Sex Differences in Cardiovascular Disease Risk Factor Prevalence, Morbidity, and Mortality in Colombia: Findings from the Prospective Urban Rural Epidemiology (PURE) Study.

Background: Controversies exist on whether the presence of cardiovascular risk factors and their association with major cardiovascular events (MACE) is different between men and women. Most of the evidence comes from high-income countries, hindering extrapolation of sociocultural and demographic factors of other regions. Objective: To evaluate sex differences in the prevalence of cardiovascular risk factors and the incidence of MACE and diabetes in Colombian adults. Methods: We performed a survival analysis from women and men aged 35-70 belonging to the Prospective Urban Rural Epidemiology-Colombia prospective study. Incidence rates for MACE composite (myocardial infarction, stroke, heart failure, death) and each outcome and diabetes were calculated. Kaplan-Meier curves and log-rank tests were performed. The association between demographic, behavioral, and metabolic variables with MACE and diabetes were evaluated with Cox proportional hazards models. Results: 7,552 participants (50±9.7 years) were included; 64% were women. Women had higher hypertension prevalence, body mass index, levels of total cholesterol, LDL-c, and HDL-c but lower triglycerides levels. Women were more sedentary but fewer smokers or active alcohol consumers and had higher educational levels. After 12-year mean follow-up (SD 2.3), the incidence rate of MACE composite was higher in men [4.2 (3.6-4.9) vs. 3.2 (2.8-3.7) cases per 1000 person-years]. Diabetes had the greatest association with MACE (HR = 2.63 95%CI:1.85;3.76), followed by hypertension (HR = 1.75 95%CI:1.30;2.35), low relative grip strength (HR = 1.53 95%CI:1.15;2.02), smoking (HR = 1.47 95%CI: 1.11;1.93), low physical activity (HR = 1.42 95%CI: 1.03;1.96). When evaluating risk factors by sex, only an increased waist-to-hip ratio was more strongly associated with MACE in men (p-interaction <0.05). Conclusions: The composite MACE outcome was higher in men despite having a lower overall burden of risk factors. The risk factors contribution was similar, leading us to reconsider the need to carrying out differentiated cardiovascular risk prevention and management campaigns, at least in our region.

Waist circumference cut-off points to identify major cardiovascular events and incident diabetes in Latin America: findings from the prospective Urban rural epidemiology study Colombia.

Background: Abdominal obesity (AO) indirectly represents visceral adiposity and can be assessed by waist circumference (WC) measurement. In Latin America, cut-off points for the diagnosis of AO are based on Asian population data. We aim to establish the WC cut-off points to predict major cardiovascular events (MACE) and incident diabetes. Methods: We analyzed data from the cohort PURE study in Colombia. WC cut-off points were defined according to the maximum Youden index. Multivariate logistic regression was used to obtain associations between WC and MACE, diabetes, and cumulative incidence of outcomes visualized using Kaplan-Meier curves. Results: After a mean follow-up of 12 years, 6,580 individuals with a mean age of 50.7 ± 9.7 years were included; 64.2% were women, and 53.5% were from rural areas. The mean WC was 85.2 ± 11.6 cm and 88.3 ± 11.1 cm in women and men, respectively. There were 635 cases of the MACE composite plus incident diabetes (5.25 events per 1,000 person-years). Using a cut-off value of 88.85 cm in men (sensitivity = 0.565) and 85.65 cm in women (sensitivity = 0.558) resulted in the highest value for the prediction of the main outcome. These values were associated with a 1.76 and 1.41-fold increased risk of presenting the composite outcome in men and women, respectively. Conclusions: We defined WC cut-off points of 89 cm in men and 86 cm in women to identify the elevated risk of MACE and incident diabetes. Therefore, we suggest using these values in cardiovascular risk assessment in Latin America.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis.

Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.

Experimentos de elección discreta. Diseño, análisis e implementación en salud / Discrete choice experiments. Design, analysis and implementation in health

Resumen: Los experimentos de elección discreta (DCE, su sigla en inglés), son una metodología usada para evaluar preferencias de desenlaces o intervenciones relacionadas con salud. A diferencia de otras técnicas de medición que utilizan métodos simples de elección o herramientas estadísticas básicas que fallan al evaluar los beneficios específicos de una intervención, proceso de entrega, beneficio, satisfacción y preferencia de los usuarios en términos de tiempo, calidad o atributo específico, los DCE combinan, en la generación de atributos y modelamiento matemático, complejas tareas de diseño y ejecución, que mejoran la calidad y optimizan la cantidad necesaria de información mediante el uso eficiente de recursos y resultados de excelente calidad. Este documento presenta la historia, el desarrollo y la fundamentación teórica de los DCE y muestra las críticas, las potenciales limitaciones y las precauciones.

