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R3i EDITORIAL

22 June 2017

Why we need to re-focus on Latin America

Prof. Jean Charles Fruchart, Prof. Michel Hermans, Prof. Pierre Amarenco

An Editorial from the R3i Trustees
Prof. Jean Charles Fruchart, Prof. Michel Hermans, Prof. Pierre Amarenco In March 2014, the Residual Risk Reduction Initiative (R3i) extended its mission to Latin America, recognizing the specific challenge of cardiometabolic disease in this region, a direct consequence of escalating rates of obesity and diabetes. This approach was in response to accumulating evidence that atherogenic dyslipidaemia was a key issue. For example, the Carmela study showed that the prevalence of dyslipidaemia was high albeit variable in seven Latin American countries, ranging from 75% in men in Barquisimeto to 24% in women in Buenos Aires.1 However, the definition used in this study was somewhat broad, encompassing high triglycerides (?200 mg/dl), high total cholesterol (?240 mg/dl), low levels of high-density lipoprotein cholesterol (HDL-C <40 mg/dl) and/or low-density lipoprotein cholesterol (LDL-C) not at goal. To encapsulate the risk of cardiometabolic disease in the region, the R3i recognized that it was essential to more precisely define the prevalence of atherogenic dyslipidaemia, the key driver of cardiometabolic complications.2,3

The new initiative by the Latin American Academy for the study of Lipids, featured in this month’s Focus article, is therefore much needed. The R3i would add their endorsement to those from a range of notable bodies including the Inter-American Society of Cardiology, the South American Society of Cardiology, the Pan-American College of Endothelium, and the International Atherosclerosis Society. The key aim of this initiative, to define the true prevalence and consequences of atherogenic dyslipidaemia in this region, is fundamental to the development of much needed region-specific guidelines for management of dyslipidaemia beyond LDL-C. These aims are also in alignment with the mission of the R3i.

Why is this initiative so critical to Latin America?
It is well recognized that there are inequalities in understanding cardiovascular risk in Latin America, most notably in the countries of Central America and northern South America.4 In addressing the need for a global study of atherogenic dyslipidaemia prevalence in this region, this initiative will provide a key step forward in ensuring cardiovascular disease management that is appropriate for this region.

The implications of this initiative go beyond the individual. Cardiovascular disease imposes a major burden on countries in this region, affecting more than 90 million people (almost a third of the adult population, 2015 data).5 Not only is there substantial impact on the individual, with nearly 7 million disability-adjusted life years, but there is also the economic cost to societies which can ill afford these. In 2015, the estimated total cost was estimated at more than £30 billion, although this did not allow for costs due to loss of productivity of those affected by cardiovascular disease.
Clearly new initiatives are needed to address the specific issues associated with cardiometabolic disease in this region. The urgent call for a global study of atherogenic dyslipidaemia by the Latin American Academy for the study of Lipids is a much-needed critical step in the development of region-specific guidelines for the management of dyslipidaemia, with the ultimate aim of countering the challenge of cardiometabolic disease in Latin America.

References

1. Vinueza R, Boissonnet CP, Acevedo M et al. Dyslipidemia in seven Latin American cities: CARMELA study. Prev Med 2010;50:106-11.
2. Fruchart JC, Sacks F, Hermans MP et al. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol 2008;102(10 Suppl):1K-34K.
3. Catapano AL, Graham I, De Backer G et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016;37:2999-3058.
4. Fleischer NL, Diez Roux AV. Inequities in cardiovascular diseases in Latin America [Spanish]. Rev Peru Med Exp Salud Publica 2013;30:641-8.
5. Stevens B, Pezzullo L, Verdian L et al. The economic burden of heart diseases in Latin America. World Congress of Cardiology & Cardiovascular Health 2016, 4-7 June, 2016, Mexico City, Mexico. https://www2.deloitte.com/content/dam/Deloitte/au/Documents/Economics/deloitte-au-economics-burden-heart-conditions-latin-america-090616.pdf