The Effect of Statins on Serum Vitamin D Concentrations Among Older Adults.

Background Randomized and observational studies have previously reported inconsistent results for the direct association between statin therapy and 25, hydroxyvitamin D [25(OH)D] levels. Thus, the present study aimed to examine the relationship between statin use and 25(OH)D and its metabolites concentrations in a large nationally representative sample of older adults. Methods This study was conducted using data from the National Health and Nutrition Examination Survey. Participants were asked to show the medication containers of all the products used in the previous 30 days, and the prescription of statins was defined on the three-level nested therapeutic classification scheme of Cerner Multum's Lexicon. General linear models adjusted for potential confounders were created to compare 25(OH)D concentrations between older adults taking statins and those who did not.  Results A total of 6,261 participants with a mean age of 69.5 years comprised the study sample. Of those, 40.2% were taking statins with a median length of therapy of 5 years. Adjusted mean 25(OH)D3 and 25(OH)D levels were 3.3 and 4.4 nmol/L higher among participants taking statins than those who did not, respectively. Moreover, this association was consistently seen regardless of the duration of therapy and particularly in subjects taking simvastatin, atorvastatin, or rosuvastatin. In subgroup analyses according to BMI categories and vitamin D intake, higher 25(OH)D levels were also seen among statin users. By contrast, this association was attenuated among those with a daily vitamin D between 400 and 800 and >800 IU. Conclusion Older adults on statin therapy had significantly higher serum 25(OH)D concentrations. Additional research should be conducted to define the mechanism of this association and determine if the pleiotropic effects attributed to statins may be mediated by vitamin D.

Optimal waist circumference cutoff values for predicting metabolic syndrome among older adults in Ecuador.

AIMS: To determine optimal waist circumference cutoff values for predicting metabolic syndrome (MetS) among adults aged 60 years and older in Ecuador. MATERIAL AND METHODS: The National Survey of Health, Wellbeing, and Aging survey was used to describe the prevalence of MetS according to standard definitions. Receiver operating characteristics (ROC) curve analyses and the Younden index J (YI) were performed to examine optimal waist circumference cutoff values for predicting MetS. Moreover, the prevalence of MetS according to country-specific waist circumference cutoff values was compared with those using standard definitions. RESULTS: Among 2306 participants with a mean age of 70.6 years, the optimal waist circumference cutoff value for predicting MetS was 90.7 cm in women with a sensitivity of 66.1%, specificity of 65.6% and YI of 0.31. In men, a waist circumference of 91.2 cm with a sensitivity of 73.2%, specificity of 62.8%, and YI of 0.36 was the optimal cutoff point for predicting MetS. In general, applying country-specific cutoff values decreased the prevalence of MetS among older Ecuadorian women. In men, except with the ATP III definition, similar MetS prevalence rates were seen whether the country-specific or standard waist circumference cutoff values were applied. CONCLUSIONS: The optimal waist circumference cutoff values for predicting metabolic syndrome among older Ecuadorians adults were 90.7 cm for women and 91.2 cm for men. Moreover, current standard definitions of abdominal obesity may overestimate the prevalence of MetS, particularly in Latin American women.

Low prevalence of atrial fibrillation in Amerindians: a population-based study in frequent fish consumers living in rural coastal Ecuador (The Atahualpa Project).

BACKGROUND: Information on the burden of atrial fibrillation (AF) in rural areas of developing countries is limited. Here, we aimed to assess AF prevalence in community-dwelling older adults living in rural Ecuador. METHODS: Atahualpa residents aged ≥60 years (mean age 70.5 ± 8.1 years) underwent 24-h Holter monitoring. Participants belong to the Amerindian ethnic group. The mean height in the study population was 147.9 ± 8.9 cm. Oily fish was a major source of food (mean intake: 8 ± 4 servings/week). RESULTS: Seven of 298 participants (2.3%) had AF. Persons with AF were older than those without (p = 0.051), but there were no differences in cardiovascular risk factors across groups. None of the seven AF cases had been detected in routine 12-lead ECGs taken at enrollment. CONCLUSIONS: Prevalence of AF in older Amerindians living in rural Ecuador is low. Both, racially-determined short stature and frequent dietary oily fish intake might explain the low prevalence of AF in this rural setting.

