Regional Updates on CVD Trends and Actions: Latin America and the Caribbean

Transcription

1 Regional Updates on CVD Trends and Actions: Latin America and the Caribbean Beatriz Marcet Champagne, PhD Public Information-Gathering Session, Wash., DC, April 14, 2009 Institute of Medicine of the National Academies

2 1. KEY MESSAGES 1.The magnitude of CVD in Latin America and the Caribbean is significant, with a large burden and cost to the region 2.The greatest and most sustainable impact has come from policy, structural, systemic and environmental interventions (e.g., smokefree environments, tobacco tax, banning trans fats, salt reduction)

3 TRENDS

4 Population: mill. Rapid urbanization: 41% in 1950 to 75% in 2000

5 Country Income classification Low income Haiti Not classified Countries Countries excluded excluded from from the the analysis analysis Anguilla French Guiana Guadeloupe Martinique Montserrat Saint Pierre and Miquelon Turks and Caicos Islands Virgin Islands (UK) Lower-middle Bolivia Bolivia Colombia Dominican Republic Ecuador El El Salvador GUATEMALA Guatemala GUYANA Guyana NICARAGUA Nicaragua PARAGUAY Paraguay PERU Peru Upper-middle High Argentina Antigua & Barbuda Belize Aruba Brazil Bahamas Chile Barbados Costa Rica Bermuda Cuba Canada Dominica Cayman Islands Grenada Netherlands Antilles Jamaica Puerto Rico Mexico Trinidad & Tobago Panama United States St. Kitts and Nevis Virgin Islands (US) St. Lucia St. Vincent & Grenadines Suriname Uruguay Venezuela World Bank, 2007

6 Burden of Disease Distribution w b_in c o m e (g ro up ) / ag eg roup 60% 50% Lo w, Lo w er-m id d le U p p er-m id d le H ig h Higher proportion of deaths in early age groups in Lower Income countries 40% 30% 20% 10% 0% < 1 year 1-4 years 5-9 years yea yea yea.. 70 and over < 1 year 1-4 years 5-9 years yea yea yea.. 70 and over < 1 year 1-4 years 5-9 years yea yea yea.. 70 and over Proportion of deaths cau se (g ro u p ) Sig n s y m p to m s ill-d efined C h ro n ic n o n -c o m m un ic able d iseases Source: Mortality reported by Member State and registered in PAHO Mortality Database, 2008 C o m m un ic able, m atern al, p erin atal, n utritio n al d is eas es Ex tern al c aus es

7 Trends in Coronary Heart Disease Source: Rodriguez et al: Trends in Mortality from coronary heart and cerebrovascular diseases in Americas: Heart:2006;92:

8 Stroke Mortality Rates, 2000 Source: Rodriguez et al: Trends in Mortality from coronary heart and cerebrovascular diseases in Americas: Heart:2006;92:

9 The CARMELA Study: Risk Factors for CVD in Seven Latin American Cities

10 CARMELA Study Director: Dr. Herman E. Schargrodsky Country City Institution National Coordinator Argentina Buenos Aires CEMIC Dr. Carlos Boissonnet Chile Santiago de Chile Católica University Dr. Ximena Berrios Colombia Bogota Javeriana University Dr. Alvaro Ruiz Ecuador Quito Metropolitano de Quito. H Dr. Francisco Benitez Mexico Mexico D.F Mexicano Institute of the Social Security Dr. Jorge Escobedo Peru Lima Cayetano Heredia University Dr. Raúl Gamboa Venezuela Barquisimeto ASCARDIO Dr. Ricardo Granero

11 Sampling Methods Cross-sectional study Probabilistic sampling of about 200 subjects by age-sex groups, aged 25 to 64 years (N=11,550) Multiple-stage stratified sampling by clusters Common basic design for each participating city Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-

12 Study Procedure Electoral Registers Cholesterol Triglycerides HDL - LDL Glycemia Carotid ecography Waist hip circumference BP HR Weight Height

13 60 CARMELA Study Smoking by sex 51,6 50,3 47, ,9 40,2 43,9 39, ,6 32,5 % 30 18,9 23,5 Men Women ,7 11, Barq Bogota Bs As Lima Mejico Quito Santiago Current smokers or have quit smoking in the last year. Standardized rates. Prevalence and 95% CI. Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-

14 Smoking prevalence among adults Comparable calculations adapted to the age group from years of age Tobacco consumption is defined as a current daily smoker Argentina Barbados Bolivia Brasil Canadá Chile Costa Rica Cuba Ecuador Estados Unidos Guatemala Jamaica México Perú Paraguay República Dominicana San Vicente y las Granadinas Santa Lucía Trinidad y Tobago Uruguay Venezuela Source (except Peru):WHO Infobase, Source Peru: CEDRO Note: For Honduras, there is no available data. Data only exists for the Prevalence of Drug Consumption among Students in the UNAH, 2004 (IHADFA). For Panama: there is no available data for the prevalence of tobacc consumption among adults.

15 Smoking Prevalence among Youth Comparable calculation adapted to the age group Definition of tobacco consumption is that of current daily smoker Uruguay Paraguay Chile Brasil Argentina Panamá Nicaragua Honduras Guatemala El Salvador Costa Rica Haití República Dominicana Cuba Trinidad y Tobago Suriname Santa Lucía Saint Kitts and Nevis Jamaica Guyana Granada Dominica Belice Barbados Bahamas Antigua y Barbuda Venezuela Perú Ecuador Colombia Bolivia EEUU Mexico Source: Global Youth Tobacco Survey (GYTS). PAHO/WHO and CDC. There is no information for Canada and St. Vincent and the Granadines.

