Tobacco smoking in seven Latin American cities: the CARMELA study

Objective

This study aimed to explore tobacco smoking in seven major cities of Latin America.

Methods

The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study is a cross-sectional epidemiological study of 11 550 adults between 25 and 64 years old in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Tobacco smoking, including cigarettes, cigars and pipes, was surveyed among other cardiovascular risk factors.

Results

Santiago and Buenos Aires had the highest smoking prevalence (45.4% and 38.6%, respectively); male and female rates were similar. In other cities, men smoked more than women, most markedly in Quito (49.4% of men vs 10.5% of women). Peak male smoking prevalence occurred among the youngest two age groups (25–34 and 35–44 years old). Men and women of Buenos Aires smoked the highest number of cigarettes per day on average (15.7 and 12.4, respectively). Men initiated regular smoking earlier than women in each city (ranges 13.7–20.0 years vs 14.2–21.1 years, respectively). Exposure to secondhand tobacco smoke at workplace for more than 5 h per day was higher in Barquisimeto (28.7%), Buenos Aires (26.8%) and Santiago (21.5%). The highest prevalence of former smokers was found among men in Buenos Aires, Santiago and Lima (30.0%, 26.8% and 26.0% respectively).

Conclusions

Smoking prevalence was high in the seven CARMELA cities, although patterns of smoking varied among cities. A major health and economic burden is inevitable in urban Latin America unless effective comprehensive tobacco control measures recommended by the World Health Organisation Framework Convention on Tobacco Control are implemented.

High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study

AIMS

Cardiovascular risk is increased with glucose metabolism abnormalities. Prevalence data can support public health initiatives required to address this risk. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was designed to estimate the prevalence of Type 2 diabetes, impaired fasting glucose and related risk factors in seven urban Latin American populations.

METHODS

CARMELA was a cross-sectional, population-based study of 11 550 adults 25-64 years of age. With a multi-stage sample design of a probabilistic nature, approximately 1600 subjects were randomly selected in each city.

RESULTS

Overall, the prevalence of diabetes was 7.0% (95% confidence intervals 6.5-7.6%). The prevalence of individuals with diabetes or impaired fasting glucose increased with increasing age. In the oldest age category, 55-64 years of age, prevalence of diabetes ranged from 9 to 22% and prevalence of impaired fasting glucose ranged from 3 to 6%. Only 16.3% of people with prior diagnosis of diabetes and who were receiving pharmacologic treatment, were in good glycaemic control (fasting glucose < 6.1 mmol/l). The prevalence of diabetes in individuals with abdominal obesity was approximately twofold higher. Participants with hypertension, elevated serum triglycerides and increased common carotid artery intima-media thickness were also more likely to have diabetes.

CONCLUSIONS

The prevalence of diabetes and impaired fasting glucose is high in seven major Latin American cities; intervention is needed to avoid substantial medical and socio-economic consequences. CARMELA supports the associations of abdominal obesity, hypertension, elevated serum triglycerides and carotid intima-media thickness with diabetes.

The Argentine Factores de Riesgo Coronario en America del Sur (FRICAS) Investigators

The relationship between a history of hypertension and the quality of its control in routine clinical practice and the risk of acute myocardial infarction was examined in a multicenter, case-control study conducted in Argentina between November 1991 and August 1994, within the framework of the FRICAS study. The cases were 939 patients with acute myocardial infarction and without a history of ischemic heart disease. The controls were 949 subjects identified in the same centers as the cases and admitted with a wide spectrum of acute disorders unrelated to known or suspected risk factors for acute myocardial infarction. The odds ratios and the 95% confidence intervals were derived from multiple logistic regression equations, including terms for age, gender, education, social status, exercise, smoking status, cholesterolemia, history of diabetes, body mass index, and family history of myocardial infarction. The quality of hypertension control was assessed with the most recent blood pressure reading reported by the subjects. Seventy-two percent of hypertensive cases and 62.6% of hypertensive controls had a history of antihypertensive therapy by self-report, when admitted to the medical center. The adjusted odds ratio for acute myocardial infarction due to hypertension was 2.58 (95% confidence interval, 2.08-3.19). The odds ratio was 2.42 (95% confidence interval, 1.88-3.11) when hypertensives reported that their greatest systolic value was below 200 mm Hg (moderate status) and 4.12 (95% confidence interval, 2.87-5.89) when it was above 200 mm Hg (severe status). When the highest diastolic blood pressure value was below 120 mm Hg (moderate status), the risk increased to 2.48 (95% confidence intervals, 1.90-3.24) and to 4.12 (95% confidence interval, 2.83-5.99) when it was above 120 mm Hg (severe status). If the most recent systolic blood pressure was less-than-or-equal140 mm Hg, the odds ratio was 2.59 (95% confidence interval, 1.96-3.41), and it was 3.42 (95% confidence interval, 2.40-4.87) when the value was >140 mm Hg. If the most recent diastolic blood pressure was less-than-or-equal90 mm Hg, the risk increased more than two fold (odds ratio=2.48; 95% confidence interval, 1.91-3.22), and if it was >90 mm Hg, it increased nearly four-fold (odds ratio=3.72; 95% confidence interval, 2.33-5.96). In smokers, the odds ratio was 2.28 in the absence of hypertension and increased to 7.51 when hypertension was present. In this Argentine population, hypertension is a strong and independent risk factor for acute myocardial infarction. In routine clinical practice, the control of blood pressure to levels below 140/90 seems to be required in order to reduce part (but not all) of the risk of acute myocardial infarction in hypertensive patients. (c) 2001 by CHF, Inc.

