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In Argentina, cardiovascular disease (CVD) represents the first cause of mortality, but effective coverage for CVD prevention is low. Strategies based on behavioral economics are emerging worldwide as key pieces to increase the effectiveness of CVD prevention approaches. The aim of this study was to evaluate whether the implementation of two strategies based on financial incentives and framing increased attendance to clinical visits as proposed by the national program for CVD risk factors management among the uninsured and poor population with moderate or high CVD risk in Argentina. We conducted a cluster randomized trial in nine primary care clinics (PCCs) in Argentina. Three PCCs were assigned to financial incentives, 3 to framing-text messages (SMS) and 3 to usual care. The incentive scheme included a direct incentive for attending the first clinical visit and the opportunity to participate in a lottery when attending a second clinical visit. The framing-text messages group received messages with a gain-frame format. The main outcome was the proportion of participants who attended the clinical visits. A total of 918 individuals with a risk ≥10% of suffering a CVD event within the next 10 years were recruited to participate in the study. The financial incentive group had a significantly higher percentage of participants who attended the first (59.0% vs 33.9%, pË 0.001) and the follow up visit (34.4% and 16.6%, pË 0.001) compared to control group. However, the framing-SMS group did not show significant differences compared to the control group. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT03300154.
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Enfermedades Cardiovasculares , Motivación , Atención Ambulatoria , Argentina , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Factores de Riesgo , Poblaciones VulnerablesRESUMEN
BACKGROUND AND AIMS: in the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS I Study. METHODS AND RESULTS: the participants (n = 4626) were derived from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). To define DP, a food-frequency questionnaire was applied and principal component analysis was performed. Blood pressure was determined according to standardized guidelines. A multivariate regression model was developed to determine the association between each DP and blood pressure values, according to the quartile (Q) of adherence to DP. Two predominant DP were detected, Prudent (PDP, higher consumption of fruits, vegetables, legumes, whole grains, fish, seafood and nuts) and Western (WDP, higher consumption of red and processed meats, dressings, sweets, snacks and refined grains). A significant inverse association was found between adherence to PDP and systolic and diastolic blood pressure (-1.85 and -1.29 mmHg for Q4 vs Q1, respectively). Adherence to WDP was positively associated with systolic blood pressure (2.09 mmHg for Q4 vs Q1). CONCLUSION: the WDP detected in the studied population is positively associated with higher levels of blood pressure, while greater adherence to healthy DP has a positive impact on blood pressure.
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Presión Sanguínea , Dieta , Hipertensión , Dieta/efectos adversos , Dieta/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , América Latina/epidemiologíaRESUMEN
BACKGROUND: Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. METHODS: CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. RESULTS: A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. CONCLUSIONS: A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.
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Enfermedades Cardiovasculares , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Chile/epidemiología , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , América Latina , Masculino , Factores de RiesgoRESUMEN
Several previous epidemiological studies from developed countries have shown that an unhealthy dietary pattern affects plasma lipid levels and inflammation biomarkers. We assessed the cross-sectional associations between dietary patterns and cardiovascular risk factors among 961 adults from a multi-city cohort in South America. We conducted a principal component analysis to derive dietary patterns. As outcomes, we examined plasma levels of apo A-I, apo B, high-sensitivity C-reactive protein (hs-CRP), LDL-, HDL- and serum total cholesterol and TAG. The crude and adjusted changes in each outcome were estimated for quartiles of dietary patterns using multivariable linear regression models. The prudent pattern (PP) characterised by higher intake of fruits, vegetables, fish, seafood, whole cereal and low-fat dairy products was associated with reduced plasma concentrations of apo B (-8·5 mg/l), total cholesterol (-18·8 mg/dl) and LDL-cholesterol (-16·5 mg/dl) and hs-CRP (-1·6 mg/l) in men. In women also reduced plasma concentrations of apo B (-6·6 mg/l), total (-12·0 mg/dl) and LDL (-9·3 mg/dl). The 'Western-like' pattern characterised by higher intake of eggs, pastry and cakes, pizza, snacks, refined grains, red meat, vegetable oils and poultry was not significantly associated with any of the selected serum lipid or inflammatory biomarkers. The explained variances were 10·3 and 7·4 %, respectively. The PP was associated with better lipid profile, mainly lower atherogenic particles (apo B) and LDL-cholesterol and serum total cholesterol. This study provides possible evidence of a prudent diet in South American populations to help reduce the burden of CVD.
