In the first population-based study to estimate how many people in Haiti have cardiovascular disease, researchers from local health care organization GHESKIO and Weill Cornell Medicine in New York City. I found that Twelve percent of participants in the capital, Port-au-Prince, had early-stage heart failure — a rate more than 15 times higher than previous estimates and more than three times higher than that of black Americans.
Research that emerged from this study The Lancet Regional Health Americas, “This directly translates to improved health outcomes in Haiti as a model for similar low-income countries,” said Margaret McNairy, lead researcher on the study and a member of Weill Cornell Medicine’s Center for Global Health.
Although it is predicted 80% of the world’s cardiovascular diseases For diseases that affect people in low- and middle-income countries, the researchers note that prior to this study, there was little direct data from these settings to quantify how many people have these diseases, whether statistics are changing, and what the consequences are for these populations.
The study found that about 15 percent of Haitian adults suffer from heart failure, stroke, heart attack or chest pain, and most of them suffer from hardening of the heart muscle.
Among participants with heart failure, 68.5% were women.
These figures suggest that cardiovascular disease is a widespread problem for Haitians, and the most common risk factor for heart failure is high blood pressure, known as hypertension. Despite the link between the two diseases, Previous research It found that only 13% of Haitian adults with hypertension have their blood pressure under control.
Local data are essential to “designing practical, tailored interventions for primary prevention and treatment of cardiovascular disease,” says study correspondent Lily Yang, assistant professor of medicine at Weill Cornell University. “If we can lower blood pressure even a little bit at the population level, we can reduce cardiovascular disease mortality.”
Inside the lab
From 2019 to 2021, GHESKIO community outreach workers surveyed participants in the Haiti Cardiovascular Disease Cohort, a population-based urban cohort of approximately 3,000 Port-au-Prince residents aged 18 and older. Of the participants, 58.1% were women.
All participants answered health questionnaires and underwent a comprehensive physical examination, including blood pressure measurement and blood tests, at the GHESKIO Cardiovascular Disease Clinic. They also underwent non-invasive tests such as an electrocardiogram, which measures the heart’s electrical activity, and an echocardiogram, an ultrasound scan that shows how well the heart muscle and valves are functioning.
Among participants with heart failure, 68.5% were women and the median age was 57 years. The average age was recorded as 72 years old. Among similar U.S. residents, gender differences are evident, and researchers are investigating why they exist.
Heart failure is a category of cardiovascular disease. It is a chronic condition that occurs when the heart muscle cannot pump enough blood to meet the body’s needs. This results in blood pooling and fluid buildup in the lungs and legs, causing shortness of breath and swelling in the legs.
Heart failure also has a very high one-year mortality rate, McNairy said. The most common subtype was heart failure with preserved ejection fraction, which was present in 80.4 percent of participants. This type of heart failure, traditionally thought of as a disease of older adults, can also affect younger patients and reduce their quality of life.
Preventing heart disease
With a focus on prevention strategies, Weill Cornell and GHESKIO are partnering with the Haitian Ministry of Health and the Haitian College of Cardiology to develop guidelines and train health care workers on proper blood pressure measurement, as well as to expand knowledge and services about cardiovascular disease, including community-based screening and treatment of risk factors such as hypertension.
A doctor examines an X-ray of a patient’s heart at the Degando Clinic in Port-au-Prince, Haiti, on April 15, 2012.
REUTERS/Swan Parker
“Prevention is the most important aspect of our work,” says Rodney Safra, chief physician at the GHESKIO Cardiovascular Diseases Clinic in Port-au-Prince. “We [that] Controlling high blood pressure is an important step in preventing heart failure and death from cardiovascular disease.” The researchers also found that heart failure was associated with obesity, chronic kidney disease, depression and stress.
Other efforts, McNairy said, aim to educate inner-city residents about the impact of excess salt on blood pressure and the importance of reducing their salt intake. She and her collaborators are also studying the effects of heavy metals and air pollution on high blood pressure and ways to reduce their exposure.
“GHESKIO, with the support of Weill Cornell Medicine, has helped treat thousands of heart failure patients across all of its clinics,” says Vanessa Rouzier, assistant professor of medicine at Weill Cornell and director of research at GHESKIO. The organization provides outpatient care and medications free of charge, and refers patients to local hospitals if inpatient care is needed, Sufulla adds.
Next steps
“For 40 years, Weill Cornell has partnered with GHESKIO to build an equitable global health partnership focused on clinical care for the most vulnerable and training and capacity building for Haitians,” McNairy said.
The concerted effort to eliminate cardiovascular disease in Haiti grew out of earlier efforts to control HIV/AIDS and tuberculosis (TB). For more than 30 years, HIV/AIDS has been the leading cause of death among adults in Haiti, says Jean Pape, executive director of GHESKIO and professor at Cornell University Medical School. GHESKIO was founded in 1982 as the first developing country to lead the fight against HIV/AIDS.
In Port-au-Prince, nearly one in three adults, including those under 30, suffer from high blood pressure.
“Our work as one of the world’s first and largest HIV and TB centers has been a major factor in shifting AIDS to the seventh leading cause of death in our population,” says Papé. “Cardiovascular disease is now the number one cause of death, by a large margin. Our AIDS patients are more likely to die from cardiovascular disease than from HIV-related infections.”
In Port-au-Prince, nearly one in three adults suffers from high blood pressure, including those under the age of 30. The number of people aged 18 to 30 with high blood pressure in Haiti is about two to four times higher than in other countries. Young black American coworker.
Although 97 percent of Haitian adults are screened for high blood pressure, only 13 percent have it under control, says Mary Masterson, program director at the National Heart, Lung, and Blood Institute, part of the National Institutes of Health in Bethesda, Maryland, which funds cardiovascular disease research in Haiti.
A previous study in Haiti found that women were six times more likely to be obese than men, Another study The results showed that there was no effect on the prevalence of heart failure between the two groups.
“Findings of this nature merit investigation and highlight the potential impact this and other studies can have on the research community,” Masterson said. “We need to better understand the mechanisms and risk factors that influence disease symptoms.”
People walk through an open-air market in Petionville, Port-au-Prince, Haiti, on February 28, 2020.
REUTERS/Andres Martinez Casares
