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Risk factors for acute myocardial infarction in Latin America: the INTERHEART Latin American study
Abstract
Current knowledge of the impact of cardiovascular risk factors in Latin America is limited.
As part of the INTERHEART study, 1237 cases of first acute myocardial infarction and 1888 age-, sex-, and center-matched controls were enrolled from Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico. History of smoking, hypertension, diabetes mellitus, diet, physical activity, alcohol consumption, psychosocial factors, anthropometry, and blood pressure were recorded. Nonfasting blood samples were analyzed for apolipoproteins A-1 and B-100. Logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs). Persistent psychosocial stress (OR, 2.81; 95% CI, 2.07 to 3.82), history of hypertension (OR, 2.81; 95% CI, 2.39 to 3.31), diabetes mellitus (OR, 2.59; 95% CI, 2.09 to 3.22), current smoking (OR, 2.31; 95% CI, 1.97 to 2.71), increased waist-to-hip ratio (OR for first versus third tertile, 2.49; 95% CI, 1.97 to 3.14), and increased ratio of apolipoprotein B to A-1 (OR for first versus third tertile, 2.31; 95% CI, 1.83 to 2.94) were associated with higher risk of acute myocardial infarction. Daily consumption of fruits or vegetables (OR, 0.63; 95% CI, 0.51 to 0.78) and regular exercise (OR, 0.67; 95% CI, 0.55 to 0.82) reduced the risk of acute myocardial infarction. Abdominal obesity, abnormal lipids, and smoking were associated with high population-attributable risks of 48.5%, 40.8%, and 38.4%, respectively. Collectively, these risk factors accounted for 88% of the population-attributable risk.
Interventions aimed at decreasing behavioral risk factors, lowering blood pressure, and modifying lipids could have a large impact on the risk of acute myocardial infarction among Latin Americans.
... Cerca de 50% de todos los participantes registraron cifras tensionales normal-alta o HTA, lo que significa que la mitad de la población requiere cambios radicales en el estilo de vida para prevenir la morbimortalidad de la enfermedad cardiovascular. 39 El segundo estudio es el informe publicado sobre los datos del INTERHEART para Latinoamérica 40 , donde la prevalencia de HTA fue de 29%, diez puntos porcentuales por encima de los demás países en el resto del mundo. La obesidad, la dislipidemia, la HTA y la diabetes fueron los factores de riesgo más importantes para el IAM. ...
... la dislipidemia (OR 2.49 -IC 95% 1.4-4.3) y la HTA (OR 2.27 IC 95% 1.6-2.2). 40 El estudio PURE incluyó 7.485 pacientes de Colombia, la mitad de procedencia urbana y 64,1% fueron mujeres. Se encontró una prevalencia de HTA de 37,5%. ...
... Cerca de dos tercios de los pacientes con tratamiento farmacológico no tenían control de su enfermedad y el uso de medicación combinada fue muy bajo (27,5%). 40,46 Entre 2014 y 2015 el Ministerio de Salud realizó la Encuesta Nacional de Salud, Bienestar y Envejecimiento (SABE), que tuvo como objetivo caracterizar la salud de las personas mayores de 60 años a nivel geográfico, sociodemográfico y económico, permitiendo generar indicadores en salud para esta población. A partir de los datos obtenidos se realizaron varios estudios enfocados al conocimiento epidemiológico de la HTA que permitieron determinar la prevalencia, conciencia, tratamiento y control de esta enfermedad. ...
Introduction: hypertension is one of the leading medical conditions worldwide and is an important cause of morbidity and mortality in low and middle-income countries. Objective: to determine the epidemiological importance of hypertension as a risk factor for cardiovascular diseases (CVD) in different studies carried out in the world, Latin America and Colombia. Methodology: a search of the scientific literature using the PudMed / Medline, Scielo, LILACS databases, as well as the medical journals and texts published by the Colombian Ministry of Health and Social Protection. Discussion and conclusions: more than 90% of hypertensive patients have primary hypertension, which is associated with increased peripheral vascular resistance. Prevalence and adequate management of hypertension are related with the socioeconomic characteristics of countries and individual educational level. The increase in prevalence of chronic diseases together with important historical events, were determinant for the development of worldwide epidemiology studies such as the Framingham Heart Study. Diverse studies aimed to gather information on hypertension showing alarming figures in terms of awareness, treatment and control of this condition, have been conducted in Latin America and Colombia. Thus, it is necessary to perform programs for detecting hypertension, in order to design strategies to enable significant reduction of CVD.
... The INTERHEART study is an international case-control study that determined the impact of conventional and emerging cardiovascular risk factors on AMI [31,32]. Between 1999 and 2003, the INTERHEART was conducted in LATAM; to date, it is the most representative study of the risk factors for AMI in this region [28,32]. ...
... The INTERHEART study is an international case-control study that determined the impact of conventional and emerging cardiovascular risk factors on AMI [31,32]. Between 1999 and 2003, the INTERHEART was conducted in LATAM; to date, it is the most representative study of the risk factors for AMI in this region [28,32]. It was performed specifically in Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico, where 1237 cases of AMI and 1888 controls were registered. ...
... It was performed specifically in Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico, where 1237 cases of AMI and 1888 controls were registered. Obesity, smoking, and dyslipidemia reportedly represent an 88% risk of AMI [32]. ...
By 2030, non-communicable diseases will have accounted for more than three-quarters of deaths worldwide. Cardiovascular diseases (CVDs) have been the leading cause of death worldwide for several years. Acute myocardial infarction (AMI) is a CVD characterized by necrosis of the heart at the myocardial level due to prolonged ischemia caused by the reduction or sudden absence of coronary blood supply. The prevalence of AMI is higher in men at all ages. The incidence of AMI has decreased in industrialized nations; however, it has been on the rise in Latin America (LATAM) due to lifestyle changes. These changes have caused the combined incidence of CVDs and unresolved health concerns in LATAM, such as infections and malnutrition. It is well known that periodontitis, a highly prevalent chronic infectious inflammatory disease, has been associated with systemic diseases, such as diabetes, kidney diseases, and AMI. This review addresses proposed aspects of the correlation between periodontitis and AMI, explains the importance of preventing periodontitis and CVDs, and analyzes the preventative measures being implemented in LATAM, particularly in Mexico.
... Sua etiologia é complexa e pode ocorrer por fatores de risco não modificáveis, como, idade, raça, e gênero masculino, ou fatores de risco modificáveis, como a obesidade. A obesidade tem sido apontada como fator de risco independente para as DCV, estando ou não associada a outros fatores de risco (HASLAM;JAMES, 2005;LANAS et al., 2007;GOMES et al., 2010). O Estudo de Risco de Aterosclerose em Comunidades (ARIC), publicado em 2021, incluiu 14.983 homens e mulheres com idades entre 45-75 anos, e revelou que desses, 39,15% dos homens e 60,85% das mulheres apresentaram obesidade global de acordo com IMC (SAADATI et al., 2021). ...
... Desse modo, a medida abdominal pela RC/Q, é indicada como melhor preditor de fator de risco individual para doença coronariana e mortalidade cardiovascular (WELBORN; DHALIWAL, 2007;SPOSITO et al., 2007;GOMES et al., 2010;SAADATI et al., 2021;ALMEIDA;MATOS;AQUINO, 2021;). A obesidade abdominal, determinada como fator de risco para DAC no estudo INTERHEART Latino-Americano, corresponde a 48,5% da população nos casos de infarto, seguido por dislipidemia e tabagismo, que totalizam 88% de risco atribuído a população (LANAS et al., 2007). ...
... To begin with, only six Latin American countries were considered (Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico), leaving out most of the American nations. 26 Secondly, the Mexican population studied reached a meager number of 8 cases and 17 controls from a single research center. 26 What solid conclusions can be derived from this scanty number, which, in addition to making matters worse, did not constitute a paired set? ...
... 26 Secondly, the Mexican population studied reached a meager number of 8 cases and 17 controls from a single research center. 26 What solid conclusions can be derived from this scanty number, which, in addition to making matters worse, did not constitute a paired set? Thirdly, the results of a previous, more rigorous although much less extensive, Latin America case-control study were already known (and probably inspired the INTERHEART design), assembling data from the FRICAL study (enclosing the subjects of four Latin American countries: Argentina, Cuba, Mexico, and Venezuela). ...
... ). Cuando el IMC es ≥25 kg/m 2 , se incrementa el riesgo de padecer hipertensión arterial, angina de pecho, diabetes mellitus, dislipidemia e insuficiencia cardiaca en ambos sexos 41-45.[30][31][32][33][34] Se refiere un riesgo 10 veces mayor de desarrollar Diabetes Mellitus y 3 veces más riesgo de desarrollar coronariopatía.30,31 ...
... ). Cuando el IMC es ≥25 kg/m 2 , se incrementa el riesgo de padecer hipertensión arterial, angina de pecho, diabetes mellitus, dislipidemia e insuficiencia cardiaca en ambos sexos 41-45.[30][31][32][33][34] Se refiere un riesgo 10 veces mayor de desarrollar Diabetes Mellitus y 3 veces más riesgo de desarrollar coronariopatía.30,31 Según los resultados obtenidos a través de la cuantificación de los niveles de glucometría en ayuno de 8 horas, la intolerancia a la glucosa fue del 80,29%(110), mayor que las cifras en un estudio realizado por Brito-Núñez NJ et. ...
Type 2 Diabetes Mellitus is a chronic disease that affects the quality of life of the adult population, and some of its complications are related to high morbidity. In Latin America, as in our environment, there is little data on the risk of suffering from Diabetes, which is why we decided to carry out this research.
Objective: to establish the risk of developing type 2 Diabetes Mellitus in adults in the influence area of El Carrizal, Metropolitan Region of Central District, Francisco Morazán department, Honduras.
Methodology: a cross-sectional descriptive study was carried out in from July to August 2018. Sample consists of 210 people over 18 years of age chosen randomly by two stage cluster sampling. To establish the risk of developing Diabetes Mellitus type 2 "The Risk Assessment Form for Finnish Type 2 Diabetes Mellitus (FINDRISC).
Results: The incidence of Diabetes Mellitus type 2 in the total population was 8, 76 %( 12, CI 95%:4, 9-14, 8%). The incidence of impaired glucose in the population was 80, 29 % (110, CI 95%: 72, 7-86, 1%). 20,95%(44, CI 95%: 15,97-26,98) of the studied population had a high and very high risk of developing Diabetes Mellitus type 2 in a period of 10 years, being unhealthy physical activity the risk factor with the highest frequency, followed by unhealthy diet and visceral obesity.
Conclusion: the highest risk of developing Diabetes Mellitus type 2 in 10 years was found in overweight population, with major frequency in female gender.
Key words: diabetes mellitus type 2, insulin resistance, obesity, metabolic syndrome, hyperglycemia
... 44 Furthermore, in a case review of 1237 individuals that were characterized as being at high risk of developing CVD, 49% of participants demonstrated associated levels of high visceral fat and abdominal obesity, 41% of dyslipidemia, 38% of smoking and 33% of hypertension. 45 Accordingly, the combination of obesity and hypertension in the same individual appears to be a particular characteristic of Latin American populations, which dramatically increases cardiovascular risk factors. 46 The clustering of these significant cardiovascular risk factors may be associated with socioeconomic changes that promote the adoption of more sedentary lifestyles and less healthy eating habits. ...
... 48 Abdominal obesity has been identified as the most important risk factor of CVD in Latin America, significantly contributing to risk of a first acute myocardial infarction. 45 Furthermore, if cardiovascular risk factors are not controlled in middle-aged adults, they can facilitate a series of pathophysiological processes in old age. ...
Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health.
... *Taiwanese hypertension guidelines strongly recommend the use of angiotensin-receptor blockers over angiotensin-converting enzyme inhibitors due to their exceptional tolerability and lowest discontinuation rate among all five classes of antihypertensive drugs tested. 24 Healthcare system 28,[30][31][32] In LA, the percentage of strokes attributed to HTN is among the highest in the world (up to 60-80%), with HTN being responsible for a significant number of heart failure cases (22%). 28,[30][31][32] The impact of HTN on chronic renal disease is still unknown. ...
