Lifestyle Risk Factors and Cardiovascular Disease in Cubans and Cuban Americans

Cardiovascular disease is the leading cause of mortality in Cuba. Lifestyle risk factors for coronary heart disease (CHD) in Cubans have not been compared to risk factors in Cuban Americans. Articles spanning the last 20 years were reviewed. The data on Cuban Americans are largely based on the Hispanic Health and Nutrition Examination Survey (HHANES), 1982–1984, while more recent data on epidemiological trends in Cuba are available. The prevalence of obesity and type 2 diabetes mellitus remains greater in Cuban Americans than in Cubans. However, dietary preferences, low physical activity, and tobacco use are contributing to the rising rates of obesity, type 2 diabetes mellitus, and CHD in Cuba, putting Cubans at increased cardiovascular risk. Comprehensive national strategies for cardiovascular prevention that address these modifiable lifestyle risk factors are necessary to address the increasing threat to public health in Cuba

Usefulness for surveillance of hypertension prevalence studies in Latin America and the Caribbean: the past 10 years Utilidad de los estudios de prevalencia para la vigilancia de la hipertensión en América Latina y el Caribe: los 10 últimos años

OBJECTIVE: To compare the usefulness for surveillance of the peer-reviewed literature on the prevalence of hypertension in Latin America and the Caribbean published from 2001 to 2010 with a previous study of the published literature from 1962 to 2000. METHODS: A bibliographic search was conducted of publications from 2001 to 2010 that examined the prevalence of hypertension using MEDLINE and LILACS databases. The methodology of each paper was evaluated with the same critical appraisal tool used in the previous study. RESULTS: A total of 81 papers were published from 2001 to 2010 on the prevalence of hypertension in Latin America and the Caribbean. Only 24 of these studies met the minimum methodologic criteria for evaluation. While the total number of studies published in the past 10 years exceeds the number published from 1962 to 2000, the percentage of studies that met the minimum methodologic criteria has not substantially increased. In addition to major methodologic shortcomings, less than 46% of the published studies reported rates of awareness, treatment, and control of hypertension. The hypertension prevalence estimates from the peer-reviewed literature range from 7% to 49%. These studies were primarily done in urban centers and are not evenly distributed throughout the region. CONCLUSIONS: The quality and geographic distribution of the published literature on the prevalence of hypertension in Latin America and the Caribbean are inadequate. Research resources and efforts should be directed in the future toward closing this gap.OBJETIVO: Comparar la utilidad para la vigilancia epidemiológica de los artículos sobre prevalencia de hipertensión en América Latina y el Caribe publicados en revistas con arbitraje científico del 2001 al 2010, con un estudio anterior de la bibliografía publicada en el período 1962-2000. MÉTODOS: En las bases de datos MEDLINE y LILACS se efectuó una búsqueda bibliográfica de los artículos que examinaron la prevalencia de hipertensión publicados del 2001 al 2010. La metodología empleada en cada artículo se valoró con la misma herramienta de evaluación usada en el estudio anterior. RESULTADOS: Del 2001 al 2010 se publicaron 81 artículos sobre la prevalencia de la hipertensión en América Latina y el Caribe. Solo 24 de estos estudios cumplieron los criterios metodológicos mínimos para la evaluación. Aunque en los 10 últimos años se publicaron más estudios que en el período 1962-2000, el porcentaje de estudios que cumplieron los criterios metodológicos mínimos no aumentó sustancialmente. Además de presentar deficiencias metodológicas importantes, menos de 46% de los estudios publicados incluyeron información sobre la concientización, el tratamiento y el control de la hipertensión. Las estimaciones sobre la prevalencia de hipertensión en los artículos estudiados varían entre 7% y 49%. Estos estudios se realizaron principalmente en centros urbanos y no se distribuyeron de manera uniforme en toda la región. CONCLUSIONES: La bibliografía publicada sobre la prevalencia de la hipertensión en América Latina y el Caribe es insuficiente para ser útil con fines de vigilancia, y su calidad y la distribución geográfica son inadecuadas. En el futuro, los recursos y los esfuerzos de investigación deben enfocarse en reducir esta diferencia

Financial strain and ideal cardiovascular health in middle-aged and older women: Data from the Women's health study

Financial strain is a prevalent form of psychosocial stress in the United States; however, information about the relationship between financial strain and cardiovascular health remains sparse, particularly in older women.MethodsThe cross-sectional association between financial strain and ideal cardiovascular health were examined in the Women's Health Study follow-up cohort (N = 22,048; mean age = 72± 6.0 years).Six self-reported measures of financial strain were summed together to create a financial strain index and categorized into 4 groups: No financial strain, 1 stressor, 2 stressors, and 3+ stressors. Ideal cardiovascular health was based on the American Heart Association strategic 2020 goals metric, including tobacco use, body mass index, physical activity, diet, blood pressure, total cholesterol and diabetes mellitus. Cardiovascular health was examined as continuous and a categorical outcome (ideal, intermediate, and poor). Statistical analyses adjusted for age, race/ethnicity, education and income.ResultsAt least one indicator of financial strain was reported by 16% of participants. Number of financial stressors was associated with lower ideal cardiovascular health, and this association persisted after adjustment for potential confounders (1 financial stressor (FS): B = -0.10, 95% Confidence Intervals (CI) = -0.13, -0.07; 2 FS: B = -0.20, 95% CI = -0.26, -0.15; 3+ FS: B = -0.44, 95% CI = -0.50, -0.38).ConclusionFinancial strain was associated with lower ideal cardiovascular health in middle aged and older female health professional women. The results of this study have implications for the potential cardiovascular health benefit of financial protections for older individuals

Occupational Exposures and Cardiac Structure and Function: ECHO-SOL (Echocardiographic Study of Latinos)

Background Our objective was to determine associations of occupational exposures with cardiac structure and function in Hispanic/Latino adults. Methods and Results Employed participants were included (n=782; 52% women, mean age 52.9 years). Occupational exposures to burning wood, vehicle exhaust, solvents, pesticides, and metals at the current and longest-held job were assessed by questionnaire. Survey multivariable linear regression analyses were used to model the relationship of each self-reported exposure with echocardiographic measures of cardiac structure and function. Exposure to burning wood at the current job was associated with decreased left ventricular (LV) ejection fraction (-3.1%; standard error [SE], 1.0 [ =0.002]). When the analysis was restricted to exposure at the longest-held job, occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL; SE, 1.6 [ <0.0001]), decreased LV ejection fraction (-2.7%; SE, 0.6 [ <0.0001]), worse LV global longitudinal strain (1.0%; SE, 0.3 [ =0.0009]), and decreased right ventricular fractional area change (-0.02; SE, 0.004 [ <0.001]). Exposure to pesticides was associated with worse average global longitudinal strain (0.8%; SE, 0.2 [ <0.0001]). Exposure to metals was associated with worse global longitudinal strain in the 2-chamber view (1.0%; SE, 0.5 [ =0.04]), increased stroke volume (3.6 mL; SE, 1.6 [ =0.03]), and increased LV mass indexed to BSA (9.2 g/m ; SE, 3.8 [ =0.01]) or height (4.4 g/m ; SE, 1.9 [ =0.02]). Conclusions Occupational exposures to burning wood, vehicle exhaust, pesticides, and metals were associated with abnormal parameters of LV and right ventricular systolic function. Reducing exposures to toxic chemicals and particulates in the workplace is a potential opportunity to prevent cardiovascular disease in populations at risk