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Apolipoproteínas/sangre , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/etiología , Colesterol/sangre , Dieta , Inflamación/sangre , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Ciudades , Estudios de Cohortes , Estudios Transversales , Dieta Saludable , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Componente Principal , América del Sur , Triglicéridos/sangreRESUMEN
Importance: Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. Objective: To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. Design, Setting, and Participants: A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. Interventions: Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. Main Outcomes and Measures: The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. Results: Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. Conclusions and Relevance: Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. Trial Registration: clinicaltrials.gov Identifier: NCT01834131.
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Agentes Comunitarios de Salud , Servicios de Atención de Salud a Domicilio , Hipertensión/terapia , Adulto , Argentina , Presión Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pobreza , Atención Primaria de Salud/métodos , Servicios Urbanos de SaludRESUMEN
OBJECTIVE: To estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs. METHODS: We estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted. FINDINGS: We estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually. CONCLUSION: Even under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.
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Enfermedad Coronaria/economía , Enfermedad Coronaria/epidemiología , Costo de Enfermedad , Grasas de la Dieta/efectos adversos , Industria de Alimentos , Ácidos Grasos trans/efectos adversos , Ácidos Grasos trans/provisión & distribución , Argentina/epidemiología , Enfermedad Coronaria/inducido químicamente , Enfermedad Coronaria/mortalidad , Femenino , Humanos , Masculino , Años de Vida Ajustados por Calidad de Vida , Factores de RiesgoRESUMEN
OBJECTIVE: The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality. DESIGN: We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject Eleven prospective studies with 229 785 participants and average follow-up period of 13.37 years (range 5.5-19 years). RESULTS: Higher Na intake was significantly associated with higher CVD mortality (relative risk=1.12; 95 % CI 1.06, 1.19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1.08; 95 % CI 1.01, 1.15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0.016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality. CONCLUSIONS: Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.
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Enfermedades Cardiovasculares/mortalidad , Sodio en la Dieta/efectos adversos , Humanos , Estudios Prospectivos , Sodio en la Dieta/administración & dosificaciónRESUMEN
INTRODUCTION: Current recommendations for cardiovascular disease (CVD) prevention are guided CVD risk classification. This study aims to analyze the level of compliance with pharmacological and non-pharmacological recommendations outlined in the World Health Organization (WHO) CVD prevention clinical practice guideline within the general population of two cities in Argentina. METHODS: We analyzed the compliance with preventive recommendations from the WHO 2007 Guidelines for Management of Cardiovascular Risk in two cities of Argentina participating in the CESCAS population-based study in the Southern Cone of Latin America. RESULTS: 3990 participants were included. Considering the WHO recommendations, the use of antiplatelet medication was 5.6% (95% CI 3.5, 8.9) in primary prevention and 20.5% (95%= CI 16.0, 25.9) in secondary prevention. Regarding lipid-lowering medication, it was 6.7% (CI 95%= 4.4, 10.1) and 15.4% (CI 95%= 11.6, 20.1), respectively. As per non-pharmacological recommendations in the general population: low intake of fruit and vegetables was 78.4% (CI 95%= 76.8, 79.9); low physical activity was 26.9% (CI 95%= 25.3, 28.5), current cigarette smoking was 28.3% (CI 95%= 26.6, 30.0), overweight/obesity was 73.9% (CI 95%= 72.3, 75.6), and excessive alcohol intake was 2.6% (CI 95%= 2.1, 3.4). CONCLUSIONS: It was observed a significantly low compliance with pharmacological and non-pharmacological recommendations for CVD prevention in the general population of two cities in Argentina. Urgent efforts are needed to improve compliance to cardiovascular preventive recommendations promoted by CPG, especially in Low- and Middle- Income Countries.
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Enfermedades Cardiovasculares , Humanos , Estudios Transversales , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/epidemiología , Argentina/epidemiología , Obesidad , Organización Mundial de la Salud , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate the effectiveness of blood pressure (BP) self-monitoring and peer mentoring to improve the control of hypertension in clinical practice in primary care centers (PCCs) located in low-resource settings in Argentina. METHODS: An individual randomized controlled trial was carried out to test two different approaches based on behavioral interventions in PCCs in Argentina. Hypertensive adults were randomly assigned to one of three arms: BP self-monitoring, peer mentoring, and usual care. The primary outcome was the change in BP values from baseline to the end of follow-up at 3 months. A qualitative approach of participants' experiences of the peer mentoring arm was also conducted. RESULTS: A total of 442 participants with hypertension were included in the study. Self-monitoring and peer mentoring interventions did not show a significant difference in BP control compared to usual care. However, this trial showed an improvement regarding antihypertensive medication adherence among those assigned to the peer mentoring intervention compared to the control at the end of follow-up (p = 0.031). DISCUSSION: Self-monitoring and peer mentoring interventions did not demonstrate to be effective in BP control compared to usual care. Implementing a peer support strategy was demonstrated to be feasible and effective in improving medication adherence in this population.
