INTRODUCTION Atherosclerosis is the common underlying cause of cardiovascular diseases; the leading cause of morbidity and mortality globally. It is a major contributor to disability and poorer quality of life and is costly to health systems, individuals, families and society. Early signs of atherogenesis are manifestations of atherosclerosis and known atherogenic risk factors occurring at young ages and detectable by health professionals. Early detection of such signs in children and adolescents enables actions to prevent short- and long-term complications.

OBJECTIVE Detect early signs of atherogenesis in adolescents in Family Doctor-and-Nurse Office No. 13 of the Raúl Gómez García Polyclinic in Havana’s 10 de Octubre Municipality.

METHODS An observational, cross-sectional descriptive study was conducted: the universe consisted of 110 adolescents and, once exclusion criteria were applied, the sample was made up of 96 adolescents in the office’s geographical catchment area. Variables included sociodemographic data; measurements from physical and anthropometric examinations (weight, height, body mass index, waist circumference, blood pressure, presence of acanthosis nigricans); maternal history of diabetes mellitus and hypertension, smoking during pregnancy; birth weight and duration of exclusive breastfeeding; lifestyle (physical activity, dietary habits by frequency of consumption of fruits and vegetables, salt intake, and smoking); and a history of atherogenic risk factors and atherosclerotic diseases (hypertension, diabetes mellitus, heart disease, cerebrovascular disease, peripheral arterial disease and chronic kidney disease) in adolescents and their families. The number of early signs of atherogenesis was determined. Descriptive statistics and a chi-square test, with significance threshold set at p = 0.05, were used to examine differences by sex and age.

RESULTS A total of 62.5% of participating adolescents were female and the same percent of the total were in early adolescence. Prevalent risk factors were poor dietary habits (81.3%), passive smoking (54.2%) and sedentary lifestyle (45.8%). The latter was more frequent among female and adolescents aged 10–14 years. Prehypertension and active smoking were prevalent during late adolescence. Hypertension was the disease most often found in family history (91.7%). All adolescents had at least one early sign of atherogenesis, and 72.9% had ≥3 signs, noted especially in female participants.

CONCLUSIONS The high prevalence of ≥3 early signs of atherogenesis in this study suggests the need to initiate primary prevention before onset of adolescence, and even prior to birth, using a gender perspective, to conduct educational interventions designed to change the risk factors highlighted in the study and reduce cardiovascular risk in adolescents.

KEYWORDS Adolescents, adolescent health, atherosclerosis, atherogenesis, arterial occlusive diseases, early detection of disease, risk factors, Cuba

INTRODUCTION A population health profile is a cumulative product of socioenvironmental and political factors that create the contexts in which health problems arise, as well as opportunities and barriers to addressing them. Research on context has focused on demonstrating its effects, direct or indirect, on health indicators, but has made few incursions into assessing its role as a mediator of other factors. While individual risk factors for chronic diseases are well known, the same cannot be said for the complex of contextual factors operating at various levels and over the lifespan.

OBJECTIVES Estimate relative influences by contextual versus individual factors as determinants of diabetes type 2 and heart disease.

METHODS A cross-sectional study was carried out in populations served by 12 family doctor-and-nurse practices in Havana, in 840 families selected by simple random sampling, 70 per practice. Principal components analysis was used, as well as contextual logistic regression models with a nested model strategy, whose fit was meant to estimate the relative contributions of contextual compared to individual risk factors for diabetes and heart disease. Context was described and analyzed at two levels: that of the family or household and that of the catchment area served by a family doctor-and-nurse practice (geographically defined as a neighborhood).

RESULTS For diabetes, the contextual effect of neighborhood was modified when household effect was removed; that is, the effect of neighborhood was indirect and mediated by household. Individual coefficients were practically invariant; the principal effect of household changed noticeably on removal of individual effects, while age maintained its effect without variation.

For heart disease, the effect of neighborhood was slightly modified when household effect was controlled for. Individual coefficients showed little change. There was an important direct effect of household on risk of heart disease. Age and high blood pressure coefficients hardly varied.

CONCLUSIONS We confirmed interactions between individual and contextual (neighborhood and household) factors, whose effects on individual health are not entirely mediated by individual factors. Research needs to pay more attention to context beyond its direct effect on individual risk factors.

KEYWORDS Risk factors, risk reduction, community, neighborhood, type 2 diabetes mellitus, heart disease, logistic models, Cuba