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The Need for Creating a Unified Knowledge of Cardiovascular Diseases in Latin America

Manuel Urina-JassirI; Maria Alejandra Jaimes-ReyesI; Samuel Martinez-VernazaII; Miguel Urina-TrianaI

DOI: 10.21470/1678-9741-2022-0954

Cardiovascular diseases (CVDs) have persistently been the principal cause of disease burden and mortality throughout the world as well as in Latin America (LATAM)[1,2]. Congruently, as CVDs continue to grow, the research production in this discipline has followed the same trend; global CVD publications have been increasing in the last decades[3,4]. However, as with other health-related topics, disparities in the quantity of research exist when comparing low- and middle-income countries with high-income nations[3,4].

Despite the simultaneous increasing trend in CVD research output in LATAM, this region is clearly behind in terms of publications when compared to North America or Europe. A bibliometric analysis of CVD papers in PubMed® identified that 4% of them were from LATAM, as opposed to 40% from European countries[5]. Even between Latin American countries, disparities also exist, with Argentina, Brazil, and Mexico being the most represented countries in published research in the region[5,6].

As a reader, when assessing collaborative or pooled studies such as clinical trials or systematic reviews, there seems to be a lower representation of the Latin American population, publications, and/or journals. This could possibly be explained due to language barriers, as Spanish or Portuguese publications are excluded in many cases from systematic reviews, or due to the lack of indexation of many Latin American medical journals in major international databases such as PubMed®/MEDLINE®[7,8].

In our recent experience, we identified that information about the Latin American population’s characteristics of infective endocarditis (IE) was lacking. Therefore, our approach was to conduct a systematic review including the two major international databases, as well as two regional Latin American databases. We identified and described compiled information on the major characteristics of IE that hopefully will be useful, or at least be a starting point for clinicians, researchers, and local guidelines[9]. Efforts to develop a unified knowledge, via systematic reviews, have also been conducted by other authors in the field of CVDs in LATAM[10,11]. For instance, Ciapponi et al.[10] assessed the burden of heart failure (HF) in the region. They described crucial data on the prevalence, readmission, and mortality rates due to HF providing an overall assessment of this disease situation in LATAM. Similarly, Carrillo-Larco et al.[11] produced essential information on the prevalence of dyslipidemia as well as the trends among the lipid profile levels in Latin American population-based studies. Besides the mentioned value of these systematic reviews, this type of study is also key to identify what is missing in the literature, such as more robust multicenter studies, registries, and/or population studies[9,10].

Population-based or national registries in CVDs have proven to be useful in the generation of information and research that will ultimately improve the quality of patient care[12,13]. On the topic of IE, a great example of multicenter studies is the “Infective Endocarditis in Argentina” study, which has now published its third cohort (EIRA-3), in which 48 centers throughout that nation reported information on IE to generate updated information on this disease[14]. Likewise in the HF literature, based on the need for this type of work, national registries such as those in Argentina[15], Brazil[16], and Colombia[17] have been developed. Moreover, the “Brazilian Registry of Adults Undergoing Cardiovascular Surgery” is an example in which the clinical outcomes of cardiovascular interventions can be systematically assessed[18]. In addition to these examples of national efforts, collaborations between researchers from distinct Latin American countries (with or without researchers from other regions) have also been generated or are being conducted on topics such as traditional risk factors and CVD (PURE study[19]), coronary heart disease (ACCESS[20] and INTERASPIRE[21] registries), and, more recently, coronavirus disease 2019 (COVID-19) cardiovascular complications (CARDIO-COVID 19-20 registry[22]). These examples demonstrate that research collaborations between Latin American researchers are feasible and should continue to grow over time.

There are multiple benefits of developing local and regional research such as obtaining truthful information about CVDs as well as identifying the needs in healthcare or research[6], but most importantly, there has been described an inverse relationship between the number of publications and cardiovascular burden[4]. In other words, research output may be related to an improvement in CVD-associated death rates and disability-adjusted life years[4], which should be the most important motivator for researchers.

In conclusion, as a region, LATAM is heading in the right direction in CVD research, but there is still work to do. The current momentum and research efforts should be continued with the aim of improving and continuously creating consolidated research in the region. This could be attained by using systematic reviews and meta-analyses, but more importantly, by developing collaborative strategies between researchers to produce high-quality primary research data.


1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982-3021. Erratum in: J Am Coll Cardiol. 2021;77(15):1958-9. doi:10.1016/j.jacc.2020.11.010. [MedLine]

2. Fernando L, Pamela S, Alejandra L. Cardiovascular disease in Latin America: the growing epidemic. Prog Cardiovasc Dis. 2014;57(3):262-7. doi:10.1016/j.pcad.2014.07.007. [MedLine]

3. Huffman MD, Baldridge A, Bloomfield GS, Colantonio LD, Prabhakaran P, Ajay VS, et al. Global cardiovascular research output, citations, and collaborations: a time-trend, bibliometric analysis (1999-2008). PLoS One. 2013;8(12):e83440. doi:10.1371/journal.pone.0083440.

4. Qureshi NQ, Mufarrih SH, Bloomfield GS, Tariq W, Almas A, Mokdad AH, et al. Disparities in cardiovascular research output and disease outcomes among high-, middle- and low-income countries - an analysis of global cardiovascular publications over the last decade (2008-2017). Glob Heart. 2021;16(1):4. doi:10.5334/gh.815.

5. Jahangir E, Comandé D, Rubinstein A. Cardiovascular disease research in Latin America: a comparative bibliometric analysis. World J Cardiol. 2011;3(12):383-7. doi:10.4330/wjc.v3.i12.383.

