Hypertension in seven Latin American cities: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study

Hypertension Prevalence, Awareness, Treatment, and Control in Selected LMIC Communities: Results From the NHLBI/UHG Network of Centers of Excellence for Chronic Diseases

BACKGROUND

Hypertension is the leading cause of cardiovascular disease and premature death worldwide. The prevalence of this public health problem is increasing in low- and middle-income countries (LMICs) in both urban and rural communities.

OBJECTIVE

The aim of this study was to examine hypertension prevalence, awareness, treatment, and control in adults 35 to 74 years of age from urban and rural communities in LMICs in Africa, Asia, and South America.

METHODS

The authors analyzed data from 7 population-based cross-sectional studies in selected communities in 9 LMICs that were conducted between 2008 and 2013. Age- and sex-standardized prevalence rates of pre-hypertension and hypertension were calculated. The prevalence rates of awareness, treatment, and control of hypertension were estimated overall and by subgroups of age, sex, and educational level.

RESULTS

In selected communities, age- and sex-standardized prevalence rates of hypertension among men and women 35 to 74 years of age were 49.9% (95% confidence interval [CI]: 42.3% to 57.4%) in Kenya, 54.9% (95% CI: 51.3% to 58.4%) in South Africa, 52.5% (95% CI: 50.1% to 54.8%) in China, 32.5% (95% CI: 31.7% to 33.3%) in India, 42.3% (95% CI: 40.4% to 44.2%) in Pakistan, 45.4% (95% CI: 43.6% to 47.2%) in Argentina, 39.9% (95% CI: 37.8% to 42.1%) in Chile, 19.2% (95% CI: 17.8% to 20.5%) in Peru, and 44.1% (95% CI: 41.6% to 46.6%) in Uruguay. The proportion of awareness varied from 33.5% in India to 69.0% in Peru, the proportion of treatment among those who were aware of their hypertension varied from 70.8% in South Africa to 93.3% in Pakistan, and the proportion of blood pressure control varied from 5.3% in China to 45.9% in Peru.

CONCLUSIONS

The prevalence of hypertension varies widely in different communities. The rates of awareness, treatment, and control also differ in different settings. There is a clear need to focus on increasing hypertension awareness and control in LMICs.

Characteristics Associated With Antihypertensive Treatment and Blood Pressure Control: A Population-Based Follow-Up Study in Peru

BACKGROUND

Over one-quarter of the world's adult population has hypertension, yet achieving adequate treatment or control targets remains a challenge.

OBJECTIVE

This study sought to identify, longitudinally, characteristics associated with antihypertensive treatment and blood pressure (BP) control among individuals with hypertension.

METHODS

Data from individuals enrolled in the population-based CRONICAS Cohort Study (adults ≥35 years, living in 4 different rural/urban and coastal/high-altitude Peruvian settings) with hypertension at baseline were used. Antihypertensive treatment and BP control were assessed at baseline and at 15 months. Multinomial logistic regressions were used to estimate relative risk ratios (RRR) and 95% confidence intervals (95% CI) of factors associated with antihypertensive treatment and BP control at follow-up.

RESULTS

At baseline, among 717 individuals with hypertension (53% women, mean age 61.5 ± 12.4 years), 28% were unaware of their hypertension status, 30% were aware but untreated, 16% were treated but uncontrolled, and 26% were treated and controlled. At follow-up, 89% of unaware and 82% of untreated individuals persisted untreated, and only 58% of controlled individuals remained controlled. Positive predictors of receiving treatment and being controlled at follow-up included age (RRR: 0.81; 95% CI: 0.73 to 0.91 for every 5 years) and family history of a chronic disease (RRR: 0.53; 95% CI: 0.31 to 0.92 vs. no history); whereas Puno rural site (RRR: 16.51; 95% CI: 1.90 to 143.56 vs. Lima) and male sex (RRR: 2.59; 95% CI: 1.54 to 4.36) were risk factors. Systolic BP at baseline (RRR: 1.27; 95% CI: 1.16 to 1.39 for every 5 mm Hg) and male sex (RRR: 1.75, 95% CI: 1.02 to 2.98) were risk factors for being treated but uncontrolled at follow-up.

