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INTRODUCTION: Over the last decade, total cardiovascular risk assessment and management has been recommended by cardiovascular prevention guidelines in most high-income countries and by WHO. Cardiovascular risk prediction charts have been developed based on multivariate equations of values of some well-known risk factors such as age, sex, smoking, systolic blood pressure and diabetes, including or omitting total blood cholesterol. OBJECTIVE: The objectives of this study were: to determine the distribution of cardiovascular risk in a Cuban population using the WHO/International Society of Hypertension risk prediction charts with and without cholesterol; and to assess applicability of the risk prediction tool without cholesterol in a middle-income country, by evaluating concordance between the two approaches and comparing projected drug requirements resulting from each (at risk thresholds of ≥20% and ≥30%) and for the single-risk-factor approach. METHODS: From April through December 2008, a cross-sectional study was conducted in 1287 persons (85.8% of the sample selected), aged 40-80 years living in a polyclinic catchment area of Havana, Cuba, based on the protocol and data from a WHO multinational study. The study used the two sets of the WHO and the International Society of Hypertension (WHO/ISH) risk prediction charts, with and without cholesterol. Percentages and means were calculated, as well as prevalence (%) of risk factors. The chi-square test was used to compare means (p ≤0.05). Concordance between the two prediction charts was calculated for different risk levels, using the chart with cholesterol as a reference. RESULTS: Using the risk assessment tools with and without cholesterol, 97.1% and 95.4% respectively of the study population were in the ten-year cardiovascular risk category of <20%, while 2.9% and 4.6% respectively were in the category of ≥20%. Risk categories were concordant in 88.1% of the population; overestimation was higher among the nonconcordant (136/153). When risk assessment did not include cholesterol, there was 2.6% (34/1287) overestimation of drug requirements and 0.5% (6/1287) underestimation, compared to estimates including cholesterol. CONCLUSION: Total cardiovascular risk assessment using the WHO/ISH charts without cholesterol could be a useful approach to predict cardiovascular risk in settings where cholesterol cannot be measured. This does not introduce overconsumption of drugs, but does enable better targeting of resources to those who are more likely to develop cardiovascular disease. KEYWORDS Cardiology, risk assessment, health risk appraisal, hypertension, health policy, cost savings, atherosclerosis, Cuba.

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INTRODUCTION: Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. OBJECTIVE: Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. METHODS: A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. RESULTS: A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). CONCLUSIONS: Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care assessments for these patients.

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UNLABELLED: Introduction Cardiovascular morbidity and mortality increase in women after menopause. Various scoring models assess qualitative risk of cardiovascular disease. The Framingham Heart Study global risk score is among the most widely used. Objective Determine level of coronary heart disease risk among women aged ≥60 years in a Havana health catchment area (geographic area whose residents are served by the M�rtires del Corynthia Polyclinic, in the Plaza de la Revoluci�n municipality of Havana). Methods A descriptive, cross-sectional study was conducted in 2006. Universe: all women (3,396) aged ≥60 years in the catchment area, attended at the primary care level by the Polyclinic and 42 neighborhood family doctor-and-nurse offices. Equal probability sample: 1,082 women meeting the inclusion criteria, chosen through single-stage cluster sampling considering a <10% error margin for estimates for this parameter, a 95% confidence interval (CI) and a design effect of 1.5. Absolute frequencies and percentages were calculated to summarize the qualitative data obtained. Results were presented as tables. Results The most common cardiovascular risk factors found in this study were: physical inactivity, 74.9%; hypertension (HTN), 70.6%; abdominal obesity, 53%; reported family history of coronary heart disease (CHD), 41.8%; diabetes mellitus (DM), 21.8%; and cigarette smoking, 17.2%. Scoring according to number of risk factors present in each individual, 79.3% of these women fell into the high- or moderate-risk categories. Conclusion The large number of women categorized as high- or moderate-risk for coronary heart disease in this population emphasizes the need for preventive actions aimed at reducing these figures. KEYWORDS: Cardiovascular diseases, vascular diseases, ischemic heart disease, coronary heart disease, postmenopause, woman, aged, risk factors, risk assessment, hypertension, high blood pressure, lifestyle, diabetes mellitus, obesity, abdominal adipose tissue, body mass index, physical inactivity, tobacco use.

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Introducción: Los radicales libres juegan un papel fundamental en la patología de diferentes enfermedades degenerativas, entre las que se encuentra el infarto del miocardio. Tanto la disponibilidad alimentaria como inadecuados hábitos dietéticos sobre el consumo de frutas y vegetales han provocado una ingestión limitada de diversos antioxidantes. Objetivo: Analizar indicadores nutricionales antropométricos y vitamínicos junto con factores ambientales de riesgo que pudieran estar asociados al Infarto del Miocardio. Métodos: Se seleccionó una muestra compuesta por 34 casos con un primer infarto del miocardio, los controles se tomaron al azar en el último mes de cada trimestre con un total de 61 personas. Se determinaron los niveles séricos de vitamina E, C y A y lipidograma, se realizó evaluación nutricional antropométrica por medición del IMC y pliegues cutáneos, se obtuvieron los datos de la dieta mediante encuesta de frecuencia semicuantitativa de alimentos y hábitos dietéticos. Resultados: Se encontró que el 73,5% de los casos pertenecían al sexo masculino con una edad promedio de 57 años. El 93,3% de los casos y el 59,3% de los controles fumaron alguna vez durante su vida. Predomina la hipertensión arterial en los casos (60%) en relación con los controles (15%). El 60% de los casos y el 55% de los controles realizaban actividad física ligera. Las variables que explican los resultados de alfa tocoferol fueron el índice cintura-cadera y las mayores concentraciones de colesterol total. De los factores estudiados que pudieran explicar el desarrollo del infarto sólo resultaron significativos el hábito de fumar, los antecedentes de hipertensión arterial y las concentraciones de vitamina C (AU)

Background: Free radicals play an important role in the development of degenerative diseases, among those yocardial infarction. Both food availability and inadequate dietary habits related to low consumption of fruit and vegetables have influenced a limited intake of several antioxidants. Objetive: To analyze anthropometical and vitamin nutritional status indicators along environmental risk factors which could be associated to myocardial infarction. Methods: A sample of 34 cases, patients diagnosed of a first myocardial infarction, and randomly selected control individuals were included in the sample. Control subjects were selected on the last month of each trimestre to complete 61 subjects. Seric levels of vitamin E, C and A as well as lipid profile were assessed. Anthropometrical appraisal was completed considering BMI and skinfolds. Dietary assessment was completed by means of a semiquantitative food frequency questionnaire and questions related to dietary practices. Results: 73,5% of the cases in the sample were males, with an average age of 57 years. 93,3% of the cases and 59,3% of controls had smoked sometime in their lives. 60% of the cases had high blood presión, while 15% in the control group. 60% of the cases and 55% of the control subjects practiced light physical activity. Variables explaining the results observed regarding TF were waist-hip ratio and higher levels of total cholesterol. Among the different factors which could explain the development of myocardial infarction analysed, only smoking, history of hypertension and serum levels of vitamin C were significant (AU)

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