Salud cardiovascular en habitantes de Atahualpa: características y correlatos / Cardiovascular health status in Atahualpa residents: characteristics and correlates

RESUMEN Las enfermedades vasculares son consideradas como las nuevas epidemias de salud en América Latina debido al aumento en la expectativa de vida y a cambios en el estilo de vida de sus habitantes. El conocimiento del estado de salud cardiovascular (SCV) de estas poblaciones es mandatorio para implementar estrategias costo-efectivas dirigidas a reducir la prevalencia de estas enfermedades en la región. En el Proyecto Atahualpa se ha valorado el estado de SCV de los participantes, utilizando los marcadores de salud propuestos por la Asociación Americana del Corazón. El estudio basal incluyó 616 sujetos libres de enfermedad cerebrovascular y cardiopatía isquémica, con edad ≥40 años. De estos, el 2.1% tuvieron un estado de salud ideal, el 28.1% intermedio y el 69.8% pobre. Los peores marcadores incluyeron presión arterial, glucosa en ayunas e índice de masa corporal. La posibilidad de tener un estado de SCV pobre estuvo aumentada en sujetos ≥60 años y en aquellos con escolaridad primaria. Luego, comparamos el estado de SCV de nuestra población con la de hispanos enrolados en el NOMAS, y encontramos que los residentes de Atahualpa tuvieron mejores marcadores de salud, con excepción de los niveles de glucosa en ayunas. La posibilidad de tener 5-7 marcadores en rango ideal fue más elevada en los residentes de Atahualpa, independientemente de la edad. También realizamos un estudio para valorar la SCV dependiendo del aislamiento social y encontramos que el vivir solo se asoció con un peor estado de SCV. Otros estudios mostraron relación entre ciertas patologías del sueño y un peor estado de SCV. Finalmente, hemos empezado el programa "conoce tus números", el cual sumado a charlas comunitarias, se encuentra dirigido a mejorar la SCV de los residentes de Atahualpa y reducir la incidencia de eventos vasculares en la región.

ABSTRACT Stroke and cardiovascular diseases will be the next epidemics in Latin America due to changes in lifestyle and increased life expectancy. Knowledge of cardiovascular health (CVH) status of the population is mandatory to implement cost-effective strategies directed to reduce the burden of vascular diseases in the region. In the Atahualpa Project, we assessed the CVH status of participants using the metrics proposed by the American Heart Association. The basal study included 616 subjects free of stroke and ischemic heart disease aged ≥40 years. Of these, 2.1% had ideal, 28.1% had intermediate and 69.8% had poor CVH status. Poorest metrics were blood pressure, fasting glucose, and BMI. The odds for having a poor CVH status were increased in persons aged ≥ 60 years and in those with only primary school education. Then, we compared our results with the Hispanic population of the Northern Manhattan Stroke Study (NOMAS), and found that Atahualpa residents had significantly better metrics than those enrolled in the NOMAS, with the exception of fasting glucose levels. Likewise, the odds for having 5 to 7 ideal metrics were also better in Atahualpa residents, irrespective of age. We also conducted a case-control study to assess the CVH status of Atahualpa residents according to their living arrangements, and found that social isolation was associated with a worse CVH status in this population. A couple of studies showed correlation between some sleep related disorders and poor CVH status. We have also started an ongoing program called "known your numbers", which, together with community talks, is directed to improve the CVH status and to reduce the burden of vascular diseases in the region.

Prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador.

AIMS: To describe the prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador. MATERIALS AND METHODS: The present study used data from the National Survey of Health, Wellbeing, and Aging survey to examine the prevalence of abdominal obesity according to certain demographic, behavioral, and health characteristics of the participants. Logistic regression models adjusted for potential confounders were used to evaluate the association of abdominal obesity with cardio metabolic risk factors. RESULTS: Of 2053 participants aged 60 years and older, the prevalence of abdominal obesity was 65.9% (95% CI; 62.2%, 69.4%) in women and 16.3% (95% CI; 13.8%, 19.2%) in men. Notably, a higher prevalence of abdominal obesity was seen among residents in the urban areas of the country, those who reported their race as black or mulatto, individuals with sedentary lifestyle and obesity, and older adults with greater number of comorbidities. Moreover, after adjustment for potential confounders, women with abdominal obesity were 2.0, 2.8, and 1.6 times more likely to have diabetes, the metabolic syndrome, and hypertriglyceridemia as compared with those without, respectively. Likewise, men with abdominal obesity had 51% and 22% higher rates of hypertension and diabetes than their non-obese counterparts, respectively. CONCLUSIONS: the prevalence of abdominal obesity is high among older adults in Ecuador. Moreover, abdominal obesity is significantly associated with cardio metabolic risk factors. Therefore, further research is needed to evaluate sociodemographic and nutritional determinants of this emerging public health burden among older Ecuadorians.