... 24 Healthcare system 28,[30][31][32] In LA, the percentage of strokes attributed to HTN is among the highest in the world (up to 60-80%), with HTN being responsible for a significant number of heart failure cases (22%). 28,[30][31][32] The impact of HTN on chronic renal disease is still unknown. As observed in other parts of the world, HTN is the highest contributor of death in LA, followed by smoking, obesity, hyperglycaemia, and hypercholesterolaemia. ...
This symposium provided an excellent forum in which to discuss the global burden of hypertension (HTN), its challenges, and approaches to best management in new frontiers. The symposium speakers also reviewed recent data for clinical practice, especially those relevant for patients at high risk of HTN. The presentations were delivered within a highly interactive setting to facilitate audience questions and discussion. The symposium was opened by Prof Bryan Williams, who gave a description of the global burden of HTN, emphasising the need for effective, simplified treatment strategies and algorithms to effectively control blood pressure (BP). Prof Gordon Thomas McInnes then gave an overview of the challenges faced when treating HTN in the developing world and the best management practices of HTN adopted across different countries. HTN control in Latin America (LA) and the Caribbean region, and its opportunities and challenges was the subject of the next presentation given by Dr Jesús Isea-Pérez. Lastly, Dr Jorge Sison discussed HTN control in Asia and the Middle East, presenting real-world data in addition to a review of the latest clinical data on optimal management of HTN, and focussing on the use of single-pill combination (SPC) therapies. This engaging and interactive symposium was facilitated by multiplechoice questions posed by speakers, allowing audience participation via an electronic voting system. The meeting closed with a lively panel discussion and concluding remarks from Prof Bryan Williams. This truly international symposium brought together more than 550 delegates from across Europe and North America, Africa and the Middle East, Asia and Pacific regions, and Central and South America, with attendees representing a wide range of clinical and professional settings.
... The prevalence of Metabolic Syndrome in Latin American countries indicates that the most frequent components of MetS are low HDL cholesterol levels (62.9%) and abdominal obesity (45.8%) [36]. The INTERHEART study observed that abdominal obesity is the most significant risk factor for cardiovascular diseases in Latin America compared to the rest of the world [37]. Colombia, in particular, stands out with a higher prevalence of elevated cholesterol [38] and high triglycerides [38] compared to other Latin American countries. ...
Metabolic syndrome (MetS) comprises a set of risk factors that contribute to the development of chronic and cardiovascular diseases, increasing the mortality rate. Altered lipid metabolism is associated with the development of metabolic disorders such as insulin resistance, obesity, atherosclerosis, and metabolic syndrome; however, there is a lack of knowledge about lipids compounds and the lipidic pathways associated with this condition, particularly in the Latin-American population. Innovative approaches, such as lipidomic analysis, facilitate the identification of lipid species related to these risk factors. This study aimed to assess the plasma lipidome in subjects with MetS.
This correlation study included healthy adults and adults with MetS. Blood samples were analyzed. The lipidomic profile was determined using an Agilent Technologies 1260 liquid chromatography system coupled to a Q-TOF 6545 quadrupole mass analyzer with electrospray ionization. The main differences were determined between the groups.
The analyses reveal a distinct lipidomic profile between healthy adults and those with MetS, including increased concentrations of most identified glycerolipids -both triglycerides and diglycerides- and decreased levels of ether lipids and sphingolipids, especially sphingomyelins, in MetS subjects. Association between high triglycerides, waist circumference, and most differentially expressed lipids were found.
Our results demonstrate dysregulation of lipid metabolism in subjects with Mets, supporting the potential utility of plasma lipidome analysis for a deeper understanding of MetS pathophysiology.
... It is essential to mention that these are the five most critical RFs for DALYs due to CVD, with special emphasis on high blood pressure and dietary risks in LA in 2021 ( Figure 2). 2 Numerous studies carried out before 2014 with population groups from different Latin American countries have demonstrated significant variability in the prevalence of different modifiable CV RFs in Latin American women as compared to men, with a higher frequency of obesity [28.5% (18.4% -42.6%) x 23.7% (13.8% -36.5%)], diabetes [10.2% (4.8% -17.2%) x 10.2% (4.8% -17.2%)], sedentary lifestyle (84.3% x 75.6%), and depression (36.7% x 26.4%) in women. [3][4][5] The analysis of 389 population studies carried out in 37 countries and 6 subregions of the Americas, comparing the prevalence of high blood pressure, obesity, and diabetes mellitus between 1980 and 2014, has shown an increase in the prevalence of obesity and diabetes in all countries, with a tendency towards a reduction or stabilization in hypertension prevalence in the region. 6 Although CVD is the leading cause of death in women in the Americas and around the world, it is understudied, under-recognized, underdiagnosed, and undertreated. ...
... En América Latina, el 31 % de todas las muertes están relacionadas con enfermedades no transmisibles en el año 2000, y aproximadamente la mitad se debieron a enfermedad cardiovascular. (7) El infarto agudo al miocardio (IAM) se ubica entre las primeras tres causas de morbimortalidad en nuestra región. El grupo de pacientes Tratamiento trombolítico efectivo en pacientes con infarto agudo del miocardio con elevación del segmento ST Alejandro Elias García 1 , Juan Pablo Pineda 2 , Delfy Barrientos Morales 3 ...
La cardiopatía isquémica continúa siendo la principal causa de mortalidad en adultos a nivel mundial y Guatemala no es la excepción. En la población general se ha observado que la ruptura de placa ateroesclerótica con consecuente trombosis es la principal causa de infarto agudo al miocardio con elevación del segmento ST. Actualmente existen diversos métodos de reperfusión mediante procedimientos de intervencionismo, sin embargo, en Guatemala la mayoría de los hospitales del Ministerio de Salud Pública y Asistencia Social no cuentan con estas técnicas, por lo que es necesario utilizar fármacos para la reperfusión coronaria. Se realizó un estudio descriptivo-retrospectivo con el objetivo de determinar la eficacia del tratamiento trombolítico con el uso de estreptoquinasa en los pacientes ingresados al departamento de Medicina Interna del Hospital Pedro de Bethancourt, de enero de 2014 a diciembre de 2018. Se determinó la frecuencia de los principales factores de riesgo y se listaron los criterios utilizados para determinar si el tratamiento trombolítico fue efectivo. Se concluye que el tratamiento trombolítico fue efectivo en el 69 % de los pacientes, siendo los principales factores de riesgo el pertenecer al género masculino con el 77 %, la edad mayor de 60 años (62 %) y el tabaquismo con el 38 %. Los criterios de trombolisis efectiva más relevantes fueron la disminución delsegmento ST con el 77 % y el alivio del dolor referido por el paciente con igual porcentaje.
... El estudio INTERHEARTH presentó asociaciones convincentes entre los factores de riesgo psicosocial y riesgo de infarto agudo de miocardio (IAM); en Latinoamérica, este estudio evidenció cómo el estrés psicosocial persistente está asociado a padecer IAM (OR, 2.81; 95% IC, 2.07 -3.82), con un riesgo similar a los factores tradicionales (Lanas et al., 2007;Yusuf et al., 2004). ...
El objetivo de este estudio fue determinar la relación entre estrés con variables sociodemográficas y biomarcadores de carga alostática, en pacientes con enfermedad coronaria aguda. Es un estudio cross sectional, en pacientes con enfermedad coronaria confirmada por coronariografía. El estrés se midió a través de la escala de estrés percibido y las variables sociodemográficas y clínicas fueron tomadas de las historias clínicas. Por medio de estadística descriptiva se analizaron las covariables. Se conformaron dos grupos según la presencia o no de estrés, al momento de la hospitalización; se evaluó la diferencia entre los grupos. Se exploró la correlación por medio de regresión lineal. Se reclutaron 138 pacientes, 50% de ellos tenían 65 o más años, 65.9% eran hombres, el infarto agudo de miocardio fue el principal diagnostico documentado y el factor de riesgo más frecuente fue la hipertensión arterial. El 22,8% de los pacientes puntuaron para estrés. El HDL fue mayor entre los pacientes con estrés (Me 45,57) frente a aquellos sin estrés (Me 39,12), siendo un factor diferenciador (p= 0,024). En el análisis multivariable se encontró relación positiva (r: 0.3; p: 0.003) del HDL con el estrés y una relación inversa (r: -0.95; p: 0.02) del IMC con el HDL en los hombres. Los resultados sugieren una relación directa y significativa entre niveles elevados de HDL y el estrés, pudiendo actuar el HDL como un factor proinflamatorio en el momento agudo de la enfermedad coronaria aguda.
... Según la Organización Mundial de la Salud (OMS) al menos un 80% de las muertes por Infarto Agudo de Miocardio podrían evitarse si se controlaran los factores de riesgo principales como el colesterol elevado, hipertensión arterial, diabetes, tabaquismo, obesidad, sedentarismo y estrés, entre otros(2). La modificación de los factores de riesgo, permite reducir los episodios cardiovasculares y la muerte prematura tanto en las personas con enfermedad cardiovascular establecida como en aquellas con alto riesgo cardiovascular debido a uno o más factores presentes (3). En el año 2013 todos los Estados Miembros acordaron, bajo el liderazgo de la OMS, una serie de mecanismos mundiales para reducir la carga evitable de enfermedades crónicas no transmisibles (ENT), entre ellos el "Plan de acción mundial para la prevención y el control de las enfermedades no transmisibles 2013-2020". ...
Objetivo: Determinar el nivel de información sobre factores de riesgo de Infarto agudo de miocardio en los pacientes ambulatorios que asisten a una institución de salud de la provincia de Corrientes año 2021. Metodología: Estudio cuantitativo descriptivo, transversal y observacional. Muestra obtenida mediante muestreo probabilístico aleatorio simple compuesta por 108 pacientes que asistieron a los consultorios de Diabetes, Presurometría y Hospital de Día. Se aplicó un cuestionario validado mediante una prueba piloto. Variables: edad, sexo, nivel de instrucción, Nivel de información sobre alimentación, hábitos nocivos, actividad física y preguntas generales. Los resultados fueron volcados a una matriz diseñada en programa Excel. Resultados: La población en estudio presento una mediana de edad de 43, moda 39 y predomino del sexo masculino 56%, sobre el femenino 44%, en el nivel de instrucción prevaleció el secundario completo 19% seguido de primario incompleto 15%. Abordando los niveles de información sobre factores de riesgo de Infarto agudo de miocardio predominaron los niveles altos en todas las variables trabajadas, obteniendo un nivel general de información alto del 82%, se apreció en la alimentación 65%, hábitos nocivos 70%, aspectos generales un 86% y actividad física 48%. Conclusión: Esta investigación remarca la importancia de la educación permanente y en etapas tempranas sobre los factores de riesgo de Infarto Agudo de Miocardio. La población en estudio presento un nivel alto de información. No obstante, la educación debe fomentarse para llegar al 37% restante que obtuvo niveles inferiores.
... (15) • Body Mass Index (BMI) = weight (kg) / height 2 (m), which was classified into 4 groups (underweight: • Waist-hip ratio (WHR) = waist measurement (cm) / hip measurement (cm), which was classified into 2 groups (high: ≥ 0.95 in men and ≥ 0.90 in women, low: ≤ 0.95 in men and ≤ 0.90 in women). (16) • Waist index height (WHtR) = waist measurement (cm) / height (cm), which was classified into 3 groups (high: ≥ 0.52, low: ≤ 0.48, and normal: 0.48 -0.52). (17) • Waist circumference weight index (WRWC) = weight (kg) / waist circumference measure (cm), which was classified into 4 groups (deficit: <0.44; normal: 0.44 -0.80, overweight: 0.80 ≤ -<0.98, obesity: ≥ 0.98). ...
Introducción: El exceso de grasa en el organismo puede ser un problema multifactorial y predispone a la presencia de enfermedades crónicas no transmisibles, entre las que se encuentran las cardiovasculares.
Objetivo: Establecer el corte óptimo de los índices antropométricos para predecir el síndrome metabólico en personal militar que se atiende en la atención primaria de salud.
