[Cardiovascular risk and cardiometabolic risk: an epidemiological evaluation].
ABSTRACT On the basis of a critical literature review, this article deals with the concepts of global cardiovascular risk and cardiometabolic risk, pointing out their links but also their unresolved issues and discussing their usefulness in clinical practice. The global cardiovascular risk is the probability of suffering from a coronary event or stroke in a given period of time and in this sense it is an absolute risk, generally reported as percentage at 10 years. Usually risk functions are used, derived from longitudinal studies of healthy people at baseline. They consider some factors that are coherently linked with events in population analyses: among these there are some metabolic factors (total cholesterol, HDL cholesterol, fasting blood glucose), some biological factors (blood pressure) and some lifestyle factors (tobacco smoking), all modifiable beyond those non-modifiable like age and gender. The chosen factors must be independent at multivariate analysis, simple and standardized to measure, and contribute to significantly increase the risk-function predictivity. To be reliable, these risk functions must be derived from the same population where they will be later administered. For this reason the Italian Progetto CUORE, in the longitudinal study section, built a database of risk factors from longitudinal comparable studies started between the mid '80s and '90s and followed up the participants for cardiovascular mortality and morbidity to estimate the Italian global cardiovascular risk (first coronary or cerebrovascular event) for men and women. Two tools have been produced, the risk charts and a score software (see www.cuore.iss.it). The ongoing epidemics of obesity and diabetes and the fact that diabetes is associated with classical risk factors like hypertension and dyslipidemia induced the American Diabetes Association and the American Heart Association to launch a "call to action" to prevent both cardiovascular disease and diabetes. In this paper, as cardiometabolic risk factors were considered those "closely related to diabetes and cardiovascular disease: fasting/postprandial hyperglycemia, overweight/obesity, elevated systolic and diastolic blood pressure, and dyslipidemia". The association among the cardiometabolic risk factors has been known for a long time, and much of their etiology has been ascribed to insulin resistance. Also, the fact that these "metabolic" abnormalities can cluster in many individuals gave rise to the term "metabolic syndrome", a construct embraced by many organizations but questioned by other authors. From an epidemiological point of view the metabolic syndrome seems to increase modestly the cardiovascular risk, whereas in non-diabetic individuals it predicts diabetes much more efficiently. Many studies have compared the performance of the classical cardiovascular evaluation tools (the Framingham risk score, the SCORE charts, the Progetto CUORE score) and metabolic syndrome in cardiovascular disease prediction. Usually in people at high risk the presence of the metabolic syndrome does not improve the risk, whereas in people at lower risk its presence increases significantly the chances of cardiovascular disease. Many studies have shown that positive lifestyle interventions markedly reduce the rate of progression of type 2 diabetes. Also some drugs were tested for diabetes prevention, usually in people with impaired glucose tolerance. Oral diabetes drugs considered together (acarbose, metformin, flumamine, glipizide, phenformin) were less effective than lifestyle interventions, with different results among the drugs; the antiobesity drug orlistat gave similar results to lifestyle interventions. In Italy an appropriate approach to cardiovascular disease and diabetes prevention may be that of first evaluating the global cardiovascular risk using the charts or the score software of the Progetto CUORE, because high-risk subjects (> or =20%) must be treated aggressively independently of the presence of the metabolic syndrome; as a second step the metabolic syndrome may be sought, because it increases the risk; finally some attention should be paid to non-diabetic hyperglycemic individuals.
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ABSTRACT: The cardiovascular diseases (CVD) are the major causes of morbidity and mortality at worldwide level and Venezuela is not the exception. To evaluate the prevalence of hypercholesterolemia and other risk factors for CVD in a population of young students of the University of Zulia, Venezuela. 155 students in ages between 17 and 22 years were evaluated. For the data collection a medical card was used. Values of fasting glucose, cholesterol and triglycerides were determined by enzymatic methods. 19.35% and 18.71% of the students exhibited hipercholesterolemia and overweight, respectively, like major modifiable risk factors for ECV. 37.5% of individuals with overweight presented elevated cholesterol levels (pRevista Latinoamericana de Hipertension 01/2011; 6(1):8-13. · 0.04 Impact Factor
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ABSTRACT: CVDs, including coronary heart disease (CHD) and stroke, currently represent the major causes of mortality and morbidity all over the world. In Europe, CVDs are responsible for 43% of deaths in men and 55% in women and for 30% of all deaths before the age of 65 years. CVD burden could be substantially reduced by early diagnosis and appropriate measures, since atherosclerotic lesions may be substantially improved in response to measures taken. CVD results from a combination of genetic and environmental factors; some factors vary between different ethnic groups. Plasma lipid profile is an important, but certainly not the only, risk factorfor CVD. Prevention includes healthy lifestyle: no smoking, weight control, physical activity, and healthy dietary intake; control of blood pressure, plasma glucose, and inflammation is important; The Mediterranean diet is a good example of healthy dietary pattern. Components of the Mediterranean diet may be adapted to nutritional habits of different countries, taking into account differences of taste and culture.The benefits of a healthy lifestyle exceed, but are additive to, those of medical treatment.e-SPEN the European e-Journal of Clinical Nutrition and Metabolism 12/2011;
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ABSTRACT: The development of cardiovascular complications in patients with diabetes is often associated with an imbalance between reactive oxygen species and antioxidant systems. This imbalance can contribute to high cardiac collagen content, which increases cross-linking and the stiffness of the myocardium. In this study, the protective effect of phaseolamin against damage under oxidative stress and collagen deposition in the cardiac tissue in association with diabetes was evaluated. Non-diabetic and diabetic animals were distributed into groups and treated for 20 days with commercial phaseolamin. The phaseolamin treatment increased total antioxidant activity but reduced the following in diabetic rats: (a) hyperglycaemic state, (b) catalase and superoxide dismutase activity and (c) tissue damage caused by lipid peroxidation. Additionally, the phaseolamin treatment attenuated the collagen levels compared to non-treated diabetic rats. Thus, the short-term anti-hyperglycaemic effect of the phaseolamin treatment may prevent the initial changes caused by oxidative stress and the deposition of collagen, as well as reduce the incidence of heart complications.Diabetes & Vascular Disease Research 03/2014; 11(2):110-117. · 3.04 Impact Factor