High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

doi:10.1016/j.ahj.2010.05.016

American Heart Journal

Volume 160, Issue 2, August 2010, Pages 230-236

https://doi.org/10.1016/j.ahj.2010.05.016 Get rights and content

Background

Whereas developed nations have witnessed a drop in the occurrence and mortality of ischemic heart disease, developing nations have recorded a constant rise. The burden of cardiovascular disease risk factors may explain this increase.

Methods

We conducted a population-based cross-sectional survey to estimate the prevalence of cardiovascular risk factors in the population protected by the Mexican Social Security Institute. A total of 20,062 Mexicans, aged ≥20 years, 43.5% (8,727) male and 56.5% (11,335) female, randomly selected in a 4-stage stratified population-based sampling process were included.

Results

The most prevalent cardiovascular risk factor in men was smoking (31.9%), whereas in women, it was obesity (26.6%) and central obesity (49.7%). A similar high age-adjusted prevalence was observed in women and men for hypertension (29.7% and 28.8%), diabetes (12.94% and 12.66%), and hypercholesterolemia (13.81% and 12.36%). There was a clear age effect on the prevalence of diabetes, hypertension, and hypercholesterolemia, with increasing prevalence with aging. Smoking also had an age effect, but its prevalence increases as age diminishes. More than half of the subjects in reproductive age (20-44 years old) have at least 1 cardiovascular risk factor, mainly smoking.

Conclusions

Cardiovascular risk factors are highly prevalent in the Mexican population, which seems to be between the second and third stages of the tobacco epidemic. The increased prevalence of risk factors clustering indicates the need for comprehensive integrated management of cardiovascular risk factors in Mexicans, with special emphasis on individuals at younger ages.

Section snippets

Methods

In 2006, a national population survey of the insured population of the IMSS was carried out with the purpose of evaluating the coverage of disease prevention measures undertaken by the institution. It was decided that the prevalence of main CVRF would be studied through the subsampling of the adult population this survey covered.

Results

The study encompassed 20,062 subjects ≥20 years old, of which 43.5% were men (8,727) and 56.5% were women (11,335). The prevalence of different CVRFs is shown on Table I, Table II. Hypertension was characterized by a similar elevated occurrence in both men (28.8%) and women (29.7%). In men, smoking was the most frequent risk factor (31.9%). At the same time, obesity was much more frequent in women (26.6%), as was central obesity (49.7%). Prevalence of diabetes and high serum cholesterol was

Discussion

Lifelong risk for CVD is among the highest ever published for humans, by far surpassing the risk of the most frequent forms of cancer, such as breast cancer in women or prostate cancer in men.²³ At age 50 years, 51.7% of men and 39.2% of women exhibit a lifelong risk for CVD.

The greatest lifelong risk for CVD is diabetes because 67.1% of men and 57.3% of women at age 50 years with diabetes will have a CVD at 75 years of age.²³ The high prevalence of diabetes observed in the population studied

Disclosures

None of the authors have any conflicts of interest to declare.

The work was supported by a grant from the Health Research Coordination, IMSS (Coordinación de Investigación en Salud, IMSS).

Acknowledgements

Gonzalo Gutiérrez and Onofre Muñoz participated in the conception of the study.

References (33)

OkrainecK. et al.
Coronary artery disease in the developing world
Am Heart J
(2004)
YusufS. et al.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): a case-control study
Lancet
(2004)
SchargrodskyH. et al.
CARMELA: assessment of cardiovascular risk in seven Latin American cities
Am J Med
(2008)
HertzR.P. et al.
Diabetes, hypertension, and dyslipidemia in Mexican Americans and non-Hispanic whites
Am J Prev Med
(2006)
LeeC.M.Y. et al.
Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis
J Clin Epidemiol
(2008)
Aguilar-SalinasC.A. et al.
High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nationwide survey
J Lipid Res
(2001)
ReddyK.S. et al.
Emerging epidemic of cardiovascular disease in developing countries
Circulation
(1998)
LozanoR. et al.
Trends of ischemic heart disease mortality in Mexico, 1950-1985
Salud Publica Mex
(1990)
RodríguezT. et al.
Trends in mortality from coronary heart and cerebrovascular disease in the Americas: 1970-2000
Heart
(2006)
Secretaría de Salud
Sistema Nacional de Información en Salud 2007. México

UnalB. et al.

Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary and secondary prevention

BMJ

(2005)

FordE.S. et al.

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000

N Engl J Med

(2007)

EscobedoJ. et al.