CONCLUSIONS

Large gaps in treatment of hypertension were observed. Targeting specific populations such as men, younger individuals, or those without family history of disease may increase coverage of antihypertensive treatment. Also, targeting male individuals or those with higher systolic BP could yield better rates of BP control in the short term.

Association Between Hypertension, Menopause, and Cognition in Women

The aim of this study was to investigate the cognitive state in women and its relation to menopause and hypertension (HTN). The authors included 1034 women aged 47.13±15.71 years. The prevalence of HTN was 47.1%, with 67.8% of patients treated and 48.6% controlled. Cognitive impairment was higher among hypertensive menopausal (mini-Boston Naming Test: 7.4±3.1 vs 8.5±2.4, P<.001; Clock-Drawing Test: 5.2±2 vs 5.6±1.6, P<.01). Using logistic regression adjusted by age and education level, statistical differences were found in the results from the mini-Boston Naming Test between menopausal hypertensive vs menopausal normotensive women (odds ratio, 1.48; 95% confidence interval, 1.06-2.07; P=.021), and no difference between nonmenopausal hypertensive vs menopausal normotensive women (odds ratio, 0.89; 95% confidence interval, 0.51-1.57; P=.697). The P interaction between both groups was significant (P=.038). The possibility of alteration in cortical functions in menopausal hypertensive woman showed a relative increment of 48% (P=.021). The association between HTN and menopause increases the possibility of compromising the semantic memory by 50%.

Applicability of the current hypertension guidelines in Latin America

Recent research has focused on the development of evidence-based guidelines that are intended to regulate the conduct of physicians in the diagnosis and control of hypertension, with the goal of achieving greater effectiveness and equity at the lowest possible cost. In Latin America, guidelines are available for the management of hypertension at three levels: national, regional and international. The national and regional Latin American and Caribbean (LAC) guidelines are in fact adaptations of the international guidelines. The potential benefit of applying guidelines developed in other regions to local healthcare decision making is that it will enable decision makers to take advantage of existing analyses and transfer or adapt them to their local contexts. However, this adaptation precludes the assessment of their generalizability and potential transferability. In addition, this region is characterized by wide socioeconomic differences between its inhabitants, both among and within nations. Therefore, new guidelines for the LAC region must include recommendations that are common to all hypertensive patients in the region. Moreover, we advocate the inclusion of a specific section that makes comprehensive recommendations and provides strategies for implementation according to the socioeconomic conditions of particular groups. In addition to developing guidelines that are truly applicable to the LAC region, it seems sensible to consider information that is specific to this region. Furthermore, developing evidence-based guidelines is not enough to affect positively the burden of disease caused by hypertension. Therefore, professional programs are required for the implementation of such guidelines as well as the auditing of their results. Achieving these ambitious goals will require collaborative efforts by many groups including policymakers, international organizations, healthcare providers, universities and society.

Factors associated with hypertension prevalence, awareness, treatment and control among participants in the International Mobility in Aging Study (IMIAS)

The aim of this study is to assess the factors associated with hypertension prevalence, awareness, treatment, and control, in the elderly populations of the International Mobility in Aging Study (IMIAS). Approximately 200 men and 200 women aged 65-74 years were recruited at each site (n=1995) during IMIAS' 2012 baseline survey at five cities: Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Blood pressure and anthropometric measurements were taken at participants' homes. Hypertension prevalence ranged from 53.4% in Saint-Hyacinthe to 83.5% in Tirana. Diabetes and obesity were identified as risk factors in all cities. More than two-thirds of hypertensive participants were aware of their condition (from 67.3% in Saint-Hyacinthe to 85.4% in Tirana); women were more aware than men. Awareness was positively associated with diabetes in Kingston, Manizales and Natal. Though most of those aware of their hypertensive condition were being treated pharmacologically, associations between awareness and physical activity and refraining from smoking were weak. Control among treated hypertensive participants was low, especially in Tirana and Natal. Diabetes and physical inactivity were associated with poor hypertension control. Hypertension is common in the older populations of IMIAS. Diabetes is strongly associated with hypertension prevalence, awareness and lack of control of hypertension. The fact that awareness is not strongly associated with healthy behaviours suggests that antihypertensive medication is not accompanied by non-pharmacological therapies. Improved health behaviours could strengthen hypertension control. Efforts should be made to increase men's awareness of hypertension. Hypertension control in diabetic patients is a challenge.

