guy e probably had the main environmental factor that favors its appearance is overcrowding; often occurs in developing regions, and it is estimated that 25 to 40% is the cause of cardiovascular disease; its incidence and prevalence have declined in north America and Western Europe for what seems to be that the disease is caused more by economic factors than by genetic factors. Currently in our country is not within the top 20 causes of burden of disease, a situation that should not be your reduction, but the under-reporting and the lack of consensus for inclusion in any age group and disease.