Regional Workshop on Non-Communicable Diseases, Rio de Janeiro, May 3-5, 2012.

Transcription

1 Regional Workshop on Non-Communicable Diseases, Rio de Janeiro, May 3-5, Academia Brasileira de Ciências and Academia Nacional de Medicina of Brazil, InterAcademy Medical Panel (IAMP), Global Network of Science Academies (IAP), Interamerican Network of Academies of Sciences (IANAS), and Latin American Association of Academies of Medicine (ALANAM). Prevention and Control of Cardiovascular Disease Prof. Dr. José E. Fernández-Britto Rodríguez, Ph.D., Dr.Sc. Center for Investigations and Reference of Atherosclerosis of Havana, University of Medical Sciences of Havana, Cuba U M S H

2 1. Some features related with the Cuban Health System 2. Statistical results of the three survey of Risk Factors on Cardiovascular (Atherosclerosis) Diseases 3. Results of a whole population research in the Island of Youth of Cuba (one municipality) CVD and C. Kidney D. 4. Some results of research from CIRAH 5. A challenger to study CVD (atherosclerosis), its risk factors and derived diseases.

3 Evolution of measures taken by the Cuban Ministry of Public Health for prevention and control of Non-Communicable Diseases (NCD) The Cuban government launches a campaign for the surveillance of Risk Factors (RF) of NCD Objectives, Purposes and Guidelines of Cuban health care are established giving priority to NCD, their RF and surveillance , 1 st. National and Provincial Survey of Risks Factors took place 1996, MINSAP implements and organizes Program for Prevention and Control of NCD 2000, Governmental Order 3790 on Health and Quality of Life in Cuba.

4 Evolution of measures taken by the Cuban Ministry of Public Health for prevention and control of Non-Communicable Diseases (NCD) , Completion of 2nd National Survey of Risk Factors and NCD which contributes to improve strategies 2006, Design of Projections for Cuban Public Health for 2015, with goals and fundamental objectives based on the National Surveys of RF. 2010, Completion of 3rd National Survey of Risk Factors, 2011, National Surveillance System for NCD is set up.

5 Health situation in Cuba according to 2011 indicators Universal coverage through family doctor-and-nurse program, benefitting all citizens Cuban population- 11, 230, 000 inhabitants Administratively, divided into 15 provinces and one special municipality Living in urban areas- 75% 60 years old or above- 17,6% Life expectancy at birth- 77, 97 years Survival of females years

6 Health situation in Cuba according to 2011 indicators Levels of human reproduction- low Births decrease by 1990 as compared to 2009 Birth rate - 11 births per 1000 inhabitants General fertility rate births/1000 women (reproductive age) Average offspring per woman Women in the health workforce- 69.5%. Doctors (1 per 147 inhabitants) Dentists (1 per 925 inhabitants)

7 General mortality gross rate 8.1/1000 inhabitants (2010) The first five causes of death are: Total deaths 2010 = 72% Heart-related diseases, Malignant tumors, Cerebro-vascular diseases, Influenza and pneumonia, and Accidents. Ischemic disease >5% Hypertensive disease >14% Cerebro-vascular disease >4% 80% heart related deaths

8 The largest increases in mortality rates are: 1 st. Heart related diseases 2 nd. Malignant tumors but The largest increases in rates of potential years of life lost are 1 st. Malignant tumors 2 nd. Heart related diseases

9 1. Some features related with the Cuban System of Health 2. Statistical results of the three survey of Risk Factors on Cardiovascular (Atherosclerosis) Diseases 3. Result of a whole population research in a Cuban Island of Youth (one municipality) CVD and C. Kidney D. 4. Some results of research from CIRAH 5. A challenger to study CVD (atherosclerosis), its risk factors and consequent diseases.

10 2010, 3rd National Survey of Risk Factors, This is a national transversal study, with results which are representative for the country, urban and rural areas, gender and age groups. (National Statistics Office). The sample design for home surveys was taken by the National Statistics Office (ONE). A sample for three-stage conglomerates was used adding 4150 homes and interviewing there all persons 15 years old or older. A total of 7914 people were eventually interviewed, representing 98% of the total planned. The information was gathered using the survey proposed by WHO/PAHO for surveillance of Risk Factors in Non Communicable Diseases (STEPs)

11 Smoking prevalence in Cuba Prevalence % % % & IC 95 % Global Male Female

12 Prevalence of physical activities, according to place it is practiced. Cuba Actives Non Actives No. & % IC 95% No. & % IC 95% Physical Activities Global 59,5 40,4 Work ,6 76,3 Movement , ,2 Free time ,7

13 Prevalence of hypertension according to Knowledge of diagnosis. Cuba, Prevalence total 30.6% 33.5% 30.9% Knowing 18.6% 22.0% = 22.4% News 12.0% 11.5% 8.5% Non hypertensive 69.4% 66.5% 69.1%