Métodos: Estudio analítico, no experimental, llevado a cabo en personal militar de la Universidad de las Fuerzas Armadas, durante el año 2020. La muestra está representada por 203 participantes, los métodos de colección fueron los registros médicos y antropométricos, tomando en consideración variables como talla y peso, circunferencia de cintura y cadera, índice de masa corporal, pruebas de laboratorio, entre otros. Todos los datos fueron analizados usando criterios de clasificación internacional.
Resultado: La prevalencia de síndrome metabólico (MetSyn), según los diferentes criterios es: MetSyn ALAD: 4,08 % (SD: 0,52), MetSyn ATP III: 7,65 % (SD: 0,52), MetSyn HARM: 5,4 % (SD: 0,52) y finalmente, MetSyn OMS: 7,65 % (SD: 0,52). Además, los índices antropométricos predictivos son el WC y WHtR en todos los criterios estudiados, y según MetSyn ATP III, el corte óptimo del WC es de 91 cm y del WHtR es de 0,53.
Conclusiones: Los puntos de corte óptimos para los índices antropométricos que predicen el síndrome metabólico en el personal militar son WC y WHtR, con un punto de corte óptimo inferior a los criterios establecidos por ALAD para el diagnóstico de MetSyn.
... If they are associated with poor eating habits, lack of regular physical activity, excessive alcohol consumption, and psychosocial stress, they can foster the formation of atheroma plaques. 11 Most of patients with a first AMI have at least one of the main risk factors. The greater the accumulation of risk factors, the higher the risk of in-hospital mortality during the first myocardial infarction. ...
... Regarding WHR in patients with previous CVD, a systematic review concluded that AMI is strongly associated with an increased WHR, with a stronger association among women [46]. Although most of the evidence regarding this association derives from developed countries, a case-control study showed that even in low-income and middle-income countries, abdominal obesity estimated by the WHR was an important risk factor presented in patients with AMI [47], and this is consistent in other regions of the world such as Latin America [48]. Even in certain populations such as patients with chronic kidney disease or diabetes, WHR but not BMI has been associated with cardiovascular events [49,50]. ...
Background: Several anthropometric measurements are used to assess cardiovascular risk and progress during clinical treatment. Most commonly used anthropometric measurements include total body weight and body mass index (BMI), with several other simple anthropometric measures typically underused in clinical practice. Herein, we review the evidence on the relationship between different anthropometric measurements and cardiovascular risk in patients with and without cardiovascular disease (CVD). Methods: Data for this review were identified by searches in PubMed, the Web of Science, Google Scholar, and references from relevant articles by using appropriate and related terms. The last search was performed on June 22, 2022. Articles published in English and Spanish were reviewed and included, if appropriate. We included studies detailing the relationship between skinfolds thickness, waist-to-hip ratio (WHR) and Conicity index with cardiovascular risk in adults with/without CVD. Results: In patients from the general population, elevated subscapular and triceps skinfolds showed a positive relationship with the development of hypertension, diabetes mellitus, hypercholesterolemia, cardiovascular mortality, and all-cause mortality. A higher subscapular skinfold was also associated with increased risk of coronary artery disease and stroke. A higher WHR, as well as other less common anthropometric measurements such as the Conicity index, was associated with an increased risk of myocardial infarction, incident CVD, major adverse cardiovascular events, and mortality in both patients with and without previous CVD. Conclusions: Non-traditional anthropometric measurements including skinfolds and WHR seem to improve the prediction of cardiovascular risk in the general population, and recurrent events in patients with previous CVD. Use of additional anthropometric techniques according to an objective and standardized method, may aid cardiovascular risk stratification in patients from the general population and the evaluation of therapeutic interventions for patients with CVD.
... Although risk factors between both groups showed no difference, patients with NSTEMI/ UA had a higher incidence of hypertension and diabetes mellitus, similar to the GRACE registry [25]. The INTERHEART Latin American Study reported that history of hypertension, diabetes mellitus, or current smoking were associated with higher risk of AMI [26]. ...
Background:
Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care.
Objective:
Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model.
Methods:
The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala's National Healthcare System were included. These represent six out of the country's eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student's t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant.
Results:
One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2-24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%.
Conclusions:
There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used.
... Latin America is one of the regions with the highest burden of cardiovascular risk factors (CVRF), especially overweight, dyslipidemia, diabetes mellitus and hypertension (HT) [6][7][8] . In the INTERHEART study, conducted in Latin American countries 9 , the risk attributable to the combination of abdominal obesity, dyslipidemia, smoking and hypertension was 80%. ...
... De hecho, la hipertensión es el factor de riesgo más fuertemente asociado con el primer infarto de miocardio en los países latinoamericanos (6) . Además, el daño de órganos terminales (p. ...
RESUMEN El objetivo de esta publicación es la revisión crítica de los estudios de prevalencia de la hipertensión en relación con otros factores de riesgo realizados en Venezuela desde la década de los 90. El primer estudio, con un buen número de sujetos, fue realizado en Barquisimeto, en una muestra de 15 000 personas de cualquier sexo, casa por casa y un promedio de edad de 44,2 años a mediados de los años 90, encontrándose una prevalencia de 23,5 % del total (21.4 % mujeres; 27,1 % hombres), seguido por otro estudio realizado en la ciudad de Maracaibo, en 7 424 sujetos, encontrándose una prevalencia de 36,9 % (45,2 % hombres y 28,9 % mujeres). En el 2008 se publicó el estudio CARMELA, con un muestreo representativo en 1 864 sujetos, entre 25 a 64 años (media: 45,1 años), con una prevalencia de 24,7 %. Entre los años 2014 y 2016 se realizó el estudio EVESCAM en diversas regiones de Venezuela, en una muestra de 3 420 sujetos, con edad media de 50,1 años y una prevalencia de hipertensión de 37,9 % para hombres y 36,3 % para mujeres. Posteriormente, la Sociedad Internacional de Hipertensión diseñó el protocolo May Measurement Month, para ser aplicado en unos 100 países a escala mundial, donde Venezuela participó en los años 2017, 2018 y 2019. En total se han incluido 74 965 sujetos (edad media de 54,03 años), con una prevalencia de hipertensión de 48,8 %, de los cuales el 40,7 % eran tratados, el 34 % controlados y el 13,5 % no conocidos. A través de los años los estudios muestran un incremento de la prevalencia de hipertensión, pero ese incremento se debe fundamentalmente al incremento de la media de edad de los estudios; el grado de conocimiento, tratamiento y control ha mejorado significativamente, presumiblemente debido a un mayor uso de fármacos antihipertensivos, reducción de obesidad e índice de masa corporal, reducción en el consumo de alcohol y tabaco en la población venezolana. SUMMARY The objective of this publication is the critical review of studies on the prevalence of hypertension in relation to other risk factors carried out in Venezuela since the 1990s. The first study, with a good number of subjects, was carried out in Barquisimeto, in a sample of 15 000 people of either sex, house by house and with an average age of 44.2 years in the mid-1990s, finding a prevalence of 23.5 % of the total (21.4 % women; 27.1 % men), followed by another study conducted in the city of Maracaibo, in 7 424 subjects, finding a prevalence of 36.9 % (45.2 % men and 28.9 % women). In 2008, the CARMELA study was published, with a representative sample of 1864 subjects, between 25 and 64 years old (mean: 45.1 years), with a prevalence of 24.7 %. Between 2014 and 2016, the EVESCAM study was conducted in various regions of Venezuela, in a sample of 3 420 subjects, with a mean age
... Cardiovascular diseases are the leading cause of death in the region of the Americas and in the world. Ischemic heart disease (IHD) has become the first isolated cause of death [1] despite the fact that the risk factors for the majority of IHD events are known, easy to identify and potentially treatable [2]. In Latin America rheumatic heart disease and Chagas disease, once a major health problem in the region of the Americas, are now responsible for only 1% of the mortality [3]. ...
Background: In latest decades, mortality rates from ischemic heart disease (IHD) had declined steadily in most of the world as a consequence of improvements in prevention and therapy.
Objective: The aim of this study was to analyze trends in mortality caused by IHD in the region of the Americas from 2000 to 2019.
Methods: Estimates of the age-adjusted mortality rate (AAMR) due to IHD were extracted from the Data Portal on Noncommunicable Diseases, Mental Health, and External Causes (ENLACE), Pan American Health Organization. We used Joinpoint regression to analyze significant changes in mortality trends by country, gender,
geographical sub-region, and country income, according to the World Bank classification. We also calculated the average annual percent change (AAPC) mortality rate for the overall period in the Americas as a whole and by country and sub-region.
Results: In the region of the Americas, the AAMR from IHD decreased from 117.80 (95% uncertainty interval (UI)) 106.64–135.90) in 2000 to 73.64 (62.65–92.66) per 100,000 in 2019. In males, from 149.08 (95% UI 138.23–168.08) to 96.02 (95% UI 83.48–117.19) and in females 92.36 (95% UI 81.35–109.42) to 54.84 (95% UI 45.28–71.76). The AAPC mortality rate in the region decreased –2.5% (95% CI: –2.7, –2.3), with joinpoints in 2007 and 2012, –2.3% (95% CI: –2.5, –2.1) in men and –2.7% (95% CI: –3.0, –2.5) in women. According to the sub-region analysis, the highest decrease was recorded in North America, AAPC –3.1% (95% CI: –3.3, –3.0) with one joinpoint in 2011, whereas there was a stagnation of the mortality rate in Central America, Mexico, and Latin Caribbean with an AAPC of 0.1 (–0.2, 0.3) with one joinpoint in 2007.
Conclusions: Age-adjusted mortality rate from IHD between 2000 and 2019 has decreased in the region of the Americas. However, different trends were observed, North America had the highest reduction in AAPC, while Central America, Mexico, and Latin Caribbean Region had a stagnation. This trend was highly influenced by country income.
... Nuestros países tienen etnias y condiciones sociodemográficas, económicas y culturales muy diversas, que pueden llevar a la necesidad de enfoques distintos del problema. El estudio INTERHEART, como otros con inclusión de población latinoamericana, demostró que las mujeres latinoamericanas tienen un mayor riesgo atribuible para IAM que las del resto del mundo 14,15 . ...
... Since stress is associated with risk factors for CVD, its identification and control become According to the INTERHEART study, the most prevalent cardiovascular risk factor is abdominal obesity, with a prevalence of 48.6% in Latin America compared to 31.2% in other participating countries. 6 A high calorie intake, rich in simple carbohydrates and saturated fats, associated to a sedentary lifestyle and psychosocial factors such as stress and depression, are responsible for this worldwide epidemic. 4 Moreover, a Brazilian study with patients subjected to coronary angioplasty showed that 74% of the participants who received pre-intervention psychological assistance by the hospital did not present emotional stress signs. ...
... 8 Our finding that the largest population-level risk factors of MI were related to abdominal obesity, elevated lipids, and tobacco use is consistent with prior observations from the INTERHEART Latin American substudy where these three risk factors were also associated with the largest population-level risks. 17 Hypertension, tobacco use, and obesity (in addition to low education level) were the leading risk factors for death in the region. Compared with our prior findings in PURE by country income level, and in other regions of the world, the similar contribution of metabolic risk factors and tobacco use to CVD and to death is what has been mainly observed in high-income countries rather than other middle-income countries, likely reflecting the epidemiological transition in South America to non-communicable diseases accounting for the vast majority of deaths. ...
Aims:
In a multinational South American cohort, we examined variations in CVD incidence and mortality rates between subpopulations stratified by country, by sex and by urban or rural location. We also examined the contributions of 12 modifiable risk factors to CVD development and to death.
Methods and results:
This prospective cohort study included 24 718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia. The mean follow-up was 10.3 years. The incidence of CVD and mortality rates were calculated for the overall cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and for death were examined for 12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (tobacco, alcohol, diet quality, and physical activity), and others (education, household air pollution, strength, and depression). Leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). The incidence of CVD (per 1000 person-years) only modestly varied between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates (per 1000 person-years) between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07). Men had a higher incidence of CVD (4.48 vs. 2.60 per 1000 person-years) and a higher mortality rate (6.33 vs. 3.96 per 1000 person-years) compared with women. Deaths were higher in rural compared to urban areas. Approximately 72% of the PAF for CVD and 69% of the PAF for deaths were attributable to 12 modifiable risk factors. For CVD, largest PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), tobacco use (13.5%), low strength (5.6%), and diabetes (5.3%). For death, the largest PAFs were from tobacco use (14.4%), hypertension (12.0%), low education (10.5%), abdominal obesity (9.7%), and diabetes (5.5%).
