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标题：Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control
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作者：Richard S. Cooper ; Pedro Orduñez ; Marcos D. Iraola Ferrer 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：1
页码：94-101
DOI：10.2105/AJPH.2004.051417
语种：English
出版社：American Public Health Association
摘要：Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there. Methods. We reviewed Cuban public health statistics, surveys, and reports of health services. Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors. Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD. Cardiovascular disease (CVD) is now recognized as an important public health problem for many nonindustrialized countries. 1 ^– 4 Increasing death rates and prevalences of risk factors have been observed in Asia, Africa, and South America, leading to dire predictions about the size of the coming epidemic. 1 ^, 3 ^, 4 In most industrialized countries, on the other hand, the rapid declines in CVD continue, 5 ^– 8 demonstrating the effectiveness of current strategies for prevention and control. Whether any of these strategies can be applied with equal success in nonindustrialized countries is not known. The process of adaptation will clearly face many difficult challenges, including the need to strike a balance between primary prevention and reliance on medical care to treat affected patients. As in any area of public health, surveillance systems are essential for helping countries define the scope of the CVD epidemic and develop appropriate local strategies. 9 ^, 10 Unfortunately, almost without exception, the epidemiological data that are required for an accurate description of the trends in mortality and causal risk factors at a national level are not available in poor countries. Within the general framework of the ongoing global health transition, whereby infectious diseases and malnutrition are replaced by chronic CVD and cancer, 11 it is still unclear whether most developing countries will simply recapitulate the epidemiology of CVD observed in North America and Europe or whether the transition will display distinct new varieties shaped by regional culture and geography, or even by the economic models that have been adopted. Tropical island countries and indigenous peoples in the Americas, for example, have typically been confronted with severe epidemics of diabetes at the onset of the health transition, rather than coronary heart disease (CHD), as was the case in the United States and Europe. 12 Other countries, such as India, struggle with persistently high rates of infection and undernutrition along with CVD. 1 ^– 3 ^, 13 Cuba occupies an unusual position in the nonindustrialized world. The political and economic path of development is based on the ideology of revolutionary socialism. 14 ^, 15 As part of the state’s commitment to collective welfare, a sophisticated and comprehensive public health sector has eliminated epidemic infectious diseases and reduced infant mortality to 6.3 per 1000. 16 ^, 17 With the extension of life expectancy to 76 years and the rapid growth of the population aged older than 65, the potential for a large disease burden from CVD and other chronic diseases has likewise increased. A further essential condition for a high prevalence of atherosclerosis is the transition of the majority of the population into a lifestyle made possible only by industrial technology. The productive capacity of Cuban society as a whole is very modest, however—average annual income is variously estimated as $1000 to $5000 per year, and access to consumer goods is limited. 15 Whereas Cuba’s cultural orientation over the last century has been primarily toward Spain and the United States, 18 in terms of personal consumption patterns—ranging from the reliance on convenience meals to the availability of private cars—a wide gap currently persists between material conditions on the island and those found in North America and Europe. No precedents exist on which to predict the burden of CVD that would emerge from such a mixture of factors. Whereas CVD among the elite in many developing countries is well recognized, the dispersion of the disease throughout the general population has not yet been described. Because the Cuban health system produces complete and accurate statistical data on both vital events and health services, it should be possible to describe the process there in substantial detail. Our review was undertaken with several purposes in mind. First, we set out to determine whether the data resources available from Cuba would actually make possible a comprehensive description of the current state of the CVD epidemic and a characterization of the secular trends in a nonindustrialized country. Second, we wanted to assess the response of the public health and medical care systems to the emergence of CVD as the most common cause of death. Finally, we hoped to place the Cuban situation in the context of its closest geographic neighbors, the other Caribbean countries, and to compare the situation in Cuba with that in North America and Europe through use of available data from the latter 2 regions. Results of these analyses should make it possible to assess the unique strengths and weaknesses of the Cuban experience, the extent to which this experience can be attributed to the model of economic development that was adopted, and its implications for other nonindustrialized countries.