Novartis Aztra Zeneca

Sanofi AventisSchering Plough

AsofarmaPfizer

Merck SeronoMerck Sharp Dohme

BayerAbbottServierRoche

MenariniTakedaFerrer

DISCLOSUREAdvisory Board Research

Economic Growth, Income, Employment and

Cardiovascular Disease

Dr. Fernando Stuardo Wyss Quintana Md, Phd, GCSM, ESHM, ESCM

Vice-president of Interamerican Society of Cardiology Guatemala City, Guatemala, C.A.

fernandowyss@gmail.com

Globalization / Urbanization and the Epidemiologic Transition

Our final Conclusion be that from the point of view of Cardiovascular Disease

powerfuls, arrogants and impotents

Vital Basic Basket and Minimum Wage

The National Survey of Living Conditions ENCOVI 2006

Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

VITAL BASIC BASKET

FOOD

AGRICULTURE WAGE NOT AGRICULTURE WAGE

Vital Basic Basket and Minimum Wage

The National Survey of Living Conditions ENCOVI 2006

Wyss; Source: Based on data: Guatemala 2011 government salary

- Agriculture / not Agriculture Q. 2,187.54 per month $ 276.90

- Export and manufacture Q. 2,058.27 per month $ 260.24

- Cardiologist in GH Q. 4,000.00 per month $ 506.32

In accordance with Government Agreement No. 388-2010 published in the Journal of Central America, December 30, 2010, establishes the new minimum wage that

governed from January 1, 2011.

All Poor Extremely Poor Poor Not Poor0

10

20

30

40

50

60

70

80

51

15

36

49

75

27

48

25

36

8

29

64

All PopulationIndigenousNon-Indigenous

N = 12,987,829

Guatemala: Poverty nationwide distribution of poverty by ethnic identity National Survey of Living Conditions 2006 ENCOVI absolute

and relative numbers

Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

%

The National Survey of Living Conditions ENCOVI 2006

Guatemala: Poverty Incidence by Region

Wyss; Source: Based on data from the National Survey of Living Conditions ENCOVI 2006.

All Poor´ 51%Extremely poor 15%Poor 36% Not Poor 49%

The National Survey of Living Conditions ENCOVI 2006

The National Survey of Living Conditions ENCOVI 2006

Incidence of Poverty in each Department

Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

Poor Not Poor

11%1%

Guatemala: Social Spending on Education, Health and Housing% Of GDP (Gross Domestic Product), 2001 -2007.

The National Survey of Living Conditions ENCOVI 2006

Education Health Housing

Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

1.7574 %

Guatemala: Social Spending on Health % Of GDP

(Gross Domestic Product), 2001 -2007.

13

3

36

6

% GDP 2001 - 2007

GuatemalaEl SalvadorHondurasNicaraguaCosta RicaPanama

The National Survey of Living Conditions ENCOVI 2006

Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

Cardiovascular Risk Assessment in Guatemala

• General population

• Bedroom City´s

• Chronically ill population

• High-income population

Data in Pediatric Populations

OBESITY IN ELEMENTARY SCHOOL EDUCATION, UNIVERSITY OF SAN

CARLOS DE GUATEMALA

67%

Dr. Luis Moya MD, PhD; Verbal Information

Cardiometabolic Risk Factors Guatemalan Heart League

N = 111,201

Dr. Wyss, Data Base; Guatemalan Heart League

HypertensionDiabetes MellitusDyslipidemia

HypertensionDiabetes Mellitus

Dyslipidemia

0

5

10

15

20

25

30

35

25

43

35

8

6

34

8

6

200120072008

Cardiometabolic Risk Factors Guatemalan Heart League

Dr. Wyss, Data Base; Guatemalan Heart League

%

N = 111,201

Commuter Town StudyThe Villa Nueva Study, OPS, OMS CDC

OPS, OMS, Villa Nueva Study Paper

OverweigthAbnormal glucouse Hypertension Obesity Abdominal Circunference

Prevalence of Metabolic Syndrome Hypertension Unit, St. Jhon of God General Hospital

Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

Hypertension Obesity

• 398 patients• Routine Cardiovascular Screening• High income• Lifestyle modification• Fitness cardiovascular activity• Play Golf• Balanced diet• They drink wine

Global Cardiovascular Risk Assessment in an apparently healthy population EVRICARDS

Fernando Wyss; in press, 2010

LIPID PROFILE

BLOOD PRESURE

Economic Growth, Income, Employment and

Cardiovascular Disease ??We have a social difference in the appearance of

cardiovascular disease ?

