Dietary patterns and blood pressure in Southern Cone of Latin America.

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.

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America.

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.

Estimating prevalence of chronic obstructive pulmonary disease in the Southern Cone of Latin America: how different spirometric criteria may affect disease burden and health policies.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. The study aimed to determine and compare the prevalence of COPD in the general population aged 45-74 years old according to fixed ratio and lower limit of normal (LLN) thresholds in four cities in the Southern Cone of Latin America. METHODS: The Pulmonary Risk in South America (PRISA) study used a 4-stage stratified sampling method to select 5814 participants from 4 cities in the Southern Cone of Latin America (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Data on demographic information, medical history, risk factors, pre-bronchodilator and post-bronchodilator spirometry were obtained using a standard protocol. According to GOLD, COPD was defined as a post-bronchodilator ratio of forced expiratory volume in one second (FEV1) over forced vital capacity (FVC) less than 70%. The LLN threshold was defined as the lower fifth percentile for predicted FEV1/FVC, and was evaluated as an alternative COPD definition. RESULTS: Overall COPD prevalence was 9.3% (95% CI 8.4, 10.2%), and men had a higher prevalence [11.8% (95% CI 10.3, 13.3%)] than women [7.3% (95% CI 6.2, 8.3%)] with the fixed ratio. Overall COPD prevalence using LLN was 4.7% (95% CI 4.1, 5.3%), higher in men: 5.8% (95% CI 4.7, 6.8%) than women: 3.9% (95% CI 3.1, 4.7%). COPD prevalence was significantly higher among those who were older, had

Compliance with a WHO guideline for cardiovascular disease prevention. A population based cross-sectional study in Argentina.

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.

Elevated Lipoprotein(a) prevalence and association with family history of premature cardiovascular disease in general population with moderate cardiovascular risk and increased LDL cholesterol.

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) ​​≥ 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.

Detection and follow-up of chronic obstructive pulmonary disease (COPD) and risk factors in the Southern Cone of Latin America: the pulmonary risk in South America (PRISA) study.

BACKGROUND: The World Health Organization has estimated that by 2030, chronic obstructive pulmonary disease will be the third leading cause of death worldwide. Most knowledge of chronic obstructive pulmonary disease is based on studies performed in Europe or North America and little is known about the prevalence, patient characteristics and change in lung function over time in patients in developing countries, such as those of Latin America. This lack of knowledge is in sharp contrast to the high levels of tobacco consumption and exposure to biomass fuels exhibited in Latin America, both major risk factors for the development of chronic obstructive pulmonary disease. Studies have also demonstrated that most Latin American physicians frequently do not follow international chronic obstructive pulmonary disease diagnostic and treatment guidelines. The PRISA Study will expand the current knowledge regarding chronic obstructive pulmonary disease and risk factors in Argentina, Chile and Uruguay to inform policy makers and health professionals on the best policies and practices to address this condition. METHODS/DESIGN: PRISA is an observational, prospective cohort study with at least four years of follow-up. In the first year, PRISA has employed a randomized three-staged stratified cluster sampling strategy to identify 6,000 subjects from Marcos Paz and Bariloche, Argentina, Temuco, Chile, and Canelones, Uruguay. Information, such as comorbidities, socioeconomic status and tobacco and biomass exposure, will be collected and spirometry, anthropometric measurements, blood sampling and electrocardiogram will be performed. In year four, subjects will have repeat measurements taken. DISCUSSION: There is no longitudinal data on chronic obstructive pulmonary disease incidence and risk factors in the southern cone of Latin America, therefore this population-based prospective cohort study will fill knowledge gaps in the prevalence and incidence of chronic obstructive pulmonary disease, patient characteristics and changes in lung function over time as well as quality of life and health care resource utilization. Information gathered during the PRISA Study will inform public health interventions and prevention practices to reduce risk of COPD in the region.

Attributes of the food and physical activity built environments from the Southern Cone of Latin America.

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.

Adherence to Drinking Guidelines and Reasons for Alcohol Consumption Cessation in the Southern Cone of Latin America - Findings from the CESCAS Study.