Case-control study of passive smoking at home and risk of acute myocardial infarction. Argentine FRICAS Investigators. Factores de Riesgo Coronario en América del Sur

OBJECTIVES

We sought to study the relation between passive smoking at home and the risk of acute myocardial infarction (AMI).

BACKGROUND

Previous epidemiologic studies have linked environmental tobacco smoke to an increased risk of coronary heart disease, but the evidence to support this view is not strong enough. To study this issue further, we analyzed the data from a case-control study conducted in Argentina between 1991 and 1994.

METHODS

Case patients included 336 never-smokers with AMI. Control patients were 446 never-smokers admitted to the same network of hospitals with a wide spectrum of acute disorders unrelated to smoking or to known or suspected risk factors for AMI. Data on the smoking habits of the participants' close relatives (spouse and children) were collected by trained interviewers using a structured questionnaire.

RESULTS

Compared with subjects whose relatives had never smoked, the multivariate odds ratios for passive smokers, according to the smoking status of their relatives, were 1.68 (95% confidence interval [CI] 1.20 to 2.37) for one or more relatives who smoked; 1.59 (95% CI 0.85 to 2.96) for a spouse who smoked; 1.24 (95% CI 0.61 to 2.52) for a spouse who smoked 1 to 20 cigarettes/day; 4.03 (95% CI 0.99 to 16.32) for a spouse who smoked >20 cigarettes/day; and 1.80 (95% CI 1.20 to 2.68) for one or more children who smoked. There was a significant interaction between passive smoking and hypercholesterolemia (> or = 240 mg/dl), hypertension, diabetes and family history of MI.

CONCLUSIONS

In never-smokers, passive smoking at home appeared to be associated with the risk of AMI, and approximately 14% of cases in men and 18% of cases in women in this Argentinian cohort are attributable to passive smoking.

Frequency of family history of acute myocardial infarction in patients with acute myocardial infarction. Argentine FRICAS (Factores de Riesgo Coronario en America del Sur) Investigators

The relation between family history of acute myocardial infarction (AMI) and the risk of AMI was analyzed using data of a case-control study conducted in Argentina between 1992 and 1994. Case patients were 1,060 subjects with AMI admitted to 35 coronary care units, and controls were 1,071 subjects admitted to the same network of hospitals where cases had been identified, for a wide spectrum of acute conditions unrelated to known or likely risk factors for AMI: 31% of cases versus 15% of controls reported > or = 1 first-degree relative with history of AMI. Compared with subjects without family history of AMI, the odds ratio (OR) of AMI, after allowance for age, sex, cholesterolemia, smoking, diabetes, hypertension, body mass index, education, social class, and physical exercise, was 2.18 (95% confidence interval [CI] 1.74 to 2.74) for those with family history of AMI. The OR was 2.04 (95% CI 1.60 to 2.60) for subjects with 1 relative, and 3.18 (95% C 1.86 to 5.44) for those reporting > or = 2 relatives with AMI. In women the OR for any family history of AMI was 2.83, and in men 2.01. The association was of similar magnitude if the mother (OR 1.98), the father (OR 2.13), or a sibling (OR 2.48) had had an AMI. The association with family history was stronger at a younger age because the OR for subjects reporting > or = 2 more relatives with a history of AMI was 4.42 for subjects aged < 55 years, and 3.00 for those aged > or = 55 years. The association between AMI and family history of AMI was consistent across separate strata of education, social class, smoking, and serum cholesterol, but was less strong in subjects with history of diabetes and hypertension. When the interaction of known risk factors with family history of AMI was analyzed, hypercholesterolemia, hypertension, and smoking had approximately multiplicative effects on the relative risk. The OR was 4.50 for subjects with family history and cholesterol > or = 240 ml/dl, 4.52 for those with hypertension, and 5.77 for current smokers with family history of AMI. Thus, this study confirms that a family history of AMI is a strong and independent risk factor for AMI. In this population from Argentina, family history accounted for 14% of all cases of AMI in men and 26% in women.

Body weight and nonfatal myocardial infarction in a case-control study from Argentina

The relationship between overweight and obesity and the risk of acute nonfatal myocardial infarction was analyzed, using data from a case-control study from Buenos Aires, Argentina. The study included 1000 patients with acute myocardial infarction and 1000 controls, who had been admitted to the same hospitals in which the cases had been identified, for acute conditions unrelated to known or potential risk factors for coronary heart disease. Only 32% of the cases and 41% of the controls had a Quetelet's index (body mass index, BMI, kg m-2) under 25% of the cases and 51% of the controls were overweight (BMI 25 to 30), and 15% of the cases and 8% of the controls severely obese (BMI > 30). After allowance for age and sex, the relative risks (RR) were 1.4 (95% confidence interval, CI, 1.1 to 1.7) for subjects with a body mass index of 25 to 30 and 2.2 (95% CI 1.7 to 3.1) for those with a body mass index more than 30. When additional adjustment was made for hypertension, diabetes, smoking and a family history of coronary heart disease, the RR was 1.2 (95% CI 1.0 to 1.6) among subjects with a body mass index of 25 to 30 and 1.7 (95% CI 1.3 to 2.4) for those with a body mass index more than 30. The trend in risk was significant. In the stratified analysis, the RR in younger people (30-44 years) with a body mass index more than 30 was 4.7 (95% CI 2.0 to 10.8), and the association was less strong in middle and older age.(ABSTRACT TRUNCATED AT 250 WORDS)