[Show abstract][Hide abstract] ABSTRACT: . Impaired fasting glucose (IFG) through the nondiabetic range (100–125 mg/dL) is not considered in the cardiovascular (CV) risk profile.
. To compare the clustering of CV risk factors (RFs) in nondiabetic subjects with normal fasting glucose (NFG) and IFG.
Material and Methods
. Cross-sectional study in 3739 nondiabetic subjects. Demographics, medical history, and CV risk factors were collected and lipid profile, fasting glucose levels (FBG), C-reactive protein (hsCRP), blood pressure (BP), anthropometric measurements, and aerobic capacity were determined.
. 559 (15%) subjects had IFG: they had a higher mean age, BMI, waist circumference, non-HDL cholesterol, BP, and hsCRP (
) and lower HDL (
) and aerobic capacity (
). They also had a higher prevalence of hypertension (34% versus 25%;
), dyslipidemia (79% versus 74%;
), and obesity (29% versus 16%;
) and a higher Framingham risk score (8% versus 6%;
). The probability of presenting 3 or more CV RFs adjusted by age and gender was significantly higher in the top quintile of fasting glucose (≥98 mg/dL; OR = 2.02; 1.62–2.51).
. IFG in the nondiabetic range is associated with increased cardiovascular RF clustering.
[Show abstract][Hide abstract] ABSTRACT: Background: Lack of adherence with medications is the main cause of antihypertensive treatment failure. Aim: To assess adherence to antihypertensive drugs and its determinants. Material and Methods: The Morinsky-Green questionnaire to determine treatment adherence was applied to 310 hypertensive patients from primary care centers, aged 60 ± 10 years (65% females) in treatment for 4 ± 1 months. Socio-demographic features, use of medications and quality of life using EQ5D questionnaire were also assessed. Results: Twenty percent of patients were diabetic and 19% were smokers. Fifty four percent were adherent to therapy. A higher age and being unemployed were associated with a higher compliance. The main reasons to justify the lack of adherence were forgetting to take the pills in 67% and adverse effects in 10%. Only diastolic pressure was lower in adherent patients, compared with their non-adherent counterparts (78 ± 12 and 81 ± 17 mmHg, respectively p < 0.01). Conclusions: Only half of hypertensive patients comply with their antihypertensive therapy.
No preview · Article · Jul 2015 · Revista medica de Chile
[Show abstract][Hide abstract] ABSTRACT: High sensitivity C-reactive protein (hsCRP) is a marker of metabolic syndrome (MS) and cardiovascular (CV) disease. Lipoprotein-associated phospholipase A2 (Lp-PLA2) also predicts CV disease. There are no reports comparing these markers as predictors of MS. Methods. Cross-sectional study comparing Lp-PLA2 and hsCRP as predictors of MS in asymptomatic subjects was carried out; 152 subjects without known atherosclerosis participated. Data were collected on demographics, cardiovascular risk factors, anthropometric and biochemical measurements, and hsCRP and Lp-PLA2 activity levels. A logistic regression analysis was performed with each biomarker and receiver operating characteristic (ROC) curves were constructed for MS. Results. Mean age was 46 ± 11 years, and 38% of the subjects had MS. Mean Lp-PLA2 activity was 185 ± 48 nmol/mL/min, and mean hsCRP was 2.1 ± 2.2 mg/L. Subjects with MS had significantly higher levels of Lp-PLA2 (
) and hsCRP (
) than those without MS. ROC curves showed that both markers predicted MS. Conclusion. Lp-PLA2 and hsCRP are elevated in subjects with MS. Both biomarkers were independent and significant predictors for MS, emphasizing the role of inflammation in MS. Further research is necessary to determine if inflammation predicts a higher risk for CV events in MS subjects.
Full-text · Article · Jun 2015 · International Journal of Endocrinology
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:
Body mass index (BMI) and waist circumference (WC) are the most commonly measured anthropometric parameters given their association with cardiovascular risk factors (RFs). The relationship between percentage body fat (%BF) and cardiovascular risk has not been extensively studied.