Progression of blood pressure and cardiovascular outcomes in hypertensive patients in a reference center

BACKGROUND

Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications.

OBJECTIVE

Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil.

METHODS

Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥ 18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes.

RESULTS

We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7 ± 13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases.

CONCLUSION

Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

Prevalence and Factors Associated to Hypertension Among Older Adults in Bogotá, Colombia

Objective: To characterize older adults in Bogotá with high blood pressure and identify factors associated to this condition within this population. Method: Using data from the Salud, Bienestar y Envejecimiento (SABE) (Health, Well-being and Aging) Bogotá Study, we analyzed community-dwelling adults 60 years and older with hypertension. We estimated the prevalence and used logistic regression models to identify factors associated to hypertension. Results: The overall prevalence for hypertension was 56.9%. Older age (odds ratio [OR] = 1.46, 95% confidence interval [CI] = [1.07, 1.97]), having health insurance (OR = 4.15, CI = [1.95, 8.85]), cardiovascular diseases (ORs between 1.70 and 3.65), and poor self-rated health (OR = 1.57, CI = [1.20,2.06]) significantly increased the odds of hypertension. Most individuals received pharmacologic treatment (93.5%); however, 28.4% of individuals had uncontrolled hypertension. Discussion: We found a high prevalence of hypertension in our cohort and found that comorbidities and poor self-rated health increase the odds of hypertension. Future studies need to tailor interventions for hypertension management in old age.

Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America

BACKGROUND

Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts.

OBJECTIVE

To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru.

METHODS

An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages.

RESULTS

Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations-742 out of a total of 767 (96.7%) valid responses-revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set, 9, 8, and 16 of the SMS text messages were improved based on participant evaluations from Argentina, Guatemala, and Peru, respectively. Most SMS text messages selected for the final set (49/56, 88%) were the same in all countries, except for small wording differences.

CONCLUSIONS

The final set of SMS text messages produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple, preventative SMS text messages, grounded in evidence and theory, across three different Latin American countries with active engagement of end users.

Multiple cardiometabolic risk factors in the Southern Cone of Latin America: a population-based study in Argentina, Chile, and Uruguay

Background

Cardiovascular disease is a major cause of death, and its mortality is increasing in Latin America. However, population-based data on cardiovascular disease risk factors are sparse in these countries.

Methods

A total of 7,524 men and women, aged 35 to 74 years old, were recruited between February 2010 and December 2011 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay) in the Southern Cone of Latin America. Cardiovascular risk factors were measured using standard methods by trained and certified observers.

Results

Approximately 85.5% of adults ate less than five servings of fruit or vegetables per day, 35.2% engaged in low physical activity, and 29.7% currently smoked cigarettes. The prevalences of obesity, central obesity, hypertension, chronic kidney disease, dyslipidemia, diabetes, and metabolic syndrome were 35.7%, 52.9%, 40.8%, 2.0%, 58.4%, 12.4%, and 37.4%, respectively. The proportion of individuals with ≥3 cardiovascular risk factors, including low intake of fruit and vegetables, low physical activity, current cigarette smoking, obesity or central obesity, hypertension, chronic kidney disease, dyslipidemia, and diabetes, was 68.3%, and the proportion of individual with ≥3 cardiometabolic risk factors, including obesity or central obesity, hypertension, chronic kidney disease, dyslipidemia, and diabetes, was 22.9%.

Conclusions

Cardiovascular disease risk factors are highly prevalent in the general population in the Southern Cone of Latin America. These data suggest that national efforts on the prevention, treatment, and control of cardiovascular risk factors should be a public health priority in the Southern Cone of Latin America.

Reference values of pulse wave velocity in healthy people from an urban and rural argentinean population

In medical practice the reference values of arterial stiffness came from multicenter registries obtained in Asia, USA, Australia and Europe. Pulse wave velocity (PWV) is the gold standard method for arterial stiffness quantification; however, in South America, there are few population-based studies. In this research PWV was measured in healthy asymptomatic and normotensive subjects without history of hypertension in first-degree relatives. Normal PWV and the 95% confidence intervals values were obtained in 780 subjects (39.8 ± 18.5 years) divided into 7 age groups (10–98 years). The mean PWV found was 6.84 m/s ± 1.65. PWV increases linearly with aging with a high degree of correlation (r² = 0.61; P < 0.05) with low dispersion in younger subjects. PWV progressively increases 6–8% with each decade of life; this tendency is more pronounced after 50 years. A significant increase of PWV over 50 years was demonstrated. This is the first population-based study from urban and rural people of Argentina that provides normal values of the PWV in healthy, normotensive subjects without family history of hypertension. Moreover, the age dependence of PWV values was confirmed.

