Résumé
This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI) attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR). AR were estimated using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR) derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass Index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Infarctus du myocarde , Études cas-témoins , Amérique latine , Analyse multifactorielle , Odds ratio , Prévalence , Facteurs de risqueRésumé
La hipertension arterial es una de las enfermedades que frecuentemente enfrentan los medicos de la familia. El numero de pacientes hipertensos controlados en el mundo y en nuestro pais es aun bajo. Se efectuo un estudio para medir la efectividad de un grupo de acciones dirigidas al control del paciente hipertenso. Se ejecuto con los 76 pacientes hipertensos encontrados entre las 532 personas adultas de un consultorio del medico de la familia. A cada enfermo se le ofrecieron charlas sobre su enfermedad y sus riesgos, se le aclararon dudas y se discutio el tratamiento que se le indicaba. Los pacientes fueron seguidos durante 18 meses. Se hallo una prevalencia mayor en las mujeres (14,2 por ciento) y se logro controlar a mas del 80 por ciento de los casos durante todo el periodo. La cifra media de presion arterial disminuyo notablemente en ambos sexos, como resultado de los metodos de control utilizados