Cancer, heart and respiratory disease cause more than two-thirds of deaths in South America

The international study PURE (Prospective of Rural and Urban Epidemiology), one of the most relevant scientific-population papers on the incidence of cardiovascular diseases, concluded for its South American chapter that more than two thirds of deaths are caused by heart disease, cancer and respiratory diseases. The countries of the region analyzed for more than 10 years were Argentina, Brazil, Chile and Colombia.

“Cardiovascular diseases, cancer and respiratory diseases account for more than two-thirds of deaths in South America,” underlined the study that Infobae had access to, setting out its main findings in the four countries mentioned. In the case of men, “they have consistently higher rates of CVD (cardiovascular disease) and mortality than women.”

In addition, he concluded, “a large proportion of CVD and premature deaths could be prevented by controlling metabolic risk factors and tobacco use, which are the main common risk factors” for the region.

The PURE study, led by Dr. Salim Yusuf of the Population Health Research Institute (PHRI), Canada, is a follow-up analysis that assesses the effect of macro and microeconomic factors on lifestyle and dietary risk factors for cardiovascular disease. It was first presented at the European Congress of Cardiology in 2011 and published in The Lancet. The study involved a total of 153,996 adult volunteers from urban and rural communities in countries categorized as high-income (Canada, Sweden and the United Arab Emirates), upper-middle-income (Argentina, Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower-middle income (China, Colombia and Iran) and income low (Bangladesh, India, Pakistan, and Zimbabwe).

In the case of South America, whose conclusions Infobae had access to, the scientists specified that “24,718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile and Colombia” were included, recruited between 2006 and 2009, who were “followed by an average of 10.3 years” . In that course, the “risk reasons and fractions attributable to the population (FAP) for CVD and death were analyzed. The average age was 51.4 years, with 61.4% of women, 57% of the urban population, 59% with primary education or below.

This set included “12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity and high non-HDL cholesterol), behavioral (tobacco, alcohol, diet quality and physical activity) and others (education, household air pollution, strength and depression).”

The results indicated that “the leading causes of death were CVD (31.1%), cancer (30.6%) and respiratory diseases (8.6%). Cardiovascular disease was the most common cause of death in men, while cancer was the most common cause of death in women.”

“The incidence of CVD varied only modestly between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07),” they said.

Regarding the prevalence of these diseases between genders, the authors found that “men had a higher incidence of CVD (4.48 versus 2.60 per 1000 person-years) and a higher mortality rate (6.33 versus 3.96 per 1000 person-years) compared to women”.

Regarding modifiable risk factors, analysts found “hypertension (18.7%), abdominal obesity (15.4%), smoking (13.5%), low strength (5.6%) and diabetes (5.3%). When analyzing the cases of death, due to population-attributable risks (FAP), they detected that “they were due to smoking (14.4%), hypertension (12.0%), low schooling (10.5%)” abdominal obesity (9.7%) and diabetes (5.5%).

The study conducted in the four South American countries included specialists from Clinical Trials Latin America, Rosario, Argentina; the University of Santander (UDES), the Center for the Prevention of Cardiometabolic Diseases (CIPCA), FOSCAL International, Bucaramanga, Colombia, the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada; La Frontera University in Temuco, Chile; Alemao Oswaldo Cruz Hospital, Sao Paulo, Brazil.

Dr. Fernando Botto (MN 79,189), cardiologist from the Instituto Cardiovascular Buenos Aires (ICBA) research area, highlighted to Infobae four items that he considered to be the most relevant in the study. “First of all, the incidence of cardiovascular disease (CVD) given by AMI (acute myocardial infarction), stroke (stroke) and CHF (chronic heart failure) every 1000 people/year is interesting, which although it is lower in Argentina than in the rest (of the countries analyzed), it is similar among the 4 countries. For this reason, we could extrapolate the results to other non-participating countries, at least if they are considered 'medium income' by the World Bank, given that this is how the 4 participating countries were classified.”

“Secondly, it was observed that standardized mortality by sex and age is between 4 and 6 per 1000 people/year, being the highest in Argentina and the lowest in Chile. The article refers to total death (cardiovascular and non-cardiovascular), so we should not assume that cardiovascular mortality is the highest in Argentina,” he clarified. In addition, he said he was not surprised that this incidence is higher in men than in women, “but that mortality is higher in rural than urban areas, given a lower incidence of CVD, indicates that the structure and functioning of the health system may be inadequate, possibly with failure of the adequate and early diagnosis, and lack of access to the system when complications arise”.

“Thirdly, it is surprising that the incidence of death from cancer was' almost 'the same as CVD, with predominance of it in men and cancer in women. This is novel, and it resembles the 'high income' countries, where the number of cancer deaths already exceeds cardiovascular deaths,” he added. As “a previous publication by PURE points out that in Argentina and Chile the above is already happening,” he stressed, “this indicates an epidemiological transition with a reduction in CV death, although without proportional improvement in cancer.”

And finally, he indicated that “in relation to modifiable RFs (risk factors), the prevalence observed in PURE Argentina is similar to official surveys of those years. PURE showed that Argentina has the highest prevalence of alcohol consumption and smoking, as well as a higher rate of 'scarce education'.”

Dr. Botto remarked that “the contribution that the PURE study continues to generate to the global epidemiology of cardiovascular disease, risk factors and other prevalent diseases is enormous.” He also estimated that due to the methodology used and the size of the sample, “PURE South America provides robust regional evidence. While it should not be extrapolated to non-participating countries, we could assume a certain 'regionality' of information for the Southern Cone.”

“It is not evidence that arises from a hospital, from a city or from a country, which may suffer from selection biases and characteristics peculiar to each health system. In Colombia, geographically dispersed communities participated, while in Brazil, Chile and Argentina they were localities in narrower geographical areas. In Argentina, different urban neighborhoods of the city of Rosario, and rural localities in the province of Santa Fe participated. We could point out a certain limitation as it is not a very representative sample of our country. Of course, the study design responded to the best feasibility conditions that allowed it to be carried out”, he concluded.

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