14 Without risk Increased risk Very high risk Prevalence of risk of central adiposity with waist circumference in total population and in both genders. Cuba Population Total Male Female N % N % N %

15 GENERAL PREVALENCE OF GLYCEMIA BY SEX, GEOGRAPHIC AREAS IN DIABETICS AND TREATMENT. CUBA, Both areas Urban Rural (N = ) (N = ) (N = ) % % % Glycemia N IC 95% N IC 95% N IC 95% Diabetes Prevalence ( ) ( ) ( ) Male ( ) ( ) ( ) Female ( ) ( ) ( ) White ( ) ( ) ( ) Mixed ( ) ( ) ( ) Black ( ) ( ) ( ) Medication Yes ( ) ( ) ( ) Medication No ( ) ( ) ( )

16 Quality of life in relation with health in the Cuban population. Frequency of persons who did not refer any problem by gender. Cuba, Frequency of persons who did not refer any problem by gender. Cuba, MOV CUID PERS ACT COT D/M A/D M ASCULINO FEM ENINO 60 movility, personal care, daily activities, pain &disturbance anxiety & depression MOV CUID PERS ACT COT D/M A/D MASCULINO FEMENINO

17 1. Some features related with the Cuban System of Health 2. Statistical results of the three survey of Risk Factors on Cardiovascular (Atherosclerosis) Diseases 3. Result of a whole populaton research in a Cuban Island of Youth (one municipality) CVD and C. Kidney D. 4. Some results of researh from CIRAH 5. A challenger to study CVD (atherosclerosis), its risk factors and consequent diseases.

18 The Cuban Health System s Strategies From Chronic Diseases and Chronic Kidney Disease The Isle of Youth Community Based Epidemiological Study (CKD-YSYS) Cuba Special Municipality of Cuba Same health system and indicators of the country Similar geographic and demographic characteristics as other Caribbean islands Area: 2419 km² Population: 86,614 ISYS Phase 1: Screening for CKD (total population)

19 Screening Results: Positive Cohort Population (Census: 2002) (100%) Resident population (92.5%) Families screened < 20 years Persons screened (96.7%) 20 years Negative (82.2%) Population with positive markers for renal damage Positive (17.8%)

20 Positive urine markers in total population. Positive cohort for renal damage markers: 17.8% Proteinuria Hematuria Hematuria + Proteinuria Microalbuminuria Markers 0.7

21 Percentage distribution of positive markers & Odds Ratio for each risk factor in the population 20 years *2.86 *Odds Ratio *3.03 *2.85 *3.01 *3.22 *2.37 *1.53 *1.07 *1.42 *1.31 *1.39 > < 60 years F M Sex B W Skin color Yes No Yes No Diabetes HBP mellitus Yes No CVD Yes No CeVD Yes No Under weight Yes No Over weight Yes No Yes No Obesity Smoking

22 Distribution of renal marker damage in the population 20 years according to age and sex. % Male Age groups Negative markers Marcadores Negativos Positive markers Marcadores Positivos % Female Negative markers Marcadores Negativos Positive markers Marcadores Positivos Age groups

23 1. Some features related with the Cuban System of Health 2. Statistical results of the three survey of Risk Factors on Cardiovascular (Atherosclerosis) Diseases 3. Result of a whole populaton research in a Cuban Island of Youth (one municipality) CVD and C. Kidney D. 4. Some results of research from CIRAH 5. A challenger to study CVD (atherosclerosis), its risk factors and consequent diseases.

24 Center for Investigations and Reference of Atherosclerosis of Havana. CIRAH PBDAY (WHO-ISFC) U C M H Havana- Cuba University of Medical Sciences of Havana

25 CIRAH The Center of researcher education in the field of Atherosclerosis. Is a postgraduate degree course organized in 3 levels, Diplomat (1 year)-master (1 year)-doctorate (2 years). Ten years of experiences, with the official specialization (PhD) and one collaborative curriculum program. At present 325 health professionals are participating from 18 different specialties, 153 master graduated and 7 PhD.

26 CIRAH The main research themas Atherosclerosis in the course of life The atherosclerotic lesions. Pathomorphology and morphometry Señal Aterosclerótica Temprana - (Early Atherosclerotic Signal) Risk Factors of Atherosclerosis Atherosclerosis derived diseases Climateric and Menopause Contextual factors in developing of atherosclerosis

27 Autopsy material (> 5000, all ages and both sex) Applying Atherometric System (WHO-1990) Pathomorphological and Morphometric System Atherosclerosis Risk Factors Hypertension Diabetes type 2 Smoking Obesity Overweight Arteries studied (26) Circle of Willis (7) Carotid arteries (4) Coronary arteries (3) Aorta Thor.-Abd.(2) Renal arteries (2) Iliaca arteries (4) Femoral arteries (4) Organs studied (4) Heart - Brain Kidney - Liver Atherosclerosis Derived Diseases Ischemic Cardiopathy Stroke Chronic Renal Disease Peripheral Arterial Dis.

