Functional capacity and cognitive performance of adults from Argentina in cardiopulmonary rehabilitation / Capacidad funcional y rendimiento cognitivo de adultos argentinos en rehabilitación cardiopulmonar.

Introduction: Functional capacity is decreased in people with Cardiovascular Diseases and Chronic Respiratory Diseases. These diseases have also been associated with cognitive dysfunction. The study examines the efficacy of a cardiopulmonary rehabilitation program in the recovery of functional capacity and analyzes whether subjects with cardiopulmonary diseases suffer from cognitive dysfunction. Materials and methods: Participated 50 adults with medium-high education who completed a cardiopulmonary rehabilitation program of between 3 and 6 months based on physical education, nutritional education, promotion of healthy habits and medication management. Functional capacity was evaluated with the Duke index at the beginning and end of the program. Memory and language tests were also administered, for the only time, at the beginning of the program, comparing the values obtained with Argentine normative studies. The data was analyzed with the Wilcoxon test, bivariate correlations, and linear regression. Results: Functional capacity increased significantly at the end of the program. In any case, the post-program Duke value suggests that the functional capacity of the patients continues to be affected. On the other hand, a memory test explained 10,8% of the variance in the Duke index, and there are no findings of cognitive dysfunction. Conclusion: The functional capacity of cardiopulmonary patients improved with the rehabilitation program, although this improvement is clinically insufficient. Better memory performance predicted greater functional capacity, which is why it is suggested to add cognitive stimulation workshops to cardiopulmonary rehabilitation programs. This sample with cardiopulmonary disease does not present cognitive dysfunction, probably due to its high cognitive reserve. Introduction: Functional capacity is decreased in people with Cardiovascular Diseases and Chronic Respiratory Diseases. These diseases have also been associated with cognitive dysfunction. The study examines the efficacy of a cardiopulmonary rehabilitation program in the recovery of functional capacity and analyzes whether subjects with cardiopulmonary diseases suffer from cognitive dysfunction. Materials and methods: Participated 50 adults with medium-high education who completed a cardiopulmonary rehabilitation program of between 3 and 6 months based on physical education, nutritional education, promotion of healthy habits and medication management. Functional capacity was evaluated with the Duke index at the beginning and end of the program. Memory and language tests were also administered, for the only time, at the beginning of the program, comparing the values obtained with Argentine normative studies. The data was analyzed with the Wilcoxon test, bivariate correlations, and linear regression. Results: Functional capacity increased significantly at the end of the program. In any case, the post-program Duke value suggests that the functional capacity of the patients continues to be affected. On the other hand, a memory test explained 10,8% of the variance in the Duke index, and there are no findings of cognitive dysfunction. Conclusion: The functional capacity of cardiopulmonary patients improved with the rehabilitation program, although this improvement is clinically insufficient. Better memory performance predicted greater functional capacity, which is why it is suggested to add cognitive stimulation workshops to cardiopulmonary rehabilitation programs. This sample with cardiopulmonary disease does not present cognitive dysfunction, probably due to its high cognitive reserve.

Introducción: La capacidad funcional está disminuida en personas con Enfermedades Cardiovasculares y Enfermedades Respiratorias Crónicas. Estas enfermedades también han sido asociadas a disfunción cognitiva. El estudio examina la eficacia de un programa de rehabilitación cardiopulmonar en la recuperación de la capacidad funcional, y analiza si sujetos con enfermedades cardiopulmonares sufren disfunción cognitiva. Materiales y métodos: Participaron 50 personas adultas con instrucción media-alta que completaron un programa de rehabilitación cardiopulmonar de entre 3 y 6 meses basado en educación física, educación nutricional, promoción de hábitos saludables y manejo de medicación. Se evaluó la capacidad funcional con el índice Duke al iniciar y finalizar el programa. Se administró también, por única vez, al iniciar el programa, pruebas de memoria y de lenguaje, comparando los valores obtenidos con estudios normativos argentinos. Se analizó los datos con test Wilcoxon, correlaciones bivariadas y regresión lineal. Resultados: La capacidad funcional aumentó significativamente al finalizar el programa. De todos modos el valor Duke pos- programa sugiere que la capacidad funcional de los pacientes continúa afectada. Por otro lado, una prueba de memoria explicó el 10,8% de la varianza en el índice Duke, y no hay hallazgos de disfunción cognitiva. Conclusión: La capacidad funcional de los pacientes cardiopulmonares mejoró con el programa de rehabilitación, aunque dicha mejora, es clínicamente insuficiente. Mejor rendimiento de memoria predijo mayor capacidad funcional, por lo que se sugiere añadir talleres de estimulación cognitiva a los programas de rehabilitación cardiopulmonares. Esta muestra con enfermedad cardiopulmonar no presenta disfunción cognitiva, probablemente por su elevada reserva cognitiva.