Cardiovascular health status and metabolic syndrome in Ecuadorian natives/Mestizos aged 40 years or more with and without stroke and ischemic heart disease--an atahualpa project case-control nested study.

BACKGROUND: Knowledge of regional-specific cardiovascular risk factors is mandatory to reduce the growing burden of stroke and ischemic heart disease in Latin American populations. We conducted a population-based case-control study to assess which risk factors are associated with the occurrence of vascular events in natives/mestizos living in rural coastal Ecuador. METHODS: We assessed the cardiovascular health (CVH) status and the presence of the metabolic syndrome in all Atahualpa residents aged 40 years or more with stroke and ischemic heart disease and in randomly selected healthy persons to evaluate differences in the prevalence of such risk factors between patients and controls. RESULTS: A total of 120 persons (24 with stroke or ischemic heart disease and 96 matched controls) were included. A poor CVH status (according to the American Heart Association) was found in 87.5% case-patients and 81.3% controls (P = .464). The metabolic syndrome was present in the same proportion (58.3%) of case-patients and controls. Likewise, both sets of risk factors (poor CVH status and the metabolic syndrome) were equally prevalent among both groups (58.3% versus 49%, P = .501). CONCLUSIONS: This case-control study suggests that none of the measured risk factors is associated with the occurrence of vascular events. It is possible that some yet unmeasured risk factors or an unknown genetic predisposition may account for a sizable proportion of stroke and ischemic heart disease occurring in the native/mestizo population of rural coastal Ecuador.

Prevalence of the metabolic syndrome and its correlation with the cardiovascular health status in stroke- and ischemic heart disease-free Ecuadorian natives/mestizos aged ≥40 years living in Atahualpa: a population-based study.

AIMS: Epidemiologic studies assessing cardiovascular risk factors affecting a given population may prove cost-effective to reduce the burden of cardiovascular diseases in the developing world. We evaluated the prevalence of the metabolic syndrome in Atahualpa, a village representative of rural coastal Ecuador. METHODS: Prevalence of the metabolic syndrome and its correlation with the cardiovascular (CVH) status was assessed in a door-to-door survey performed in stroke- and ischemic heart disease-free Ecuadorian native/mestizos aged ≥40 years. RESULTS: The metabolic syndrome was diagnosed in 288 (55.7%) out of 517 persons. Worst individual components were: increased waist circumference (75%), increased fasting glucose (68.1%) and high blood pressure (56.5%). Prevalence of individual components of this condition varied according to age, gender, education, and alcohol intake. However, no differences were found in the odds for having the metabolic syndrome when persons were stratified according to these parameters. A poor CVH status was found in 80.2% persons with and in 55.9% without the metabolic syndrome (p<0.0001). CONCLUSIONS: Prevalence of the metabolic syndrome in Atahualpa is high. Most persons with the metabolic syndrome also have a poor CVH status. However, sizable subsets only have either the metabolic syndrome or a poor CVH status. Stratification of cardiovascular risk according to whether the person has both, one, or none of these two sets of risk factors would be of value to evaluate if the metabolic syndrome, a poor CVH status or the combination of both, better predict the occurrence of vascular outcomes in the long-term follow-up.

Spanish translation, cross-cultural adaptation, and validation of the Questionnaire for Diabetes-Related Foot Disease (Q-DFD).

PURPOSE: To translate, cross-culturally adapt, and validate the Questionnaire for Diabetes-Related Foot Disease (Q-DFD), originally created and validated in Australia, for its use in Spanish-speaking patients with diabetes mellitus. PATIENTS AND METHODS: The translation and cross-cultural adaptation were based on international guidelines. The Spanish version of the survey was applied to a community-based (sample A) and a hospital clinic-based sample (samples B and C). Samples A and B were used to determine criterion and construct validity comparing the survey findings with clinical evaluation and medical records, respectively; while sample C was used to determine intra- and inter-rater reliability. RESULTS: After completing the rigorous translation process, only four items were considered problematic and required a new translation. In total, 127 patients were included in the validation study: 76 to determine criterion and construct validity and 41 to establish intra- and inter-rater reliability. For an overall diagnosis of diabetes-related foot disease, a substantial level of agreement was obtained when we compared the Q-DFD with the clinical assessment (kappa 0.77, sensitivity 80.4%, specificity 91.5%, positive likelihood ratio [LR+] 9.46, negative likelihood ratio [LR-] 0.21); while an almost perfect level of agreement was obtained when it was compared with medical records (kappa 0.88, sensitivity 87%, specificity 97%, LR+ 29.0, LR- 0.13). Survey reliability showed substantial levels of agreement, with kappa scores of 0.63 and 0.73 for intra- and inter-rater reliability, respectively. CONCLUSION: The translated and cross-culturally adapted Q-DFD showed good psychometric properties (validity, reproducibility, and reliability) that allow its use in Spanish-speaking diabetic populations.