Conclusions:
Cardiovascular disease, cancer, and respiratory diseases account for over two-thirds of deaths in South America. Men have consistently higher CVD and mortality rates than women. A large proportion of CVD and premature deaths could be averted by controlling metabolic risk factors and tobacco use, which are common leading risk factors for both outcomes in the region.
Key questions:
How do the rates of cardiovascular disease (CVD) and death vary within South America, and what are the predominant risk factors for each?
Key findings:
Cardiovascular disease and death rates were both higher in men compared with women. Death rates were higher in rural compared with urban areas. Hypertension, obesity, diabetes, and tobacco use were leading risk factors for both CVD and death.
Take-home message:
A large proportion of CVD and premature deaths in South America could be averted by policies aimed at controlling metabolic risk factors and tobacco use.
... Prospective epidemiological studies have shown that the presence of certain behavioral risk factors including tobacco smoking, unhealthy diet, sedentary lifestyle, alcoholism, and psycho-emotional stress 6 increases the probability of clinical cardiovascular disease (CVD) 7 . These factors are associated with increased risk for cardiovascular complications, such as acute myocardial infarction (AMI), cerebrovascular accident (CVA), and heart failure (HF). ...
ABSTRACT
Background: The leading cause of death worldwide is cardiovascular disease (CVD), including among physicians. The latter have professional peculiarities that increase cardiovascular risk, making it relevant to analyze mortality in the medical population (MPop) and non-medical population (NMPop). Objective: To compare the CVD mortality coefficient (MC) in the Brazilian MPop and NMPop by analyzing the epidemiological profile and the main causes of deaths from CVD. Methods: Time-series study conducted through the Mortality Information System of the Federal Council of Medicine and the Brazilian Institute of Geography and Statistics, from 2014 to 2018, assessing age group, sex, race, occupation, and the CVD that caused the death in the Brazilian MPop and NMPop. MC, relative risk and odds ratio between the populations were calculated. Tests for difference in proportions, with approximation by normal distribution, and chi-squared tests were performed, assuming p<0.01 as statistically significant. Results: Both the MPop and NMPop had a predominance of men (86.7% and 52.3%), senior citizens (85.9% and 79.7%) and white individuals (86.4% and 52.2%), with the MC of the MPop and NMPop being 92.2 and 255.1 deaths/100,000 individuals, respectively. Among the causes of death, there was a predominance of Acute Myocardial Infarction [AMI] (32.5% and 24.6%) and Cerebrovascular Accident [CVA] (5.1% and 10.5%). Conclusion: Among physicians, mortality from CVD in Brazil was higher in male, elderly and white individuals, as a consequence of AMI and CVA. Being a doctor, man and over 60 years old represents a greater chance of death from CVD in comparison with non-physicians.
... Furthermore, residents' interactions with their food environment are complex and can be influenced by several factors beyond their local context, including work schedules, time constraints, food prices, personal mobility, and safety-to name a few [50,51]. Given the link between persistent stress and overall cardiovascular risk [52], we point to psychosocial measures as additional considerations in future population studies to improve our understanding of individual changes in blood pressure. ...
Shifting food environments in Latin America have potentially contributed to an increase in the consumption of ultra-processed foods and sugar-sweetened beverages, along with decreases in healthy foods, such as fruits and vegetables. Yet, little is known about the impact that such changes in the food environment have on blood pressure in low- and middle-income countries, including Mexico. We utilized individual-level systolic and diastolic blood pressure (SBP and DBP) measures from the 2016 Mexican Health and Nutrition Survey (ENSANUT, n = 2798 adults). Using an inventory of food stores based on the economic census for 2010 and 2016, we calculated the change in the density of fruit and vegetable stores, convenience stores, and supermarkets. Multilevel regression was used to estimate the association between the 2010–2016 food environment neighborhood-level changes with individual-level blood pressure measured in 2016. Declines in neighborhood-level density of fruit and vegetable stores were associated with higher individual SBP (2.67 mmHg, 95% CI: 0.1, 5.2) in unadjusted models, and marginally associated after controlling for individual-level and area-level covariates. Increases in the density of supermarkets were associated with higher blood pressure outcomes among adults with undiagnosed hypertension. Structural interventions targeting the retail food environment could potentially contribute to better nutrition-related health outcomes in Latin American cities.
... As DCV representam a principal causa de morbimortalidade no Brasil e no mundo, e, mesmo com FRCV, em sua maioria, passíveis de prevenção, continuam-se exibindo altas taxas de prevalência e níveis crescentes de incidência (Lanas et al., 2007;Sousa Rodrigues et al., 2017). Nesta pesquisa foram avaliados alguns desses FRCV, além de complicações responsivas à hipertensão, em adultos hipertensos, verificando-se que, dentre aquelas variáveis que apresentaram significância em suas variações temporais, a grande maioria apresentou tendência de aumento em seu comportamento ao longo dos anos, sinalizando controle insuficiente de tão importante problema de saúde pública, na população hipertensa de Maceió. ...
Objetivou-se investigar a frequência de fatores de risco cardiovascular (FRCV) e complicações cardiovasculares em adultos hipertensos de Maceió-AL, com dados de dois estudos transversais (2007/2009 e 2013/2016). Analisou-se FRCV: tabagismo, sedentarismo, antecedentes familiares, baixa estatura, sobrepeso/obesidade (SBP/OB), obesidade (OB), razão cintura/estatura (RCE), índice de conicidade (IC) e obesidade abdominal (OA), e complicações cardiovasculares: doença renal (DR), infarto agudo do miocárdio, outras coronariopatias e acidente vascular cerebral. Foi analisada a razão de prevalência pela regressão de Poisson, com ajuste robusto da variância na análise bruta e multivariável. RCE, OA, IC, SBP/OB, sedentarismo e antecedentes familiares apresentaram as maiores prevalências: 91,59%, 83,17%, 85,85%, 86,33%, 68,44 e 63,64% respectivamente. Quanto à evolução na prevalência entre os dois recortes no tempo após ajuste para sexo e idade, sedentarismo (RP=1,35; IC95%: 1,02-1,77) e SBP/OB (RP=1,17; IC95%: 1,04-1,32) apresentaram aumento e RCE (RP=0,87; IC95%: 0,81-0,94) redução significantes. O aumento do excesso de peso e da inatividade entre os hipertensos, mesmo com redução da RCE, indica vulnerabilidade no controle pressórico neste grupo de alto risco cardiovascular.
... Atualização da Diretriz Brasileira de Hipercolesterolemia Familiar -2021 os sobreviventes, 19% em média evoluem com insuficiência cardíaca, importante causa de internações e morbidade. 30,31 Embora conhecidos fatores de risco cardiovascular sejam responsáveis pela maioria dos casos de DASCV e suas complicações, [32][33][34][35][36] existem condições clínicas que aumentam o risco e antecipam sua ocorrência, como a HF. [37][38][39][40] ...
... In Southern Latin America, previous reports from the Global Burden of Disease Study (GBD) have shown that hypertension is the leading risk factor for death, and this trend has not changed in the last decade, with the prevalence of hypertension of up to 23% [4,5]. Besides, the Latin American INTERHEART study showed that most cardiovascular risk in the Southern Cone could be explained by tobacco use, abnormal lipids, abdominal obesity and high blood pressure [6]. ...
Background and Aims
In the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS I Study.
Methods and Results
The participants (n=4626) were derived from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). To define DP, a food-frequency questionnaire was applied and principal component analysis was performed. Blood pressure was determined according to standardized guidelines. A multivariate regression model was developed to determine the association between each DP and blood pressure values, according to the quartile (Q) of adherence to DP. Two predominant DP were detected, Prudent (PDP, higher consumption of fruits, vegetables, legumes, whole grains, fish, seafood and nuts) and Western (WDP, higher consumption of red and processed meats, dressings, sweets, snacks and refined grains). A significant inverse association was found between adherence to PDP and systolic and diastolic blood pressure (-1.85 and -1.29 mmHg for Q4 vs Q1, respectively). Adherence to WDP was positively associated with systolic blood pressure (2.09 mmHg for Q4 vs Q1).
Conclusion
The WDP detected in the studied population is positively associated with higher levels of blood pressure, while greater adherence to healthy DP has a positive impact on blood pressure.
The assessment of the ameliorative potentials of A. cepa and its fractions on doxorubicin-induced cardiotoxicity in Wistar rats was evaluated in this study. 45 Wistar rats of both sexes were randomly divided into 9 groups of 5 animals each; as follows: group I, served as control and received 10 ml/kg body weight of 0.9% saline, group II, 10mg/kg body weight of doxorubicin, group III, 4 mg/kg body weight of vitamin E plus Dox. Group IV, 1000mg/kg body weight of crude extracts of A. cepa plus Dox. Group V, 1000mg/kg body weight of n-hexane fraction of A. cepa plus Dox. Group VI, 1000mg/kg body weight of DCM fraction of A. cepa plus Dox. Group VII, 1000mg/kg body weight of EA fraction of A.cepa plus Dox. Group VIII, 1000mg/kg body weight of methanol fraction of A. cepa plus Dox, and group IX, combinations of 1000mg/kg, 4mg/kg 10mg/kg body weight of crude extract of A. cepa, vitamin E and Dox respectively for 16 days. Groups I and II treatments lasted 14 days, while treatments for groups III-VIII lasted 16 days (making 14 day for respective treatments and addition 2 days for doxorubin administered once 48 hourly) before sacrificing. All substances in this study were administered orally except doxorubicin that was done intravenously. The results showed that doxorubicn administration (group II) significantly (p<0.05) elevated troponin and NO levels; CK and LDH activities, compared to the control group indicating cardiotoxicity. This cardiotoxic effect of doxorubincin was significantly reversed by administration of vitamin E, crude extract, DCM, n-hexane to groups III, IV, V and VI respectively. A significant (p<0.05) reduction of only NO was recorded with EA fraction, compared with group II (dox). Methanol fraction (group VIII) further escalated doxorubicin-induced cardiotoxicity with a significantly (p<0.05) elevated myoglobulin and NO levels and CK activity. But the combined treatment with vitamin E, Crude extract and dox significantly (p<0.05) reduced cardiotoxic markers in this study except myoglobulin where a significant (p<0.05) elevation was recorded. It can be concluded that fresh A. cepa leaves extract possesses cardio-protective properties and may be a suitable cardio-protector against drug-induced cardiotoxicity in crude extract form, fractions of DCM and n-hexane but definitely not with methanol fraction as shown in this study.
Background
About 80% of cardiovascular diseases (including heart failure [HF]) occur in low‐income and developing countries. However, most clinical trials are conducted in developed countries.
Hypothesis
The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America.
Methodology
Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro–Wilk test.
Results
This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7–75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta‐blockers (BB), 77.4% for angiotensin‐converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor‐neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium–glucose cotransporter type‐2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet‐warm (68.3%).
Conclusions
AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two‐thirds do not receive SGLT2i.
La Academia Nacional de Medicina, dentro de las actividades del año 2022, formó los Comités Extraordinarios Transitorios con la participación de especialistas de diversa procedencia, académicos, invitados nacionales y extranjeros. Ellos, en grupos de trabajo, analizaron diversos temas de salud que impactan en el mundo y son asimismo importantes en nuestra población peruana. Cada Comité Transitorio ha evaluado los temas de Salud Mental, Enfermedades Reumatológicas (especialmente osteoporosis), Cáncer, Obesidad y Diabetes, Hipertensión arterial y Envejecimiento Saludable. Estos y otros problemas de salud deben ser detectados y controlados en el Primer Nivel de Atención y en consecuencia el tema de Atención Primaria era conveniente abordarlo.
Background:
Blended mHealth interventions (mHealth interventions including a facilitator) promote user engagement and increase effectiveness of health behavior change interventions. Little is known about how blended mHealth interventions are used outside the research context.
