CV risk factors in Latin America are comparable to the US

Miranda JJ, Herrera VM, Chirinos JA, et al.
PLoS One. 2013;8(1):e54056. doi: 10.1371/journal.pone.0054056.

Background

Cardiovascular disease (CVD) is a major cause of death in Latin America and the Caribbean (LAC)[1]. The sparse information that is available on the distribution of CV risk factors in LAC region suggests that substantial variation exists among different countries [2]. The scarcity of data on the distribution of risk factors and their impact on CVD incidence and mortality hampers efforts to restrict the epidemic of CVD in LAC.
The authors report de distribution of CV risk factors based on data from population-based studies from 8 LAC countries. They compare this with risk factor distribution in the United States (US).
Data of the Latin American Consortium of Studies in Obesity (LASO [3,4]) was used, as well as the US National Health and Nutrition Examination (NHANES [5]). Data of 31009 individuals from LASO were included and 13441 of NHANES.

Main results

• The average prevalence of hypertension was 20.2% (95%CI: 12.5-31.0), but varied considerably with age. Overall, men were more often hypertensive than women (21.1 vs. 19.4%, specifically among younger individuals.
• The average prevalence of diabetes mellitus was 5% (95%CI: 3.4-7.9), but increased from 0.9% in 20-29 year-old participants to 16.4% in people >70 years old.
• The prevalence of high total cholesterol was about 9% and increased with age. Over one half of the population had low HDL-cholesterol, but more so in women (76.9%) than in men (32.8%). Hypertriglyceridemia was seen in about a quarter of the population.
• A quarter of the study population is a current smoker, of whom more were men (32.2%) than women (19.5%). Smoking prevalence decreased from 28.2% in the 20-29 year-old category to 9,9% in >70 year-olds.
• Mean BMI was 26.2 kg/m² (95%CI: 25.1-27.3) in men and 26.7 kg/m² (95%CI: 25.9-27.5) in women. BMI increased with age, with maximum values for both men (26.7 kg/m²) and women (28.0 kg/m²). 18.4% of women and 13.8% of men were obese (BMI>30 kg/m²). Weight circumference (WC) was 90.8 cm (95%CI: 86.8-94.8) in men and 87.2 (95%CI:83.2-91.2) in women. More women than men (55.5% vs 15.4%) had abdominal obesity according to the definition of the WHO (WC>88cm for women and >102 for men).
• Comparisons between each country and the rest of the region showed that Argentina had lower prevalence of hypertension, while more hypertension was seen in Chili. Colombia and Costa Rica showed higher total cholesterol levels, but less smoking. Peru showed a lower prevalence of hypertension and diabetes, while in Puerto Rico more people had diabetes. Chili tended to show a higher prevalence for each risk factor than the LAC region, while they were generally lower in Peru.
• In comparison with the US, both systolic and diastolic blood pressure was slightly but consistently higher in LAC in all age categories, although age- and gender-adjusted prevalence of hypertension was similar between the US and LAC populations.
  The LAC population showed consistently lower total cholesterol levels across all age and gender categories. About 25% fewer individuals have high total cholesterol in LAC as compared to the US.

In all age groups the US population showed higher HDL cholesterol than LAC.
Age-specific levels of blood glucose were higher in US men, but lower in US women than in LAC groups.
Men and women had higher BMI in the US than in LAC, in all age groups. The prevalence of overall and abdominal obesity were lower in the LAC population than in the US population.

Conclusion

The prevalences of major CV risk factors in the LAC region lie within the range seen in developed countries. Although the prevalence of hypertension, diabetes and smoking were similar between the LAC and the US, differences are observed between countries of the LAC region. The largest difference between the US and the LAC was a 42% lower prevalence of obesity and 63% more low HDL-c in Latin-Americans. These insights can help to define and implement more effective preventive strategies in the whole Americas region.

References

1. Ford ES, Ajani UA, Croft JB, et al. (2007) Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 356: 2388–2398.
2. Schargrodsky H, Hernandez-Hernandez R, Champagne BM et al. (2008) CARMELA: assessment of cardiovascular risk in seven Latin American cities. Am J Med 121: 58–65.
3. Bautista LE, Casas JP, Herrera VM et al. (2009) The Latin American Consortium of Studies in Obesity (LASO). Obes Rev 10: 364–370.
4. Herrera VM, Casas JP, Miranda JJ et al. (2009) Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease. Int J Obes (Lond) 33: 568–576.
5. Centers for Disease Control and Prevention, National Center for Health Statistics (2006). National Health and Nutrition Examination Survey. Analytic and reporting guidelines. Available from: http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/nhanes_analytic_guidelines_dec_2005.pdf. Accessed 2012 Dec 17.

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