6. Borracci RA, Di Stéfano MM, Voos Budal Arins MG, Calderón JG, Manente D, et al. The production of articles on cardiology from Latin America in medline indexed journals. Arch Cardiol Mex. 2011;81(4):343-50. Erratum in: Arch Cardiol Mex. 2012;82(1):78.

7. Bonfill X, Osorio D, Posso M, Solà I, Rada G, Torres A, et al. Identification of biomedical journals in Spain and Latin America. Health Info Libr J. 2015;32(4):276-86. doi:10.1111/hir.12110.

8. Clark OA, Castro AA. Searching the literatura latino americana e do Caribe em ciências da saúde (LILACS) database improves systematic reviews. Int J Epidemiol. 2002;31(1):112-4. doi:10.1093/ije/31.1.112.

9. Urina-Jassir M, Jaimes-Reyes MA, Martinez-Vernaza S, Quiroga-Vergara C, Urina-Triana M. Clinical, microbiological, and imaging characteristics of infective endocarditis in Latin America: a systematic review. Int J Infect Dis. 2022;117:312-21. doi:10.1016/j.ijid.2022.02.022.

10. Ciapponi A, Alcaraz A, Calderón M, Matta MG, Chaparro M, Soto N, et al. Burden of heart failure in Latin America: a systematic review and metaanalysis. Rev Esp Cardiol (Engl Ed). 2016;69(11):1051-60. doi:10.1016/j. rec.2016.04.054.

11. Carrillo-Larco RM, Benites-Moya CJ, Anza-Ramirez C, Albitres-Flores L, Sánchez-Velazco D, Pacheco-Barrios N, et al. A systematic review of population-based studies on lipid profiles in Latin America and the Caribbean. Elife. 2020;9:e57980. doi:10.7554/eLife.57980.

12. Palmieri L, Veronesi G, Corrao G, Traversa G, Ferrario MM, Nicoletti G, et al. Cardiovascular diseases monitoring: lessons from population-based registries to address future opportunities and challenges in Europe. Arch Public Health. 2018;76:31. doi:10.1186/s13690-018-0283-3.

13. Meltzer SN, Weintraub WS. The role of National registries in improving quality of care and outcomes for cardiovascular disease. Methodist Debakey Cardiovasc J. 2020;16(3):205-11. doi:10.14797/mdcj-16-3- 205.

14. Avellana PM, García Aurelio M, Swieszkowski S, Nacinovich F, Kazelian L, Spenato M, et al. Infective endocarditis in Argentina. Results of the EIRA 3 study. Rev Argent Cardiol. 2018;86(1):21–9. doi:10.7775/rac.v86. i1.10935.

15. Lescano A, Sorasio G, Soricetti J, Arakaki D, Coronel L, Cáceres L, et al. Registro Argentino de insuficiencia cardiaca aguda (ARGEN-IC). Evaluación de cohorte parcial a 30 dias. Rev Argent Cardiol. 2020;88(2):118– 25. doi:10.7775/

16. Albuquerque DC, Neto JD, Bacal F, Rohde LE, Bernardez-Pereira S, Berwanger O, et al. I Brazilian registry of heart failure - clinical aspects, care quality and hospitalization outcomes. Arq Bras Cardiol. 2015;104(6):433-42. Erratum in: Arq Bras Cardiol. 2015;105(2):208. doi:10.5935/abc.20150031.

17. Gómez-Mesa JE, Saldarriaga-Giraldo CI, Echeverría LE, Luna-Bonilla P, RECOLFACA GI. Registro colombiano de falla cardiaca (RECOLFACA): resultados. Rev Colomb Cardiol. 2022;28(4):334–44. doi:10.24875/RCCAR. M21000063.

18. Gomes WJ, Moreira RS, Zilli AC, Bettiati LC Jr, Figueira FAMDS, D’ Azevedo SSP, et al. The Brazilian registry of adult patient undergoing cardiovascular surgery, the BYPASS project: results of the first 1,722 patients. Braz J Cardiovasc Surg. 2017;32(2):71-6. Erratum in: Braz J Cardiovasc Surg. 2017;32(5):442. doi:10.21470/1678-9741-2017-0053.

19. Lopez-Jaramillo P, Joseph P, Lopez-Lopez JP, Lanas F, Avezum A, Diaz R, et al. Risk factors, cardiovascular disease, and mortality in South America: a PURE substudy. Eur Heart J. 2022:ehac113. doi:10.1093/eurheartj/ ehac113.

20. Martínez-Sánchez C, Jerjes-Sánchez C, Nicolau JC, Bazzino O, Antepara N, Mármol R, et al. Síndromes coronarios agudos en Latinoamérica: lecciones aprendidas del registro ACCESS. Rev Med Inst Mex Seguro Soc. 2016;54(6):726-37.

21. McEvoy JW, Jennings C, Kotseva K, De Backer G, De Bacquer D, Erlund I, et al. INTERASPIRE: an international survey of coronary patients; their cardiometabolic, renal and biomarker status; and the quality of preventive care delivered in all WHO regions : in partnership with the world heart federation, European society of cardiology, Asia Pacific society of cardiology, InterAmerican society of cardiology, and PanAfrican society of cardiology. Curr Cardiol Rep. 2021;23(10):136. doi:10.1007/s11886-021-01568-2.

22. Gómez-Mesa JE, Galindo-Coral S, Montes MC, Alarco W, Barisani JL, Magaña A, et al. Latin-American registry of cardiovascular disease and COVID-19: rationale and design of the CARDIO COVID 19-20 registry. Glob Heart. 2021;16(1):14. doi:10.5334/gh.925.

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