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Cardiovascular Risk Factors in
Women of "10 of October" Municipality

De la Noval, Reynaldo; Debs, Gisell;
Dueñas, Alfredo; Pages, J.C.;
Armas, Nurys; Acosta, Magda

Cardiology Institute, Havana, Cuba

SUMMARY
Introduction: Statistics of the WHO between 1990-1995 show that the mortality for ischaemic heart diseases in Cuban women was in the third place of the world. (relation male/female: 1.27). For this reason is very important for us to know the prevalence of cardiovascular risk factors (CRF) in this special group of people, more if they have 55 or more years old.
Objectives: Determinate the prevalence of CRF in a randomized sample of people, means of systolic and diastolic blood pressure and cholesterol levels.
Methodology: Observational cross sectional study. (n= 2230) in peoples between 25 - 64 years olds.
Results: Table 1

Discussion: Among women is most frequently the prevalence of diabetes, HBP and total cholesterol levels. (Framingham Study)
Conclusions: The prevalence of CRF in Cuban women is elevate, and the risk of death is very high. It's important for early prevention actions.

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INTRODUCTION
   Statistics of the WHO between 1990-1995 show that the mortality for ischemic heart diseases in Cuban women was the third place of the world. (relation male/female: 1.27) and the fourteen place between men, only in Russia and Czechoslovakia this mortality in women is higher.

   The anatomic characteristics of the coronary atherosclerotic lesions in the women are different that the men, because in them predominate the cells and the fibrous tissue and are most frequently the vasoespastics episodes. The presence of cardiovascular risk factors (CRF) is different in both sexes too. In the women is most high the prevalence of arterial hypertension (HTA), dyslipidemia and diabetes. The risk of death for coronary artery diseases (CAD) in men is 10 years more early, however the frequency of acute heart attack is very high in women after of 55 years old, and the mortality for myocardial infarction (MI) is higher in this sex after this age.

   For this reason to know the early presence of CRF in this gender is very important for us, because identifying and altering risk factors to prevent the onset of cardiovascular disease leading to heart attack or stroke and is possible to educate people about risk factors and lifestyle changes.

OBJETIVES
   1. Determinate the prevalence of cardiovascular risk factors in a randomized sample of people and comparer then.
   2. Determinate the means values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) for groups of age seleccionate and the means levels of this population.

METHODOLOGY
   Observational cross sectional study (February 1999 - October 2000) to 2230 peoples, both sexes, with age between 25 and 64 years old, randomized, and residents in the 10 de October urban municipality the third most great in Cuba with a population with more than 250 000 persons.

   They were visited at home, interviewed filling an specific record form, some data was obtained by a revision of the personal medical record, blood pressure was measured (two times) following the methodology suggested by W.H.O. and total cholesterol blood level.

   This data was analyzed by the SPSS-10 software 1999. We used Pearson chi squares test and independent samples t test for compare means. The normality of the distribution of continues variables SBP, DBP and cholesterol was previous determinate.

   In this investigation participate the Municipality Cardiovascular Diagnostic Center of the "10 of October Project" and the Cardiology Institute.

RESULTS
   In this study predominate the female sex (61.3%). By age groups the most numerous were to the 25 to 34 and 55 to 64 years olds. (Table 1).

    (Table 2) shows the prevalence of some cardiovascular risk factors in this population:
The hypercholesterolemia, (total cholesterol number >=6.2 mmol/l) was in the 6.9 % of the women and in the 3 % of male (p: 0.63).

   The prevalence of high blood pressure (criteria >=140/90 mm Hg) was more high in the female sex with 32.7 % , in the male was 31 % (p: 0.54).

    There was a significative difference between prevalence of smoke habit by sex, 48.3 % in men and 34.2 % in women. (p: 0.00001)

    The percentage of diabetes mellitus was more high in women 7.7 % , than in men (7.4 %) (p: 0.80)

   The obesity occurrence rate was calculated using the body mass index (BMI) Quetelet. It was similar in both sex; 8.9 % in women and 8.7 % in men. (p: 0.83).

    Physical inactivity prevalence was most high between men 45.1 %, in the women was minor 32.5 % this difference was statistic significative (p: 0.00006).

    (Table 3) shows the means levels of SBP and DBP by sex and seleccionate groups of age. (< 55 years old) and (>=55 years old).