16 40 CARMELA Study Arterial Hypertension % ,7 13,4 29,0 12,6 11,7 8,6 23,8 5 0 BARQ BOG BS AS LIMA MEX QUI SANT Systolic BP 140 mmhg or Diastolic BP 90 mmhg or taking medication for HBP Prevalence and 95% CI Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-6

17 30 CARMELA Study Hypercholesterolemia according to ATP III 25 20,7 % ,4 17,1 11, ,1 10 5,7 5 0 BARQ BOG BS AS LIMA MEX QUI SANT ypercholesterolemia: total cholesterol 240 mg/dl. tandardized rates. Prevalence and 95% CI. Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-

18 14 CARMELA Study Diabetes % ,4 8,4 5,9 4,5 9,6 6,2 7, BARQ BOG BS AS LIMA MEX QUI SANT ubjects with reported diabetes or glycemia 126 mg/dl. tandardized rates. Prevalence and 95% CI. Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-

19 Metabolic Syndrome according to ATP III Risk Factors ( 3)( Abdominal Obesity Triglycerides HDL-C Blood pressure Fasting Glucose * Men: > 102 cm; Women >88 cm Waist Circumference* 150 mg/dl <40 mg/dl hombres; <50 mg/dl mujeres 130/ 130/ 85 mm Hg 110 mg/dl Levels Expert Panel. JAMA 2001;285:

20 30 27,4 CARMELA Study Metabolic Syndrome according to ATP III 28 % ,7 16,3 18,7 15, BARQ BOG BS AS LIMA MEX QUI SANT Standardized rates. Prevalence and 95% CI. Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-

21 % CARMELA Study Obesity 31,4 26,7 25, ,5 19,4 17,5 BARQ BOG BS AS LIMA MEX QUI SANT MI 30 tandard rates. Prevalence and 95% CI. Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-

22 Source: PAHO

23 CARMELA Study Conclusions CARMELA permits the evaluation of different CV risk factors with a uniform and comparable methodology Prevalence of risk factors show significant differences among study cities High levels seen for all common risk factors in almost all subgroups Schargrodsky H., Hernández R., Marcet Champagne B., y col. Am. J. of Med. 2008; 121,58-6

24 ACTIONS

25 Some Initiatives Trans Fat Free Americas (PAHO) Physical Activity Network of the Americas (CDC & Agita Mundo) Ciclovías (Bogotá, PAHO) Dietary Salt Reduction Initiative (WHL) CARMEN (PHAC( PHAC, PAHO) Tobacco control/fctc implementation (IAHF, PAHO,, FCA)

26 Latin America and Caribbean: Tobacco Control Policies (FCTC). Tobacco taxation Brazil, Uruguay, México. Banning advertisement, sponsorship and promotion of tobacco products: Brazil (2000), Venezuela & Chile (2007), Panamá (2008), Uruguay (2008). Warning labels (pictorial) : Brazil, Uruguay, Venezuela, Chile, Panamá & Perú. Cessation services: Brazil & Uruguay offer free NRT

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28 Community Interventions For Health (CIH CIH) Mexico City Also India, China and UK Policy interventions in: diet, physical activity, tobacco, worksites, schools, community

29 Comprehensive approach Media

30 CARICOM Heads of Government Summit 15 September 2007 Declaration of Port of Spain - Uniting to Stop the Epidemic of Chronic Non-communicable Diseases Healthy Caribbean Civil Society Coalition Collaboration: Heart & Stroke Foundation of Barbados, PAHO and IAHF

31 Lessons learned Difficult to sell prevention of cardiovascular diseases and stroke in region Need to re-frame a more specific focus

32 Tobacco Objective: To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. (FCTC, Art. 3) ACTIONS: Implement FCTC (legal obligation for those that ratified) Taxation Warning Labels Smokefree environments Reducing smuggling Banning publicity, sponsorship and promotion

33 Obesity Objective: Reduce overweight and obesity ACTIONS: Economic and other incentives to sugar, fat and salt in diet and fruits and vegetables Community-wide consumer education Food labeling Ban trans fats Nutritional standards for food in all government facilities/schools Limit/abolish all marketing to children Policies supporting breast feeding

34 Physical Activity Objective:To increase physical activity ACTIONS: Daily school physical activity (60 min.) Community after-school physical activity Availability and accessibility of walkable spaces Progressively adapt towns to favour pedestrian/cycling with car restrictions

35 Individual approaches Treatment for smokers Screening, early diagnosis, counseling and treatment Hypertension Diabetes Obesity Rehabilitation programs

36 ivil society in Latin America & Caribbean Advocacy Service Provider / Health Promotion Evidence base info Watchdog

37 Lessons learned (2) No amount of funding is sufficient for the task we have activism,, guerrilla warfare, advocacy Strengthen civil society Don t do anything not linked to policy or structural change What are the legal underpinnings (Constitution Constitution,, human rights,, labor protections, consumer laws)

38 Lessons learned (3) Play watch dog (shadow reports, independent monitoring) To change social norms, you need a social movement de de-medicalize Modify public opinion,, re-frame the issue Organize coalitions to pressure gov t Leverage and working collaboratively Identify and grow people and organizations

39 KEY MESSAGE 1. The greatest and most sustainable impact comes from policy, structural, systemic and environmental interventions (e.g., smokefree environments, tobacco tax, banning trans fats, salt reduction) 2. All else (education, public information, health promotion, awareness, communications campaigns, media outreach) is done to make structural and policy change.