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INTRODUCTION: One of the self-report adherence scales most widely used is the 8-item Morisky Medication Adherence Scale (MMAS-8). AIM: To evaluate construct validity and reliability of the MMAS-8 in hypertensive adults from low-resource settings within the public primary care level in Argentina. METHODS: Prospective data from hypertensive adults under antihypertensive pharmacological treatment that participated in the "Hypertension Control Program in Argentina" study was analyzed. Participants were followed at baseline, 6, 12 and 18 months. Based on MMAS-8, adherence was defined as low (score < 6), medium (score 6 to < 8) and high (score of 8). RESULTS: 1214 participants were included in the analysis. In comparison to low adherence, high adherence category was associated with a reduction of - 5.6 mmHg (CI 95%: - 7.2; - 4.0) in systolic blood pressure (BP) and - 3.2 mmHg (CI 95%: - 4.2; - 2.2) in diastolic BP; and with a 56% higher likelihood to have controlled BP (p < .0001). Among those participants with baseline score ≤ 6, two points increase in MMAS-8 along follow-up showed a tendency to reduce BP in almost all-time points and a 34% higher likelihood of having controlled BP at the end of the follow-up (p = 0.0039). Cronbach's alpha total-item values in all time-points were higher than 0.70. CONCLUSIONS: Higher MMAS-8 categories were positively associated with BP reduction and higher likelihood of BP control over time. Internal consistency was acceptable and in line with previous studies.
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Hipertensión , Cumplimiento de la Medicación , Humanos , Adulto , Presión Sanguínea , Estudios Prospectivos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Estudios Transversales , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Antihipertensivos/efectos adversos , Atención Primaria de SaludRESUMEN
OBJECTIVES: Cardiac resynchronization therapy (CRT) has recently been shown to reduce both mid-term and long-term mortality in patients with mild heart failure. Although proven effective, it is unclear whether CRT is cost-effective in low and middle-income countries (LMIC). Therefore, we set out to analyze the cost-effectiveness of CRT in Argentina in patients with New York Heart Association (NYHA) functional class (FC) I or II heart failure (HF). We chose to compare patients receiving optimal medical treatment (OMT) and CRT with those patients receiving only OMT. METHODS: We constructed a Markov model with a cohort simulation, and a life-time horizon to assess costs, life-years, and quality-adjusted life-year (QALY) gained as a result of treatment with both CRT and OMT from an Argentine third party payer perspective. We included patients who met the following criteria: left ventricular ejection fraction (LVEF) ≤ 40 percent, sinus rhythm with a QRS ≥ 120 msec, and NYHA FC I-II HF. The results were expressed as cost per life-year and QALY gained in international dollars (ID$) for the year 2009. RESULTS: For the base case analysis performed, we started at a fixed age of 65. After applying a 3 percent annual discount rate, the incremental cost-effectiveness ratio (ICER) was 38.005 ID$ per year of life gained and 34.185 ID$ per QALY gained. CONCLUSIONS: Long-term treatment with CRT appears to be cost-effective in Argentina compared with patients treated solely with OMT. Similar analysis should be performed to determine if this treatment option is cost-effective in other LMIC.