Cardiovascular disease in Latin America: the growing epidemic

Cardiovascular diseases (CVD) produce almost a million deaths a year in Latin America (LA), becoming the main cause of death in the last years, and it is estimated that the number of deaths in the region attributable to CVD will increase in the near future. This new epidemic is a consequence of the demographic, economic and social changes observed in LA in recent years. Coronary heart disease and stroke causes 42.5% and 28.8%, respectively of the CVD mortality in the region. Chagas heart involvement and rheumatic heart disease, once a major health problem, are responsible of only 1% of the mortality each. Improving in socioeconomic status, increased life expectancy and high prevalence of risk factors for atherosclerosis have been the major determinants of this marked epidemiologic change.

Use of electronic health records to evaluate the quality of care for hypertensive patients in Mexican family medicine clinics

OBJECTIVES

Patients with hypertension require life-long care and should be monitored to identify whether they are receiving the appropriate healthcare and reach their expected health outcomes. Our objectives were to develop quality of healthcare indicators (QCI) and evaluate the quality of care that hypertensive patients receive in family medicine clinics at the Mexican Institute of Social Security.

METHOD

We used a two-stage mixed methods approach: development of QCIs following the RAND-UCLA method; quality of care evaluation using electronic health record (EHR) data from 47 150 hypertensive patients who received care in 2009. We developed 15 QCIs, which were possible to construct using EHR data. The QCIs evaluated the process of care and health outcomes.

RESULTS

Most hypertensive patients were women (64%) more than 60 years old; 79% were overweight/obese and 31% had diabetes. On average, these patients attended regularly to the family doctor (≥7 visits a year); however, they received only 27% of recommended care. Among the hypertensive patients without comorbidity, 62% had achieved blood pressure (BP) control, whereas in the group of hypertensive patients with diabetes or chronic kidney disease, only 7% had achieved BP control.

CONCLUSION

EHR can become a source of information to evaluate routinely quality of care in developing countries that are beginning to modernize their health information systems.

Prevalence of obesity, tobacco use, and alcohol consumption by socioeconomic status among six communities in Nicaragua

OBJECTIVE

To describe the prevalence of noncommunicable disease (NCD) risk factors (overweight/obesity, tobacco smoking, and alcohol consumption) and identify correlations between these and sociodemographic characteristics in western and central Nicaragua.

METHODS

This was a cross-sectional study of 1 355 participants from six communities in Nicaragua conducted in September 2007-July 2009. Demographic and NCD risk-related health behavior information was collected from each individual, and their body mass index (BMI), blood pressure, diabetes status, and renal function were assessed. Data were analyzed using descriptive statistics, bivariate analyses, and (non-stratified and stratified) logistic regression models.

RESULTS

Of the 1 355 study participants, 22.0% were obese and 55.1% were overweight/obese. Female sex, higher income, and increasing age were significantly associated with obesity. Among men, lifelong urban living correlated with obesity (Odds Ratio [OR] = 4.39, 1.18-16.31). Of the total participants, 31.3% reported ever smoking tobacco and 47.7% reported ever drinking alcohol. Both tobacco smoking and alcohol consumption were strikingly more common among men (OR = 13.0, 8.8-19.3 and 15.6, 10.7-22.6, respectively) and lifelong urban residents (OR = 2.42, 1.31-4.47 and 4.10, 2.33-7.21, respectively).

CONCLUSIONS

There was a high prevalence of obesity/overweight across all income levels. Women were much more likely to be obese, but men had higher rates of tobacco and alcohol use. The rising prevalence of NCD risk factors among even the poorest subjects suggests that an epidemiologic transition in underway in western and central Nicaragua whereby NCD prevalence is shifting to all segments of society. Raising awareness that health clinics can be used for chronic conditions needs to be priority.