Abstract: Discrete choice experiments (DCE) are a methodology for evaluate patient preferences for health-related outcomes or interventions. Other preference measurement techniques that use simple methods of choice or basic statistical tools that fail to evaluate the specific benefits of an intervention, delivery process, benefit, satisfaction and patients' preferences in terms of time, quality or specific attribute. The DCE combine in the generation of attributes and mathematical modeling, complex task of designing and execution, to improve the quality and optimize the necessary amount of information, achieving an efficient use of resources with excellent quality results. This document presents globally a brief of the history, development and theoretical foundation of the DCE and then presents in a critical way the potential limitations, precautions in their use and implementation that allow to establish the possible scenarios of use and development.

Modelo de aceptación tecnológica de la aplicación móvil de seguimiento ControlVit® en pacientes con falla cardiaca / Technological acceptance model of the ControlVit® mobile monitoring application in patients with heart failure

Resumen Introducción: Los sistemas de monitoreo remoto basados en teléfonos inteligentes para pacientes con falla cardiaca podrían ser herramientas sencillas y económicas para mejorar el seguimiento ambulatorio. Objetivo: Identificar la utilidad y aceptación de la aplicación ControlVit® en pacientes con falla cardiaca. Método: Estudio piloto observacional descriptivo, en 20 pacientes ambulatorios con fracción de eyección reducida, que asisten a un programa de falla cardiaca. Durante seis meses, los pacientes utilizaron la aplicación ControlVit®, que suministra al paciente información para mejorar su autocuidado y permite el registro diario de variables médicas relevantes. Los datos se consignaron en la bitácora del sistema para verificar la frecuencia y el envío de datos. Se aplicó un cuestionario de aceptación tecnológica (TAM) a todos los pacientes y profesionales. Resultados: 100% de los pacientes reconoció la utilidad de la aplicación frente a su autocuidado, 90% niegan ansiedad tecnológica o temor para emplearla por la facilidad de uso. En general, se detectaron 164 alertas en tiempo real ―el aumento de peso fue la más frecuente (49%)―, y en 91% de los pacientes no se registraron reingresos hospitalarios. Conclusión: la aplicación ControlVit® es útil para la detección temprana de síntomas que permiten identificar, de forma precoz, complicaciones y modificar su tratamiento. La excelente aceptación de la aplicación por parte de los pacientes y su facilidad de uso plantean la posibilidad de implementarla como una estrategia complementaria de seguimiento en pacientes con falla cardiaca.

Abstract Introduction: Mobile phone based remote monitoring systems for heart failure patients could become simple and affordable tools to improve home management. Objective: to identify utility and acceptance of ControlVit® in heart failure patients. Method: descriptive observational pilot study in 20 outpatients with reduced ejection fraction, attending at hospital heart failure program. For six months, patients use the ControlVit® application, which supplies patient information to improve self-care and allows daily recording of specific medical variables. The data was recorded in the system log to verify frequency and data transmission. A technological acceptance questionnaire (TAM) was applied to all patients and professionals. A descriptive analysis with absolute and relative frequency distribution was also performed. Results: 100% of patients recognized the usefulness of the application compared to self-care, 90 % deny technological anxiety or fear of using it due to the ease of use. Overall, 164 real-time alerts were detected, weight gain was the most frequent (49 %) and 91 % of patients had no hospital readmissions. Conclusion: The ControlVit® application is useful for the early detection of symptoms that allow timely detection of complications and early modification of treatment. The excellent acceptance of the application by patients and its ease of use, raise the possibility of implementing it as a complementary monitoring strategy in patients with heart failure.