Introduction: Alcohol consumption is a risk factor for morbidity and mortality globally. Consumption levels in Southern Latin America are among the highest in the world. Objectives: To describe consumption patterns and adherence to guidelines in the general adult population of Southern Latin America, as well as exploration of reasons for alcohol cessation and the advising role of the health worker in this decision. Methods: In 7,520 participants from the Centro de Excelencia en Salud Cardiovascular para el America del Sur (CESCAS) cohort, consumption patterns were described and the proportion excessive drinkers (i.e. >7 units/week for women and >14 for men or binge drinking: >4 (women) or >5 (men) units at a single occasion) was calculated. Former drinkers were asked if they had quit alcohol consumption on the advice of a health worker and/or because of health reasons. Furthermore, among former drinkers, multivariable logistic regression analysis was performed to assess which participant characteristics were independently associated with the chance of quitting consumption on a health worker's advice. Results: Mean age was 54.8 years (SD = 10.8), 42% was male. Current drinking was reported by 44.6%, excessive drinking by 8.5% of the population. In former drinkers, 23% had quit alcohol consumption because of health reasons, half of them had additionally quit on the advice of a health worker. The majority of former drinkers however had other, unknown, reasons. When alcohol cessation was based on a health worker's advice, sex, country of residence, educational status and frequency of visiting a physician were independent predictors. Conclusion: In this Southern American population-based sample, most participants adhered to the alcohol consumption guidelines. The advising role of the health worker in quitting alcohol consumption was only modest and the motivation for the majority of former drinkers remains unknown. A more detailed assessment of actual advice rates and exploration of additional reasons for alcohol cessation might be valuable for alcohol policy making.

Suicidal ideation is associated with cardiovascular disease in a large, urban cohort of adults in the Southern Cone of Latin America.

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 74 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% CI = 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 (OR = 1.9, 95% CI = 1.5, 2.4). This association remained strong and significant after adjusting for potential confounders (OR = 1.8, 95% CI = 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 (OR = 1.1, 95% CI = 0.6, 1.7), adjustment for functional impairment yielded a marginal statistically significant association (OR = 1.5; 95% CI = 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.

Detección de fibrosis en imágenes de cine de resonancia cardíaca mediante el uso de técnicas de inteligencia artificial / Fibrosis detection on MR-Cine images by using artificial intelligence techniques

RESUMEN Introducción: Las técnicas de inteligencia artificial han demostrado tener un gran potencial en el área de la cardiología, especialmente para identificar patrones imperceptibles para el ser humano. En este sentido, dichas técnicas parecen ser las adecuadas para identificar patrones en la textura del miocardio con el objetivo de identificar y cuantificar la fibrosis. Objetivos: Proponer un nuevo método de inteligencia artificial para identificar fibrosis en imágenes cine de resonancia cardíaca. Materiales y métodos: Se realizó un estudio retrospectivo observacional en 75 sujetos del Sanatorio San Carlos de Bariloche. El método propuesto analiza la textura del miocardio en las imágenes cine CMR (resonancia magnética cardíaca) mediante el uso de una red neuronal convolucional que determinar el daño local del tejido miocárdico. Resultados: Se observó una precisión del 89% para cuantificar el daño tisular local en el conjunto de datos de validación y de un 70% para el conjunto de prueba. Además, el análisis cualitativo realizado muestra una alta correlación espacial en la localización de la lesión. Conclusiones: El método propuesto permite identificar espacialmente la fibrosis únicamente utilizando la información de los estudios de cine de resonancia magnética nuclear, mostrando el potencial de la técnica propuesta para cuantificar la viabilidad miocárdica en un futuro o estudiar la etiología de las lesiones.