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Terapia de Resincronización Cardíaca/economía , Insuficiencia Cardíaca/economía , Factores de Edad , Anciano , Argentina , Terapia de Resincronización Cardíaca/psicología , Terapia de Resincronización Cardíaca/estadística & datos numéricos , Estudios de Cohortes , Análisis Costo-Beneficio , Insuficiencia Cardíaca/diagnóstico , Humanos , Cadenas de Markov , Años de Vida Ajustados por Calidad de Vida , Encuestas y Cuestionarios , Análisis de SupervivenciaRESUMEN
Background: Elevated Lipoprotein(a) [Lp(a)] is independently associated with increased cardiovascular disease (CVD) risk. There are discrepancies regarding its epidemiology due to great variability in different populations. This study aimed to evaluate the prevalence of elevated Lp(a) in people with moderate CVD risk and increased LDL-c and to determine the association between family history of premature CVD and elevated Lp(a). Methods: Random subjects from the CESCAS population-based study of people with moderate CVD risk (Framingham score 10-20 %) and LDL-c ≥ 130 mg/dL, were selected to evaluate Lp(a) by immunoturbidimetry independent of the Isoforms variability. The association between family history of premature CVD and elevated Lp(a) was evaluated using multivariate logistic regression models. Elevated Lp(a) was defined as Lp(a) ââ≥ 125 nmol/L. Results: Lp(a) was evaluated in 484 samples; men = 39.5 %, median age = 57 years (Q1-Q3: 50-63), mean CVD risk = 14.4 % (SE: 0.2), family history of premature CVD = 11.2 %, Lp(a) median of 21 nmol/L (Q1-Q3: 9-42 nmol/L), high Lp(a) = 6.1 % (95 % CI = 3.8-9.6). Association between family history of premature CVD and elevated Lp(a) in total population: OR 1.31 (95 % CI = 0.4, 4.2) p = 0.642; in subgroup of people with LDL-c ≥ 160 mg%, OR 4.24 (95 % CI = 1.2, 15.1) p = 0.026. Conclusions: In general population with moderate CVD risk and elevated LDL-c from the Southern Cone of Latin America, less than one over ten people had elevated Lp(a). Family history of premature CVD was significantly associated with the presence of elevated Lp(a) in people with LDL-c ≥ 160 mg/dL.
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Previous studies have shown the influence of the physical and social environments on the development of obesity and non-communicable diseases (NCD). An obesogenic environment promotes higher dietary energy intakes and sedentary behaviors while limiting opportunities or incentives for active living. This paper presents a dataset with key attributes of the food and physical activity built environment, including green spaces, quality of streets and sidewalks, and different types of food retail outlets in four cities of the Southern Cone of Latin America. A total of 139 representative neighborhoods randomly selected from: Marcos Paz and Bariloche (Argentina), Temuco (Chile) and Canelones-Barros Blancos (Uruguay) were evaluated, where standardized community walks were conducted for direct observation of the built environment. This dataset will contribute valuable data to the evaluation of obesogenic environments in the region, and could be linked to additional ecological information about risk factors for NCDs and socio-economic features from other sources. Understanding environmental influences on cardiovascular risk factors and individual habits may help explain NCD outcomes and plan urban policies.
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Entorno Construido , Ejercicio Físico , Alimentos , Humanos , América Latina , Enfermedades no Transmisibles/epidemiología , Obesidad/epidemiología , Características de la Residencia , Factores de Riesgo , Factores SocioeconómicosRESUMEN
BACKGROUND: Peak VO2 has traditionally been used for prognostic evaluation in systolic heart failure. However, in the past years, VE/VCO2 slope has been shown to be similar or even superior in many studies. We performed a systematic review and a meta-analysis of diagnostic studies of VE/VCO2 slope to assess its ability to predict cardiovascular events in systolic heart failure. METHODS: We searched the published literature in PubMed and ISI Web of Science for VE/VCO2 slope in heart failure, and performed a systematic review and a meta-analysis of diagnostic studies in articles fulfilling previously established selection criteria. End points were serious cardiovascular events defined as death or the combined end point of death, ventricular assist device implantation, or heart transplant. A sub-analysis was also performed with those articles providing enough data to compare VE/VCO(2) slope prognostic ability to that of peak VO2. RESULTS: Four hundred ninety-one articles that are potentially relevant were identified, and 12 studies were selected based on our predefined criteria. No heterogeneity or evidence of publication bias was found. The 12 studies included a total of 2,628 patients with a mean follow-up of 31 months (95% CI 16-46 months). The combined event rate at 1 year was 11.2% (95% CI 7.8%-14.6%). Diagnostic odds ratio and area under the curve for serious cardiovascular events were 5.02 (95% CI 4.06-6.21) and 0.75 (95% CI 0.72-0.78), respectively. Six studies provided sufficient data for VE/VCO2 slope and peak VO2 comparison. Both variables showed similar performance, although VE/VCO(2) did present a trend to superiority. CONCLUSIONS: In this meta-analysis, VE/VCO2 slope represents a reasonable ability to predict serious cardiovascular events in systolic heart failure, and is at least as effective as peak VO2.
