INTRODUCTION
⌅Coronary risk factors are physical, psychological or social agents that expose individuals to an increased susceptibility to suffer from heart disease (Álvarez et al, 2014Álvarez, R. (2014). Medicina general integral. Volumen II. Editorial Ciencias Médicas. http://aulavirtual.sld.cu/pluginfile.php/74420/mod_resource/content/1/medicinagraltomo2.pdf ). Its identification and modification is essential for the prevention and treatment of coronary diseases at all health levels (Cartaya-Ortiz & Del Prado, 2021Cartaya, E. & Del Prado, L. M. (2021). Factores de riesgo de trastornos coronarios en pacientes con cardiopatía isquémica incluidos en un programa de rehabilitación cardiovascular. MEDISAN, 25(1), 111-122. https://www.medigraphic.com/pdfs/medisan/mds-2021/mds211i.pdf ).
There are different coronary risk factors considered non-communicable chronic diseases and others as inappropriate habits, which predispose and precipitate the onset of cardiovascular or cerebrovascular diseases.
These, together with other factors such as age, sex and personality type, increase the chances of suffering from these diseases at an increasingly early age (Álvarez et al, 2014Álvarez, R. (2014). Medicina general integral. Volumen II. Editorial Ciencias Médicas. http://aulavirtual.sld.cu/pluginfile.php/74420/mod_resource/content/1/medicinagraltomo2.pdf ; ACSM, 2018American College of Sport Medicine, ACSM (2018). Guidelines exercise testing and prescription. Tenth edition. Editorial Lippincott Williams and Wilkins. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139760/ , MINSAP, 2019).
The longer the influence of these factors is maintained, depending on their irreversibility, the greater the impact on the organism, which, as an aggravating factor, has the particularity of not arising in isolation, but rather have a cause and effect relationship between them, for what an individual has a risk factor, must be carefully evaluated for the presence of other aggravating agents for their health.
Physical exercise is a very useful instrument to intervene in advance and avoid or reduce the damage to health caused by coronary risk factors. The precept of physical exercises, like other therapies, is based on an adequate knowledge of its benefit-risk relationship, on the diagnosis of the particulars of the participants, as well as on adequate control and supervision by qualified personnel; when it is, the benefits are maximum and it is safe for most individuals (ACSM, 2018American College of Sport Medicine, ACSM (2018). Guidelines exercise testing and prescription. Tenth edition. Editorial Lippincott Williams and Wilkins. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139760/ ; Cartaya-Ortiz & Del Prado, 2021Cartaya, E. & Del Prado, L. M. (2021). Factores de riesgo de trastornos coronarios en pacientes con cardiopatía isquémica incluidos en un programa de rehabilitación cardiovascular. MEDISAN, 25(1), 111-122. https://www.medigraphic.com/pdfs/medisan/mds-2021/mds211i.pdf ).
In addition, for it to serve its purposes, it must have an adequate rate of progression, depending on the functional capacity of the individual, their age, state of health, needs, objectives and preferences (Abellán-Alemán, Sainz de Baranda-Andujar & Ortín- Ortín, 2010, p.68Abellán, J., Sainz de Baranda, P. & Ortín, E. J. (2010). Guía para la prescripción de ejercicio físico en pacientes con riesgo cardiovascular. Sociedad Española de Hipertensión. Liga Española para la Lucha contra la Hipertensión Arterial. https://sid.usal.es/idocs/F8/FDO25050/seh-guia-01.pdf )
The study's general objective was to identify the main coronary risk factors present in a sample of Cuban adults, as a tool to increase the individualization of physical exercise programs.
MATERIALS AND METHODS
⌅A descriptive cross-sectional study was developed, using a sample of 467 participants between 40 to 69 years of age, 280 women and 187 men, who attended community health promotion centers due to risk coronary factors. At the beginning of this stage of life, aging processes begin to become more evident and it is necessary to pay attention to them to guarantee a better quality of life when they reach the elderly and avoid the occurrence of deaths at an early age due to cardiovascular or cerebrovascular diseases.
A health questioning was applied to those selected individuals that included general personal, family and health data (age, weight, height, toxic habits, the disease for which they attended the program, other diseases suffered and history of the practice of physical exercises). Regarding the family history, the main diseases suffered by the parents and, if they were deceased, the causes were investigated. In addition, their resting blood pressure and heart rate were measured.
The inclusion criteria were the systematic participation in the exercise programs, the signing of the informed consent of the participants and the commitment of the work team, the ethical management of the information provided, as stipulated by the Helsinki Convention (World Medical Association, 2013World Medical Association (2013). World Medical Association Declaration of Helsinki ethical principles for medical research involving human subjects. JAMA: Journal of the American Medical Association, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053 ).