Methods:
In the present work, we characterized patterns of app use among users of a blended mHealth intervention in real-world conditions. Program users were Veterans Health Administration (VHA) primary care patients (n = 56) who received an invite code for a blended mHealth intervention between 2019 and 2021. Cluster analysis was used to examine user engagement with health coach visits and program features.
Results:
Of patients who received an invite code, 34% initiated the program. Most users were men (63%) and white (57%). The mean number of health conditions was 5 (68% with obesity). The mean age was 55. Cluster analysis suggested that most users did sustain engagement at either moderate (57%) or very high levels (13%). The remaining 30% of users were low engaged users. Users completing any health coach visit (about half) reported more overall engagement than their counterparts who did not. Weight was the most frequently tracked metric. Of users entering weights in the first and last month of the program (n = 18), the mean percent body weight change was 4.0% (SD = 3.6).
Conclusions:
A blended mHealth intervention may be a scalable option to extend the reach of health behavior change interventions for those that use it. However, a significant portion of users do not initiate these interventions, choose not to use the health coach feature, or engage at lower levels. Future research should examine the role of health coaching visits in promoting sustained engagement.
Background:
Sudden cardiac death (SCD) represents a frequent etiology of sudden death. It represents a major public health issue. Few data about SCD in women are available from the Arab world. Our work aimed to analyze the risk factors of sudden cardiac death in Tunisian women in comparison with men.
Methods:
A cross-sectional retrospective study including all sudden cardiac death cases, conducted in the Forensic Medicine Department of the main teaching hospital of Tunis, between January 2010 and December 2019.
Results:
We counted 417 cases of sudden cardiac death in women representing 17.5% of the total number of sudden cardiac deaths recorded during the study period. The average age was 60.03 ± 15.01 years with a predominance of urban married women. The most frequent cardiac risk factors were high blood pressure (50%), diabetes (36.2%), and cardiac disease history (34.2%). Predominately married women with a history of High blood pressure and diabetes, had a high predictive of sudden cardiac death.
Conclusion:
Cardiac sudden death is no longer a male focused issue. As a matter of facts Rates of SCD in women are rising with a different pattern. We will highlight the importance of adopting specific preventive measures of SCD in female.
Introducción: la herramienta FINDRISC permite calcular el riesgo de desarrollar diabetes con punto de corte para Colombia de 12. Existe evidencia de que el riesgo cardiovascular se incrementa a medida que lo hace el puntaje, pero en Colombia no existe información cuando es ≥ 12. Objetivo: establecer el riesgo cardiovascular (RCV) en pacientes con FINDRISK-C ≥ 12 mediante score Framingham ajustado para Colombia. Materiales y métodos: subanálisis transversal retrospectivo en 796 pacientes a quienes se les aplicó el cuestionario FINDRISC-C, de ellos 293 con puntaje ≥ 12 y 262 cumplieron los criterios de elegibilidad. Antes se les calculó el RCV mediante análisis uni y multivariado, significancias estadísticas y análisis de correspondencias múltiple. Resultados: 262 pacientes, 63% mujeres, 87% tuvieron sobrepeso y obesidad, promedio de perímetro abdominal 97 cm, 10% eran fumadores y 48% tenían antecedente familiar de diabetes mellitus tipo 2. Se encontró una media de RCV de 8,10 (IC 7,29-8,91), al estratificar por FINDRISC-C la media para cada una de las categorías fue: FINDRISC-C moderado 7,83; FINDRISC-C alto 7,87, FINDRISC-C muy alto 12,61. La prevalencia de dislipidemia fue de 46,2 % (IC 95%: 40-50) siendo mayor en hombres (53,6%). Conclusión: los pacientes con FINDRISC-C ≥ 12 tienen un RCV entre moderado y alto, existiendo tendencia al incremento del porcentaje de riesgo calculado según score Framingham ajustado para Colombia, a medida que aumenta el puntaje FINDRISC-C. La prevalencia de dislipidemia en pacientes con FINDRISC-C ≥ 12 fue elevada.
We present cardiovascular disease (CVD) incidence and mortality rates reported for South America stratified by country, sex, and urban/rural location in a multinational cohort included in the Population Urban Rural Epidemiological Study (PURE). This study included 24,718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia and the mean follow-up was 10.3years. CVD incidence and mortality rates were calculated for the total cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and death were examined for 12 modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (smoking, alcohol, diet quality, and physical activity) and other (education, household air pollution, strength, and depression). The leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). Approximately 72% of the PAFs for CVD and 69% of the PAFs for deaths were attributed to 12 modifiable risk factors. For CVD, the main PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), smoking (13.5%), low muscle strength (5.6%), and diabetes (5.3%). For death, the main PAFs were smoking (14.4%), hypertension (12.0%), low educational level (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). Cardiovascular diseases, cancer, and respiratory diseases account for more than two-thirds of deaths in South America. Men have consistently higher CVD rates and mortality than women. A large proportion of CVD and premature deaths could be avoided by controlling metabolic risk factors and smoking, which are the main risk factors in the region for both CVD and all-cause mortality.
Objetivo: Identificar preditores antropométricos para o surgimento de novos Eventos Cardiovasculares Não Fatais (ECNF) em indivíduos em prevenção cardiovascular secundária. Métodos: Foram realizadas buscas nas bases de dados MedLine, Scopus, Web of Science, EBSCO e LILACS e incluídos os estudos de coorte e seguimentos de ensaios clínicos que analisaram a ocorrência de ECNF em adultos e idosos com histórico pessoal de evento cardiovascular. Resultados: Foram incluídos 20 estudos para a síntese narrativa, sendo estes realizados com indivíduos de ambos os sexos, apresentando doenças das artérias coronárias e cerebrais e o índice de massa corporal foi o indicador mais utilizado na predição de novos ECNF. Ao avaliar a qualidade metodológica, apenas sete estudos foram classificados com “forte” nível de evidência. Considerações finais: A presente revisão, identificou o “paradoxo da obesidade” ou seja, o Índice de Massa Corporal (IMC) elevado como fator de proteção para a ocorrência de novos ECNF, e que, com a abordagem estratificada por estado nutricional e alterações metabólicas esta associação não se mantém, apontando esta abordagem como promissora para a compreensão deste fenômeno.
Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The “double burden of malnutrition” (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world.
Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development.
Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies.
Objective:
To determine the initial management and in-hospital mortality of patients with acute coronary syndrome who attended referral hospitals in Paraguay.
Method:
Observational, multicenter study, in patients over 18 years with a confirmed diagnosis of acute coronary syndrome.
Results:
780 patients were included from May 2015 to February 2016; the mean age was 64.1 ± 12.3 years, 64.1% male. The clinical presentation was acute coronary syndrome with ST elevation in 40.1% and without elevation in 59.9%. In patients with ST elevation there is a high percentage of late attendance, more than 12 h of evolution in 49.8%; those with less than 12 h of evolution underwent reperfusion in 52.2% of the cases, received fibrinolytics in 36.3% of the cases, and primary percutaneous coronary intervention 15.9%. In-hospital mortality for acute coronary syndrome was 10.3%, with ST-segment elevation was 12.8%, and without ST-segment elevation was 8.6%.
Conclusions:
The management of acute coronary syndrome in Paraguay needs a comprehensive approach, which promotes earlier care, and increases the implementation of reperfusion therapies in the health services network, in order to improve the therapeutic response rates and decrease hospital mortality.
Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The “double burden of malnutrition” (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world.
Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development.
Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies.
En América Latina, 13% de todas las muertes y 5,1% de los años de vida ajustados por discapacidad se deben a la hipertensión. El exceso de sodio en la dieta puede incrementar aproximadamente un 30% el riesgo de hipertensión. El objetivo fue determinar la concentración de sodio en orina de 24 de horas para estimar la ingesta de sal en trabajadores del Ministerio de Salud Pública y Bienestar Social (MSPBS). Estudio transversal, en trabajadores de 25 a 64 años (n = 397) del MSPBS en Asunción-Paraguay en el 2014. La información sociodemográfica y económica, así como los factores de riesgo de enfermedades cardiovasculares, se evaluaron mediante un cuestionario validado y desarrollado por la OMS. Los niveles de sodio y potasio en orina de 24 horas se midieron usando un protocolo estandarizado. La mediana de la ingesta diaria de sal fue de 13,7 g. La mediana de la excreción de sodio en orina de 24 horas fue de 239 mEq, superando el valor de excreción de sodio recomendado en un 20%. Los hombres tuvieron una excreción de sodio en orina de 24 horas más alta que las mujeres tanto en el grupo de 25 a 44 años (251 mEq / 24 horas frente a 218 mEq/ 24 horas) como en el grupo de 45 a 64 años (266 mEq / 24 horas frente a 233 mEq / 24 horas) de los participantes del estudio. En conclusión, la ingesta de sal fue notablemente superior a la recomendada por la OMS (<5g/d).
Abstract
Despite the iconoclasts of the LDL-centric principle and the net benefit of statins, the plurality, quantity, and especially the scientific quality of the evidence that supports the causal role of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis, as well as the net benefit of statins in its prevention, make these two concepts, universal principles accepted by all guidelines worldwide.
The efficacy, safety, and cost-effectiveness of statins have been confirmed in multiple randomized and controlled clinical trials. However, paradoxically, and especially in developing countries like Mexico, the use of this therapeutic class is suboptimal. The reasons to explain this paradox are multiple and are analyzed in this article, which has the purpose of confirming the efficacy, safety, and significant potential impact of statins in the "real developing world." To fulfill this purpose, this article presents our center experience using statins, especially atorvastatin®, in patients without atherosclerotic cardiovascular disease (ASCVD). Founded on an evidence-based, personalization, and empowerment program, our results in almost four hundred patients in primary cardiovascular prevention are as follows. In intermediate-risk patients, atorvastatin® 10 mg/day with a baseline LDL-C of 111.6 mg/dL (±25.1), reduced LDL-C by 38.0% (±13.9); atorvastatin® 20 mg/day with a baseline LDL-C of 124.4 mg/dL (±25.3), reduced LDL-C by 44.9% (±15.0) (p <0.005 for both). In the atorvastatin® 10/20 mg/day cohort (a total of 294 patients), 87.7% (258 patients) achieved a ≥30% LDL-C reduction, and 36.7% (108 patients) a ≥50% reduction. In the atorvastatin 10/20 mg/day cohort, with an average baseline LDL-C of 122.6 mg/dL (±25.6), 92.5 and 55.7% achieved LDL-C of ≤100 and ≤70 mg/dL, respectively. In high-risk patients, atorvastatin® 40 mg/day with a baseline LDL-C of 151.7 mg/dL (±31.6), there was an LDL-C average reduction of 54.7% (±12.2). Atorvastatin 80mg/day with a baseline LDL-C of 160.2 mg/dL (±41.5) produced an LDL-C average reduction of 62.5% (±10.8) (P <0.005 for both). In the atorvastatin® 40/80 mg/day cohort (89 patients), 98.8% (88 patients) achieved a ≥30% LDL-C reduction, and 76.4% (68 patients) achieved a ≥50% reduction. In the atorvastatin 40/80 mg/day cohort, with an average baseline LDL-C of 153.0 mg/dL (±33.2), 95.8 and 62.9% achieved LDL-C of ≤100 and ≤70 mg/dL, respectively.
Our center results show that, in primary cardiovascular prevention, atorvastatin® prescribed under a based-on-evidence program from randomized and controlled trials (RCT), and cost-effectiveness, personalization, and empowerment is a high-efficacy tool with a significant potential net therapeutic benefit.
Introducción:
La pandemia actual representa un reto para la atención hospitalaria, los servicios de cirugía cardiovascular han modificado su funcionamiento y están constantemente evaluando el riesgo cardiovascular frente al riesgo de la COVID-19.
Objetivo:
Caracterizar el funcionamiento de 23 centros cardiovasculares de Colombia, con el fin de generar información que permita optimizar los servicios y evitar muertes de causa cardiovascular prevenibles.
Método:
Estudio observacional transversal con fuente primaria de información. Muestra por conveniencia de 23 centros cardiovasculares de Colombia.
