Introduction: Cerebrovascular disease (CVD) is the third cause of death and second cause of disability and dementia in adults aged ≥65 years worldwide. The few epidemiological studies of stroke in Latin America generally report lower prevalence and different patterns than developed countries.

Objective: Estimate the prevalence of stroke and associated risk factors in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba.

Methods: Single phase, cross-sectional, door-to-door study of 3015 adults aged ≥65 years in selected municipalities of Havana City and Matanzas provinces. Variables studied were age, sex, educational level, and self-report and description of chronic disease (stroke, heart attack, angina, and diabetes mellitus), substance use (alcohol, tobacco), and dietary habits. Respondents were given a structured physical and neurological exam, and blood pressure was measured. Laboratory tests comprised complete blood count, fasting glucose, total cholesterol and fractions, triglycerides, and apolipoprotein E (APOE) genotype. Diagnosis of stroke was based on the World Health Organization’s definition. Stroke prevalence ratios (crude and adjusted), with 95% confidence intervals (CI), were calculated for the variables studied using a Poisson regression model. Risk association was analyzed using multiple logistic regression for dichotomous responses.

Results: Assessments were made of 2944 older adults (97.6% response rate). Prevalence of stroke was 7.8% (95% CI 6.9–8.8), and was higher in men. The risk profile for this population group included history of hypertension (OR 2.8; 95% CI 2.0–4.0), low HDL cholesterol (OR 2.6; 95% CI 1.7–3.9), male sex (OR 1.7; 95% CI 1.2–2.5), anemia (OR 1.6; 95% CI 1.1–2.5), history of ischemic heart disease (OR 1.5; 95% CI 1.0–2.3), carrier of one or two apolipoprotein E4 genotype (APOE ε4) alleles (OR 1.4; 95% CI 1.0–2.0), and advanced age (OR 1.3; 95% CI 1.1–1.9).

Conclusions: Stroke prevalence in this study is similar to that reported for Europe and North America, and higher than that observed in other Latin American countries. The risk profile identified includes classic risk factors plus anemia and APOE ε4 genotype.

Keywords: Apolipoprotein E4, population-based study, epidemiology, risk factors, stroke, prevalence, Cuba

Introduction Many studies to date on the link between blood lipid levels and cerebrovascular disease have been hampered by conceptual and methodological limitations, especially failure to separate different types of stroke.

Objective Determine the relationship between serum lipid levels and the occurrence of different types of stroke.

Methods Two case and control studies were undertaken. The first consisted of three groups: subjects with cerebral infarction (CI), subjects with cerebral hemorrhage (CH) and a control group of healthy individuals with no history of cerebrovascular disease. The second study included three groups: those with atheromatous CI, those with CI of other etiology, and the healthy control group. The influence of variables such as age, sex, and presence of risk factors was also assessed.

Results CI patients were found to have higher total cholesterol levels (p<0.01), low-density lipoprotein (LDL) cholesterol (p<0.01), and triglycerides (p<0.01) than those in the control group. CH patients had lower total cholesterol levels (p<0.05), and higher triglycerides levels (p<0.05) than the control group. The second study revealed a link between blood lipid levels and CI only in cases of atheromatous stroke. This association was prevalent in women, and was independent of other risk factors.

Conclusions The type of stroke (ischemic or hemorrhagic) and the etiopathogenic subtype of CI must be considered when studying association between blood lipids and occurrence of stroke. Elevated levels of total cholesterol, LDL and triglycerides are associated with occurrence of atheromatous CI, while low total cholesterol levels and high triglycerides levels are associated with the CH occurrence.

Keywords cholesterol, HDL, LDL, triglycerides, cerebral hemorrhage, cerebral infarction, atherosclerosis, vascular diseases, cerebrovascular disorders, stroke, cerebrovascular accident, CVA, ischemia, hyperlipidemias

The following erratum has been corrected in all versions of this article.

Page 28, full paragraph 8, second sentence should read: “Serum was stored at -20ºC for no longer than 20 days.”

Introduction Cerebrovascular diseases (CD) are a global health problem. They are the second and third causes of death in the world and in Cuba, respectively. Projections for year 2020 suggest they will continue to be among the main causes of death and disability, both in developed and developing countries. In 2006, the National Health System (NHS) presented its Public Health Projections in Cuba for Year 2015, which set the following specific goals for CD mortality reduction: overall mortality by 25%, female mortality by 30%, and hospital mortality by 30%.

Objective Analyze CD mortality in Cuba from 1970 to 2006, before and after implementation of the National Program for Cerebrovascular Disease Prevention and Control (NPCD-PC) to obtain a better understanding of the current situation, which may serve as the basis to meet the goals set for year 2015.

Methods CD mortality databases from the National Statistical Division of the Cuban Ministry of Public Health were used. The following variables were applied: sex, CD-related causes, and place of death. Crude and age-adjusted mortality rates were determined. Overall mortality, mortality by sex, years of potential life lost, hospital mortality, incidence, and prevalence were calculated.

Results Crude mortality rates showed a sustained increase within the time series under study; conversely, age-adjusted rates showed a decrease in mortality during the 1970s, were stable in the 1980s and 1990s and, finally, decreased since year 2000, when the NPCD-PC program was started in the country. The male/female ratio increased slightly from the late 1990s until 2005; yet female mortality has shown a tendency to increase. Between 1993 and 2002, cerebral hemorrhage caused more deaths than the cerebral infarction; since then, this profile has reversed. CD-related years of potential life lost (YPLL) showed a decrease from 1970 to 1975, followed by a sustained increase through 1985, and a gradual decrease since 1990. Hospital mortality diminished steadily from 1990 to 1999 and has remained stable since year 2000. Even though there was greater CD incidence from 2000 to 2001, it has decreased since then. However, prevalence has increased slightly every year from 2000 to 2005.

Conclusion Although overall mortality and female mortality rates, in particular, increased following implementation of the NPCD-PC program, age-adjusted mortality, hospital mortality, and incidence diminished during the same period. Further study is recommended to determine specific actions required to achieve CD mortality reduction goals by 2015.

Keywords: Vascular diseases, stroke, cerebrovascular accident, CVA, intracranial hemorrhage, brain ischemia, cerebral infarction, cerebral hemorrhage, epidemiology, hospital mortality, mortality