Implicancias de la pandemia por COVID-19 y el aislamiento social sobre el perfil cardiometabólico de una cohorte de individuos en la Ciudad de Buenos Aires / Implications of the COVID-19 Pandemic and Social Isolation on the Cardiometabolic Profile of a Cohort of Individuals from the City of Buenos Aires

RESUMEN Introducción : La pandemia por COVID-19 ha conmocionado a la humanidad. Durante la misma, la necesidad de aislamiento social ha fomentado la baja adherencia a un estilo de vida saludable en muchos individuos. Sin embargo, existe poca evidencia del impacto metabólico que ha tenido la pandemia por COVID-19 en nuestro medio. Objetivos : Evaluar el impacto del aislamiento social producido por la pandemia COVID-19 sobre el peso corporal y los pará metros cardiometabólicos de una población de adultos en la Ciudad Autónoma de Buenos Aires. Materiales y métodos : En un diseño observacional, se analizaron los datos de pacientes (pac.) que asistieron a un programa de prevención y promoción de salud en la Ciudad de Buenos Aires. Se individualizaron datos de participantes que concurrieron a realizarse estudios en el año 2019 y repitieron los mismos en el año 2021. Los registros médicos se utilizaron como fuente para la recopilación de datos generales, medidas antropométricas y valores de laboratorios. Se utilizaron los criterios NCEP para definir la presencia de Síndrome Metabólico (SM). Resultados : Se identificaron un total de 558 pac. con evaluaciones disponibles en 2019 y 2021. La edad promedio de la población fue 52,2 ± 12,8 años, con 41% de mujeres. Se observó un incremento en el peso corporal (82,1 ± 17,7 kg vs. 83,1 ± 18,5kg; p <0,0001) y del índice de masa corporal (29,4 ± 5,4 vs. 29,8 ± 5,7, p <0,0001). También se observaron incrementos en la presión arterial sistólica (123,1 ± 15,1 mmHg vs. 126,6 ± 16,3 mmHg; p <0,0001) y diastólica (77,7 ± 9,3 mmHg vs. 79,6 ± 9,4 mmHg; p <0,0001). Dentro de los parámetros de laboratorio, se evidenció un incremento en los valores de glucemia plasmática, con mediana y rango intercuartilo (RIC) de 95 (89-103 mg/dL) vs. 99 (92-107 mg/dL), p <0,0001; y descenso del colesterol HDL (51,8 ± 12,7 mg/dL vs. 49,3 ± 12,8 mg/dL; p <0,00001). No se observaron cambios en el colesterol LDL (116,4 ± 32,6 mg/dL vs. 116,1 ± 34 mg/dL; p = NS), colesterol total (194,9 ± 37,4 vs. 193 ± 39,6 mg/dL; p=NS) o la concentración de triglicéridos, con mediana (RIC) de 114,5 (83,2-162,7 mg/dL) vs 118 (88-169 mg/dL), p=NS. Esto se acompañó de un au mento de la prevalencia de SM (21,5% vs 34%; p<0,0001). También se incrementó la proporción de pac. con placas a nivel carotídeo (35,8% vs. 40,5%; p <0,01). El 18,8% de los pac. incrementaron su peso corporal más del 5%. Esta población estuvo representada por pac. más jóvenes (47,6 ± 14 años vs. 53,3 ± 12 años; p< 0,0001), y se observó correlación inversa entre edad y magnitud del incremento del peso (r =-0,1; p<0,02). Conclusiones : El aislamiento social, durante la pandemia COVID-19, mostró tener importantes consecuencias en los factores de riesgo de la población estudiada. Las implicancias prospectivas de estos hallazgos podrían verse en los próximos años, si estas alteraciones metabólicas no se revierten.

