La enfermedad cardiovascular es la principal causa de muerte en Latinoamérica. Datos de la Organización Mundial de la Salud indican que en la región está en curso una epidemia de enfermedad cardiovascular de grandes proporciones, lo que se puede atribuir a cambios demográficos y de hábitos de vida inherentes a la transición epidemiológica: el incremento en la expectativa de vida trae como consecuencia periodos de exposición a factores de riesgo más largos, lo que resulta en mayor probabilidad de eventos adversos. Latinoamérica es una de las regiones del mundo con más alta carga de factores de riesgo cardiovascular, especialmente sobrepeso, dislipemia y diabetes mellitus; estos factores tendrán un impacto significativo en la incidencia de eventos coronarios e insuficiencia cardiaca en un futuro cercano. Además, factores infecciosos, especialmente Chagas y fiebre reumática, afectan a enormes grupos de población en la región. A menos que se introduzcan medidas preventivas, en las próximas tres décadas el número de muertes en la región atribuidas a enfermedad cardiovascular se incrementará en más del 200%. Los datos disponibles indican que la mortalidad de los pacientes con síndrome coronario agudo en Latinoamérica es mayor que en los países desarrollados. Como causas potenciales para explicar este hallazgo, se mencionan la subutilización de medidas terapéuticas demostradamente eficaces y un uso más conservador y tardío de los procedimientos intervencionistas. La insuficiencia cardiaca en Latinoamérica se presenta en sujetos más jóvenes que en el resto del mundo y se relaciona más frecuentemente con cardiopatía isquémica; sin embargo, la etiología chagásica se aproxima a la hipertensiva como segunda causa. Se necesitan con urgencia estudios epidemiológicos adecuadamente diseñados que permitan guiar la implementación de medidas preventivas y tratamientos apropiados.
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Bibliografía
[1]
Gaziano T, Reddy S, Paccaud F, Horton S, Chaturvedi V. Cardiovascular disease. En: Disease control priorities in developing countries. 2.a ed. Oxford: Oxford University Press and The World Bank; 2006. p. 645-62.
[2]
American Heart Association. International Cardiovascular Disease Statistics [serie en internet]. Disponible en: http://www.sld.cu/galerias/pdf/servicios/hta/international _cardiovascular_disease_statistics.pdf.
[3]
Gaziano T. Cardiovascular disease in the developing world and its cost-effective management. Cardiologyrounds [serie en internet]. 2005; 9 (2). Disponible en: http://www.cardiologyrounds.org/crus/cardious_0205.pdf.
[4]
Roses Periago M. Situación de salud en las Américas. Indicadores básicos 2009. Disponible en: http://new.paho.org/hq/dmdocuments/2009/IB_SPA_2009.pdf.
[5]
Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;XLIX:509-38.
[6]
Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: The age of delayed degenerative diseases. Milbank Mem Fund Q. 1986;64:355-91.
[7]
Global burden of cardiovascular diseases part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001; 104:2746-53.
[8]
Emerging epidemic of cardiovascular disease in developing countries. Circulation. 1998; 97:596-601.
[9]
Tunstall-Pedoe H. The WHO MONICA Project. J Clin Epidemiol. 1988;41:105-13.
[10]
Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease study. Lancet. 1997; 349:1498-504.
[11]
Estimation of contribution of changes in classic risk factors to trends in coronary event rates across the WHO MONICA Project populations. Lancet. 2000; 355:675-87.
[12]
The WHO Statistical Information System (the WHOSIS), 2003. Disponible en: http://www3.who.int/whosis/menu.cfm.
[13]
2003 World Development Indicators CD-ROM, World Bank. Disponible en: http://devdata.worldbank.org/hnpstats/deaselection.asp.
[14]
Sachs J. CVD status and projections in five developing countries. En: Sachs, J., editor. A race against time: the challenge of cardiovascular disease in developing economies. New YorK: The Trustees of Columbia University in the City of New York; 2004.
[15]
Low priority of cardiovascular and chronic diseases on the global health: agenda: a cause for concern. Circulation. 2007; 116:1966-70.
[16]
Risk factors for acute myocardial infarction in Latin America: the INTERHEART Latin American Study. Circulation. 2007; 115:1067-74.
[17]
Obesity in Latin American women and children. J Nutr. 1998; 128:1464-73.
[18]
Comparative case fatality analysis of the International Tissue Plasminogen Activator/Streptokinase mortality Trial: variation by country beyond predictive profile. J Am Coll Cardiol. 1993; 21:281-6.
[19]
Van de Werf F, Topol EJ, Lee KL, Woodlief LH, Granger CB, Armstrong PW, et al. Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries. Results from the GUSTO trial. JAMA. 1995;273:1586-91.
[20]
The PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med. 1998;339:436-43.
[21]
O'Shea JC, Califf RM. Inter-regional differences in acute coronary syndrome trials. Eur Heart J. 2000;21:1397-9.