RESULTS
⌅The following tables show the fundamental results of the study.
| Age ranges | 40-44 | 45 - 49 | 50 - 54 | 55-59 | 60-64 | 65-69 | Total |
|---|---|---|---|---|---|---|---|
| Women | 42 | 54 | 62 | 31 | 48 | 43 | 280 |
| Men | 31 | 33 | 44 | 18 | 31 | 30 | 187 |
| X | 54 | ||||||
| SD | 9,4 | ||||||
For the stratification by age ranges, the criteria of the yearbook of the Oficina Nacional Estadística e Information, ONEI (2021, p. 17)Oficina Nacional de Estadística e Información, ONEI (2021). Anuario estadístico de Cuba 2020. Población. Oficina Nacional de Estadística e Información. www.onei.gob.cu were assumed.
| Diseases | Women | Men | Total | Percentage |
|---|---|---|---|---|
| Obesity | 234 | 137 | 371 | 79,4% |
| Arterial hypertension | 183 | 112 | 295 | 63,2% |
| Obese-hypertensive | 148 | 77 | 225 | 48,2% |
| Myocardial infarction | 8 | 11 | 19 | 4,1% |
| Anginas | 8 | 5 | 13 | 2,8% |
| Diabetes mellitus | 44 | 37 | 81 | 17,3% |
| Hyperlipidaemia | 28 | 31 | 59 | 12,6% |
| Bronchial asthma | 24 | 14 | 38 | 8,1% |
| Chronic bronchitis | 23 | 10 | 33 | 7,1 % |
| Pulmonary emphysema | 5 | 5 | 10 | 2,1% |
| Venous insufficiency | 18 | 2 | 20 | 4,3% |
| Parkinson's disease | 2 | 4 | 6 | 1,3% |
| Musculoskeletal diseases | 49 | 40 | 89 | 19,1% |
| Ranks | Classification | Men | Women | Total | % |
|---|---|---|---|---|---|
| Over 140 / Under 90 | Isolated systolic HBP | 10 | 13 | 23 | 7,8 % |
| 120-139 / 80-89 | Pre-hypertension | 22 | 38 | 60 | 20,3 % |
| 140- 159 / 90-99 | HBP Grade I | 57 | 89 | 146 | 49,5 % |
| 160- 179 / 100-109 | HBP Grade II | 23 | 43 | 66 | 22,4 % |
| Subtotal | 112 | 183 | 295 | ||
| Total | |||||
To establish the classification, the criteria of Pérez et al (2017, p.12)Pérez, Y. & Soto, A. (2017). Factores de riesgo de las enfermedades cardiovasculares [Trabajo de grado, Facultad de Farmacia] Universidad Complutense de Madrid. http://147.96.70.122/Web/TFG/TFG/Memoria/ANA%20SOTO%20GARCIA.pdf were assumed. The blood pressure figures reflected are the result of the measurement at rest during the study.
| Type of diabetes | Men | Women | Total | % |
|---|---|---|---|---|
| Insulin dependent | 5 | 7 | 12 | 14,8 % |
| Non-insulin dependent | 32 | 37 | 69 | 85,2 % |
| Total | 37 | 44 | 81 |
| Risk stratification | Number | Percentage |
|---|---|---|
| Low risk | 95 | 20,4% |
| Moderate risk | 332 | 71,1% |
| High risk | 40 | 8,5% |
To establish the stratification, the ACSM (2010, p.34) criterion was assumed, with the purpose of optimizing the guidelines in the treatments to be followed, where the number of risk factors and the diagnosis of cardiorespiratory or metabolic diseases taken into account are present. In this way, the participants were classified as:
Low risk: Men under 45 years old, and women under 55 years old, asymptomatic and with no more than one risk factor.
Moderate risk: 45 year-old men and older and 55 year-old women and older, or with symptoms of two or more coronary risk factors.
High risk: Individuals with one or more signs and symptoms of cardiovascular, pulmonary or metabolic diseases.