Resultados:
Se encontró que el 39.1% de los centros suspendieron la actividad en algún momento entre enero y mayo de 2020 y el 34.8% han tenido una disminución en la actividad del servicio del 76-100%; en los meses de abril y mayo se encontró una reducción de alrededor del 50% con referencia a los primeros 2 meses. De las 2258 intervenciones realizadas, solo el 0.17% fueron en pacientes con COVID-19. El estudio muestra que el 60.1% de los servicios han presentado problemas con la utilización de elementos de protección personal. El 17.4% de los centros realizan reacción en cadena de la polimerasa para el virus de forma sistemática en el prequirúrgico, y el 44% la realiza a pacientes con síntomas respiratorios.
Conclusiones:
Durante la pandemia se requiere una detección temprana de posibles infectados que vayan a cirugía, adaptar la programación y promocionar un adecuado uso de los equipos de protección personal. Urge aplicar estrategias dirigidas a pacientes que no pueden ser postergados para evitar segundas y terceras víctimas de la pandemia.
Objetivo:
Evaluar la utilidad del índice UDT-65 para la estratificación del dolor torácico en urgencias en una población colombiana en la que se sospecha enfermedad coronaria.
Método:
Se condujo la validación externa del índice UDT-65 en una cohorte concurrente que incluyó pacientes que ingresaron a urgencias de una clínica cardiovascular en Bogotá con dolor torácico no traumático, y electrocardiograma normal o no diagnóstico. Se evaluaron 1320 pacientes de 18 o más años y se determinó la utilidad del índice en términos de calibración (uso de gráfico, ji al cuadrado para datos agrupados y prueba de bondad de ajuste de Hosmer-Lemeshow) y de capacidad de discriminación del modelo (curva de características operativas del receptor [ROC] y área bajo ella [AUC]).
Resultados:
El índice UDT-65 en esta población suministró evidencia de su utilidad en términos de calibración y capacidad de discriminación, para efectuar una buena aplicación de él en aquellos pacientes que consulten al servicio de urgencias de una clínica cardiovascular por dolor torácico no traumático de posible origen coronario. La capacidad de discriminación del índice UDT-65 fue adecuada, pues con un área bajo la curva ROC de 0.867 (IC 95% 0-847-0.885), que se acerca al valor obtenido (AUC 0.87) en la población española en que se desarrolló el índice.
Conclusiones:
Se necesitan más estudios similares en otras instituciones, dado el buen resultado, en beneficio de más pacientes.
The Hispanic/Latino population in the United States is a heterogeneous group representing the largest minority racial/ethnic subgroup in the United States. The Hispanic/Latino population in the United States includes individuals from many racial and cultural backgrounds. The largest Hispanic/Latino heritage subgroup in the United States is from Mexico. However, heritage subgroups from the Caribbean region (Cuba, Dominican Republic, and Puerto Rico) and Central and South America represent growing subgroups. Historically, epidemiologic data and research pertaining to cardiovascular disease risk factors in the Hispanic/Latino population in the United States have focused mainly on the Mexican heritage subgroup. With the increasing diversity in the Hispanic/Latino population, emerging data are providing valuable information that further enhances our understanding of the differences in cardiovascular risk factors by Hispanic/Latino heritage subgroups. In this chapter, we summarize the recent and currently available information pertaining to cardiovascular risk factors including metabolic syndrome, hypertension, dyslipidemia, type 2 diabetes, and obesity in this heterogeneous segment of the US population.
Objective: 1. To estimate the prevalence of pre-obesity and obesity in a 1992 to 1993 national survey of the Mexican urban adult population. 2. To compare our findings with other national surveys and with data for Mexican Americans.
Research Methods and Procedures: The national representative sample of the Mexican urban adult population included 8462 women and 5929 men aged 20 to 69 years from 417 towns of >2500 people. Body mass index (BMI), calculated from measured weight and height, was classified using the World Health Organization categories of underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5 to 24.9 kg/m2), pre-obesity (PreOB = BMI 25 to 29.9 kg/m2) and obesity (OB = BMI 30+ kg/m2). Estimates for Mexican Americans were calculated from U.S. survey data.
Results: Overall, 38% of the Mexican urban adult population were classified as pre-obese and 21% as obese. Men had a higher prevalence of pre-obesity than women did at all ages, but women had higher values of obesity. Both pre-obesity and obesity increased with age up to the age range brackets of 40 to 49 or 50 to 59 years for both men and women. Both pre-obesity and obesity prevalence estimates were remarkably similar to data for Mexican Americans from 1982 through 1984. Comparison with other large surveys showed that countries differed more in the prevalence of obesity than of pre-obesity, leading to differences in the PreOB/OB ratio, and that countries also differed in the gender ratio (female/male) for both pre-obesity and obesity.
Discussion: Pre-obesity and obesity were high in our population and increased with age. Our approach of characterizing large surveys by PreOB/OB and gender ratios appeared promising.
To describe and analyse changes in child and adult nutritional status in Brazil during the past several decades.
Two large nationally representative cross-sectional anthropometric surveys undertaken in 1974 and 1989 are the primary source of information. Child nutritional status was described based on weight-for-age and weight-for-height indices using NCHS/WHO standards. Body mass index was employed to assess adult nutritional status.
27,960 children and 94,699 adults in 1974 and 5969 children and 23,544 adults in 1989.
All regions in Brazil.
Undernutrition, although still relevant particularly in children from lower income families, is declining among adults and children of all economic strata. Concurrent increases in adult obesity have been occurring among all groups of men and women with a higher proportion of increase among lower income families. A profound change in the income-obesity relationship determines that in the most recent survey: (1) income and body mass index are inversely related among the 30% richest women; (2) a higher prevalence of female obesity (15.4%) occurs for the 40% middle-income group; and (3) the 30% poorest Brazilian women (9.7% prevalence) can no longer be considered to be protected from obesity.
Brazil is rapidly shifting from the problem of dietary deficit to one of dietary excess.
Smoking has become a major public health problem in Latin America, and its scope varies from country to country. Despite difficulty in obtaining methodologically consistent data for the region, we analyzed the results from prevalence surveys in 14 Latin American countries. We observed that smoking prevalence among men varied from 24.1% (Paraguay) to 66.3% (Dominican Republic) and among women from 5.5% (Paraguay) to 26,6% (Uruguay). By applying point prevalence data to the stage model of the tobacco epidemic in developed countries, we concluded that the Latin American countries are in stage 2, i.e., with a clearly rising prevalence among men, a prevalence for women that is beginning to increase, and mortality attributable to smoking among men still not reflecting peak prevalence. None of the countries analyzed appeared to have reached stage 3, in which one observes a downward trend in prevalence of smoking among men and peak prevalence among women, with broad impact on tobacco-related mortality. The only exception appears to be Paraguay, which is still emerging from stage 1, i.e., with low prevalence rates among men, too. Nevertheless, high lung cancer mortality rates in Uruguay and Argentina are comparable to those of the developed countries.
In healthy populations, prospective cohort studies show a possible aetiological role for type A/hostility (6/14 studies), depression and anxiety (11/11 studies), psychosocial work characteristics (6/10 studies), social support (5/8 studies). In populations of patients with coronary heart disease, prospective studies show a prognostic role for depression and anxiety (6/6 studies), psychosocial work characteristics (1/2 studies), and social support (9/10 studies); none of five studies showed a prognostic role for type A/hostility. Although this review can not discount the possibility of publication bias, prospective cohort studies provide strong evidence that psychosocial factors, particularly depression and social support are independent aetiological and prognostic factors for coronary heart disease.
In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases.
To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile.
A random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic.
Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6% were smokers, 15% drank alcohol in two or more occasions per month, 84.6% were physically inactive, 19.7% had a body mass index over 30 kg/m2, 11.1% had high blood pressure, 3.9% were diabetic and 46.9% had high serum cholesterol levels.
The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among Chileans.
The nutritional situation of Latin America is changing rapidly from one characterized by underweight and stunting to one where chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes are increasingly prevalent. In Chile, under-nutrition has virtually disappeared, but rising obesity rates and risk factors for chronic diseases indicate the need to modify existing programs and emphasize prevention of diet-related chronic diseases.
To examine the association between work stress, according to the job strain model and the effort-reward imbalance model, and the risk of death from cardiovascular disease.
Prospective cohort study. Baseline examination in 1973 determined cases of cardiovascular disease, behavioural and biological risks, and stressful characteristics of work. Biological risks were measured at 5 year and 10 year follow up.
Staff of a company in the metal industry in Finland.
812 employees (545 men, 267 women) who were free from cardiovascular diseases at baseline.
Cardiovascular mortality 1973-2001 from the national mortality register.
Mean length of follow up was 25.6 years. After adjustment for age and sex, employees with high job strain, a combination of high demands at work and low job control, had a 2.2-fold (95% confidence interval 1.2 to 4.2) cardiovascular mortality risk compared with their colleagues with low job strain. The corresponding risk ratio for employees with effort-reward imbalance (low salary, lack of social approval, and few career opportunities relative to efforts required at work) was 2.4 (1.3 to 4.4). These ratios remained significant after additional adjustment for occupational group and biological and behavioural risks at baseline. High job strain was associated with increased serum total cholesterol at the 5 year follow up. Effort-reward imbalance predicted increased body mass index at the 10 year follow up.
High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality. The evidence from industrial employees suggests that attention should be paid to the prevention of work stress.
Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management.
The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI.
A total of 1279 pairs, matched by age (+/- 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: > or =5 cigarettes per day (odds ratio [OR] 4.90, P <.00001); glucose > or =126 mg/dL (OR 2.82, P <.00001); waist/hip ratio > or =0.94 (OR 2.45, P <.00001); family history of CAD (OR 2.29, P <.00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P <.00001); reported hypertension (OR 2.09, P <.00001); <5 cigarettes per day (OR 2.07, P =.0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P <.00001); reported diabetes mellitus (OR 1.70, P =.0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P =.0212); alcohol intake (up to 2 days/week) (OR 0.75, P <.0309); alcohol intake (3-7 days/week) (OR 0.60, P =.0085); family income R$600 to R$1200 and college education (OR 2.92, P =.0499); family income >R$1200 and college education (OR 0.68, P = 0.0239)
The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.
To describe the prevalence, frequency, type, motivation for, and demographic and socioeconomic distribution of leisure-time physical activity (LTPA) among adults in Brazil.
The data source for our study was the Brazilian Living Standards Measurement Survey (LSMS) (Pesquisa sobre Padrões de Vida), which was conducted in 1996 and 1997. This survey studied a multistage stratified probabilistic sample of 4 893 households, which included 11 033 persons who were 20 years of age or older. The surveyed households were selected in the two most populous Brazilian regions, the Northeast and the Southeast, where in total 70% of all Brazilians live. The selected persons responded to a series of questions concerning their leisure-time physical activities.
Only 13% of the Brazilians surveyed reported performing at least a minimum of 30 minutes of LTPA on one or more days of the week, and only 3.3% reported doing the recommended minimum of 30 minutes on 5 or more days of the week. In younger age groups, men were more active than were women. However, this difference sharply decreased with increasing age, and by the age range of 40 to 45 years the prevalence of LTPA was similarly low in both genders. Men reported engaging in more team sports, and women reported more walking/jogging activities, but walking/jogging was relatively more common in both genders when physical activity was performed on 5 or more days of the week. Recreation was by far the leading reason given by men to engage in LTPA, while recreation, health concerns, and even esthetic concerns were all relevant for women. In both genders, health concerns tended to be relatively more important for those exercising more days of the week. Also in both genders, increasing age was associated with more frequent LTPA, more walking/jogging than team sports, and more health concerns reasons than reasons related to recreation. Among both men and women there was a strong association between LTPA and socioeconomic status, measured either by income or schooling, independent of age, region, and urban or rural place of residence.
The prevalence of adult LTPA in Brazil was much lower than the levels that have been reported for developed countries. However, the demographic and social distribution of LTPA in Brazil followed a pattern similar to the one usually observed in developed nations, where men tend to be more active than women, increasing age limits LTPA, and higher socioeconomic status is associated with more LTPA. Our data will provide a baseline to evaluate the impact on LTPA of "Agita Brasil" ("Move, Brazil"), an initiative to encourage physical activity that was implemented in the country after 1997.