Living alone and cardiovascular health status in residents of a rural village of coastal Ecuador (The Atahualpa Project).

OBJECTIVES: Knowledge of region-specific factors affecting the cardiovascular health (CVH) is mandatory to reduce the growing burden of stroke and ischemic heart disease in rural areas of Latin American. We conducted a population-based case-control study to assess the CVH status of Atahualpa residents-a rural village representative of Coastal Ecuador-according to their living arrangements. METHODS: All Atahualpa residents aged ≥40 years and free of stroke or ischemic heart disease that lived alone were identified during a door-to-door census, and their CVH status was compared to that of a sample of residents that lived with relatives. Four controls individually matched for age, gender, education, job and alcohol intake, and randomly selected from different households, were selected for each case-person. RESULTS: A total of 185 persons (37 who lived alone and 148 matched controls) were included. A poor CVH status was found in 89.2 % case-patients and 72.3 % controls (p = 0.03). We found significantly worse levels of physical activity (p < 0.0001) and non-significant trends for worse healthy diet and glucose levels among case-persons than controls. CONCLUSIONS: This study suggests that social isolation is associated with a worse CVH in rural coastal Ecuador. An ongoing community-based intervention may prove effective to improve CVH status in these social isolated persons.

Changing profile of 7,519 neurologic outpatients evaluated over 20 years.

INTRODUCTION: There is scarce information on the demographic profile and diseases affecting neurologic outpatients. METHODS: We evaluated 7,519 neurologic outpatients over 20 years at the outpatient clinic of the Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador. RESULTS: Mean age was 48 ± 19.4 years, and 57.8% were women. Common reasons for consultation included headache (33.2%), focal deficits (10.7%), and seizures (9%). The most common categories of neurologic diseases were cerebrovascular (10.6%), degenerative (7.6%), and traumatic (7.1%). Diseases of uncertain/unknown etiology accounted for 50.2% of cases. Young patients were most often evaluated for headache and seizures, while elderly patients usually presented with focal deficits, movement disorders, or cognitive decline. We also found significant variations in the prevalence of neurologic diseases over the study years. While the prevalence of degenerative diseases increased from 5.7% in 1990-1994 to 10.2% in 2005-2009, that of infectious diseases steadily decreased from 3.7 to 2.1% over the study years. CONCLUSION: There was a dynamic pattern of neurologic diseases over the years. Nowadays, distribution of neurologic symptoms and diseases in our population is more similar to that reported from the developed world than it was 20 years ago.

Tinta china en orina como método de diagnóstico en criptococosis diseminada asociado a VIH/SIDA. Estudio transversal realizado en el hospital de infectología José Rodríguez M. durante el año 2009 / China ink in the urine as a diagnostic tool in disseminated cryptococcosis associated with HIV/AIDS. Sectional study of infectious diseases in the José Rodríguez M. Hospital in 2009

Tipo estudio: transversal y descriptivo. Objetivos: determinar la utilidad de la aplicación de tinta china en orina como método de diagnóstico en los pacientes con sospecha de criptococosis diseminada asociada a VIH/SIDA. Métodos: el universo del estudio está establecido por los pacientes VIH/SIDA que ingresaron durante el año 2009 con sospecha de esta enfermedad al hospital de Infectología “José Rodríguez Maridueña”. Resultados: la sensibilidad del test de tinta en orina fue de un 71,79% con un valor predictivo positivo del 90,32%. Del universo total de pacientes, se obtuvo una media de CD4 de 97,5 +/- 90,6 ul; no hubo diferencia estadísticamente significativa entre el test de tinta china y las variables independientes. Conclusión: el test de tinta china en orina se establece como un método práctico, no invasivo y económico en los pacientes VIH/SIDA que ingresan con alta presunción de criptococosis en este nosocomio. El test de tinta china en orina nos propicia una detección de casos de forma anticipada, ante la expectativa de la convalidación de los cultivos o de métodos más específicos que nos permitan su confirmación o corrección.

