ABSTRACT
It has been determined that the prevalence and incidence of coronary artery disease has been lower in Puerto Rico than in the United States. In a controlled comparison with a matched cohort of men from Framingham, Mass, Puerto Rican men were found to have lower serum cholesterol and lower systolic blood pressure, to smoke less, to be more active physically, and to be less sensitive to coronary risk factors. Community surveys have shown that there is moderately less hypertension but more diabetes and possibly more obesity in Puerto Rico than in the United States. Hispanic groups in the United States have shown similar characteristics. Possible reasons for the relative protection from coronary artery disease in Puerto Rico include genetic factors, diet, and life-style. Recent epidemiologic data show that, although mortality from coronary disease and stroke has been steadily decreasing in the United States, it is increasing in Puerto Rico. Recent life-style and dietary changes, social stress, increased life expectancy, and a high death rate from diabetes and hypertension may be contributing to this reversal. Stronger efforts to control cardiovascular risk factors and to improve the management of diabetes and hypertension are needed in Puerto Rico