[4] Kavsak PA, MacRae AR, Yerna MJ, Jaffe AS. Analytic and clinical utility of a next- generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury. Clin Chem 2009;55:573–7. [5] Mather AN, Fairbairn TA, Artis NJ, Greenwood JP, Plein S. Relationship of cardiac biomarkers and reversible and irreversible myocardial injury following acute myocardial infarction as determined by cardiovascular magnetic resonance. Int J Cardiol 2013;166:458–64. [6] Lippi G. Biomarkers of myocardial ischemia in the emergency room: cardiospecific troponin and beyond. Eur J Intern Med 2013;24:97–9. 0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.01.018 Population-based study of cardiovascular health in Atahualpa, a rural village of coastal Ecuador ☆ Oscar H. Del Brutto a, b, ⁎, Milton Santamaría c , Elio Ochoa d , Ernesto Peñaherrera a, e , Rocío Santibáñez b,d , Freddy Pow-Chon-Long e , Mauricio Zambrano b , Victor J. Del Brutto b a School of Medicine, Universidad de Especialidades Espíritu Santo, Ecuador b Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador c Health Center, Ministry of Public Health, Atahualpa, Ecuador d Hospital Teodoro Maldonado Carbo, National Institute of Social Security, Guayaquil, Ecuador e Department of Cardiology, Hospital Luis Vernaza, Guayaquil, Ecuador article info Article history: Received 6 December 2012 Accepted 18 January 2013 Available online 11 February 2013 Keywords: Cardiovascular health Epidemiology Prevalence Ecuador Atahualpa The American Heart Association (AHA) recently defined the metrics needed to categorize cardiovascular health (CVH), to implement strategies directed to reduce vascular deaths among US populations [1]. The same could be applied to developing countries, where stroke and cardiovascular diseases will be the next health epidemics due to changes in lifestyle and increased life expectancy [2]. Indeed, the rate of vascular deaths in Latin America is higher than in the developed world; this excess mortality fraction could be related to modifiable factors, including: inadequate access to medical care, increasing obesity and diabetes mellitus, and uncontrolled arterial hypertension [3]. To optimize existing sanitary resources it is mandatory to know the CVH status of a given population using standardized metrics. Here, we present the CVH status of Atahualpa inhabitants, a village representative of rural coastal Ecuador. The methodology of this study has been detailed elsewhere [4]. After informed consent was obtained, field personnel performed a door-to- door survey to identify all Atahualpa residents, and to apply ques- tionnaires designed to evaluate the CVH status of people aged ≥40 years who were free of stroke and ischemic heart disease. We used CVH metrics proposed by the AHA. Persons with stroke and ischemic heart disease were identified by the use of validated field questionnaires, and the diagnosis was further corroborated by a team of certified neurologists and cardiologists. We assessed the number of Atahualpa residents aged ≥ 40 years (free of stroke or ischemic heart disease) with one to seven ideal CVH metrics. We also noted the number of intermediate and poor CVH metrics per person. CVH status was classified as ideal, intermediate and poor (Table 1). Statistical analysis was carried out using SPSS 18 software (SPSS Inc., Chicago, Illinois, USA). Significance was tested by the use of the χ 2 test with Yates' correction when needed or the Fisher's exact test. Differences were considered significant if p b 0.05. Six-hundred forty-two (26%) of 2478 Atahualpa residents were aged ≥40 years. Twenty-six persons were excluded because of a stroke or ischemic heart disease. Therefore, CVH metrics and CVH status were evaluated in 616 persons (mean age 58.7±12.5 years, 59.4% women, and 64.4% with primary school instruction). CVH metrics of included individuals were stratified according to age, gender, and education (Table 2). Persons ≥60 years had higher rates of physical activity, blood pressure and fasting glucose in the poor range than those aged 40 to 59 years; in contrast, the rate of ideal BMI was higher for individuals aged ≥60 years. Men had lower rates of ideal smoking status, blood pressure and fasting glucose than women, but the latter had lower rates of ideal BMI, physical activity and total cholesterol than men. Physical activity, blood pressure and fasting glucose were the CVH metrics that showed lower ideal values in persons with up to primary school instruction. Overall, 13 (2%) persons had seven ideal CVH metrics (ideal CVH status), 211 (34%) had four to six ideal CVH metrics, and 392 (64%) had three or less ideal CVH metrics. Of the 603 persons with less than seven ideal CVH metrics, 173 (28%) had one or more intermediate CVH metrics but no poor metrics (intermediate CVH status), and 430 (70%) had at least one poor metric (poor CVH status). The odds for having a poor CVH status was most common in persons aged ≥60 years (OR=0.61, 95% C.I. 0.43–0.87, p = 0.006). Among the 430 persons with poor CVH status, most have only one (51%) or two (35%) poor CVH metrics, 14% had three to four poor CVH metrics, and only one person had five poor CVH metrics. The poorest CVH metrics were blood pressure, fasting glucose, and BMI. In contrast, smoking status, diet, physical activity and total cholesterol were satisfactory, with values in the poor range found in less than 10% of persons (Table 2). A sizable proportion (70%) of Atahualpa residents aged ≥ 40 years had a poor CVH status. However, most of them (86%) had only one or two poor CVH metrics and 67% of the entire population had three or more ideal CVH metrics. Individuals scored better in the so-called “health behaviors” (smoking, BMI, physical activity and diet) than in the “health factors” (blood pressure, fasting glucose and total ☆ External funding: This study was partially supported by an unrestricted grant from the Universidad Especialidades Espíritu Santo, Guayaquil, Ecuador. The sponsor had no role in the design of the study, nor in the collection, analysis, and interpretation of data. ⁎ Corresponding author at: Air Center 3542, PO Box 522970, Miami, Fl 33152-2970, USA. Tel.: +1 593 42285790. E-mail address: oscardelbrutto@hotmail.com (O.H. Del Brutto). 1618 Letters to the Editor