Stroke. 2012; 43 /doi: 10.1161/ STROKEAHA.111.632158

This study demonstrated an association between low GDP of a country:

1. A 32% increase stroke risk

2. An increase in the rate of death at 30 days post-stroke by 43%

3. An excess of 43% in intracerebral hemorrhage

4. An increase of almost double the incidence of stroke in young individuals.

Gross Domestic Product and Health Expenditure Associated With Incidence, 30-Day Fatality, and Age at Stroke Onset, A Systematic ReviewLuciano A. Sposato, MD, MBA; Gustavo Saposnik, MD, MSc, FAHA

Also, a low total health expenditure was correlated with a proportional increase in the rate of death at 30 days and:

1. A 26% increase stroke risk

2. An increase of 45% death rate at 30 days post-stroke

3. An excess of 32% in intracerebral hemorrhage

4. A 36% increase in the incidence of stroke in young individuals.

Gross Domestic Product and Health Expenditure Associated With Incidence, 30-Day Fatality, and Age at Stroke Onset, A Systematic ReviewLuciano A. Sposato, MD, MBA; Gustavo Saposnik, MD, MSc, FAHA

Stroke. 2012; 43 /doi: 10.1161/ STROKEAHA.111.632158

Intervention ModelHigh Income and compare the Relative Risk Reduction of Low-Income

POOR male NOT POOR male

POOR female NOT POOR female

74 80 65 66

161 169 151 157

29 28 29 26

BMIHEIGHT cmWEIGTH kg

Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations

N = 1403

Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

100

90

80

70

60

50

40

30

20

10

0

Obesity

RRR 4% RRR 11%

POOR

NOT POOR

94

96

94

90

MALEFEMALE

0 20 40 60 80 100

Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

N = 1403

Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations

Abdominal Circunference

RRR 5%

TOTAL CHOLESTEROL HDL

TRIGLICERIDESLDL

0

10

20

30

40

50

60

70

48

65 70

5544 4858

51

POORNOT POOR

Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

N = 1403

%

Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations

LIPID PROFILE´S

RRR 9% 27% 18% 32%

Diabetes MellitusInsulin Resistence

0

5

10

15

20

25

30

35

21 24

7

34

POORNOT POOR

Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

Cardiometabolic Risk Factors Differences Between High-Income and Low-Incomes Populations

Insulin Resistence and Diabetes Mellitus

RRR 67%

(Glucosa > 100 / < 126 mg7dl )

Prevalence of Hypertension in the Central American and the Caribbean

Wyss et al, CLCC, from Central America and Caribbean Board, march 2008

Prevalence of Dyslipidemia in the Central American and the Caribbean

Wyss et al, CLCC, from Central America and Caribbean Board, march 2008

Wyss et al, CLCC, from Central America and Caribbean Board, march 2008

Prevalence of Diabetes in the Central Americanand the Caribbean

Wyss et al, CLCC, from Central America and Caribbean Board, march 2008

Prevalence of obesity in the Central Americanand the Caribbean

CONCLUSIONS

National Statistics Institute INE - Guatemala, 2006

Rich People Middle Class Poor People

1. Overweight2. Prehypertension3. Mild dyslipidemia4. Smoking

1. Overweight / Obesity2. Hypertension I - II3. Mixed Dyslipidemia4. Smoking5. IR / Diabetes

1. Obesity2. Hypertension II - I3. Mixed Dyslipidemia4. Diabetes / IR

CENTRAL AMERICA AND CARIBBEANIn some countries of the Region, out-of-pocket expenditures account for up

to 78% of spending on medicines, and this can be catastrophic for low-income families and populations.

1. Money makes the difference in CVD and MACCE

2. The provision of human resources and training materials in adequate number if necessary

3. Access to primary prevention for POOR PEOPLE

4. Improved accessibility and availability of medicines

5. The impact of social, demographic, epidemiological and technological advances in CVD requires reorienting periodically plans of study, undergraduate and graduate, in each country to adapt to their training needs.

Pan American Health Organization.“Regional Consultation: Priorities for Cardiovascular Health in the Americas. Key Messages for Policymakers”

Washington, D.C.: PAHO, © 2011-

Cost-Effectiveness of Community-Based Strategies for Blood Pressure Control in a Low-Income Developing Country: Findings From a Cluster-Randomized, Factorial-Controlled Trial

1. Combined Home Health Education (HHE) plus Trained General Practitioner (GP)

2. HHE only3. Trained GP only

The combined intervention of HHE plus trained GP is potentially affordable and more cost-effective for BP control than usual care or either strategy alone in some communities in Pakistan, and possibly other countries in Indochina with similar healthcare infrastructure.

Circulation. 2011;124:1615-1625

Globalization / Urbanization and the Epidemiologic Transition

Pan American Health Organization.“Regional Consultation: Priorities for Cardiovascular Health in the Americas. Key Messages for Policymakers”

Washington, D.C.: PAHO, © 2011-

We have a social difference in the appearance of

Cardiovascular Disease ?

Economic Growth

Income

Employment

MAKES A DIFFERENCE

YES !!!