    In the female SBP means was (121.27 mm Hg) (SD: 15.64) in under 55 years old group and (134.65 mm Hg) (SD: 18.91) in the group more than 55 years old. (p: < 0.0001) . In this sex, the DPB means was (77.82 mm Hg) (SD: 9.95) in under 55 years group and (84.14 mm Hg) (SD: 11.45) in the group more than 55 years group. (p:< 0.001).

    In the male SBP means was (125.99 mm Hg) (SD: 15.67) in under 55 years old group and (132.13 mm Hg) (SD: 16.54) in the group more than 55 years old. (p: < 0.001) . The DPB means was (80.59 mm Hg) (SD: 10.44) in under 55 years group and (83.57 mm Hg) (SD: 8.95) in the group more than 55 years group. (p: < 0.01).

   We appreciate in this Table like the group of women >=55 years old, has the most elevated means levels of blood pressure of all , this increase the risk of CAD and of death in this group.

   Means level of cholesterol in the population studied is show in the (Table 4):
   The cholesterol means levels in the group of women under 55 years old was 4.15 mmol/l (SD: 1.18) and in women with 55 years or more was 4.39 mmol/l (SD: 1.32) (p: 0.05).

    In the men, this means were 4.28 mmol/l (SD:1.16) in the group under 55 years and 4.29 mmol/l (SD: 1.23) in the group with 55 years or more. (p: 0.86)

DISCUSION
   The concept of risk factor identification and modification is based on the premise that exposure to certain host and environmental factors increases the statistical risk for developing a disease and that alteration of these conditions decreases the risk. Major CAD risk factors established are dyslipidemia, hypertension, tobacco use, and diabetes mellitus. Other nonmodificable risk factors include age, gender, and family history of CAD. For example in young people the smoke habit and the man sex are the most important risk market, however in old people are the hypertension, the dyslipidemia and diabetes.

   In women the frequency of acute heart attack is very high in women after of 55 years old, and the mortality for MI is higher in this sex after this age.

   The association between elevated blood cholesterol and CAD has been established from 1930. After that others observational and interventional epidemiological studies like Framingham, MRFIT, PROCAM. In the Framingham Heart Study, 26-year follow-up of men and women aged 35 to 84 years indicated that CAD morbidity was twice as high in men as in women, and 60 % of coronary events occurred in men. The onset of symptomatic CAD is typically about 10 years earlier in men, but CAD incidence in women increases rapidly at menopause (approximately 55 years old) The dyslipidemia , the hypertension and diabetes were most frequently in women.

    In our study we find more prevalence of this three factors in women, however the smoke habit and the physical inactivity was high between men.

    Numerous observational epidemiological studies in geographically and ethnically diverse populations have established a direct relation between hypertension and CAD and stroke. In a meta-analysis of nine prospective studies that together included almost 420,000 individuals without prior of MI or stroke who were followed up for an average of 10 years. The relative risk for CAD events in subjects in the highest quintile of diastolic blood pressure (means: 105 mm Hg) was approximately 5 to 6 times that in subjects in the lowest quintile (means: 76 mm Hg).
In other meta-analysis of 14 randomized trials of hypotensive drug therapy, together enrolling almost 37,000 subjects, blood pressure was 6 mm Hg lower in treated subjects than in control subjects, and CAD event rate was 14 % lower.

    We find that the means of SBP and DBP in women with 55 years old and more were higher than in all the others groups. It's increase her relative risk of CAD.

   The diabetic persons has most risk of CAD or a major fatal complication. In 14-year follow-up of the Rancho Bernardo Study, in which 334 men and women with diabetes were compared with 2137 men and women without diabetes, the relative risk for CAD death was 1.9 in diabetic men and 3.3 in diabetic women compared with nondiabetic men and women after adjustment for other CAD risk factors.

    In the Framingham Heart Study the obesity was found to be an independent risk factor for cardiovascular disease in both men and women. Among subjects aged less than 50 years, incidence of cardiovascular disease was two times higher in men and almost 2.5 times higher in women in the most obese tertile compared with the leanest tertile. We find mild difference by sex in diabetes prevalence. Also the BMI in the female gender was higher than the male in our series, but without statistic significance.

   For all this analyzed differences in frequency of CRF in the women in this municipality, and may be in the rest of the female population in Cuba we propone the realization of other study similar like this with more population and in other place of the country.

CONCLUSIONS

1. The prevalence of CRF in women of the "10 of Octubre" municipality is elevated.
2. The means of blood pressures in women with 55 years old and more were the most high in all the groups.
3. In this same group the means of cholesterol number was the most high too.
4. For all this reason the risk of death of her is very high.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
apacher@satlink.com

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