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Dióxido de Carbono/metabolismo , Insuficiencia Cardíaca Sistólica/diagnóstico , Consumo de Oxígeno/fisiología , Intercambio Gaseoso Pulmonar/fisiología , Prueba de Esfuerzo , Insuficiencia Cardíaca Sistólica/fisiopatología , Humanos , Pronóstico , Índice de Severidad de la EnfermedadRESUMEN
The risk of hyperkalaemia in patients with heart failure has increased in the past few years together with the evolution of pharmacological treatment for these patients. This significant change has been associated with the introduction of angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and aldosterone antagonists. High potassium concentrations in heart failure could lead to life threatening events, and therefore should be taken seriously. In this review we summarise the information about potassium homeostasis in heart failure and the current risk of developing potentially serious hyperkalaemia, particularly in association with the use of aldosterone antagonists.
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Insuficiencia Cardíaca/tratamiento farmacológico , Hiperpotasemia/etiología , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Aldosterona/fisiología , Diuréticos/efectos adversos , Medicina Basada en la Evidencia/métodos , Humanos , Hiperpotasemia/fisiopatología , Hiperpotasemia/prevención & control , Espironolactona/efectos adversosRESUMEN
Background: Early repolarization pattern (ERP) is a frequent finding in asymptomatic subjects with controversial implications regarding to its prognosis. This study aims to estimate the prevalence of ERP and its association with sociodemographic characteristics and cardiovascular risk factors among the adult population in the Southern Cone of Latin America.Methods: A sub-sample of 5398 participants of the CESCAS I study was included in the present analysis. ERP was defined as a J peak ≥0.1 mV in two or more contiguous leads with an end-QRS notch or slur on the downslope of a prominent R-wave.Results: The global prevalence of ERP was 8.1%; 11.1% in men and 5.6% in women. The prevalence in women increased with age (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.2, at >65 years, p < 0.001), current cigarette smoking (OR 1.4, 95%CI 1.0-2.0, p = 0.045) and hypercholesterolaemia (OR 1.4, 95%CI 1.0-2.0, 0 p = 0.036). Conversely, in men, ERP prevalence decreased with age (OR 0.5, 95%CI 0.3-0.9, at >65 years, p = 0.01) and obesity (OR 0.6, 95%CI 0.4-0.8, p = 0.006). We found an increasing ERP prevalence with a higher Sokolow-Lyon index in both sexes (p < 0.001). Inferior location was found in 67.9% of cases, and the most common ERP type was a "slurring" appearance without ST elevation (76.3%).Conclusions: We found an overall prevalence of ERP of 8.1% and a robust association of ERP with normal BMI and higher Sokolow-Lyon index in men and with hypercholesterolaemia, current cigarette smoking and higher Sokolow-Lyon index in women.
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Arritmias Cardíacas/complicaciones , Muerte Súbita Cardíaca/epidemiología , Electrocardiografía , Vigilancia de la Población , Adulto , Anciano , Argentina/epidemiología , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Muerte Súbita Cardíaca/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: We examined whether dietary patterns (DPS) are associated with endothelial dysfunction (ED) markers in an Argentinian population. RESEARCH METHODS & PROCEDURES: The sample in this cross-sectional study was derived from 1,983 subjects from two mid-sized cities in Argentina who were involved in the CESCAS I Study. To define DP, a food-frequency questionnaire was applied. In a subsample randomly selected from the primary cohort, serum concentrations of C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E selectin (sSELE) were determined. Correlations and multiple linear regression models were used to assess the relation between each quartile of DP adherence score and ED markers (Q1 lowest adherence; Q4 highest adherence). RESULTS: Three DPs were identified: Traditional (TDP), Prudent (PDP), and Convenience and processed (CDP). TDP was characterized by higher intake of refined grains, red meat, whole fat dairy products, vegetable oils, and "mate", a traditional South American infused drink; PDP was characterized by higher intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes; and CDP consisted mainly of processed meat, snacks, pizza, and "empanadas", a stuffed bread served baked or fried. Lower scores (Q2, Q3) in TDP were inversely associated with concentrations of sSELE (P < 0.0001 and P < 0.05, respectively). In PDP, higher scores were inversely associated with hs-CRP, whereas lower scores showed a positive relation with sSELE (P < 0.05). Contrariwise, higher scores in CDP were directly associated with sSELE concentrations (P < 0.05). CONCLUSION: Adherence for each DP identified is differentially related to ED markers in the studied population.