This study evaluated %BF and its relationship with cardiometabolic RFs in healthy subjects and compared these findings with the relationship between BMI/ WC and cardiovascular RFs.
This was a cross-sectional study of 99 males and 83 females (mean age 38 ±10 years) evaluated in a preventive cardiology program. All subjects completed a survey about RFs and lifestyle habits. Anthropometric parameters, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting lipid profile, and blood glucose were collected. Body fat was determined using four skinfold measurements. Fat mass index (FMI) was also calculated.
Percentage body fat was significantly and directly associated with total cholesterol (R2=0.11), triglycerides (R2=0.14), low-density lipoprotein cholesterol (R2=0.16), non-high-density lipoprotein cholesterol (R2=0.24), fasting blood glucose (R2=0.16), SBP (R2= 0.22), and DBP (R2=0.13) (p.
Full-text · Article · May 2015 · Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral
[Show abstract][Hide abstract] ABSTRACT: Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory biomarker involved in atherosclerosis and directly associated with cardiovascular events. Aim: To determine Lp-PLA2 levels in asymptomatic subjects with differing cardiovascular risk. Material and Methods: We studied 152 subjects aged 46 ± 11 years (69 women). We recorded traditional cardiovascular risk factors, creatinine, ultrasensitive C-reactive protein, fibrinogen, fasting lipids, blood sugar and activity levels of Lp-PLA2. Cardiovascular risk was classified according to the number of risk factors of each subject (0,1-2 or ≥ 3 risk factors). Besides, we calculated global Framingham risk score. Results: The average Framingham score of participants was 6%. Twenty percent of participants had no risk factors, 46% had 1 or 2 and 34% had ≥ 3. Mean Lp-PLA2 levels were 185 ± 48 nmol/ml/min (201 ± 49 in men and 166 ± 38 in women). Lp-PLA2 correlated significantly (p < 0,05 for all) with non-HDL cholesterol, LDL, HDL, creatinine, waist circumference, body mass index and Framingham risk score. There was no correlation with blood sugar, C-reactive protein, fibrinogen or smoking status. Lp-PLA2 levels were significantly higher according to the number of risk factors: 0 factors: 163 ± 43, 1-2 factors: 185 ± 45 and ≥ 3 factors: 201 ± 47 nmol/ml/min, respectively. Linear regression analysis showed that the best predictor of Lp-PLA2 was non-HDL cholesterol (β = 0,74; p < 0,0001). Conclusions: Lp-PLA2 activity increased along with the number of cardiovascular risk factors and was correlated mainly with non -HDL cholesterol.
No preview · Article · Nov 2013 · Revista medica de Chile
[Show abstract][Hide abstract] ABSTRACT: Exercise and cardiac rehabilitation are indications with type I A evidence in most secondary cardiovascular prevention guidelines. Rehabilitation programs not only include exercise but also provide integral care and education about cardiovascular risk factors. However there is a paucity of such programs in Chile. Moreover there is a lack of awareness about the benefits of exercise and there is lack of knowledge about the details of exercise prescription in secondary prevention. Therefore, the divulgation of this knowledge is of utmost importance.
No preview · Article · Oct 2013 · Revista medica de Chile
[Show abstract][Hide abstract] ABSTRACT: Background: Both, C-reactive protein (usCRP) and lipoprotein-associated phospholipase A2 (LpPLA2) are inflammatory markers. usCRP is a good predictor of the Metabolic Syndrome (MetSyn) mainly associated to visceral obesity. By contrast, LpPLA2 relates principally to LDL.
Objective: To compare, in asymptomatic subjects, usCRP and LpPLA2 as determinants of MetSyn.
Methods: Cross sectional study in 152 subjects (69 women) without known CHD/CVD. We excluded subjects taking lipid lowering medication, oral contraceptives, hormonal replacement therapy and anti-inflammatory drugs, as well as inflammatory diseases or pregnancy. We determined blood pressure, BMI, waist, plasma creatinine, usCRP, fibrinogen, fasting blood sugar, lipid profile and LpPLA2 activity. MetSyn was defined by ATPIII harmonized definition. Logistic regression analysis was performed and ROC curves were built.