[22]
Simes RJ, O’Connell RL, Aylward PE, Varshavsky S, Diaz R, Wilcox RG, et al. Unexplained international differences in clinical outcomes after acute myocardial infarction and fibrinolytic therapy: Lessons from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial. Am Heart J. 2010;159:988-97.
[23]
Fox KAA, Goodman S, Bigonzi F, Louer LV, Choen M. Inter-regional differences and outcome in unstable angina. Analysis of the International ESSENCE trial. Eur Heart J. 2000;21:1433-9.
[24]
Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. N Engl J Med. 1998;339:436-43.
[25]
Latinoamérica en los ensayos clínicos internacionales: ¿Dónde está la diferencia?. ¿Son los pacientes, los médicos o el sistema?. Rev Argent Cardiol. 2003; 71:6-15.
[26]
predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation. 2000; 101:2557-67.
[27]
Cohen MG, Pacchiana CM, Corbalan R, Pérez JE, Ponte CI, Oropeza ES, et al. Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. Am Heart J. 2001;141:391-401.
[28]
Giugliano RP, Llevadot J, Wilcox RG, Gurfinkel EP, McCabel CH, Charlesworth A, et al, for the InTIME (Intravenous nPA for Treatment of Infarcting Myocardium Early) II Investigators. Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST elevation myocardial infarction treated with fibrinolysis. Results from inTIME-II. Eur Heart J. 2001:22;1702-15.
[29]
García-Castillo A, Jerjes-Sánchez C, Martínez P, Azpiri-López JR, Autrey A, Martínez C, et al; por los Investigadores del Registro Nacional de Síndromes Coronarios Agudos. RENASICA II. Registro Mexicano de Síndromes Coronarios Agudos. Arch Cardiol Mex. 2005;75:S6-19.
[30]
Fox K, Goodman G, Klein W, Brieger D, Steg PG, Dabbous O, et al; for the GRACE Investigators. Management of acute coronary syndromes. Variations in practice and outcome Findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2002:23;1177-89.
[31]
Estudios Clínicos Latino America (ECLA) Collaborative Group. Eur Heart J. 2006; 27:527-33.
[32]
De Simone, et al; for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics, 2010 Update: a report from the American Heart Association. Circulation. 2010; 121:e46-e215.
[33]
The growing burden of heart failure: The “syndemic” is reaching Latin America. Am Heart J. 2004; 147:386-9.
[34]
Cardiomyopathy, adult valve disease and heart failure in South America. Heart. 2009; 95:181-9.
[35]
Programa de la ONU: Informe sobre Desarrollo Humano 2010. Disponible en: http://78.136.31.142/en/media/PR5-HDR10-RegRBLAC-SP.pdf.
[36]
Predictors of heart failure among women with coronary disease. Circulation. 2004; 110:1424-30.
[37]
for the CARMELA Study Investigators. CARMELA: Assessment of cardiovascular risk in seven Latin American cites. Am J Med. 2008; 121:58-65.
[38]
Cubillos LA, Casas JP, Morillo CA, Bautista L. Congestive heart failure in Latin America: The next epidemic. Am Heart J. 2004;147:412-7.
[39]
WHO Expert Committee. Control of Chagas disease. World Health Organ Tech Rep Ser. 2002; 905:i-vi, 1-109.
[40]
Infect Developing Countries. 2007; 1:99-111.
[41]
Cost-effectiveness of Chagas disease interventions in Latin America and the Caribbean: Markov models. Am J Trop Med Hyg. 2005; 73:901-10.
[42]
Insuficiencia cardıaca em grande hospital terciario de Sao Paulo. Arq Bras Cardiol. 1998; 71:15-20.
[43]
Perna ER, Barbagelata A, Grinfeld L, Garcıá B, Címbaro JP, Canella Bayol PA, et al. Overview of acute decompensated heart failure in Argentina: Lessons learned from 5 registries during the last decade. Am Heart J. 2006;151:84-91.
[44]
Risk stratification in a Brazilian hospitalbased cohort of 1220 outpatients with heart failure: role of Chagas’ heart disease. Int J Cardiol. 2005; 102:239-47.
[45]
Gheorghiade M, Filippatos G. Reassessing treatment of acute heart failure syndromes: the ADHERE Registry. Eur Heart J Suppl. 2005; 7 Suppl B:B13-9.
[46]
Subanalysis of the REMADHE Prospective Trial. Circ Heart Fail. 2010; 3:82-8.
[47]
Muerte súbita en la miocardiopatía chagásica: papel del cardiodefibrilador implantable. Relampa. 2008; 21:67-83.
[48]
Decompensated heart failure in the emergency department of a cardiology hospital. Arq Bras Cardiol. 2008; 90:400-6.
[49]
Ministério da Saúde. Coordenação de Doenças Crônicas-Degenerativas. Incidência da febre reumática no Brasil. Brasília; 2003.