| Toxic habits | Women | Men | Total | Percentage |
|---|---|---|---|---|
| Alcohol consumption | 15 | 80 | 95 | 20,3 % |
| Smoking | 60 | 75 | 135 | 28,9 % |
| Coffee consumption | 176 | 99 | 275 | 58,9 % |
| Other habits | Did not refer | |||
| Accumulation | Women | Men | Total | Percentage |
|---|---|---|---|---|
| No toxic habits | 127 | 61 | 188 | 40,2 % |
| With 1 toxic habit | 59 | 84 | 143 | 30,6 % |
| With 2 toxic habits | 36 | 63 | 99 | 21,2 % |
| With 3 toxic habits | 13 | 24 | 37 | 8 % |
To establish the criteria on the presence of toxic habits, the consumption of more than two cups of coffee per day was determined (Pardo-Lozano et al, 2007, p. 9Pardo, R., Álvarez, Y., Barral, D. & Farré, M. (2007). Cafeína: un nutriente, un fármaco, o una droga de abuso. Adicciones, 19(3), 225-238. http://www.redalyc.org/articulo.oa?id=289122084002 ), smokers who consumed more than 10 cigarettes per day (Álvarez, 2008, p. 418) and, the alcohol consumption of 2 or more servings of different drinks per week (Castro-Juárez et al, 2018, p. 158Castro, C. J., Cabrera, C. E., Ramírez, S. A., García, L., Morales, L. & Ramírez, H. R. (2018). Factores de riesgo para enfermedad cardiovascular en adultos mexicanos. Revista Médica, 9(2),152-162. www.revistamedicamd.com ).
DISCUSSION
⌅The main results illustrate that the most common risk factors are: obesity (79.4%) and hypertension (63.2%); of the total, 48.2% individuals are obese-hypertensive. Except for 25 individuals who only suffer obesity, 23 hypertensive, 4 with high cholesterol levels and 6 diabetics, the rest suffer from more than one risk factor or chronic non-communicable disease, which constitutes an increased risk of suffering from cardiovascular disease.
Regarding arterial hypertension, 49.5% (146) of the participants had figures between 140-159 and 90-99 (Grade I). Furthermore, of the 81 diabetic participants, 85.2% (69) did not require insulin to control the disease.
According to the risk stratification, participants with moderate risk predominated (332, 71.1%) because they are individuals with symptoms of a chronic non-communicable disease and/or two more factors. These results confirm that, although they maintain physical activity, a high percentage is prone to suffering from cardiovascular and cerebrovascular disease in the future.
The risks to these participants are increased when analyzing toxic habits. In Tables 6 and 7, 276 participants (59.1%) consume substances that are harmful to health, 38.6% (108) of the women report toxic habits; of them 95 (33.9%) declared having between one and two. In men, 93% declared the presence of toxic habits and 147 (78.6%) reported the presence between one and two. These results show a higher frequency of toxic habits in men and a predominance of the presence of between one and two in both sexes.
Coffee consumption is the most common habit (275, 58.9%), however, although they have lower figures, alcohol and tobacco consumption is relatively high, with 95 (20.3%) and 135 (28, 9%) respectively. (,) Aspect to take into account due to the negative impact they have on personal health, family and society.
Various national and international studies have directed their attention to coronary risk factors. The health report of the Centro Nacional de Información de Ciencias Médicas, CNICM, (2019, pp. 12-13)Centro Nacional de Información de Ciencias Médicas. Biblioteca Médica Nacional. Cuba (2019). Indicadores de Salud. Factográfico salud. http://files.sld.cu/bmn/files/2019/01/factografico-de-salud-enero-2019.pdf shows the incidence in the Cuban adult population of risk factors, where, the percentage of the diabetic population in the 2014 ranged from 9.6% in women to 7.3% in men. In 2015, 16.9% of women and 20.9% of men suffered from high blood pressure. In 2016, 62.5% of women and 54.5% of men were overweight or obese. 42.8% and 30.9%, respectively, had insufficient physical activity regimen. Regarding tobacco and alcohol consumption, around 57.3% of men and 17.1% of women are regular smokers and the per capita alcohol consumption was around 6.1 liters.
Moreno et al (2008, p. 151)Moreno, F. L., Escobar, A., Díaz, F., Alegret, M., López, O., Miranda, I., Navas, M. & González, R. (2008). Factores de riesgo coronario y riesgo cardiovascular en personas adultas de un área de salud de Rancho Veloz (Cuba). Clínica e investigación en arteriosclerosis, 20(4), 151-161. in a sample from Villa Clara province, identified as predominant coronary risk factors, sedentary lifestyle, high blood pressure, obesity and smoking. A high percentage of the supposedly healthy participants had several coronary risk factors for coronary heart disease.
Hernández and Valdés (2014, p. 14)Hernández, J. & Valdés, M. (2014). Riesgo cardiovascular durante el climaterio y la menopausia en mujeres de Santa Cruz del Norte, Cuba. Revista chilena de obstetricia y ginecología, 79(1), 14-20. https://dx.doi.org/10.4067/S0717-75262014000100003 in a sample of 317 women from Santa Cruz del Norte, Mayabeque, divided into two groups, one in the climacteric or menopausal stage and the other between 20 and 39 years of age, identified a strong and significant correlation between age, Waist-Hip Index (ICC) and glycemia, a weak and significant correlation between age, Body Mass Index (BMI) and cholesterol. They concluded that during the climacteric and menopause stage there are changes in some anthropometric and metabolic values that increase the risk of cardiovascular diseases.