Results: Mean age was 46±11; 38% had MetSyn. Mean LpPLA2 and usCRP were 185±48 nmol/ml/min and 2.1±2.2 mg/L respectively. MetSyn subjects had significantly higher levels of both, LpPLA2 (p<0.01) and usCRP (p=0.04). Both biomarkers were independent determinants of MetSyn: Lp-PLA2, OR=2.2 [CI=1.1-4.6] and usCRP, OR=4.4 [IC=2.1-9.6]. ROC curves are shown in the figure (C-index for LpPLA2=0.64 [0.55-0.73] and for usCRP=0.70 [0.62-0.78]).
Preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Background: Recognizing cardiovascular risk in overweight adults is challenging, as they usually have a low Framingham risk score (FRAM). In these subjects, non-traditional biomarkers could improve risk stratification. Aim: To assess carotid intima media thickness (CIMT) and ultrasensitive C-reactive protein (usCRP) among overweight and obese subjects without metabolic syndrome (MetSyn). Subjects and Methods: In 1558 asymptomatic participants (816 women, 45 ± 11 years) we measured body mass index (BMI), waist circumference, blood pressure, lipid profile, blood glucose, FRAM, usCRP and CIMT. For analytical purposes, we divided the subjects in three groups according to BMI and number of ATPIII-MetSyn risk factors (RF): 1) BMI < 25 and < 3RF, 2) BMI ≥ 25 and < 3RF and 3) BMI ≥ 25 and ≥ 3RF. Results: Participants of group 2 (BMI ≥ 25 and < 3RF) had a low FRAM (8%). Compared with participants of group 1, they had a higher CIMT (0.61 ± 0.1 and 0.57 ± 0.09 mm, respectively, p < 0.01) and usCRP (2.1 ± 2.1 and 1.5 ± 1.9 mg/L respectively, p < 0.01). Conclusions: This study shows that although subjects with overweight/obesity without MetSyn have low cardiovascular risk based on FRAM, they have higher CIMT and usCRP than their normal weight counterparts.
No preview · Article · Aug 2013 · Revista medica de Chile
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Hypercholesterolemia is a strong risk factor for myocardial infarction (MI). There is scarce information regarding lipoprotein levels among patients with MI in Latin America as well as about the association of very early statin therapy during the course of acute MI. HYPOTHESIS: Very early statin prescription might be associated with a reduction on in-hospital mortality in MI patients with nearly normal lipid levels. METHODS: Prospective registry database analysis of MI patients admitted between 2001 and 2007 at a single university hospital from which demographics, treatments, clinical variables, and mortality were assessed. Patients naïve to statin therapy were divided in 2 groups, according to whether they received (group A) or did not receive (group B) statins during the first 24 hours after admission. RESULTS: In the 1465 patients analyzed, mean plasma levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C) were 197, 117, and 44 mg/dL, respectively, and 41.8% had HDL-C ≤40 mg/dL. Among statin naïve patients (n = 1272), 67% were classified in group A and 33% in group B. Overall in-hospital mortality was 4.1%: 1.8% in group A and 8.5% in group B. In the multivariate analysis, including propensity score for statin prescription, the odds ratio for in-hospital mortality for group A was 0.971 (95% confidence interval: 0.944-0.999, P = 0.04). CONCLUSIONS: In the Chilean registry of MI patients, low HDL-C was the main lipid disturbance. Very early statin use after MI appears to be associated with a borderline significant and independent reduction of in-hospital mortality.
Full-text · Article · Jun 2013 · Clinical Cardiology
[Show abstract][Hide abstract] ABSTRACT: The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages. (Rev Med Chile 2013; 141:237-247).
Full-text · Article · Feb 2013 · Revista medica de Chile