Serum cholesterol and diabetes mellitus: main independent risk factors of coronary heart disease mortality in Mexicans

Arch Inst Cardiol Mex

(1994)

Camacho-HernándezR. et al.

Risk factors for coronary heart disease in Mexico: a case-control study

Arch Inst Cardiol Mex

(1995)

CoronaI. et al.

Obesity, central fat distribution and ischemic heart disease in Mexican population

Arch Inst Cardio Mex

(1996)

EscobedoJ. et al.

High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study

Diabetic Medicine

(2009)

Cited by (34)

Cardiometabolic Risk Factors in Mexican Adults With Congenital Heart Disease
2023, JACC: Advances
In recent decades, adults living with congenital heart disease (ACHD) have improved their survival, thus increasing their predisposition to the onset of cardiometabolic risk factors and chronic health conditions.
The purpose of this study was to describe cardiometabolic risk profiles in the ACHD population and their relationship to congenital heart disease (CHD) lesion complexity.
We performed a cross-sectional study from ACHD in a third-tier referral center in Mexico City. The association between cardiometabolic risk factors and CHD complexity was estimated using logistic regression models.
Our study cohort included 1,171 ACHD patients (median age: 31 [IQR: 23.2-42.7] years, male 63.6%). Cardiac diagnosis was classified as mild (44.9%), moderate (37.8%), and severe (17.2%) CHD complexity. Low high-density lipoprotein cholesterol (55%) was the most common cardiometabolic risk factor; followed by insulin resistance (54.5%) and prediabetes (52.4%). Patients with mild and moderate CHD had a higher prevalence of obesity and metabolic syndrome, while patients with severe CHD had a higher prevalence of hyperuricemia and subclinical hypothyroidism. In the logistic regression analysis, the severity of CHD was associated with higher odds of hyperuricemia (moderate CHD, OR: 1.87; 95% CI: 1.20-2.93; P = 0.010; severe CHD, OR: 2.75; 95% CI: 1.64-4.62; P < 0.001) and lower risks of metabolic syndrome (OR: 0.61; 95% CI: 0.41-0.91; P = 0.010), prediabetes (OR: 0.58; 95% CI: 0.42-0.81; P < 0.001), and arterial hypertension (OR: 0.49; 95% CI: 0.33-0.74; P < 0.001) compared with mild CHD complexity.
We observed high rates of cardiometabolic risk factors in Mexican ACHD patients and these risk profiles varied by CHD lesion complexity. These results highlight the need for ongoing metabolic health surveillance in the ACHD population.
The effects of trade-induced worker displacement on health and mortality in Mexico
2021, Journal of Health Economics
Recent research in the U.S. links trade-induced job displacement to deaths of despair. Should we expect the same mortality response in developing countries? This paper analyzes the effect of a trade-induced negative shock to manufacturing employment on leading causes of mortality in Mexico between 1998 and 2013. I exploit cross-municipality variation in trade exposure based on differences in industry specialization before China’s accession to the WTO in 2001 to identify labor-demand shocks that are concentrated in manufacturing. I find trade-induced job loss increased mortality from diabetes, raised obesity rates, reduced physical activity, and lowered access to health insurance. These deaths were offset by declines in mortality from ischemic heart disease and chronic pulmonary disease. These findings highlight that negative employment shocks have heterogeneous impacts on mortality in developing countries, where falling incomes lead to less access to health care and nutritious food, but also reduce alcohol and tobacco use.
Hypertension, Diabetes and Obesity, Major Risk Factors for Death in Patients with COVID-19 in Mexico
2021, Archives of Medical Research
Citation Excerpt :
We estimated the population attributable fraction for diabetes, hypertension, and obesity, in both outpatients and inpatients. To estimate the population attributable fraction (AF) we used the available estimated diabetes (12.8%) and hypertension (29.3%) prevalence for the population covered by IMSS, (19) and the obesity national prevalence estimate (36.5%) from a national survey of 15′165,621 subjects ≥18 years, randomly selected and assessed at Family Medical Units in 2019. In the nine months of the epidemic in Mexico, 323,671 subjects with COVID-19 infection have been identified at the Mexican Institute of Social Security (Table 1).
Mexico has reported high death and case fatality rates due to COVID-19. Several comorbidities have been related to mortality in COVID-19, as hypertension, diabetes, coronary heart disease, chronic obstructive lung disease and chronic kidney disease.
To describe the main clinical characteristics of COVID-19 in the major social security institution in Mexico, as well as the contribution of chronic comorbidities and the population attributable fraction related to them.