Use of aliskiren in Latin America in a real-world setting: aliskiren in Latin America Study (ALAS)

BACKGROUND

Hypertension (HTN) is one of the major risk factors for cardiovascular disease in Western countries, and disease control is of major relevance in order to reduce cardiovascular morbidity and mortality. Different approaches have shown efficacy, and one of the proven therapies for HTN control is the blockade of the renin-angiotensin-aldosterone system, which may be accomplished by means of various drugs with different modes of action. Aliskiren is a novel direct renin inhibitor that reduces both angiotensin I and II blood levels. Different randomized clinical trials (phase II and III) have shown its safety and efficacy either alone or in combination with hydrochlorothiazide. However, although aliskiren has been on the market for some years, reports on the post-marketing experience with aliskiren in the real-world setting are lacking.

METHODS

The Aliskiren in Latin America Study (ALAS) was designed with the aim of describing the effectiveness of aliskiren at reducing blood pressure (BP) values by prospectively assessing BP control in outpatient clinics in different countries in Latin America. A total of 435 sites in 5 Latin American countries (Mexico, Ecuador, Colombia, Argentina, and Venezuela) enrolled 4588 patients who had just been initiated on aliskiren (either alone or in combination with hydrochlorothiazide) based on their treating physicians' discretion, and they were followed for a 6-month period. Prior antihypertensive drugs could be continued if their doses were not modified along the study.

RESULTS

At the end of the follow-up period, a statistically significant reduction in BP values was observed, with a mean systolic BP reduction of 29.2 mmHg and a mean diastolic BP reduction of 13.78 mmHg from baseline at the 6-month visit.

CONCLUSION

The BP reduction levels and the low adverse event rate demonstrate the adequate efficacy and safety profile of aliskiren (alone or with hydrochlorothiazide).

Review of epidemiology and management of atrial fibrillation in developing countries

BACKGROUND

Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia. In developing countries, AF is a growing public health problem with the epidemiologic transition from communicable to non-communicable diseases. However, relatively little is known about AF in the developing world. The aim of this review is to examine in developing countries the prevalence, associated medical conditions and management of AF.

METHODS

A literature search was conducted via MEDLINE and EMBASE (1990-2012).

RESULTS

Seventy studies were included in the review. The prevalence of AF in the general population ranged from 0.03% to 1.25%, while the prevalence of AF in hospital-based studies varied from 0.7% to 55.7%. Prevalence of AF in Africa was lower than in other regions. The most common conditions associated with AF were hypertension (10.3%-71.9%) and valvular heart disease (5.6%-66.3%). The prevalence of stroke in patients with AF ranged from 6.7% to 27%. The utilization of anticoagulants was highly variable (2.7%-72.7%). Approximately half of the patients with AF using warfarin had therapeutic International Normalized Ratios (INR). There was a high prevalence of use of rate control therapies (55.3%-87.3%).

CONCLUSIONS

The limited studies available suggest that in the developing world there is a significant prevalence of AF, which is predominantly associated with hypertension and valvular heart disease, and carries a risk of stroke. Highly variable use of anticoagulants may be related to different health care and socioeconomic settings. More studies are needed to improve understanding of the epidemiology and management of AF in developing countries.

Changes in calculated coronary heart disease risk using proactive multifactorial intervention versus continued usual care in Latin-American and non-Latin-American patients enrolled in the CRUCIAL trial

OBJECTIVE

To compare the change in calculated coronary heart disease (CHD) risk using a proactive multifactorial intervention (PMI) versus usual care (UC), among Latin-American (LA) and non-LA patients enrolled in the CRUCIAL trial.

RESEARCH DESIGN AND METHODS

This is a sub-analysis of the Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term-risk (CRUCIAL) trial. CRUCIAL was a prospective, multinational, open-label, cluster-randomized trial. Eligible patients had hypertension and ≥3 additional cardiovascular risk factors, but no history of CHD and baseline total cholesterol ≤6.5 mmol/l (250 mg/dl). The PMI strategy was implemented by the inclusion of single-pill amlodipine/atorvastatin (SPAA) in the patients' treatment regimen. Overall, 20% of patients resided in the LA region.

MAIN OUTCOME MEASURE

Treatment-related change in calculated Framingham 10-year CHD risk between baseline and Week 52 in the LA and non-LA regions.