Prevalencia de fibrilación auricular en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of atrial fibrillation in Colombia according to information from the Comprehensive Information System of the Social Protection (SISPRO)

Resumen Introducción: La fibrilación auricular es la arritmia cardíaca más frecuente, es una de las causas más importantes de eventos cerebrovasculares de origen embólico y se asocia con el desarrollo de insuficiencia cardíaca y muerte súbita. En Colombia, constituye una enfermedad con altos costos para el sistema de salud; sin embargo, su prevalencia es desconocida. Objetivo: Describir la prevalencia de fibrilación auricular reportada a los sistemas oficiales de información en Colombia. Método: Mediante la extracción, el tabulado y el análisis de datos de la herramienta SISPRO, del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de fibrilación auricular estandarizada por edad, global y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Se identificaron 143,656 casos reportados con el código I48X, que corresponde a fibrilación auricular en la CIE-10. La prevalencia de fibrilación auricular se incrementó desde 41 hasta 87 por cada 100,000 habitantes entre 2013 y 2017 (p < 0.001). En Colombia, la fibrilación auricular es más frecuente en las mujeres, con mayor prevalencia en mayores de 60 años (606/100,000 en 2017); hay zonas con prevalencia superior a 150/100,000 en los departamentos de Antioquia, Caldas, Santander y Bogotá D.C. Conclusiones: Este estudio sugiere que la fibrilación auricular tiene una tendencia ascendente en Colombia, es más frecuente en las mujeres y más prevalente en los centros urbanos, posiblemente debido a una mayor proporción de pacientes mayores y al mejor acceso a los sistemas de salud.

Abstract Introduction: Atrial fibrillation is the most frequent cardiac arrhythmia. It is responsible for an important proportion of embolic strokes and is associated with the development of congestive heart failure and sudden cardiac death. In Colombia, atrial fibrillation is highly costly for the healthcare system; however, its true prevalence is unknown. Objective: To describe the prevalence of atrial fibrillation reported to the official information systems in Colombia. Method: We calculated the prevalence of atrial fibrillation through the extraction, tabulation and analysis of data contained in the Integral Information System for Social Protection tool, which was created by the Ministry of Health and Social Protection in Colombia. Global and age-standardized prevalence rates were obtained for the period between years 2013 and 2017. Results: A total of 143,656 cases were identified. These were reported through the ICD-10 code I48X, corresponding to atrial fibrillation. The prevalence of atrial fibrillation increased from 41 to 87 cases per 100,000 inhabitants between years 2013 and 2017 (p < 0.001). In Colombia, atrial fibrillation is more frequent among women, and individuals over the age of 60 (606/100,000 in 2017). The departments of Antioquia, Caldas, Santander and Bogotá D.C had zones with prevalence greater than 150/100,000. Conclusions: This study suggests that atrial fibrillation displays an upward trend in Colombia. Its prevalence is higher in women and urban centers. The latter may be due to the higher proportion of older patients and better access to healthcare in these subgroups.

Prevalencia de hipertensión arterial en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of arterial hypertension in Colombia according to data from the Comprehensive Social Protection Information System (SISPRO)

Resumen Introducción: La hipertensión arterial es el principal factor de riesgo cardiovascular modificable y aumenta la probabilidad de mortalidad de causa cardiovascular. Las mediciones de prevalencia en Colombia han incluido ciudades principales y pequeñas regiones, pero no se dispone de información en el país. Objetivo: Describir la prevalencia de hipertensión arterial a partir de los reportes a los sistemas oficiales de información en Colombia. Método: Mediante la extracción y el análisis de datos de la herramienta SISPRO del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de hipertensión arterial, estandarizada por edad y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Durante los 5 años evaluados hubo 12,386,343 registros con diagnóstico principal de hipertensión arterial; en 2013 se observó la menor prevalencia (4.65%) y en 2017 la mayor (5.83%). El promedio de prevalencia nacional en los mayores de 60 años durante los 5 años fue del 28.14%. La prevalencia es mayor en las mujeres, con una relación mujer: hombre de 1.78:1. El grupo de mayor prevalencia durante el estudio fueron las mujeres mayores de 80 años en 2017, con una prevalencia ajustada del 54.4%. Las regiones con prevalencia mayor al 10% fueron Risaralda, Caldas, Boyacá, Antioquia y Sucre. Conclusiones: La prevalencia nacional de los registros de consultas por hipertensión arterial a las fuentes oficiales de información es menor que la reportada en estudios realizados en poblaciones similares y sugiere que existe un subregistro del reporte a dichas fuentes de información.

