Chronic vascular diseases constitute a growing global health problem. Objectives: To (a) determine marker positivity for renovascular damage in the total adult population of the Isle of Youth, Cuba; (b) describe marker association with common risk factors for renal and related chronic vascular conditions, and (c) identify best predictors of renovascular damage. Methods: Previous informed consent was obtained, the population studied was 55,646, and subjects were aged ≧20 years. Blood pressure, weight and height were measured and a questionnaire applied. Urine markers for renovascular damage (hematuria, proteinuria and microalbuminuria) were also determined. Results: Positive markers were detected in 21.3%: hematuria (12.6%), microalbuminuria (6.8%), proteinuria (0.9%), and proteinuria + hematuria (0.9%). Risk factors were highly prevalent: 15.1% were aged ≧60 years; 32.3% overweight, 13.9% obese, and 25.1% smokers. Prevalence of high blood pressure (30%), diabetes mellitus (5.4%) and cardiovascular disease (5%) was also high, while cerebrovascular disease registered 0.9%. Markers were more prevalent in older people and in those suffering from diabetes mellitus, high blood pressure, cardiovascular and cerebrovascular disease, overweight or obesity. Risk factor regression tree analysis identified hypertension as the best predictor of renovascular damage. Conclusions: Adult population-wide screening revealed hidden morbidity and permitted better risk stratification. Results serve to inform community-based multidisciplinary and intersectoral disease prevention and management.

INTRODUCTIONThe disease complex comprised of atherosclerosis, chronic kidney disease (CKD) and other associated chronic vascular diseases is the leading cause of mortality worldwide. Microalbuminuria is a marker for vascular damage in the heart, kidney and brain. This paper presents selected findings of the clinical-epidemiological Isle of Youth Study (ISYS) of markers for kidney and vascular damage from chronic vascular diseases and their common risk factors in total population, focusing on Phase 2 reassessment (in 2010) of Phase 1 (2004 to 2006) results.OBJECTIVES (1) Update the prevalence of risk factors in the study population aged ≥20 years (adult population). ( 2) Confirm presence of microalbuminuria in at-risk adults diagnosed as presumptive positives in Phase I. (3) Evaluate association between microalbuminuria and selected risk factors. METHODS Of 3779 adults positive for microalbuminuria in ISYSPhase 1, 73.1% were reevaluated. The risk-factor questionnaire was re-administered and blood pressure, weight and height were measured. Blood was tested for creatinine, glycemia, cholesterol and triglycerides. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Albuminuria was measured in urine using Micral-Test (Germany) and albumin/ creatinine ratio (ACR) by nephelometry. This paper uses ACR as the reference for analyzing risk factor associations. Double-entry tables were developed to analyze association among microalbuminuria, risk factors and co-morbidities. RESULTSMost prevalent risks were hypertension, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), excess weight and hypertriglyceridemia. Microalbuminuria was confirmed in 18% of cases, using the same test. Elevated prevalence of microalbuminuria was positively associated with advancing age, male sex, underweight, smoking, NSAID use, dyslipidemia, hypertension, diabetes, heart disease and stroke. CONCLUSIONSThe at-risk cohort studied presented low levels of confirmation for positive microalbuminuria. Positive microalbuminuria stratified individuals at greatest risk, except for obesity.

The methodology is described in detail for the population-based Isle of Youth Study (ISYS) for epidemiological evaluation of CKD associated with cardio-cerebral vascular disease, arterial hypertension, diabetes mellitus, and other risk factors.Background Chronic kidney disease emerges as an important and growing global health problem associated with an increase in the incidence and prevalence of the above mentioned diseases. ISYS ObjectivesAscertain CKD morbidity and its relation to chronic vascular diseases and other risk factors in whole population of Cuba's Isle of Youth special municipality.Method 96.6% of the Isle of Youth's total population (80,117 inhabitants) was studied, all ages and both sexes, November 15, 2004-April 30, 2006 The public was offered general information on the objectives and benefits of the study, and participants provided informed consent. Active screening was performed via personal interview questionnaire and urine sample to determine markers of kidney damage: proteinuria and hematuria (Combur-10-Test) and microalbuminuria (Micral-Test), according to a diagnostic algorithm. For those testing positive for any marker, serum creatinine was studied and glomerular filtration rate (GFR) calculated -in adults by Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) formulas and in children aged <15 years, by Schwartz -to stratify CKD by stages. Blood pressure, height, weight, and body mass index (BMI) were determined. Expected ResultsPrevalence of kidney damage markers in general population and risk groups; relationship in population between CKD and cardio-cerebral vascular disease, diabetes mellitus, hypertension, and other risk factors; comparison of Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) formulas for measuring the GFR and their application to studies involving mass population screenings; and stratification of CKD in population.Conclusions ISYS Phase I, active screening of markers for renal damage was concluded using the methodology described above; results are pending publication.