The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030.
Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries.
The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age.
These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI) attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR). AR were estimated using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR) derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass Index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.
This editorial refers to 'Prognostic value of apolipoprotein B and A-I in the prediction of myocardial infarction in middle-aged men and women: results from the MONICA/KORA Augsburg cohort study's by C.
We aimed to measure the prevalence of physical inactivity (PI) during leisure time and to identify variables associated with it in a southern Brazilian adult population. A population-based cross-sectional study was carried out, covering a multiple-stage sample of 1,968 subjects aged 20-69 years. Weekly participation in leisure-time physical activity was addressed. For each activity, energy expenditure was calculated using data on duration, metabolic equivalent, and body weight. Energy expenditures of individual activities were summed to give a weekly total. PI was defined as fewer than 1,000 kilocalories per week. The prevalence of PI was 80.7% (95%CI: 78.9-82.4). After adjusted analyses, the following variables were positively associated with the outcome: female gender, age, living with a partner, and smoking. Schooling and economic status were inversely associated with PI. Chronically undernourished individuals were significantly more likely to be inactive. We found no differences according to skin color or alcohol consumption. In conclusion, the prevalence of PI in this adult population was higher than in populations from developed countries, but the associated variables were similar.
Some properties of the sample estimator of attributable risk λ, defined here as the proportion of all cases of disease which may be attributed to a risk factor, are considered for the case-control study situation. It is shown that $\log (1 - \hat \lambda)$ may be expressed in terms of the prevalences of the factor in cases and healthy controls, that the bias of the estimator is minimized when 1/2 is added to the cell frequencies corresponding to nonexposed persons in the usual 2 × 2 contingency table, and that the distribution of $1 - \hat \lambda$ is asymptotically log normal. Examples of the calculations, and a discussion of the results, are given for a number of risk factors for childhood leukemia.
Objective: To examine the association between work stress, according to the job strain model and the effort-reward imbalance model, and the risk of death from cardiovascular disease. Design: Prospective cohort study. Baseline examination in 1973 determined cases of cardiovascular disease, behavioural and biological risks, and stressful characteristics of work. Biological risks were measured at 5 year and 10 year follow up. Setting: Staff of a company in the metal industry in Finland. Participants: 812 employees (545 men, 267 women) who were free from cardiovascular diseases at baseline. Main outcome measure: Cardiovascular mortality 1973-2001 from the national mortality register. Results: Mean length of follow up was 25.6 years. After adjustment for age and sex, employees with high job strain, a combination of high demands at work and low job control, had a 2.2-fold (95% confidence interval 1.2 to 4.2) cardiovascular mortality risk compared with their colleagues with low job strain. The corresponding risk ratio for employees with effort-reward imbalance (low salary, lack of social approval, and few career opportunities relative to efforts required at work) was 2.4 (1.3 to 4.4). These ratios remained significant after additional adjustment for occupational group and biological and behavioural risks at baseline. High job strain was associated with increased serum total cholesterol at the 5 year follow up. Effort-reward imbalance predicted increased body mass index at the 10 year follow up. Conclusions: High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality. The evidence from industrial employees suggests that attention should be paid to the prevention of work stress.
Some properties of the sample estimator of attributable risk λ, defined here as the proportion of all cases of disease which may be attributed to a risk factor, are considered for the case-control study situation. It is shown that log (1 -. λ) may be expressed in terms of the prevalences of the factor in cases and healthy controls, that the bias of the estimator is minimized when 2-Jan is added to the cell frequencies corresponding to nonexposed persons in the usual 2 × 2 contingency table, and that the distribution of 1-. λ is asymptotically log normal. Examples of the calculations, and a discussion of the results, are given for a number of risk factors for childhood leukemia.
Major depression has been associated with mortality from ischemic heart disease (IHD). In addition, a symptom of depression-hopelessness-has been suggested as a determinant of health status. We studied the relation of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participated in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline. We used the depression subscale of the General Well-Being Schedule to define depressed affect and a single item from the scale to define hopelessness. At baseline, 11.1% of the cohort had depressed affect; 10.8% reported moderate hopelessness, and 2.9% reported severe hopelessness. Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness were also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal role in the occurrence of both fatal and nonfatal IHD. (Epidemiology 1993;4:285-294)
(C) Lippincott-Raven Publishers.
Background. The proportions of nonfatal acute myocardial infarctions (AMI) in Italy attributable to cigarette smoking, body mass, serum cholesterol level, hypertension, diabetes, and family history of AMI (attributable risks, AR) were estimated using data from a case-control study on 614 incident cases of AMI before age 75 with no history of ischemic heart disease and 792 control subjects admitted to the same hospitals where cases were identified for acute, nonneoplastic, cardio- or cerebrovascular conditions not known or suspected to be related to cigarette smoking. Methods. The study was conducted between September 1988 and June 1989 within the framework of the GISSI-2 clinical trial. We assumed a multiplicative model and thus the risk attributable to several factors combined is not the sum of those attributable to the single factors. Results. Overall the AR of smoking was 49%, and for cholesterol, body mass, family history of AMI, hypertension, and diabetes the AR were 49, 16, 14, 13, and 6%, respectively. Together these factors explained 86% of AMI cases. Though differences emerged for each single factor, the proportion of AMI explained by the six factors together was approximately the same for both sexes, while these factors accounted for 97% of AMI cases before age 50 (and smoking alone for 70%) and for 80% after age 50. Conclusions. This study confirms that interventions on well-defined risk factors could, in principle, lead to the avoidance of the great majority of myocardial infarctions in this population (i.e., about 80% before age 75 and about 95% before age 50).
Twelve centres in 7 countries in the Developing World (China, Thailand, the Philippines, Indonesia, Chile, Colombia and Brazil) connected with the International Clinical Epidemiology Network (INCLEN) each measured cardiovascular disease (CVD) risk factors in random samples of approx. 200 men aged between 35 and 65 years. Samples of men aimed to be representative of the population from which they were drawn, but the population in each centre was not designed to be representative of the whole country. Cigarette smoking rates varied from 16 to 78% and mean cholesterol levels varied from 3.8 to 6.4 mmol/l. In Bogota, Colombia, 46% of the men had a cholesterol level > 6.5mmol/l and in another 5 communities 19% or more of the population had these levels. A body mass index (BMI) of > 25 was seen in more than 50% of 4 communities and a blood pressure ? 160mmHg systolic and/or 95 mmHg diastolic was found in more than 20% of 6 countries. BMI was strongly correlated with blood cholesterol and blood pressure levels in almost all population groups. It would appear that many communities in the Developing World have high levels of risk factors for CVD and that steps could well start to be taken now to prevent the emergence of CVD epidemics in the future.
In this study we examined the relationships between levels of several components of plasma lipoproteins and severity of coronary artery disease in 65 men and 42 women who underwent coronary arteriography for suspected coronary disease. Severity of coronary atherosclerosis was scored as the extent of disease seen at arteriography. Univariate analyses of the relationships between the plasma lipoprotein parameters and score for severity of atherosclerosis revealed a marked difference between men and women. In men, the score for severity of atherosclerosis was strongly related to the low-density lipoprotein (LDL) cholesterol and apolipoprotein B concentrations, whereas in women it was related to the triglyceride concentrations in plasma intermediate-density lipoprotein (IDL) and LDL and to the cholesterol and apolipoprotein B concentrations in IDL. The significance of these correlations was not negated by possible confounding factors such as alcohol intake, diabetes, and treatment with thiazides and beta-adrenergic blockers. Stepwise regression analyses of data adjusted for weight and age indicated that 22% of the variation in the score for severity of atherosclerosis could be accounted for by levels of LDL cholesterol in men. No other lipoprotein parameter could account for any further variation. In contrast, cholesterol did not account for any variation in the score for severity of atherosclerosis in women, whereas plasma triglyceride accounted for 16% of the observed variation in this group. No relationships were found between score for severity of atherosclerosis and high-density lipoprotein cholesterol or plasma apolipoprotein A-I concentrations in either group.(ABSTRACT TRUNCATED AT 250 WORDS)
The proportions of nonfatal acute myocardial infarctions (AMI) in Italy attributable to cigarette smoking, body mass, serum cholesterol level, hypertension, diabetes, and family history of AMI (attributable risks, AR) were estimated using data from a case-control study on 614 incident cases of AMI before age 75 with no history of ischemic heart disease and 792 control subjects admitted to the same hospitals where cases were identified for acute, nonneoplastic, cardio- or cerebrovascular conditions not known or suspected to be related to cigarette smoking.
The study was conducted between September 1988 and June 1989 within the framework of the GISSI-2 clinical trial. We assumed a multiplicative model and thus the risk attributable to several factors combined is not the sum of those attributable to the single factors.
Overall the AR of smoking was 49%, and for cholesterol, body mass, family history of AMI, hypertension, and diabetes the AR were 49, 16, 14, 13, and 6%, respectively. Together these factors explained 85% of AMI cases. Though differences emerged for each single factor, the proportion of AMI explained by the six factors together was approximately the same for both sexes, while these factors accounted for 97% of AMI cases before age 50 (and smoking alone for 70%) and for 80% after age 50.
This study confirms that interventions on well-defined risk factors could, in principle, lead to the avoidance of the great majority of myocardial infarctions in this population (i.e., about 80% before age 75 and about 95% before age 50).
Depression has been shown to adversely affect the prognosis of patients with established coronary artery disease, but there is comparatively little evidence to document the role of depression in the initial development of coronary disease.
Study participants were 409 men and 321 women who were residents of Glostrup, Denmark, born in 1914. Physical and psychological examinations in 1964 and 1974 established their baseline risk factor and disease status and their level of depressive symptomatology. Initial myocardial infarction (MI) was observed in 122 participants, and there were 290 deaths during follow-up, which ended in 1991. A 2-SD difference in depression score was associated with relative risks of 1.71 (P = .005) for MI and 1.59 (P < .001) for deaths from all causes. These findings were unchanged after we controlled for risk factors and signs of disease at baseline. There were no sex differences in effect sizes.
High levels of depressive symptomatology are associated with increased risks of MI and mortality. The graded relationships between depression scores and risk, long-lasting nature of the effect, and stability of the depression measured across time suggest that this risk factor is best viewed as a continuous variable that represents a chronic psychological characteristic rather than a discrete and episodic psychiatric condition.
Results obtained largely from case-control studies have suggested that an elevated plasma concentration of apolipoprotein (apo) B may be considered an important risk factor for ischemic heart disease (IHD). Prospective data on the relevance of measuring apo A-I and apo B levels in the assessment of IHD risk, however, remain sparse as well as controversial.
Plasma lipid, apo B, and apo A-I levels as well as other risk factors were evaluated at baseline in 1985 in a sample of 2155 men (45 to 76 years old) who were followed for a period of 5 years for clinical signs of IHD. Proportional-hazards analyses indicated that plasma apo B concentrations measured at entry were strongly associated with onset of IHD (relative rate, 1.4; 95% confidence interval [CI], 1.2 to 1.7), independent of covariables such as age, smoking, diabetes mellitus, and systolic blood pressure. Controlling for triglycerides, HDL cholesterol, and total/HDL cholesterol ratio did not eliminate the relationship between plasma apo B levels and IHD. The association between apo A-I and IHD was of lower magnitude (relative rate, 0.85; 95% CI, 0.7 to 1.0), and adjustment for selected plasma lipid and lipoprotein levels eliminated this association. Stepwise logistic regression analysis revealed that, among metabolic variables, apo B was the strongest correlate of IHD.
These prospective results emphasize the importance of apo B as a risk factor for IHD. Apo B may be regarded as a relevant tool in the assessment of IHD risk in men, because it may provide information that would not be obtained from the conventional lipid-lipoprotein profile.
Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons.
DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed.
Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene.
