Improving stroke prevention in the French West Indies: limits to lay knowledge of risk factors.

BACKGROUND AND PURPOSE: We sought to evaluate lay knowledge and understanding of cardiovascular diseases in the French West Indies. METHODS: In 2007, a cross-sectional study of 1005 randomly selected men and women (54%) age 25 to 74 years from Guadeloupe and stratified by sex, age, and region was established to ascertain the population's knowledge and awareness of chronic diseases. Questions were asked about the respondent's knowledge of cardiovascular risk factors as well as their opinions and beliefs about measures to prevent these diseases. RESULTS: Knowledge about stroke prevention in this sample was lower than for heart disease, with 69% of women and 65% of men reporting that precautions can be taken to avoid a stroke versus 84% and 77%, respectively, for heart disease. "Avoid stress" was the most commonly cited stroke prevention measure, with 35% of women and 27% of men reporting it. The first spontaneous item cited for heart disease prevention was "physical exercise or sport," reported by 47% of women and 45% of men. We hypothesize that knowledge of stroke and stroke risk factors is poor in Guadeloupe or that it reflects culturally adapted health promotion messages from doctors. CONCLUSIONS: Knowledge and awareness were found to be lower for stroke than for heart diseases. Changes in health promotion strategies are required in the French West Indies to improve the population's overall awareness of these diseases and to narrow the gap between knowledge and practice.

Controlling arterial hypertension in the French West Indies: a separate strategy for women?

BACKGROUND: To estimate the prevalence, awareness and treatment of arterial hypertension in Guadeloupe. METHODS: In 2007, a cross-sectional study of 1005 men and women (54%) aged 25-74 years from Guadeloupe, stratified by sex, age and region was set up to determine the prevalence of hypertension. Blood pressure (BP) was measured using an automated device and hypertension was defined as having a mean BP ≥ 140/90 mmHg or receiving drug treatment. RESULTS: The prevalence of hypertension was 33% for men and 37% for women (P = 0.62). Among hypertensive respondents, 57% of men and 80% of women were aware of being hypertensive (P < 0.001). BP was controlled for 22 and 44% of hypertensive men and women, respectively (P < 0.001). Compared with men (14%), 31% of women were obese (≥ 30 kg/m²). In multivariate analyses, body mass index (BMI) was associated with hypertension in both sexes after controlling for age, occupation, education, alcohol consumption, smoking status and physical activity. Compared with subjects with a normal BMI, obese men were three times [odds ratio (OR) = 3.4, 95% confidence interval (CI) = 1.8-6.6 P < 0.001] and obese women two times more likely (OR = 2.0, 95% CI = 1.2-3.4, P = 0.017) to be hypertensive. In women, low educational attainment was also associated with hypertension (OR = 2.1 95% CI = 1.1-4.0, P = 0.030) and mean diastolic BP decreased as educational attainment increased after controlling for confounders (F = 5.0, df 2, P = 0.007). CONCLUSIONS: Strong gender disparities in hypertension were identified. Separate strategies in addressing hypertension in men and women are needed, with an improvement in men's follow-up care and health promotion, focussed on nutrition, targeted at women.