Abstract Introduction: Systemic hypertension is the main modifiable cardiovascular risk factor, leading to increased probability of mortality due to cardiovascular causes. Studies assessing the prevalence of systemic hypertension in Colombia have included main cities and small regions. However, there is no available data regarding the country as a whole. Objective: To describe the prevalence of systemic hypertension according to reports made to the official information systems in Colombia. Method: The prevalence of systemic hypertension was calculated through the extraction and analysis of data contained within the SISPRO tool, the official information system for the Colombian Ministry of Health and Social Protection. The prevalence was then standardized by age, and for the different geographical regions of the country in the period comprised between years 2013 and 2017. Results: During the five years of follow-up, we located 12,386,343 registries reporting systemic hypertension as a main diagnosis. The lowest prevalence (4.65%) was found in year 2013, and the highest prevalence (5.83%) was found in 2017. The mean national prevalence for patients above the age of 60, during the aforementioned 5-year period, was 28.14%. The prevalence was higher in women, with a women-to-men ratio of 1.78:1. The group with the higher adjusted prevalence during the study period was composed of women above the age of 80 in year 2017, with an adjusted prevalence of 54.4%. The regions with a prevalence over 10% were Risaralda, Caldas, Boyacá. Antioquia and Sucre. Conclusions: The national prevalence of registered consultations due to systemic hypertension to the official information sources is lower than that reported in previous studies conducted on similar populations, suggesting the existence of underreport to said information sources.

Cardiovascular Risk Prediction Models in People Living with HIV in Colombia.

BACKGROUND: People living with HIV are at increased risk of cardiovascular disease. Cardiovascular risk (CVR) prediction scores are powerful tools for individualized assessment that inform decision-making about follow-up frequency, hypolipemiant treatment intensification, and choice antiretroviral therapy. OBJECTIVES: The objectives of the study were to evaluate the performance of multiple cardiovascular assessment scores in predicting major adverse cardiovascular events (MACE) at 5 and 10 years. Framingham (2004, 2008, and Colombia-adjusted), SCORE, PROCAM, ASCVD, and D:A:D scores were included in the analysis. METHODS: Data were obtained from a medical registry of adults living with HIV attended by a teaching hospital in Colombia. All patients with complete information necessary for risk score calculations and determination of MACE at 5 and 10 years were included in the study. Receiver operating characteristic curves (ROC) were generated using calculations with all the aforementioned models for every individual. Differences between curves were compared with De- Long's test. RESULTS: A total of 808 patients were included in the analysis. Mean age was 35 years, and 12% were female. The majority of subjects had low and very low CVR. Eight MACE occurred during follow-up. Area under ROC curves were: Framingham (0.90), Framingham ATP3 (0.92), Framingham calibrated for Colombia (0.90), SCORE (0.92), PROCAM (0.92), ASCVD (0.89), and D:A:D (0.92), with no statistically significant differences. CONCLUSIONS: The evaluated scores had an acceptable performance for HIV-infected patients in the studied cohort, especially for those in low and very low risk categories.

Uso e impacto en las redes sociales por parte de las revistas de reumatología / Use and impact of social networks by rheumatology journals

RESUMEN Introducción: Las redes sociales como Twitter®, Facebook® y YouTube® se han convertido en medios de interacción y visualización de información científica. Han surgido medidas alternativas (almetrics) que evalúan la diseminación y el impacto de las revistas científicas en las redes sociales; sin embargo, se desconoce si existe correlación entre la actividad de las revistas de reumatología en redes sociales y las métricas tradicionales de impacto basadas en número de citaciones. Métodos: Se identificaron las revistas de reumatología a partir de la base de datos de SCImago de Scopus® y se extrajo la información de las métricas tradicionales basadas en el número de citaciones. Se determinaron métricas alternativas de actividad de las revistas en Facebook®, Twitter®, YouTube® e Instagram®. Se evaluó la correlación entre ellas usando el coeficiente de correlación de Spearman, ajustado por el tiempo transcurrido desde la creación de la cuenta. Resultados: De un total de 60 revistas de reumatología, 14 contaban con la presencia en las redes sociales evaluadas. El SCImago Journal Rank (SJR) fue más alto en revistas con red social (90,5 vs. 21; p < 0,05). La correlación entre el SJR y las métricas de actividad del Twitter® fue excelente: con el número de seguidores (r = 0,85), seguidores/ano (r = 0,83) y número de tweets (r = 0,82). Conclusión: Nuestro estudio sugiere que las métricas tradicionales de impacto basadas en el número de citaciones, se correlacionan muy bien con las métricas de presencia en redes sociales de las revistas de reumatología, en especial en Twitter®.