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Biomarcadores/sangre , Dieta/efectos adversos , Endotelio Vascular/fisiopatología , Adulto , Anciano , Argentina , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Ciudades , Estudios Transversales , Encuestas sobre Dietas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Componente Principal , Factores de RiesgoRESUMEN
INTRODUCTION: Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina. STUDY DESIGN: Cluster RCT. SETTING/PARTICIPANTS: Ten primary care centers from the public healthcare system of Argentina. INTERVENTION: Primary care physicians in the intervention group received an educational program with three main components: (1) an intensive 2-day training workshop; (2) educational outreach visits; and (3) a mobile health application installed on the physician's smartphones. MAIN OUTCOME MEASURES: Reduction in mean low-density lipoprotein cholesterol level, reduction in mean Framingham risk score, proportion of patients receiving an appropriate statin dose, and mean annual number of primary care center visits. RESULTS: Data were analyzed in 2017-2018. Between April 2015 and April 2016, a total of 357 participants were enrolled (179 patients in the intervention group and 178 in the control group). The global follow-up rate was 97.2%. At the end of the follow-up period, there was no difference in low-density lipoprotein cholesterol levels in any of the follow-up points among the groups. Mean CVD risk had a significant net difference in the first 6 months in the intervention group versus the control group (-4.0, 95% CI = -6.5, -1.5). At the end of follow-up, there was an absolute 41.5% higher rate of participants receiving an appropriate statin dose in the intervention group versus the control group. CONCLUSIONS: Although the intervention did not reach a reduction in cholesterol levels, it had a significant positive impact on the promotion of adequate use of clinical practice guidelines. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02380911.
Asunto(s)
LDL-Colesterol/sangre , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Médicos de Atención Primaria/educación , Telemedicina/tendencias , Argentina , Países en Desarrollo , Femenino , Guías como Asunto/normas , Humanos , Hipercolesterolemia/sangre , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/tendencias , Factores de RiesgoRESUMEN
INTRODUCTION: Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. STUDY DESIGN: Cluster randomized trial conducted between June 2013 and October 2016. SETTING/PARTICIPANTS: A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina. INTERVENTION: Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months. MAIN OUTCOME MEASURES: Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017. RESULTS: Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000). CONCLUSIONS: The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01834131.
Asunto(s)
Peso Corporal , Ejercicio Físico , Estilo de Vida Saludable , Hipertensión/terapia , Adulto , Anciano , Argentina , Presión Sanguínea , Agentes Comunitarios de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , PobrezaRESUMEN
INTRODUCTION: To examine the relationship between suicidal ideation (SI) and cardiovascular disease (CVD) in the general adult population of four cities in the Southern Cone of Latin America (Argentina, Uruguay, Chile) and the role that depression, stressful life events (SLEs) and physical functional impairment may play in this association. METHODS: A population-based cross-sectional study was conducted among 7524 adults between 35 and 74â¯years old, randomly selected. History of CVD included acute myocardial infarction, stroke and central or peripheral revascularization. SI in the past two weeks was measured using the last item of the Patient Health Questionnaire (PHQ-9), quality of life was assessed with the 12-item Short Form Survey (SF-12), and having experience of a SLE was determined by asking participants whether they had experienced at least one of a list of events in the past year. Multiple logistic regression was used to examine the association between SI and CVD overall and by sex. RESULTS: The prevalence of SI was 8.3% (95% CIâ¯=â¯7.5, 9.0) and twice as high among women than men (11.1% vs. 5.1%). History of CVD was associated with almost twice the odds of SI (ORâ¯=â¯1.9, 95% CIâ¯=â¯1.5, 2.4). This association remained strong and significant after adjusting for potential confounders (ORâ¯=â¯1.8, 95% CIâ¯=â¯1.2, 2.7). Three additional models were tested to further adjust for depression severity, functional impairment, and SLEs separately. Adjustment for depression severity yielded no association between CVD and SI (ORâ¯=â¯1.1, 95% CIâ¯=â¯0.6, 1.7), adjustment for functional impairment yielded a marginal statistically significant association (ORâ¯=â¯1.5; 95% CIâ¯=â¯1.0, 2.4) and adjustment for SLE didn't modify either the magnitude or the statistical significance of the association. CONCLUSIONS: There is a significant association between SI and CVD, particularly among women, which may be driven, at least in part, by depression and physical functional impairment.