ABSTRACT Background : The COVID-19 pandemic has shocked humanity. During the pandemic, the need for social isolation has encouraged low adherence to a healthy lifestyle in many individuals. However, evidence of the metabolic impact of COVID-19 pandemic on our field is scarce. Objective : To evaluate the impact of social isolation produced by the COVID-19 pandemic on the body weight and the cardio metabolic parameters of an adult population in the Autonomous City of Buenos Aires. Methods : Based on an observational design, we analyzed the data from patients who attended a prevention and health pro motion program in the City of Buenos Aires. Data from participants who attended for testing in 2019 and repeated testing in 2021 were individualized. Medical records were used as source for collecting general data, anthropometric measurements, and laboratory values. The National Cholesterol Education Program (NCEP) criteria were used to define the presence of metabolic syndrome (MS). Results : A total of 558 patients with available evaluations in 2019 and 2021 were identified. The average age of the population was 52.2 ± 12.8 years, and 41% was female. An increase in body weight (82.1 ± 17.7 kg vs. 83.1 ± 18.5 kg; p<0.0001) and body mass index (29.4 ± 5.4 vs. 29.8 ± 5.7, p <0.0001) was observed. Increases in systolic (123.1 ± 15.1 mmHg vs. 126.6 ± 16.3 mmHg; p <0.0001) and diastolic (77.7 ± 9.3 mmHg vs. 79.6 mmHg± 9.4 mmHg, p <0.0001) blood pressure values were also observed. As regards the laboratory parameters, we noted an increase in plasma glucose levels with a median and an interquartile range (IQR) of 95 (89-103 mg/dL) vs. 99 (92-107 mg/dL), p <0.0001, and a decrease in HDL cholesterol (51, 8 ± 12.7 mg/dL vs. 49.3 ± 12.8 mg/dL, p<0.0001). No changes were observed in LDL cholesterol (116.4 ± 32.6 mg/dL vs. 116.1 ± 34 mg/dL; p=NS), total cholesterol (194.9 ± 37.4 vs. 193 ± 39.6 mg/dL; p=NS) or triglyceride levels, with a median and IQR of 114.5 (83.2-162.7 mg/dL) vs. 118 (88-169 mg/dL; p=NS). This was accompanied by an increased prevalence of MS (21.5% vs. 34%; p<0.0001). The proportion of patients with carotid plaques also increased, without reaching statistical significance (36.4% vs. 40.7%; p=NS). Besides, it was observed that 18.8% of the patients increased their body weight by more than 5%. This population was represented by younger patients (47.6 ± 14 years vs. 53.3 ± 12 years; p< 0.0001) showing a reverse correlation between age and scope of weight increase (r=-0.1; p<0.02). Conclusion : Social isolation during the COVID-19 pandemic was shown to have important consequences on the risk factors of the population studied. The prospective implications of these findings might become apparent in the next few years if these metabolic alterations are not reversed.