ABSTRACT Background: Artificial intelligence techniques have demonstrated great potential in cardiology, especially to detect imperceptible patterns for the human eye. In this sense, these techniques seem to be adequate to identify patterns in the myocardial texture which could lead to characterize and quantify fibrosis. Purpose: The aim of this study was to postulate a new artificial intelligence method to identify fibrosis in cine cardiac magnetic resonance (CMR) imaging. Methods: A retrospective observational study was carried out in a population of 75 subjects from a clinical center of San Carlos de Bariloche. The proposed method analyzes the myocardial texture in cine CMR images using a convolutional neural network to determine local myocardial tissue damage. Results: An accuracy of 89% for quantifying local tissue damage was observed for the validation data set and 70% for the test set. In addition, the qualitative analysis showed a high spatial correlation in lesion location. Conclusions: The postulated method enables to spatially identify fibrosis using only the information from cine nuclear magnetic resonance studies, demonstrating the potential of this technique to quantify myocardial viability in the future or to study the etiology of lesions.

Collecting Evidence to Inform Salt Reduction Policies in Argentina: Identifying Sources of Sodium Intake in Adults from a Population-Based Sample.

The maximum content of sodium in selected processed foods (PF) in Argentina was limited by a law enacted in 2013. Data about intake of these and other foods are necessary for policy planning, implementation, evaluation, and monitoring. We examined data from the CESCAS I population-based cohort study to assess the main dietary sources among PF and frequency of discretionary salt use by sex, age, and education attainment, before full implementation of the regulations in 2015. We used a validated 34-item FFQ (Food Frequency Questionnaire) to assess PF intake and discretional salt use. Among 2127 adults in two Argentinean cities, aged 35-76 years, mean salt intake from selected PFs was 4.7 g/day, higher among male and low education subgroups. Categories of foods with regulated maximum limits provided near half of the sodium intake from PFs. Use of salt (always/often) at the table and during cooking was reported by 9% and 73% of the population, respectively, with higher proportions among young people. Reducing salt consumption to the target of 5 g/day may require adjustments to the current regulation (reducing targets, including other food categories), as well as reinforcing strategies such as education campaigns, labeling, and voluntary agreement with bakeries.

Prevalence, awareness, treatment and control of diabetes and impaired fasting glucose in the Southern Cone of Latin America.

AIMS: To determine the prevalence, treatment and control of diabetes mellitus (DM) and impaired fasting glucose (IFG) as well as associated factors in the adult population of four cities of the Southern Cone of Latin America (SCLA). METHODS: This is a cross-sectional population-based study that included 7407 adults between 35 and 74 years old in four cities of the SCLA: Temuco (Chile), Marcos Paz and Bariloche (Argentina), and Pando-Barros Blancos (Uruguay). DM was defined as fasting plasma glucose ≥126 mg/dL or self-reported history of diabetes. Awareness, treatment, and control of DM were defined as subjects self-reporting a DM previous diagnosis, the use of a prescription medication or nonpharmacological intervention for DM, and fasting plasma glucose <126 mg/dl, respectively. RESULTS: Prevalence of DM varied among cities, between 8.4% in Bariloche and 14.3% in Temuco. Prevalence of IFG varied at different sites, from 3.5% in Barros Blancos to 6.8% in Marcos Paz. Of the total number of people with diabetes, 20% were newly diagnosed at the time of the study. Overall, 79.8% of patients with diabetes were aware of their condition. The treatment and control rate were 58.8% and 46.2%, respectively. Older age, family history of diabetes, lower educational attainment, overweight, obesity, central obesity, low physical activity, hypertension, hypercholesterolemia and hypertriglyceridemia were all significantly associated with an increased risk of diabetes. CONCLUSIONS: The prevalence of DM and IFG in the adult population of the SCLA is high and varies among cities. These conditions represent a public health challenge since the rates of awareness, treatment, and control are still low.

Tiempos de traslado, características y evolución de los pacientes con infarto agudo de miocardio que requirieron derivación a Centros con Hemodinamia a más de 400 km de San Carlos de Bariloche / Transfer Times, Characteristics and Evolution of Patients with Acute Myocardial Infarction Referred to Hemodynamic Centers More Than 400 km From San Carlos de Bariloche