Data for all patients with a positive test for SARS-CoV-2 in the institutional database was included for analysis. Demographic information, the presence of pneumonia and whether the patient was hospitalized or treated at home as an outpatient as well as comorbidities were analyzed. Case fatality rate was estimated for different groups. Odds ratios with 95% confidence intervals from a logistic regression model were estimated, as well as the population attributable fraction.
By November 13, 2020, 323,671 subjects with COVID-19 infection have been identified. Case fatality rate is higher in males (20.2%), than in females (13.0%), and increases with age. Case fatality rate increased with the presence of obesity, hypertension and/or diabetes. Age and sex were major independent risk factors for mortality, as well as the presence of pneumonia, diabetes, hypertension, obesity, immunosuppression, and end-stage kidney disease. The population attributable fraction due to obesity in outpatients was 16.8%.
Major cardiovascular risk factors and other comorbidities increase the risk of dying in patients with COVID-19. Identification of populations with high fatality in COVID-19, provides insight to deal with this pandemic by health services in Mexico.
Body Fat Percentage Rather than Body Mass Index Related to the High Occurrence of Type 2 Diabetes
2020, Archives of Medical Research
Citation Excerpt :
Nearly one third of the adult population in Mexico can now be classified as obese according with their body mass index (BMI), exceeding by 10 percentage points the prevalence observed at the beginning of the century. The prevalence of central obesity is also high, and both types of obesity are more common in Mexican women (1). The prevalence of type 2 diabetes is also nearly 13% in Mexico, the highest among the North American countries (2).
Diabetes prevalence estimation and reduction of its risk factors remain the major goals of health services. While obesity is the major risk factor for diabetes, body fat distribution may be a better predictor.
To estimate the prevalence of diabetes in an adult working population in Mexico City, and to evaluate the strength of association with different risk factors.
A cross-sectional survey was conducted in two city halls of Mexico City. Anthropometrics, blood pressure, physical activity, diet, and biochemical parameters were assessed. Diabetes was defined as a fasting plasma glucose level ≥7.0 mmol/l or referred diabetes. The bioelectrical impedance analysis of body components was performed and weight, soft lean mass, body fat percentage and abdominal fat were obtained. Prevalence with 95% confidence intervals was estimated, as well as odds ratios derived from a logistic regression model.
The prevalence of type 2 diabetes was 11.0% (95% CI 9.6–12.4%). The proportion of individuals with diabetes who were unaware of having the disease was higher in women (42.5 vs. 36.9%), and the degree of metabolic control was better in women (39.1 vs. 25.0%). Age, blood pressure, triglycerides and the percentage of body fat, were major risk factors related to the occurrence of type 2 diabetes. No relation was observed with physical activity and diet.
The prevalence of type 2 diabetes in Mexico continues to be high and obesity measured by body fat percentage seems to be a better predictor of its occurrence than body mass index.
The Methylenetetrahydrofolate Reductase C677T (rs1801133) and Apolipoprotein A5-1131T>C (rs662799) Polymorphisms, and Anemia Are Independent Risk Factors for Ischemic Stroke
2018, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
The prevalence of traditional risk factors explains the occurrence of ischemic stroke in different populations.1,2
Although there is adequate knowledge as to the role of traditional cardiovascular risk factors on stroke incidence, knowledge of other risk factors, particularly genetic ones, is still incomplete.
To assess the participation of some polymorphisms, along with other modifiable risk factors, a case–control study was conducted. A total of 253 cases were identified in the emergency room of a general regional hospital, with a clinical trait of stroke confirmed by a skull computerized axial tomography scan. In the surgery ward, 253 controls were identified, gender and age (±5 years) matched. Biochemical parameters were measured, and 4 polymorphisms were genotyped by polymerase chain reaction, rs1801133 (methylenetetrahydrofolate reductase [MTHFR]), rs1498373 (dimethylarginine dimethylaminohydrolase type 1 [DDAH1]), rs662799 (apolipoprotein A5 [APOA5]), and rs1799983 (endothelial nitric oxide). Odds ratios were estimated to assess the strength of association, with 95% confidence intervals, both in a matched case–control analysis and in a conditional regression analysis.
Cases had higher mean blood pressure and triglycerides and lower hemoglobin levels. Heterozygous and homozygous subjects to the rs1801133 variant of the MTHFR gene had a 3-fold higher risk of stroke. In the dominant model, those with the polymorphism rs662799 of the promoter region for APOA5 had twice the risk of stroke. Anemia increased the risk of stroke 4-fold.
