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Hearts and Minds in LAC II: What LAC Thinks About CVD
By Keith R | November 3, 2006
Topics: Health Issues, Pharmaceutical Issues | No Comments »
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Trying to Find the Story Behind the Story Behind LAC’s CVD
In Part I of “Hearts and Minds in LAC,” I expressed surprise that World Heart Day did not receive greater attention in Latin American and Caribbean (LAC) nations, given the region’s problem with cardiovascular disease (CVD). I also admitted that I myself had not been aware of World Heart Day and felt it had been given skimpy coverage here in the U.S. as well.
So how did I find out about it? By chance.
I ran across a news brief quoting an international survey released by the Geneva-based World Heart Federation (WHF) for World Heart Day that they said “reveals a significant gap between people’s desire to reduce their risk of cardiovascular disease and the preventive measures they are taking to do so.” The brief mentioned that the survey of men and women 40 or older in eight countries included Argentina and Mexico (the other six were Canada, China, Germany, South Korea, Spain and the US) but did not mention any survey results specific to those two nations.
Intrigued, I contacted the PR agency handling queries about the story and asked to see the data or summary thereof for Argentina and Mexico. With their help I received the country summaries and permission to use them.
In reading over the summaries I came across something that gives rise to the first caution I’ll make about interpreting this survey data: the survey was conducted by (or on behalf of) Bayer Healthcare. While that by itself does not necessarily make the results any less valid, interesting or useful, one should bear in mind when reading it that the survey sponsor had a stake in its outcome. Bayer not only makes the world’s best-known aspirin (often recommended by cardiologists for daily use for those at risk of heart disease), but also well-known hypertension treatments (Adalat®, Kritor®), daily vitamins that claim to have ingredients that help lower LDL cholesterol, and a diagnostic system for CVD (the ADVIA Centaur®). This might (emphasis on the might) have influenced how the survey was designed, how questions were posed and who was targeted for the survey.
The second caution comes in the design of the study: the results are based on about 300 men and women surveyed in each nation, and in the case of Argentina and Mexico, the interviews involved something the pollster calls “online panels.” This may scratch the surface of attitudes and habits in each nation, but cannot really be considered fully representative. For one thing, the respondents were all online — the market penetration of online services and activities among older Latin Americans is not nearly as high as it is among North Americans and Europeans, so the survey may be skewed to the attitudes and views of the better off, more net-attuned Argentines and Mexicans and not the average man/woman on the street.
It also is not clear how geographically spread the interviewees were — do these answer only represent attitudes in Mexico City and Buenos Aires, but not those outside the capitals?
With that in mind, let’s take a look at the results and the lessons they may hold for policymakers.
Argentina: Aware of the Problem, But Not Doing Enough
When Argentines over 40 were asked how important it was to take steps to keep their hearts “young and healthy,” nearly three out of every four (73%) answered “very important.” Although the lowest response of the eight nations surveyed, it is still respectable.
Almost two-thirds (62%) surveyed report having been diagnosed with a medical condition affecting their cardiovascular health (e.g. high cholesterol, diabetes, high blood pressure, stroke, etc).
Even so, many reported difficulty eating right: 20% of those ages 40-49 said that they ate fatty or “junk” food when under stress; this rose to 47% for those 60 years or older. [An interesting gender split here: 40% of the women agreed they ate such foods when stressed, but only 17% of the men.]
Most Argentines over 40 also agreed or strongly agreed that they did not get enough exercise to keep their hearts healthy: 61% said that they find it hard to find time to exercise, 71% agreed that their exercise levels have decreased over the years.
Argentines over 40 seem predisposed to try one of several possible “prevention therapies”: 89% agree or strongly that they would take anti-hypertension medicine if diagnosed with high blood pressure, 86% a cholesterol-lowering drug (mainly statins) if they were diagnosed with high cholesterol, and 76% would take low-dose aspirin once a day if they were considered at risk for CVD. The percentage of Argentines that would consider taking aspirin daily was the highest among the eight nations surveyed (and doubtless music to Bayer’s ears).
Mexico: Aware of the Problem, But Choosing Meds Over Lifestyle Changes
When Mexicans over 40 were asked how important it was to take steps to keep their hearts “young and healthy,” the lion’s share (88%) responded very important. This result was second highest among the eight nations surveyed.
Six of ten Mexicans over 40 surveyed report having been diagnosed with, or told that they are at risk of developing, at least one medical condition affecting their cardiovascular health (e.g. high cholesterol, diabetes, high blood pressure, stroke, etc).
Interestingly enough, the survey summary provided for Mexico omits any details of responses involving diet. Given both the traditional Mexican diet and its recent shifts, this is a curious omission.
Instead, the summary focuses on the exercise issue. Three of every four (73%) of the Mexicans surveyed said that they recognize engaging in regular, moderate exercise is very important to maintaining cardiovascular health. Although not bad, that was the lowest scores for that question among the eight nations surveryed. 47% (much less than Argentina) said that they find it hard to find time to exercise, 64% (again lower than Argentina) agreed that their exercise levels have decreased over the years.
