Cardiovascular disease prevention program for Chile

World Congress of Cardiology Report - Fifty-five percent of the Chilean adult population is at risk of a cardiovascular event with a high rate of morbidity and mortality affecting mainly a productive population, between 35 and 74 years of age. This risk is 1.4 times greater for men.

Cardiovascular disease is one of the three most common causes of incapacitation in the adult population in Chile. The average rate of invalidity is 49 years for women and 53 years for men, making it is easy to understand that this is a financial burden to the health care system.

Additionally, cardiovascular disease is the main cause of death in Chile: 29% of all people in the country die from coronary heart disease. Of those 36% are due to coronary heart disease and 36.3% from cerebrovascular disease (stroke).

Different studies have shown in Chile that major risk factors of atherosclerosis have a high prevalence in the adult population and that , most of them have increased during the last 10 years.

One of such studies performed in the Metropolitan area of the country (Santiago, the capital city and surroundings ) showed:

• Obesity 22% (1993) 25% (2001)
• Diabetes 4% 6%
• Cholesterol 37% 46%
• Hypertension 25% 26%
• Smoking 40% 37%, the only risk factor which showed a small decrease.

Even small Indian communities (mapuches) still existing in the country show a similar pattern:

• Obesity 27%(1993) 33%(2001)
• Diabetes 4% 7
• Hypertension 38% 37%
• Cholesterol 19% 21%

In 2003, the Ministry of Health performed a national survey that assessed the risk of 3600 adults aged 17 years of age or more. The results confirmed the high prevalence of major risk factors:

• Overweight 60% and obesity 32%, more prevalent in people with primary education. 17.2% of children 6 years of age or older are obese. 50% of children of the capital city are overweighed or obese.
• Cholesterol 35% ; < HDL ( “good or protective” cholesterol) 39%; > LDL( “bad” cholesterol) 25%.
• Diabetes 4.2%; but glucose intolerance was present in 20% in men and 11% in women.
• Smoking 42%, more prevalent in younger people, less than 25 years of age.
• Sedentary habits, 89%.
• Metabolic syndrome, 25%.

The Chilean government as well as private institutions (insurance companies) have addressed this important health problem by implementing strong prevention programs.

The most important initiative is the creation of a Cardiovascular Health Program that includes:

• Preventive examination of the adult population, with defined targets on Smoking, Hypertension, Cholesterolemia.
• Nutritional recommendations for the general population: avoid excessive consumption of saturated fats; to keep weight in relation to height; to reduce amount of salt to less than 6 grams /day; moderate consumption of alcohol; to perform physical activity at least 30 minutes four times a week.
• Just a few weeks ago the President of the Republic herself lead the launching of the Globlal Strategy Against Obesity with the target to decrease obesity in children from 18% to 12% in 2010. Most important this initiative involves the Ministry of Education to educate children in healthy nutritional and exercise habits.
• Food industry should label all their products to comply with the previous recommendations
• Antismoking law. (In a survey of patients presenting with a Myocardial Infarction 40% were smokers). This law, in effect since July, bans smoking in hospitals, public buildings, airports, gyms, supermarkets, commercial centers, and the Congress. Advertising is allowed only where tobacco products are sold and sales of such products are prohibited within 100m from schools. Cigarette packages also must have a label large warning labe about the dangers of tobacco. This must take up at least 50% of package size versus the present 10%.

Additionally, the government has passed the new AUGE law: (Acceso Universal con Garantias Explicitas; Universal Acces with Explicit Guarantees). Under this new law, hospitals and private institutions must take care of patients with one of 40 diseases within a predetermined period of time, including diagnosis and treatment. Among these 40 diseases are myocardial infarction, hypertension, diabetes.

For diagnosis of myocardial infarction a Telemedicine system has been implemented. According to this law, when a myocardial is suspected, an EKG should be immediately taken and transmitted by phone to a call center where a cardiologist makes the report and supports the primary care doctor on the patient’s treatment. In this way thrombolysis are being performed even in remote areas of the country. After recovery the patient enters a program of secondary prevention including statins what it was not possible until very recently.

In summary, Chile as many other countries in the world is under the threat of a high morbidity and mortality for cardiovascular diseases but is making an important effort to control them at individual, family and society levels.