28 Atherosclerosis Early Signal (SAT) Obesity Overweight Prehypertension Hypertension Smoking Active Smoking Pasive Hyperglucemia Diabetes Sedentarism Stress Waist circumf. Hip circumf. Familiar Pathological Antecedents Adolescent "SAT" Study 1rst Study (4 years) Cuba Havana Cuba Havana Chile Concepcion 752 Brasil Itapetininga 500 Panama Panama 1215 Mexico Verac.-Puebla 1234 Total 6168 Atherosclerotic Early Signal Señal Aterogénica Temprana (SAT) With 4 SAT 251 5,17% With 3 SAT 290 5,65% With 2 SAT ,7% With 1 SAT ,6%

29 Atherosclerosis Early Signal SAT 2nd Study (4 years) G. of age n % , , ,0 total Arterial Ten. n % Normal ,6 Prehyperten Hyperten ,1 Total % Arterial Tension. Classification. Normal Weight With Overweight Total Normal 2624(82,7%) 803(67,6%) 3427(78,6) Prehypertension 388(12,2%) 235(19,8%) 623(14,3) Hypertension 162(5,1%) 149(12,6%) 311(12,6) Total 3174(100) 1187(100) 4361(100)

30 1. Some features related with the Cuban System of Health 2. Statistical results of the three survey of Risk Factors on Cardiovascular (Atherosclerosis) Diseases 3. Result of a whole populaton research in a Cuban Island of Youth (one municipality) CVD and C. Kidney D. 4. Some results of researh from CIRAH 5. A challenger to study CVD (atherosclerosis), its risk factors and consequent diseases.

31 A Challenger

32 Chronic Non-Communicable Diseases Cardiovascular diseases=atherosclerosis Intelligent Epidemiological Observatory The classic approach to this health care problem has been basically reactive and not preventive Relative success in Cuba and the world have been due to secondary prevention based on control of risk factors Nevertheless, actions have been focused on risks inherent to the subjec (behavior-habits-lifestyles) and not structural factors which generate risks (causes of causes)

33 Contemporary approach to social epidemiology 1. Social determinants and - 2. The course of a lifetime. A research and action model of an epidemiological observation and intelligence device which allows us to learn of the temporal tendencies of this illnesses, and their risk factor and markers Create the basis on which to develop programs and interventions to reduce the load of illnesses which are a consequence of atherosclerosis and its aggregation factors. 1. Geographical, 2. Socio-economic, 3. Socio-demographic and 4. Socio-cultural.

34 Lalonde proposal was based on the analysis of the main causes of mortality and morbidity and their main proximal determinants identified in longitudinal mega-studies such as Framingham s. Factors considered as self-imposed, as if the subjects chose their lifestyles with total autonomy and independence from the coercion of external circumstances..but the sources of risk, deeply embedded in society and on determinants of risk behaviors, remained intact.

35 Clinical approach vs. epidemiological or health approach Geoffrey Rose noted that this approach disregarded the conditions which determine the incidence and the shape of the population distribution of risks, suggesting the population approach. (G.Rose) observed that the causes for individual cases are not the same as the causes of incidence, and that the majority of cases in a population are recruited from subjects with average risk levels.

36 Clinical approach vs. epidemiological or health approach The idea of vulnerable populations approach comes up, and the beginning of the understanding of contextual riskgenerating factors. Alternatively, we could use the term risk of being at risk. Identifying these factors, their aggregation patterns and temporary tendencies, generating new knowledge and serving as a basis for the design of effective interventions, define the central problem that this project tackles.

37 WHAT we need? A surveillance system of risk factors and markers of atherosclerosis which includes not only biological factors (individual level) but also contextual factors (family, communities, workplace, schools) and latent dimensions of social stratification. An instrument of epidemiologic intelligence intended to provide the basis for the design and implementation of plans and programs.

38 UNDER WHAT PRINCIPLES? Social determinants Developmental origins of health and disease and life course Epidemiology. Transgenerational transmission of risk and vulnerability.

39 WHAT FOR? To reach full coverage of the burden of diseases related to atherosclerosis in terms of prevalence and incidence. To know time trends, geographical patterns, familiar and sociodemographic aggregation patterns of atherosclerosis related diseases and risk factors or risk markers. To provide objective and practical bases for decision making.

40 ULTIMATE GOAL To design effective and efficient interventions to reduce mortality and morbidity due to atherosclesosis-related diseases.

41 Thanks very much for your kind attention