RESULTS

A greater relative reduction in calculated CHD risk after 52 weeks' follow-up was observed for patients in the PMI arm compared with UC arm in both LA (-32.8% vs. -7.5%, p = 0.003) and non-LA regions (-33.1% vs. -3.3%, p < 0.001), region interaction p = 0.316. The proportion of patients discontinuing treatment in the PMI arm due to adverse events (AEs) was low in both regions (both 5.9%).

CONCLUSIONS

The PMI approach based on the inclusion of SPAA in the patients' treatment regimen may improve the management of CHD risk among patients residing in LA and non-LA regions. Clinicians may be reassured by the low rate of AEs leading to discontinuation of SPAA in both regions.

Atherothrombotic disease, traditional risk factors, and 4-year mortality in a Latin American population: the REACH Registry

BACKGROUND

Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk.

HYPOTHESIS

Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort.

METHODS

We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry.

RESULTS

Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index <20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥ 65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥ 30 (HR: 0.58) were associated with a reduced risk.

CONCLUSIONS

Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin American cohort. Nearly one-third of the population with 3 symptomatic vascular-disease locations died at 4-year follow-up.

Coronary heart disease and stroke attributable to major risk factors is similar in Argentina and the United States: the Coronary Heart Disease Policy Model

BACKGROUND

Cardiovascular disease is the leading cause of death in Argentina and the U.S. Argentina is 92% urban, with cardiovascular disease risk factor levels approximating the U.S.

METHODS

The Coronary Heart Disease (CHD) Policy Model is a national-scale computer model of CHD and stroke. Risk factor data were obtained from the Cardiovascular Risk Factor Multiple Evaluation in Latin America Study (2003-04), Argentina National Risk Factor Survey (2005) and U.S. national surveys. Proportions of cardiovascular events over 2005-2015 attributable to risk factors were simulated by setting risk factors to optimal exposure levels [systolic blood pressure (SBP) 115 mm Hg, low-density lipoprotein cholesterol (LDL) 2.00 mmol/l (78 mg/dl), high-density lipoprotein cholesterol (HDL) 1.03 mmol/l (60 mg/dl), absence of diabetes, and smoking]. Cardiovascular disease attributable to body mass index (BMI) >21 kg/m² was assumed mediated through SBP, LDL, HDL, and diabetes.

RESULTS

Cardiovascular disease attributable to major risk factors was similar between Argentina and the U.S., except for elevated SBP in men (CHD 8% points higher in Argentine men, 6% higher for stroke). CHD attributable to BMI >21 kg/m² was substantially higher in the U.S. (men 10-11% points higher; women CHD 13-14% higher).

CONCLUSIONS

Projected cardiovascular disease attributable to major risk factors appeared similar in Argentina and the U.S., though elevated BMI may be responsible for more of U.S. cardiovascular disease. A highly urbanized middle-income nation can have cardiovascular disease rates and risk factor levels comparable to a high income nation, but fewer resources for fighting the epidemic.

Dietary calcium intake and its relationship with adiposity and metabolic profile in hypertensive patients

OBJECTIVE

An inverse relation between dietary calcium and adiposity has been found in several epidemiologic studies. Recent evidence has also suggested that a calcium-rich diet may have beneficial effects on insulin resistance and dyslipidemia. This study aimed to evaluate the association of dietary calcium intake with global adiposity, abdominal obesity, and metabolic profile in hypertensive patients.

METHODS

In this cross-sectional study, 85 hypertensive patients 25 to 70 y old underwent clinical, dietary, anthropometric, and biochemical evaluations. Participants were stratified into the following two groups according to their usual dietary calcium intake: low calcium group (<800 mg/d) and high calcium group (≥800 mg/d).

RESULTS

Fifty-seven participants (11 men and 46 women) were included in the final analyses. Subjects in the low calcium group compared with those in the high calcium group exhibited significantly higher levels of body mass index and percentage of body fat after adjustments for variables that could interfere with those adiposity parameters (P = 0.03 and 0.01, respectively). Patients in the high calcium group had a lower odds ratio for prevalent obesity than those in the low calcium group, even after controlling for potential confounders (P = 0.01). No significant differences were found in abdominal adiposity and metabolic profile between the two groups. Using data from all patients, an inverse and significant association was observed between dietary calcium intake and percentage of body fat, and it remained after controlling for confounders (P = 0.03).

CONCLUSIONS

The findings of the present study suggest that, in hypertensive patients, higher dietary calcium intake could be associated with lower global adiposity.