RESUMEN Introducción: Este estudio analiza los tiempos y las complicaciones de los traslados hacia centros con Hemodinamia (C-PCI) de los pacientes del registro prospectivo REGIBAR, que incluyó a todos los pacientes que sufrieron un primer infarto agudo de miocardio (IAM) en San Carlos de Bariloche entre junio de 2014 y junio de 2015. Material y métodos: Se registraron 114 casos de IAM internados. De ellos, 25 pacientes fueron trasladados a C-PCI a más de 400 km. Resultados: La mediana de tiempo de gestión del traslado (TGT) para derivación de emergencia, tanto en ambulancia (unidad de terapia intensiva móvil, UTIM) como en avión, fue de 480 minutos. La mediana de tiempo de traslado (T) con UTIM fue de 407 minutos y con avión sanitario, de 259 minutos. La sumatoria de los tiempos de gestión y de traslado, esto es, el tiempo total (TOT), fue de 915 min con UTIM de emergencia y de 780 min en avión. Este último implicó un ahorro de solo 15% del tiempo total de traslado. Conclusiones: Los tiempos de traslado fueron más prolongados de lo esperado, principalmente a expensas del TGT. Se tendió a trasladar a quienes tuvieron angina pos-IAM, mayor cantidad de derivaciones con supradesnivel del segmento ST, insuficiencia cardíaca, pero también a los más jóvenes. No hubo complicaciones durante los traslados.

ABSTRACT Introduction: This study analyzes transfer times and complications to Hemodynamics centers (PCI-C) of patients from the prospective REGIBAR registry, including all patients suffering a first acute myocardial infarction (AMI) in San Carlos de Bariloche between June 2014 and June 2015. Methods: Among 114 hospitalized AMI cases, 25 patients were transferred to PCI-C more than 400 km from San Carlos de Bariloche. Results: Median transfer management time (TMT) for emergency referral, both by ambulance [mobile intensive care unit (MICU)] and by plane, was 480 minutes. Median travel time (TT) by MICU was 407 minutes and by air ambulance, 259 minutes. The sum of management and transfer times, that is, the total time (TOT), was 915 min by emergency MICU and 780 min by plane. The latter saved only 15% of the total travel time. Conclusions: Transfer times were longer than expected, mainly at the expense of TMT. There was a tendency to transfer those who had post-AMI angina, a higher number of ST-segment elevation leads, heart failure, but also younger patients. There were no complications during transfers.

Cuantificación automática de los volúmenes y función de ambos ventrículos en resonancia cardíaca. Propuesta y evaluación de un método de inteligencia artificial / Automatic Quantification of Volumes and Biventricular Function in Cardiac Resonance. Validation of a New Artificial Intelligence Approach

RESUMEN Introducción: Las técnicas de inteligencia artificial han demostrado tener un gran potencial en el área de la cardiología, especialmente para cuantificar la función cardíaca de ambos ventrículos, volumen, masa y fracción de eyección (FE). Sin embargo, su aplicación en la clínica no es directa, entre otros motivos por la poca reproducibilidad frente a casos de la práctica diaria. Objetivos: Propuesta y evaluación de una nueva herramienta de inteligencia artificial para cuantificar la función cardíaca de ambos ventrículos (volumen, masa y FE). Estudiar su robustez para su uso en la clínica y analizar los tiempos de cómputo respecto a los métodos convencionales. Materiales y métodos: Se analizaron en total 189 pacientes, 89 de un centro regional y 100 de un centro público. El método propuesto utiliza dos redes convolucionales incorporando información anatómica del corazón para reducir los errores de clasificación. Resultados: Se observa una alta concordancia (coeficiente de Pearson) entre la cuantificación manual y la propuesta para cuantificar la función cardíaca (0,98, 0,92, 0,96 y 0,8 para los volúmenes y para la FE de ambos ventrículos) en tiempos cercanos a los 5 seg. por estudio. Conclusiones: El método propuesto permite cuantificar los volúmenes y función de ambos ventrículos en segundos con una precisión comparable a la de un especialista.