Polymorphisms of the genes MTHFR (rs1801133) and APOA5 (rs662799), as well as anemia, are independent risk factors for stroke in Mexicans, together with traditional cardiovascular risk factors such as high triglycerides and high blood pressure.
Advanced oxidation protein products and their relationship with cardiovascular risk factors in young apparently healthy people
2017, Clinica e Investigacion en Arteriosclerosis
Los productos avanzados de oxidación proteica (PAOP) son un marcador para estimar estrés oxidativo en proteínas plasmáticas. El estrés oxidativo se considera un factor de riesgo cardiovascular (FRCV), relacionado con el aumento de presión arterial y la dislipidemia. Este trabajo tuvo por objetivo evaluar la asociación entre las concentraciones plasmáticas de PAOP y los FRCV en adultos jóvenes aparentemente sanos.
Estudio transversal comparativo prospectivo en 120 estudiantes de la Facultad de Químico Farmacobiología de la UMSNH, a los que se les determinó IMC, presión arterial, así como PAOP, glucosa, colesterol total, lipoproteínas (de alta, baja y muy baja densidad) y triglicéridos.
Los grupos de jóvenes con y sin FRCV presentaron diferencias significativas respecto a IMC, cintura, grasa corporal (p < 0,05) y perfil lipídico (p < 0,0001). Se presentaron cifras más altas de PAOP en el grupo de jóvenes con 3 y 4 FRCV (F: 4,651; p = 0,002). Los PAOP correlacionaron negativamente con el colesterol LDL (r = –0,364; p = 0,0001).
Se identificó que las concentraciones de PAOP se ven incrementadas conforme aumentan los FRCV en los jóvenes, por lo que estos podrían considerarse un factor importante de riesgo debido a que su depósito en la placa de ateroma favorece el proceso aterogénico y así el desarrollo de enfermedades cardiovasculares. La cuantificación de PAOP contribuye a la determinación indirecta del estado oxidativo en el organismo. El estudio del estado metabólico y oxidativo de jóvenes de aspecto saludable es de importancia en la prevención de enfermedades cardiovasculares en etapas posteriores de la vida, sin embargo, se requieren estudios longitudinales para estudiar su evolución.
Advanced oxidation protein products (AOPPs) are used as a marker to estimate oxidative stress in plasma proteins. Oxidative stress is considered a factor of cardiovascular risk (CVRF) related to increased blood pressure, and dyslipidaemia. The aim of this study was to evaluate the association between plasma AOPPs and CVRF in apparently healthy young adults.
A prospective cross-sectional study was conducted on 120 students of the Faculty of Chemical-Pharmacobiology of the UMSNH. Body mass index (BMI) and blood pressure were determined. A blood specimen was also collected to quantify AOPPs, glucose, total cholesterol, lipoproteins (high, low, and very low density), and triglycerides.
Differences were observed in the groups with and without CVRF, with significant differences in BMI, waist, body fat (P < .05), and lipid profile (P < .0001). AOPPs were higher in the group of young people with three and four CVRF (F: 4.651; P = .002). A negatively correlation was found between AOPPs and LDL cholesterol (r = –0.364; P = .0001).
It was observed that AOPPs concentrations are increased as CVRF increase in young adults. Thus, this could be considered an important risk factor, because their deposition in the atherosclerotic plaque favours the atherogenic process, and thus the development of cardiovascular disease. Quantification of AOPPs contributes to the indirect determination of oxidative status in the body. The study of metabolic and oxidative state of apparently healthy young adults is important in the prevention of cardiovascular disease in later life. More longitudinal studies are required to study its evolution.

View all citing articles on Scopus

View full text

Clinical InvestigationAcute Ischemic Heart DiseaseHigh burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Disclosures

Acknowledgements

Am Heart J

Lancet

Am J Med

Am J Prev Med

J Clin Epidemiol

J Lipid Res

Emerging epidemic of cardiovascular disease in developing countries

Circulation

Trends of ischemic heart disease mortality in Mexico, 1950-1985

Salud Publica Mex

Trends in mortality from coronary heart and cerebrovascular disease in the Americas: 1970-2000

Heart

Sistema Nacional de Información en Salud 2007. México

Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary and secondary prevention

BMJ

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000

N Engl J Med

Serum cholesterol and diabetes mellitus: main independent risk factors of coronary heart disease mortality in Mexicans

Arch Inst Cardiol Mex

Risk factors for coronary heart disease in Mexico: a case-control study

Arch Inst Cardiol Mex

Obesity, central fat distribution and ischemic heart disease in Mexican population

Arch Inst Cardio Mex

High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study

Diabetic Medicine

Clinical Investigation
Acute Ischemic Heart Disease
High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?