World Report

Data reveal state of Venezuelan health system

The complex humanitarian crisis (CHC) in Venezuela is characterized by food insecurity, hyperinflation, insufficient basic services, and the collapse of the healthcare system. The evolution of the epidemiology of cardiometabolic risk factors in this context is unknown.

To compile the last 20 years evidence on the prevalence of cardiometabolic risk factors in adults of Venezuela in the context of the CHC.

A comprehensive literature review of population-based studies of adults in Venezuela from 2000 to 2020.

Seven studies (National EVESCAM 2014–2017, 3 regions VEMSOLS 2006–2010, Maracaibo city 2007–2010, Merida city 2015, Mucuchies city 2009, Barquisimeto city CARMELA 2003–2005, and Zulia state 1999–2001) with samples sizes ranging from 109 to 3414 subjects were included. Over time, apparent decrease was observed in smoking from 21.8% (2003–2005) to 11.7% (2014–2017) and for obesity from 33.3% (2007–2010) to 24.6% (2014–2017). In contrast, there was an apparent increase in diabetes from 6% (2003–2005) to 12.3% (2014–2017), prediabetes 14.6% (2006–2010) to 34.9% (2014–2017), and hypertension 24.7% (2003–2005) to 34.1% (2014–2017). The most prevalent dyslipidemia – a low HDL-cholesterol – remained between 65.3% (1999–2001) and 63.2% (2014–2017). From 2006–2010 to 2014–2017, the high total cholesterol (22.2% vs 19.8%, respectively) and high LDL-cholesterol (23.3% vs 20.5%, respectively) remained similar, but high triglycerides decreased (39.7% vs 22.7%, respectively). Using the same definition across all the studies, metabolic syndrome prevalence increased from 35.6% (2006–2010) to 47.6% (2014–2017). Insufficient physical activity remained steady from 2007–2010 (34.3%) to 2014–2017 (35.2%).

Changes in the prevalence of cardiometabolic risk factors in Venezuela are heterogeneous and can be affected by various social determinants of health. Though the Venezuelan healthcare system has not successfully adapted, the dynamics and repercussions of the CHC on population-based cardiometabolic care can be instructive for other at-risk populations.

La crisis humanitaria compleja (CHC) en Venezuela se caracteriza por la inseguridad alimentaria, la hiperinflación, la insuficiencia de servicios básicos y el colapso del sistema de salud. Se desconoce la evolución de la epidemiología de los factores de riesgo cardiometabólico en este contexto.

Recopilar evidencia de los últimos 20 años sobre la prevalencia de factores de riesgo cardiometabólico en adultos de Venezuela en el contexto del CHC.

Revisión bibliográfica exhaustiva de estudios poblacionales de adultos en Venezuela desde 2000 hasta 2020.

Se incluyeron 7 estudios (EVESCAM Nacional 2014-2017, 3 regiones VEMSOLS 2006-2010, ciudad de Maracaibo 2007-2010, ciudad de Mérida 2015, ciudad de Mucuchíes 2009, ciudad de Barquisimeto CARMELA 2003-2005 y estado de Zulia 1999-2001) con tamaños de muestra variables desde 109 hasta 3.414 sujetos. A lo largo del tiempo, hubo una aparente disminución del consumo de tabaco del 21,8% (2003-2005) al 11,7% (2014-2017) y de la obesidad del 33,3% (2007-2010) al 24,6% (2014-2017). Por el contrario, hubo un aparente aumento de la diabetes del 6% (2003-2005) al 12,3% (2014-2017), la prediabetes del 14,6% (2006-2010) al 34,9% (2014-2017) y la hipertensión del 24,7% (2003-2005) al 34,1% (2014-2017). La dislipidemia más prevalente, el colesterol HDL bajo, se mantuvo entre el 65,3% (1999-2001) y el 63,2% (2014-2017). Desde 2006-2010 hasta 2014-207, el colesterol total alto (22,2% versus 19,8%, respectivamente) y el colesterol LDL alto (23,3% versus 20,5%, respectivamente) permanecieron similares, pero los triglicéridos altos disminuyeron (39,7% versus 22,7%, respectivamente). Utilizando la misma definición en todos los estudios, la prevalencia de síndrome metabólico aumentó del 35,6% (2006-2010) al 47,6% (2014-2017). La actividad física insuficiente se mantuvo estable entre 2007-2010 (34,3%) y 2014-2017 (35,2%).

Los cambios en la prevalencia de factores de riesgo cardiometabólicos en Venezuela son heterogéneos y pueden verse afectados por diversos determinantes sociales de la salud. Aunque el sistema de salud venezolano no se ha adaptado con éxito, la dinámica y las repercusiones del CHC en la atención cardiometabólica de la población pueden ser instructivas para otras poblaciones en riesgo.

The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital.

Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol.

Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1 ± 13.7 (mean ± SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4 ± 11.7 (mean ± SD) years, 16.74 ± 12.99 years for limited SSc and 7.52 ± 5.25 years for diffuse SSc (p = 0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p = 0.0211 and p = 0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p = 0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p = 0.0443) and with calcinosis (p = 0.0020). Anti-topoisomerase antibodies were associated with ILD (p = 0.0077).

Typical clinical and serological manifestations were present in this sample of Venezuelan patients with SSc, with an expected distribution according to disease subtype. The autoantibody profile allows clinicians to identify those patients with limited forms of the disease and those without pulmonary involvement.

El objetivo de este estudio fue investigar las características demográficas y clínicas de los pacientes venezolanos con esclerosis sistémica (ES) examinados en un hospital terciario.

Se seleccionaron para el estudio pacientes consecutivos mayores de 18 años, que cumplieron los criterios de la clasificación ACR/EULAR de 2013 para ES, sometidos a seguimiento en la clínica ambulatoria del Departamento de Reumatología del Hospital Universitario de Caracas. Se registraron las variables demográficas y clínicas en el momento de la inclusión, utilizando un protocolo estándar.

Se incluyó a 48 pacientes con ES, de los cuales 46 (95,8%) eran mujeres; la edad media fue de 55,1 ± 13,7 (media ± DE) años, todos ellos de etnia hispana. Treinta y uno de ellos (64,6%) tenían ES limitada y 17 (35,4%) ES difusa. La duración media de la enfermedad fue de 13,4 ± 11,7 (media ± DE) años: 16,74 ± 12,99 años para ES limitada y 7,52 ± 5,25 años para ES difusa (p = 0,0077). El fenómeno de Raynaud fue la manifestación más frecuente (100%), seguida de la artritis (68,8%), la telangiectasia (60,4%), la disnea (60,4%), la disfagia (58,3%) y la hinchazón de manos (56,3%). La puntuación de la escala cutánea de Rodnan modificada (mRSS) y la frecuencia de la disnea fueron más altas en aquellos sujetos con ES difusa con respecto a los sujetos con ES limitada (p = 0,0211 y p = 0,0003, respectivamente). Realizamos una TAC de alta resolución pulmonar a 31 pacientes; 14 (45,2%) tenían evidencia de enfermedad pulmonar intersticial (EPI), 11 (68,8%) de ellos con ES difusa (p = 0,0052). El patrón más frecuente de anticuerpos anti-nucleares fue de tipo nucleolar, representando 18 (42,8%) de los casos. Los anticuerpos anti-centrómeros estuvieron presentes en el 16,7% de los casos, asociándose al subconjunto de ES limitada (p = 0,0443) con calcinosis (p = 0,0020). Los anticuerpos anti-topoisomerasa estuvieron asociados a la EPI (p = 0,0077).

Las manifestaciones clínicas y serológicas típicas estuvieron presentes en esta muestra de pacientes venezolanos con ES, con una distribución prevista con arreglo al subtipo de la enfermedad. El perfil de anticuerpos permite a los clínicos identificar a aquellos pacientes con formas limitadas de la enfermedad, y aquellos con compromiso pulmonar.

Cardiovascular health status of the Venezuelan population has not been evaluated. The American Heart Association recommends the Cardiovascular Health Score (CHS) to assess cardiovascular health.

This study sought to determine the prevalence of CHS categories in a nationally representative sample of Venezuelan adults.

EVESCAM (Venezuelan Study of Cardio-Metabolic Health) was a national population-based, cross-sectional, randomized cluster sampling study performed from July 1, 2014 to January 31, 2017, which assessed 3,454 adults, age ≥20 years, with a response rate of 77.3%. The American Heart Association's CHS evaluates 4 behaviors (smoking, body mass index, physical activity, and diet) and 3 risk factors (total cholesterol, blood pressure, and blood glucose), assigning 1 point to those meting an ideal behavior or factor or 0 points if are not. Subjects were categorized as having ideal (5 to 7 points), intermediate (3 to 4), or poor (<3) cardiovascular health. Weighted prevalence by age, sex, and regions are presented.

A total of 2,992 participants completed the data. Mean age and CHS were 41.4 ± 15.8 years and 4.3 ± 1.1 points, respectively. The prevalence of ideal CHS was 37.9% (95% confidence interval: 35.0 to 40.7); two-thirds presented with intermediate to poor CHS. Ideal CHS was most prevalent in women, in the youngest participants, and in those with higher education degree and living in a rural area. The prevalence of 7 components was 0.13%. Subjects evaluated since mid-2016 had a higher prevalence of ideal CHS (≈47%) than those evaluated before it (≈32%) (p < 0.001).

A high prevalence of ideal CHS was observed in Venezuelan adults compared with other reports; however, a large proportion remain with high risk for cardiovascular disease.