlled Trial
1. Combined Home Health Education (HHE) plus Trained General Practitioner (GP)
2. HHE only3. Trained GP only
The combined intervention of HHE plus trained GP is potentially affordable and more cost-effective for BP control than usual care or either strategy alone in some communities in Pakistan, and possibly other countries in Indochina with similar healthcare infrastructure.
Circulation. 2011;124:1615-1625
Globalization / Urbanization and the Epidemiologic Transition
Pan American Health Organization.“Regional Consultation: Priorities for Cardiovascular Health in the Americas. Key Messages for Policymakers”
Washington, D.C.: PAHO, © 2011-
We have a social difference in the appearance of
Cardiovascular Disease ?
Economic Growth
Income
Employment
MAKES A DIFFERENCE
YES !!!