ABSTRACT Introduction: The social networks like Twitter®, Facebook® and YouTube® have become interaction media with visualisation scientific information. Alternative metrics (altmetrics) have emerged that assess the dissemination and the impact of the scientific journals in the social networks. However, it is unknown if there is a correlation between the journal and the traditional measurements of impact based on the number of citations for the journal of rheumatology. Methods: The journals of rheumatology included in Scimago Country and Journal Ranking were identified, and the results of their metrics were collected based on the number of cita tions. The presence in social networks was determined using metrics, such as the number of followers and tweets. The correlation between them was evaluated using the Spearman correlation coefficient, adjusted for the time elapsed since the account was created. Results: Out of a total of 60 rheumatology journals, 14 had a presence in social networks. The Scimago journal ranking indicator (SJR) was higher in journals with a social network (90.5 vs. 21; p< .05). The correlation between the SJR and Twitter® activity metrics was excellent: with the number of followers (r = 0.85), followers/year (r=0.83), and number of tweets (r = 0.82). Conclusion: This study suggests that traditional impact metrics based on the number of cita tions correlate very well with the social network presence metrics of rheumatology journals, especially on Twitter®.

Leiomiomatosis intravascular gigante con extensión a cavidades cardíacas / Giant intravascular leiomyomatosis intravascular with extension to the cardiac cavities

Resumen Se presenta el caso de inusual crecimiento intracardíaco de leiomiomatosis intravascular gigante en una mujer de 38 años, en quien durante evaluación prequirúrgica de cirugía abdominal se documentó de manera incidental una masa en cavidades cardiacas derechas. Dada su presentación infrecuente y las dificultades en el abordaje diagnóstico y terapéutico, se realiza posterior revisión de la literatura.

Abstract The case is presented of an unusual intracardiac growth of a giant intravascular leiomyomatosis in a 38 year-old woman. During a pre-surgical evaluation for abdominal surgery, the incidental finding of a mass in the right cardiac cavities was noted. Given its uncommon presentation and the difficulties in the diagnostic and therapeutic approach, a subsequent review of the literature was performed.

Factores de riesgo asociados al desarrollo de eventos cardiovasculares en pacientes postrasplante renal / Risk factors associated with cardiovascular events in kidney transplant patients

Resumen Objetivo: describir el comportamiento de los factores de riesgo cardiovascular en pacientes con trasplante renal y su relación con los desenlaces cardiovasculares a uno y cinco años luego del trasplante. Métodos: se realizó un estudio analítico de cohorte retrospectivo en los pacientes con trasplante renal del Hospital Universitario San Ignacio con seguimiento institucional por lo menos de un año. Se analizaron las variables demográficas, los factores de riesgo cardiovascular y los desenlaces cardiovasculares a uno y cinco años. Resultados: se incluyeron 166 pacientes con seguimiento a un año y 79 con seguimiento a cinco años postrasplante renal. En el primer año postrasplante hubo una reducción significativa del tabaquismo y la hipertensión arterial sin cambios en el control de la dislipidemia ni de la diabetes mellitus. Se presentaron 9 eventos en el primer año con 6 casos de angina inestable, 2 infartos de miocardio y un ataque cerebrovascular. En la evaluación al quinto año se mantuvo el cese del tabaquismo con aumento de los casos de hipertensión arterial. Se presentaron 8 casos de angina inestable, cifra que corresponde a un 10% de eventos cardiovasculares. Conclusiones: en el seguimiento a uno y cinco años postrasplante renal de los pacientes del Hospital Universitario San Ignacio se identificó una tasa baja de eventos cardiovasculares con una modificación en la prevalencia de algunos factores de riesgo cardiovascular.

Abstract Objective: To describe the behaviour of the cardiovascular risk factors in kidney transplant patients, and its relationship with the outcomes at 1 and 5 years after the transplant. Methods: A retrospective analytical cohort study was performed on patients with kidney transplant from the Hospital Universitario San Ignacio with a follow-up of at least 1 year. An analysis was carried out on the demographic variables, cardiovascular risk factors, and the cardiovascular outcomes at 1 and 5 years. Results: The study included 166 patients with a follow-up of 1 year, and 79 with a follow-up of 5 years post-kidney transplant. In the first year post-transplant there was a significant reduction in smoking, as well as in blood pressure, with no changes in the control of dyslipidaemia or in diabetes mellitus. There were 9 events in the first year, with 6 cases of unstable angina, 2 myocardial infarctions, and one stroke. In the evaluation at the fifth year the quitting smoking was maintained, with an increase in arterial hypertension. There were 8 cases of unstable angina, corresponding to 10% of the cardiovascular events. Conclusions: A low rate of cardiovascular events was identified in the one year and five year follow-up of post-kidney transplant patients from the Hospital Universitario San Ignacio, with a change in the prevalence of some of cardiovascular risk factors.