The cause of death for the latest American tourist who died while spending time in the Dominican Republic has been confirmed. Vittorio Caruso, the 56-year-old pizzeria owner from Glen Cove,

New York, died from respiratory and heart failure on June 17 following a series of ongoing health problems, CNN reports. A preliminary autopsy report cited by the Dominican Republic’s

Attorney General’s Office showed that Caruso had suffered from hypertension, heart disease and pulmonary disease for years, according to CNN. New and previous heart attacks were also

detected in the autopsy. Additionally, the preliminary report indicated that Caruso was a smoker and drank alcohol, according to CNN. (PEOPLE could not immediately reach Dominican

and rested. Instead, he will be returning in a body bag,” Lisa Maria told the local outlet in an emailed statement. The U.S. State Department confirmed Caruso’s death to Fox News on Friday.

A spokesperson for the U.S. State Department also confirmed to PEOPLE that a U.S. citizen had died in June in the Dominican Republic. Lisa Maria told Fox News that Caruso had gone into

“respiratory distress after drinking something.” His older brother Frank Caruso noted to the _New York Post_ that Vittorio was “very healthy” when he left for vacation. “He went to the

doctor before he left, and he had no problems,” Frank said. “I spoke to the doctor. He called me when he found out he died, and he said he did not see anything wrong before he left.” • _

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the days since his death, Caruso’s partner Yomaira Ramirez de Jesus has been speaking with prosecutors about the Long Island native, who prosecutors said had been living at the Boca Chica

Resort in Santo Domingo for several years. On June 11, Ramirez de Jesus said Caruso started coughing and experiencing shortness of breath, but was treated by a doctor and released, CNN

reports. Nearly a week later, his partner said Caruso called again — this time complaining of respiratory distress and chest pain. Prosecutors said he received at-home medical attention, but

was later transferred to the Santo Domingo hospital. It was there that he suffered cardiorespiratory arrest and died, according to CNN. Dominican prosecutors also noted that his body showed

no signs of internal or external trauma. According to the U.S. State Department, at least nine American tourists have died since the summer of 2018 after falling ill in the country — and

dozens more have gotten sick. The FBI is investigating at least six of the deaths. Some of them died in what appeared to be bizarre — and similar — circumstances. The agencies involved are

not yet releasing further details about the investigations. According to the FBI, federal agents are on the island nation to investigate six cases: four from various Bahia Principe

properties and two deaths at the Hard Rock Hotel & Casino. The bodies of Edward Nathaniel Holmes and his fiancée, Cynthia Ann Day, were discovered in their hotel room at the Grand Bahia

Principe La Romana resort on May 30. Miranda Schaup-Werner, 41, collapsed on May 25 shortly after mixing a drink from the minibar in the Luxury Bahia Principe Bouganville. Pennsylvania

native Yvette Monique Sport, 51, collapsed in 2018 at the Bahia Príncipe resort in Punta Cana. At the Hard Rock Hotel & Casino in Punta Cana, David Harrison, 45, died in July 2018, and

Robert Bell Wallace, 67, died last April. Officials from the U.S. and the Dominican Republic say that despite the media scrutiny, the deaths do not represent a statistical outlier. “Speaking

generally, we have not seen an uptick in the number of US citizen deaths reported to the Department,” a statement from the U.S. State Department read. “While the overwhelming majority

travel without incident, we want to assure all Americans that we continue to work actively with the Dominican authorities at the very highest levels to ensure that U.S. citizens are safe and

feel safe while in the Dominican Republic.” Carlos Suero, the Dominican Republic’s Ministry of Public Health spokesman, told Fox News, “It’s all a hysteria against the Dominican Republic,

to hurt our tourism, this is a very competitive industry and we get millions of tourists, we are a popular destination.”