Varona et al (2015, p. 1561)Varona, P., Armas, N., Suárez, R., Bonet, M. & Dueñas, A. (2015). Estimación del riesgo cardiovascular en la población cubana. Una aproximación al tema. Revista Cubana de Cardiología y Cirugía Cardiovascular, 21(4). http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/606 , based on the III National Survey of Risk Factors for Non communicable Diseases, 2010-2011 and the risk prediction tables of the World Health Organization, identified that 5.2% of the Cuban population had high and very high cardiovascular risk, 8.6% moderate risk and 86% low risk. The higher risk prevailed in men from urban areas and in women the low risk predominated. It was also defined that the risk increased with age.
Pérez-Fernández & Soto-García (2017, pp. 7-17)Pérez, Y. & Soto, A. (2017). Factores de riesgo de las enfermedades cardiovasculares [Trabajo de grado, Facultad de Farmacia] Universidad Complutense de Madrid. http://147.96.70.122/Web/TFG/TFG/Memoria/ANA%20SOTO%20GARCIA.pdf , in a sample of autonomous communities in Spain, obtained the results that 2 392 individuals (10.6%) suffered from cardiovascular disease. They determined that the risk factors that contribute to the appearance of these diseases are: male sex, age, physical inactivity, widowhood, low level of education and/or qualification, overweight or obese, high blood pressure , high levels of low-density lipoprotein (LDL) and diabetes.
Castro-Juárez et al (2018, pp. 154-159)Castro, C. J., Cabrera, C. E., Ramírez, S. A., García, L., Morales, L. & Ramírez, H. R. (2018). Factores de riesgo para enfermedad cardiovascular en adultos mexicanos. Revista Médica, 9(2),152-162. www.revistamedicamd.com in a review of several studies, found that cardiovascular diseases in the Mexican adult population are related to biochemical, anthropometric, behavioural and socioeconomic factors such as: blood glucose levels and LDL values, BMI and ICC, physical inactivity, alcohol intake, tobacco consumption, working conditions, work stress, time and quality of food intake and insufficient rest hours.
Félix-Redondo et al (2019, pp. 3-13)Félix, F. J., Lozano, L., Álvarez, P., Grau, M., Ramírez, J. M. & Fernández, D. (2019). Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva. Atención Primaria, 52(1), 3-13. https://doi.org/10.1016/j.aprim.2018.11.006. in a sample from the Extremadura region, Spain, defined arterial hypertension as the highest risk of suffering from cardiovascular disease in the future, as well as the highest prevalence of factors risk in men and those over 50 years of age.
Cartaya-Ortiz and Del Prado (2021, pp. 115-116)Cartaya, E. & Del Prado, L. M. (2021). Factores de riesgo de trastornos coronarios en pacientes con cardiopatía isquémica incluidos en un programa de rehabilitación cardiovascular. MEDISAN, 25(1), 111-122. https://www.medigraphic.com/pdfs/medisan/mds-2021/mds211i.pdf , in a sample of adults included in a cardiovascular rehabilitation program in Santiago de Cuba, through complementary tests, identified that hypertriglyceridemia, hypercholesterolemia and diabetes mellitus are closely linked to coronary heart disease, due to the degenerative changes they cause in the cardiovascular system. As a result of the exercise program, they observed improvements in blood glucose, triglycerides, and serum cholesterol.
Sánchez and Sánchez (2021, p. 152)Sánchez, J. & Sánchez, N. (2021). Factores modificables de riesgo coronario y riesgo cardiovascular global. Revista Finlay, 11(2), 152-159. http://www.revfinlay.sld.cu/index.php/finlay/article/view/946. in a sample from Banes, Holguín, determined the highest prevalence of arterial hypertension, diabetes mellitus and smoking, as modifiable risk factors. Moderate risk and the coexistence of three or more risk factors predominated.
There is a confluence between the results of the present work and previous studies, where there is a greater presence of risk factors in men, arterial hypertension constitutes a high risk of suffering from other cardiovascular diseases.
CONCLUSIONS
⌅The most common risk factors for the sample studied are obesity and arterial hypertension and the combination of these two factors (obese-hypertensive).
Participants with moderate coronary risk predominate, with symptoms of a chronic non-communicable disease and/or two more coronary risk factors.
A high number of the sample consumes between one and two toxic habits, with a higher prevalence in men. The consumption of coffee predominates, although the consumption of tobacco and alcohol is considerable.
The identification of coronary risk factors allows a more accurate prescription of physical exercises, which contributes to increasing the benefit-risk ratio of the programs.