Evaluación del perfil metabólico y prevalencia de enfermedad cardiovascular en los ex combatientes de la guerra de Malvinas / Evaluation of the metabolic profile and prevalence of cardiovascular disease in former combatants of the Malvinas war

Resumen Introducción: Se ha informado que los veteranos de guerra están más expuestos a factores de riesgo cardiovascular. El objetivo del presente trabajo fue establecer los factores de riesgo, el perfil cardiometabólico y la prevalencia de enfermedad cardiovascular de un grupo de excombatientes de la Guerra de Malvinas (HdeM). Métodos: En un diseño caso-control se analizaron los datos de 799 HdeM y se compararon 799 controles de misma edad. La muestra se seleccionó de los participantes del Programa de Prevención de Salud Cardiovascular de la Fundación Favaloro, entre enero de 2017 y diciembre de 2019. Resultados: La edad promedio fue 56.9 ± 3.9 años. Se observó un aumento del peso entre los HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). Se observó mayor frecuencia de hipertensión arterial en HdeM (42% vs. 34%; p < 0.001) y diabetes mellitus (15.1% vs. 10.4%; p < 0.005). El síndrome metabólico fue más prevalente en HdeM (49.2% vs. 39.7%; p = 0.0001). Se observó que el antecedente de infarto agudo de miocardio fue más frecuente entre los HdeM (3.6% vs. 2%; p < 0.05), con similar prevalencia de ACV (1.2% vs. 1%; p = ns), angioplastia corona ria (3.2% vs. 2.1%; p = ns) o cirugía de revascularización miocárdica (0.8% vs. 0.4%; p = ns). Discusión: Los HdeM mostraron mayor prevalencia de factores de riesgo, síndrome metabólico e infarto agudo de miocardio. Es importante tener en cuenta este aumento de riesgo para maximizar las estrategias de prevención cardiovascular en los excombatientes.

Abstract Introduction: It has been reported in different parts of the world that war veterans are more exposed to cardio vascular risk factors. The objective of this study was to establish the risk factors, the cardiometabolic profile and the prevalence of cardiovascular disease in a group of ex-combatants of the Malvinas War (HdeM). Methods: In a case-control design, data from 799 HdeM were analyzed and compared with 799 controls matched by age. The sample was selected from the participants of the Cardiovascular Health Prevention Program of the Favaloro Foundation, between January 2017 and December 2019. Results: The average age was 56.9 ± 3.9 years. An increase in weight was observed among the HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). A higher frequency of arterial hypertension (42% vs. 34%; p < 0.001) and diabetes mellitus (15.1% vs. 10.4%; p < 0.005) was observed in HdeM. Metabolic syndrome was also more prevalent in HdeM (49.2% vs. 39.7%; p = 0.0001). It was observed that the history of acute myocardial infarction was more frequent among the HdeM (3.6% vs. 2%; p < 0.05), with a similar prevalence of stroke (1.2% vs. 1%; p = ns), coronary angioplasty (3.2% vs. 2.1%; p = ns) or myocardial revascularization surgery (0.8% vs. 0.4%; p = ns). Discussion: The HdeM showed an increase in the frequency of risk factors, metabolic syndrome and acute myocardial infarction. It is important to take this increased risk into account in order to maximize cardiovascular prevention strategies in ex-combatants.

Seguimiento de pacientes sometidos a cirugía cardiovascular: impacto de la educación en la prevención secundaria / Follow-up of patients submitted to cardiovascular surgery: impact of teaching on the secondary prevention

Cardiac rehabilitation programs (CRP), include exercise training, medical advice and education related to cardiovascular pathologies, psychosocial support and behavioral characteristics. This approach shows a sustained positive impact over the cardiovascular risk factors, the physical training and the health-related quality of life of the patients and on adherence to dietary recommendations. During the 2004 the authors started the implementation of the Integral Teaching Program (ITP), focused to convalescent patients after a cardiovascular event and with the purpose to enter in a plan of cardiac rehabilitation and secondary preventions with exercise training programs and with a multidisciplinary approach. The aim of this report was to describe the results of the ITP in a cohort of patients submitted to cardiovascular surgery. In a second term, the impact of the ITP will be measured including the total and partial adherence to the different planes of cardiac rehabilitation programs and the management of vascular risk factors. Also it was studied the improvement in physiological outcomes and health-related quality of life in patients with acute myocardial infarction.