The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
Plausible projections of future mortality and disability are a useful aid in decisions on priorities for health research, capital investment, and training. Rates and patterns of ill health are determined by factors such as socioeconomic development, educational attainment, technological developments, and their dispersion among populations, as well as exposure to hazards such as tobacco. As part of the Global Burden of Disease Study (GBD), we developed three scenarios of future mortality and disability for different age-sex groups, causes, and regions.
We used the most important disease and injury trends since 1950 in nine cause-of-death clusters. Regression equations for mortality rates for each cluster by region were developed from gross domestic product per person (in international dollars), average number of years of education, time (in years, as a surrogate for technological change), and smoking intensity, which shows the cumulative effects based on data for 47 countries in 1950-90. Optimistic, pessimistic, and baseline projections of the independent variables were made. We related mortality from detailed causes to mortality from a cause cluster to project more detailed causes. Based on projected numbers of deaths by cause, years of life lived with disability (YLDs) were projected from different relation models of YLDs to years of life lost (YLLs). Population projections were prepared from World Bank projections of fertility and the projected mortality rates.
Life expectancy at birth for women was projected to increase in all three scenarios; in established market economies to about 90 years by 2020. Far smaller gains in male life expectancy were projected than in females; in formerly socialist economies of Europe, male life expectancy may not increase at all. Worldwide mortality from communicable maternal, perinatal, and nutritional disorders was expected to decline in the baseline scenario from 17.2 million deaths in 1990 to 10.3 million in 2020. We projected that non-communicable disease mortality will increase from 28.1 million deaths in 1990 to 49.7 million in 2020. Deaths from injury may increase from 5.1 million to 8.4 million. Leading causes of disability-adjusted life years (DALYs) predicted by the baseline model were (in descending order): ischaemic heart disease, unipolar major depression, road-traffic accidents, cerebrovascular disease, chronic obstructive pulmonary disease, lower respiratory infections, tuberculosis, war injuries, diarrhoeal diseases, and HIV. Tobacco-attributable mortality is projected to increase from 3.0 million deaths in 1990 to 8.4 million deaths in 2020.
Health trends in the next 25 years will be determined mainly by the ageing of the world's population, the decline in age-specific mortality rates from communicable, maternal, perinatal, and nutritional disorders, the spread of HIV, and the increase in tobacco-related mortality and disability. Projections, by their nature, are highly uncertain, but we found some robust results with implications for health policy.
National surveys conducted since 1982 were used to assess maternal and child obesity in Latin American and Caribbean countries and in U. S. residents of Mexican descent. Obesity in women, a body mass index (BMI) >/=30 kg/m2, was 3% in Haiti, 8-10% in eight Latin American countries and 29% in Mexican Americans. Median BMI for Latin American women were near or above the 50th percentile of the general U.S. population; values exceeded the 75th percentile in the case of Mexican Americans. The prevalence of overweight (>1 SD above mean weight-for-height) in children 1-5 y of age ranged from 6% in Haiti to 24% in Peru among 13 countries. Overweight occurred in 24% of Mexican-American children. Prevalences of overweight in children and of obesity in women were greater in urban areas and in households of higher socioeconomic status. Overweight in children increased with higher maternal education; however, in some countries, obesity in women decreased with higher education. No general pattern of change over time was observed in eight countries in overweight in children. Obesity in women increased in the three countries with such data and in Mexican-American women and children. There was a tendency for greater national incomes to be associated with greater obesity levels in women and with lower levels of stunting in children. Levels of obesity in the region indicate a public health concern, particularly among women, considering that studies have identified mortality and morbidity risks associated with obesity in adults.
Although declines in mortality rates have occurred in most developed countries, increases are being seen in developing countries. Our knowledge of risk factors for acute myocardial infarction (AMI) is largely derived from studies in the former. Applicability of these results to other populations is unknown. The objectives of INTER-HEART are to determine the association between risk factors and AMI within populations defined by ethnicity and/or geographic region and to assess the relative importance of risk factors across these populations.
INTER-HEART is a study of 14,000 cases of AMI and 16,000 matched control patients from 46 countries, which was conducted with a standardized protocol. Questionnaires were translated into 11 languages; physical measurements were obtained, and 20 mL of blood was drawn and shipped frozen to a central laboratory in Canada. The study will evaluate the importance of conventional and emerging risk factors within each geographic region and whether their impact varies by region.
INTER-HEART is sponsored by the World Health Organization and the World Heart Federation and has received funding from several peer-reviewed agencies and many different pharmaceutical companies. A vanguard phase (February 1999 to 2000) enrolled 4000 subjects from 41 countries. Full data collection started in April 2000 and is expected to be completed by October 2002.
Several years of targeted work have allowed the development of the concepts that were tested in the pilot studies. This has ensured the feasibility of INTER-HEART. This study has the potential to have a major impact in developing a worldwide strategy for cardiovascular disease prevention, especially in developing countries and nonwhite populations.
Apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) are thought to be better predictors of acute myocardial infarction than total cholesterol and LDL-cholesterol. We investigated whether apoB and apoA-I are predictors of risk of fatal myocardial infarction. We also aimed to establish whether apoB and apoA-I add further information about risk of fatal myocardial infarction to that obtained with total cholesterol, triglycerides, and LDL-cholesterol.
We recruited 175553 individuals mainly from screening programmes. We measured concentrations of apoB, apoA-I, total cholesterol, and triglycerides, and calculated apoB/apoA-I ratio and concentrations of LDL-cholesterol and HDL-cholesterol. The relation between death from acute myocardial infarction and initial values for apoB, apoA-I, and the other lipids was examined.
Mean follow-up was 66.8 months (SD 41.3) for 98722 men and 64.4 months (41.4) for 76831 women. 864 men and 359 women had fatal myocardial infarction. In univariate analyses adjusted for age and in multivariate analyses adjusted for age, total cholesterol, and triglycerides, the values for apoB and apoB/apoA-I ratio were strongly and positively related to increased risk of fatal myocardial infarction in men and in women. ApoA-I was noted to be protective. In multivariate analysis, apoB was a stronger predictor of risk than LDL-cholesterol in both sexes.
Although LDL-cholesterol and HDL-cholesterol are known risk factors, we suggest that apoB, apoB/apoA-I, and apoA-I should also be regarded as highly predictive in evaluation of cardiac risk. Although increased throughout the range of values of LDL-cholesterol, apoB and apoA-I might be of greatest value in diagnosis and treatment in men and women who have common lipid abnormalities, but have normal or low concentrations of LDL-cholesterol.
Psychosocial factors have been reported to be independently associated with coronary heart disease. However, previous studies have been in mainly North American or European populations. The aim of the present analysis was to investigate the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries.
We used a case-control design with 11119 patients with a first myocardial infarction and 13648 age-matched (up to 5 years older or younger) and sex-matched controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by standardised approaches. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression.
People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0.0001). Of those cases still working, 23.0% (n=1249) experienced several periods of work stress compared with 17.9% (1324) of controls, and 10.0% (540) experienced permanent work stress during the previous year versus 5.0% (372) of controls. Odds ratios were 1.38 (99% CI 1.19-1.61) for several periods of work stress and 2.14 (1.73-2.64) for permanent stress at work, adjusted for age, sex, geographic region, and smoking. 11.6% (1288) of cases had several periods of stress at home compared with 8.6% (1179) of controls (odds ratio 1.52 [99% CI 1.34-1.72]), and 3.5% (384) of cases reported permanent stress at home versus 1.9% (253) of controls (2.12 [1.68-2.65]). General stress (work, home, or both) was associated with an odds ratio of 1.45 (99% CI 1.30-1.61) for several periods and 2.17 (1.84-2.55) for permanent stress. Severe financial stress was more typical in cases than controls (14.6% [1622] vs 12.2% [1659]; odds ratio 1.33 [99% CI 1.19-1.48]). Stressful life events in the past year were also more frequent in cases than controls (16.1% [1790] vs 13.0% [1771]; 1.48 [1.33-1.64]), as was depression (24.0% [2673] vs 17.6% [2404]; odds ratio 1.55 [1.42-1.69]). These differences were consistent across regions, in different ethnic groups, and in men and women.
Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.
Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown.
We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated.
Smoking (odds ratio 2.87 for current vs never, PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio (3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes (2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily consumption of fruits and vegetables (0.70, PAR 13.7% for lack of daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and regular physical activity (0.86, PAR 12.2%), were all significantly related to acute myocardial infarction (p<0.0001 for all risk factors and p=0.03 for alcohol). These associations were noted in men and women, old and young, and in all regions of the world. Collectively, these nine risk factors accounted for 90% of the PAR in men and 94% in women.
Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. This finding suggests that approaches to prevention can be based on similar principles worldwide and have the potential to prevent most premature cases of myocardial infarction.
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To investigate the association between apolipoprotein B (apoB), A-I (apoA-I), the apoB/apoA-I ratio, and the incidence of coronary events.
Analysis included 1414 men and 1436 women aged 35-64 years without a prior coronary event who participated in the population-based MONICA Augsburg survey 1984-85 (median followed-up period 13 years). Incidence of fatal and non-fatal myocardial infarction, and sudden cardiac death was assessed using data of the MONICA/KORA Augsburg coronary event registry. During follow-up, 114 incident coronary events occurred in men and 31 in women. In multivariable analysis, an increase of 1 standard deviation in the serum concentration of apoB was associated with an increased risk of coronary events in men [hazard ratio (HR)=1.49; 95% confidence interval (CI); 1.25-1.78] and in women (HR=1.73; 95% CI; 1.32-2.27). By contrast, elevated concentrations of apoA-I were not associated with a significantly decreased risk of coronary events in either sex (HR=0.91). Furthermore, the predictive power of the apoB/apoA-I ratio was similar to that of the total cholesterol/HDL cholesterol ratio in men and women.
ApoB and the apoB/apoA-I ratio were strong predictors of coronary events in middle-aged men and women, whereas apoA-I did not add significantly to the estimation of future coronary risk.
Although cardiovascular diseases are the main cause of death in the region, there are few data on the prevalence of cardiovascular risk factors in Latin American. We studied the distribution and impact of cardiovascular risk factors in Bucaramanga, Colombia.
We conducted a cross-sectional study in a random sample of 2989 subjects 15-64 years old. Population attributable risks were estimated from Framingham risk scores.
Smoking prevalence was 16.2% (men 26.3%; women 10.5%). Hypertension prevalence was 9.9% in women and 8.8% in men, but reached 50% in those 60-64 years old. After adjustment for body mass index, men were more likely to be hypertensive, but only if under 40 years old. Obesity was more frequent in women (15.7%) than in men (8.7%), even after age-adjustment. About 46% of the participants were overweight or obese. Women also had higher prevalence of high total cholesterol (19.7 versus 15.7%) and high low-density lipoprotein-cholesterol (23.9 versus 19.5%), but lower prevalence of low high-density lipoprotein (HDL)-cholesterol (22.2 versus 37.6%). Only low-HDL prevalence was significantly different after body mass index and age-adjustment. The prevalence of diabetes was similar in men and women (4%), but age and body mass index-adjusted impaired fasting glucose prevalence was 60% higher in women. Population attributable risks were larger and similar for high total cholesterol, hypertension, and large waist-to-hip ratio (19%).
Women had higher prevalence of all risk factors with the exception of smoking and low-HDL. Reduction in cholesterol levels, blood pressure and obesity is a priority to control the ongoing epidemic of cardiovascular diseases in this population.
Prevalence and impact of cardiovascular risk factors in Bucaramanga
- Le Bautista
- M Orostegui
- Lm Vera
- Ge Prada
- Lc Orozco
- Of Herrán
Bautista LE, Orostegui M, Vera LM, Prada GE, Orozco LC, Herrán OF.
Prevalence and impact of cardiovascular risk factors in Bucaramanga,
Colombia: results from the Countrywide Integrated Noncommunicable
Disease Intervention Programme (CINDI/CARMEN) baseline survey.
Risk factors for cardiovascular disease in the developing world: a multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN): INCLEN Multicentre Collaborative Group
Risk factors for cardiovascular disease in the developing world: a multicentre collaborative study in the International Clinical Epidemiology
Network (INCLEN): INCLEN Multicentre Collaborative Group. J Clin
Epidemiol. 1992;45:841-847.