Overall, Mexicans over 40 would more disposed to taking CVD medicines than any other nationality surveyed, but their percentage for taking aspirin was lower than Argentina’s. 90% agree or strongly that they would take anti-hypertension medicine if diagnosed with high blood pressure, 89% a cholesterol-lowering drug (mainly statins) if they were diagnosed with high cholesterol, and 68% would take low-dose aspirin once a day if they were considered at risk for CVD.
What Lessons for Policymakers?
It’s difficult to draw definitive lessons just from the limited data provided by the surveys — for Argentina and Mexico, much less for LAC as a whole. Are these results representative of the region?
Probably. One of my favorite Dominican cousins is a well-respected cardiologist who has been an prominent in the Dominican cardiology society. Whenever we meet we often talk about public health issues in the DR. He has told me more than once that while many Dominicans know generally that it is important for heart health to exercise and watch what one eats, most have little idea what exercises are best and what foods to favor and avoid. He also told me that there are no reliable statistics available on the extent of CVD in the DR or the prevalence of its risk factors, and that most Dominicans have no idea of what their blood pressure or cholesterol level is, or whether they are at risk of heart disease.
This is in line with some of the findings of the two Bayer surveys, and matches what I have heard from health officials in some other LAC nations, so I don’t think it is at all unique to the DR.
Bearing this in mind, plus the limited LAC celebration and press coverage of World Heart Day in 2006 (see Part I), and what I know about the impact of CVD in the region (see the pie graph at the end of Part I), I do have a few “food for thought” points for LAC public health policymakers to ponder:
- for 2007’s World Heart Day the WHF, the Pan American Health Organization (PAHO), national Health Ministries and national health services, the major hospitals, medical schools and cardiologists associations and colleges need to start planning now to make it a higher profile, higher impact event.
- perhaps as part of the planning and build-up, these parties should conduct their own data-gathering effort — national surveys on the prevalence of CVD, CVD risk factors, public attitudes about relevant diet and exercise, and the use (and possible misuse) and growth of preventive therapies, with some coordination and aggregation by PAHO at the subregional (CARICOM, Central America, Andean Community, MERCOSUR) and regional levels.
- All collected data should be widely disseminated and publicized as part of a well-funded, concerted public education program. If more LAC residents fully understood how prevalent and deadly CVD is to the region, and the importance and prevalence of the risk factors involved, perhaps more would seriously consider key lifestyle changes (adopting a healthier weight, avoiding fatty foods, getting proper exercise, stopping smoking, etc.), or at least be more open to public campaigns to promote such changes.
- Regular and broad-based outreach efforts on CVD should be undertaken by heart associations, medical schools and cardiology associations and facultades. Conduct free heart check days at major employment sites, hypermarkets (imagine if you managed to check everyone entering Wal-Mart and Carrefour in LAC!) and supermarkets, shopping malls, college campuses and major events open to the public, and send mobile heart-check caravans out to smaller towns.
- It is a sad commentary when the average LAC resident is more receptive to taking statins and hypertension medicines than engaging in proper diet and exercise. Don’t get me wrong — such therapies can and probably should be an important part of any public health strategy regarding CVD. But it appears that pharmaceutical companies are doing a better job at promoting their use than public health authorities are at promoting heart-friendly lifestyle choices that may reduce or prevent CVD risk in the first place.Recent market data reinforces this impression: according to IMS Health, the global healthcare information company, sales of CVD medicines in the 12 months market to August 2006 for Mexico were US$748 million (up 13% from the prior 12-month period) and US$360 million (up 19%) for Argentina. [Note: CVD drug sales in Brazil during the same period were US$1.173 billion, almost as much as Australia and New Zealand combined.]
Public health officials need to address the imbalance, since neither public health budgets nor family budgets in LAC nations can long support rapid increases in spending on such therapies, nor on the other costs associated with cardiovascular disease. Yes, it’s more difficult to get people to change eating and exercise habits (and stop smoking) than it is to get them to take a pill, but in the long run, probably less costly and more beneficial for both the average family and LAC society as a whole.
— Keith R
Tags: Adalat, ADVIA Centaur, Argentina, aspirin, Bayer Healthcare, Canada, cardiologists, cardiovascular disease, Carrefour, China, cholesterol, colesterol, Día Mundial del Corazón, diabetes, encuesta, enfermedades cardiovasculares, EUA, fatty foods, Germany, healthy lifestyle, high blood pressure, high cholesterol, hipertensión, hypertension, IMS Health, junk food, Kritor, LDL, Mexico, obesidad, obesity, OPS, PAHO, sondagem, South Korea, Spain, statins, stroke, survey, Wal-Mart, WHF, World Heart Day
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