Studio: transverse and descriptive. Objectives: to determine the usefulness of applying ink in urine as a diagnostic method in patients with suspected disseminated cryptococcosis associated with HIV / AIDS. Methods: the universe of study is established by the HIV / AIDS patients admitted during 2009 with suspicion of this disease at the "José Rodríguez Maridueña" Infectious Diseases Hospital Results: the sensitivity of the ink test in urine was 71.79% with a positive predictive value of 90.32%. Out of the total sample of patients, we obtained a CD4 mean of 97.5 +/- 90.6 ul; there was no statistically significant difference between the china ink test and the independent variables. Conclusion: the china ink test in urine was established as a practical, noninvasive and economical test in HIV / AIDS patients admitted with high presumption of cryptococcosis. The China ink test in urine allows the early detection of cases, before the validation of the culture or more specific methods that allow us confirmation or correction.

Valor del monitoreo ambulatorio de la presión arterial (mapa) como estratificador de riesgo cardiovascular y pronóstico en hipertensos esenciales, hospital Luis Vernaza, período enero de 2008 a junio de 2009 / Value of Ambulatory Blood Pressure (ABP) as a cardiovascular risk and prognosis in essential hypertension stratifier, from january 2008 to june 2009", "_i": "en

El monitoreo ambulatorio de la presión arterial constituye una herramienta útil con beneficios superiores a las mediciones realizadas en consultorio tanto en el diagnóstico como el seguimiento de la presión arterial (PA); revelando parámetros importantes en la atención clínica de la hipertensión arterial (HTA). El objetivo principal fue investigar el valor del MAPA como estratificador de riesgo cardiovascular y pronóstico en hipertensos esenciales. Se seleccionaron 190 historias clínicas (HC) que cumplieron los criterios de inclusión – exclusión, para luego recopilar los datos de talla, peso en kilogramos, esquema terapéutico utilizado, proteínas en orina, presiones otorgadas por MAPA y valores del ecocardiograma con su diagnóstico, e introducirlos en una hoja de cálculo. Se clasificó al paciente como “dipper” (D) cuando se producía caída nocturna de la presión arterial sistólica (PAS) en más del 10% con respecto al periodo diurno, hiper dipper (HD) cuando se producía esta caída en más del 20% y no Dipper (ND) aquellos en los que el descenso es inferior al 10%; para luego establecer la relación entre el patrón circadiano y los datos recolectados. De la población analizada, el 43% pertenecen al perfil D, 5% HD y 52% ND; este último presentó mayor valor de proteinuria (177,85 ± 326,17mg/D), de la misma manera se los asoció a mayor HVI con obesidad abdominal siendo esta más significativa que el IMC, y el esquema terapéutico más utilizado fue la administración de diurético + 2 drogas de primera elección (DIU+2DPE). Concluyendo así que el patrón ND se asocia a un aumento en el daño de órganos diana y al incremento de la morbimortalidad cardiovascular.

Blood pressure ambulatory monitoring is a useful tool with benefits superior to consulting office measurements in blood pressure (BP) diagnosis and monitoring, revealing important parameters in the clinical management of hypertension. The main objective was to investigate the ABP value as a cardiovascular risk and prognosis in essential hypertension stratifier. 190 medical records that fulfilled the inclusion–exclusion criteria were selected, in order to collect height, weight in kilograms, therapeutic scheme used, protein in urine, pressure provided by ABP and values of echocardiography diagnosis data and place them in a spreadsheet. When the systolic blood pressure (SBP) fell at night by more than 10% compared to the day period, the patient was classified as "dipper" (D); when this fall was over 20% the patient was classified as hyper dipper (HD), and those whose decline was less than 10% as no Dipper (ND), so as to establish the relationship between the circadian pattern and the data collected. Out of the population analyzed, 43% belong to Profile D, 5% HD and 52% ND, the latter displayed a higher proteinuria (177.85 ± 326.17 mg / D), in the same way they are associated with greater LVH with abdominal obesity being most significant than the BMI, and the most commonly used regimen treatment was the administration of diuretic + 2 first choice drug (IUD +2 FCD). Concluding that the ND pattern is associated with an increase in target organ damage and increased cardiovascular morbimortality.