HEALTH-CUBA: The Silent Killer

By Dalia Acosta Reprint | | Print |

Dalia Acosta

HAVANA, Sep 29 2004 (IPS) - Pain in the chest or left arm will send most people running to the hospital, because they know these are often the symptoms of a heart attack. But unlike a heart attack, a brain attack – more commonly known as a stroke – does its damage in silence.

A stroke is a sudden interruption in blood supply to the brain, caused by either a blockage, like a clot (ischemic stroke) or the rupture of a blood vessel (hemorrhagic stroke).

While burst blood vessels induce headaches, most strokes are ischemic, and can be entirely painless. It is quite possible to have suffered a stroke without even knowing.

This means that many stroke patients do not realise something is actually wrong until serious symptoms begin to emerge, such as partial paralysis or slurred speech.

Roughly 15 million new cases of cerebral infarction – the medical term for a stroke – are reported every year around the world, and five million of them are fatal. In Cuba, strokes are the third leading cause of death, after heart disease and cancer.

The Neurology and Neurosurgery Institute of Havana specialises in treating these cases, but as Dr. Javier Sánchez told IPS, the majority of patients do not arrive there until more than six hours after the onset of a stroke. “Quite often, by the time they get here, they are already suffering partial paralysis,” he explained.

Thrombolytic treatment involves the use of drugs to dissolve clots and restore the flow of blood. But in order to be effective, treatment must begin within the first three hours after onset.

The damage caused by strokes results from the fact that when the supply of blood to the brain is cut off, the supply of oxygen to brain cells is interrupted as well, leading to a loss of function.

Studies carried out in a number of different countries reveal that around one half of people who suffer strokes die while hospitalised for treatment, and over 70 percent of those who survive are left with some form of disability.

“Strokes are the leading cause of disabilities worldwide,” said Sánchez. “More than 60 percent of stroke survivors are limited in their social activities, while around 30 percent are dependent on caregivers.”

Although such detailed research has not been conducted in Cuba, the statistics show that the mortality rate for strokes and related cerebrovascular diseases is 126 for every 100,000 inhabitants aged 55 and over, and that it climbs to 1,100 for people over 75.

According to the most recent Cuban Statistical Yearbook on Health, the number of stroke-related deaths rose from 5,155 in 1979 to 7,656 in 2002 (out of a total population of 11.2 million people). In terms of the deaths in 2002, 3,969 were women and 3,687 were men.

Around 20,000 new stroke cases are reported every year in Cuba. While people over 60 are most vulnerable, there has been a marked increase in cerebrovascular disease among the younger population.

The condition of an individual’s vascular system – made up of the vessels that carry blood through the body, namely arteries and veins – determines the risk of suffering a stroke.

“I have 30-year-old patients with 100-year-old vascular systems, and then I have patients who are 90 years old and have the vascular system of someone much younger,” Sánchez commented.

“An individual with a healthy vascular system that permits a proper flow of blood and nutrients (oxygen and glucose) to all of the body’s tissues and organs is much less likely to suffer from a disease of this kind,” he added.

According to the specialists, the rising incidence among younger people can be largely attributed to modifiable causes, such as stress, poor diet, smoking and drinking.

Salt is a major offender because of its role in raising blood pressure, “the number-one factor affecting the appearance of cardiovascular diseases,” according to Sánchez.

“Cubans tend to put too much salt in their food, and have rather unhealthy eating habits in general. They usually eat the largest meal of the day in the evening and then go to bed on a full stomach; it’s a cultural habit,” he explained.

In addition, “there has been an increase in cardiovascular disease among younger generations as a result of smoking, drinking, obesity and a sedentary lifestyle, but these are all modifiable risk factors,” he noted.

Research shows that the damage caused to the vascular system by smoking reduces life expectancy by 15 years on average. “There are people who say, ‘But my grandfather lived to be 90, and he smoked.’ Well then, if he didn’t smoke, he would have lived to be 105,” Sánchez commented.

High blood pressure or hypertension occurs more frequently in blacks than in other racial groups, leading to a greater risk of hemorrhagic strokes.

“Because of hormonal differences, women are better protected against ischemic strokes, caused by a blockage of the blood vessels, but not from hemorrhagic strokes,” Sánchez explained.

The Cuban public health system has developed a programme to monitor individuals with high blood pressure, as well as community health units that work on reducing risk factors.

In addition, special units are being set up in all of the country’s general hospitals to deal specifically with strokes and other cerebrovascular conditions.