ABSTRACT Background: Artificial intelligence techniques have shown great potential in cardiology, especially in quantifying cardiac biventricular function, volume, mass, and ejection fraction (EF). However, its use in clinical practice is not straightforward due to its poor reproducibility with cases from daily practice, among other reasons. Objectives: To validate a new artificial intelligence tool in order to quantify the cardiac biventricular function (volume, mass, and EF). To analyze its robustness in the clinical area, and the computational times compared with conventional methods. Methods: A total of 189 patients were analyzed: 89 from a regional center and 100 from a public center. The method proposes two convolutional networks that include anatomical information of the heart to reduce classification errors. Results: A high concordance (Pearson coefficient) was observed between manual quantification and the proposed quantification of cardiac function (0.98, 0.92, 0.96 and 0.8 for volumes and biventricular EF) in about 5 seconds per study. Conclusions: This method quantifies biventricular function and volumes in seconds with an accuracy equivalent to that of a specialist.

Prevalencia de las diferentes causas de elevación de troponinas en un registro multicéntrico de Bariloche. Vinculación entre la magnitud de la elevación y la etiología / Prevalence of the Different Causes of Troponin Elevation in a Multicenter Registry in Bariloche. Link Between the Magnitude of Troponin Elevation and its Etiology

RESUMEN Objetivos: Establecer la prevalencia de infarto agudo de miocardio (IAM) y otras etiologías en pacientes con troponina elevada, relacionar su valor con la etiología y definir el mejor punto de corte para diferenciar un IAM de otras causas. Material y métodos: Se incluyeron todos los pacientes con troponina elevada internados en un año e incorporados al registro REGIBAR. Para analizar la magnitud utilizamos el valor dosado más elevado/valor de referencia. Para establecer el mejor punto de corte se realizó curva ROC y el índice Youden. Resultados: Ingresaron 150 casos (edad: 66,3 ± 13,8 años, 71% hombres); 109 IAM (edad: 71,1 años, 63,5% masculinos), 18 (12%) otras causas cardiacas, 15 (10%) causas no cardíacas y en 8 (5,3%) no se obtuvo etiología. El mejor punto de corte troponina dosada/valor de referencia para discriminar IAM fue >3,15. Conclusiones: En pacientes hospitalizados con troponina elevada el 73% de los casos fue IAM (>3,15veces el punto de corte). La segunda causa más frecuente de elevación fue la insuficiencia cardíaca.

ABSTRACT Objectives: To determine the prevalence of acute myocardial infarction (AMI) and other etiologies in patients with elevated troponin, to associate troponin values with the etiology, and to define the optimal cut-off point to differentiate AMI from other causes. Methods: All patients with elevated troponin who were hospitalized within 1 year and registered in the REGIBAR study were included. Magnitude was analyzed with the highest dose value/baseline value. The ROC curve and the Youden index were used to determine the optimal cut-off point. Results: A total of 150 cases were included (age: 66.3 ± 13.8 years, 71% male); 109 AMI (age: 71.1 years, 63.5% male), 18 (12%) with other cardiac causes, 15 (10%) with non-cardiac causes, and 8 (5.3%) with no evident etiology. The optimal cut-off point for troponin dose/baseline value to discriminate AMI was >3.15. Conclusions: A 73% of inpatients with elevated troponin were AMI cases (>3.15 times the cut-off point). Heart failure was the second most common cause of elevated troponin.

Prevalence, Awareness, Treatment, and Control of Hypertension in the Southern Cone of Latin America.

BACKGROUND: Hypertension is the leading global preventable risk factor for premature death. While hypertension prevalence has been declining in high-income countries, it has increased continuously in low- and middle-income countries. METHODS: We conducted a cross-sectional survey in 7,524 women and men aged 35-74 years from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay) in 2010-2011. Three blood pressure (BP) measurements were obtained by trained observers using a standard mercury sphygmomanometer. Hypertension was defined as a mean systolic BP ≥140mm Hg and/or diastolic BP ≥90mm Hg and/or use of antihypertensive medications. RESULTS: An estimated 42.5% of the study population (46.6% of men and 38.7% of women) had hypertension and an estimated 32.5% (36.0% of men and 29.4% of women) had prehypertension. Approximately 63.0% of adults with hypertension (52.5% of men and 74.3% of women) were aware of their disease condition, 48.7% (36.1% of men and 62.1% of women) were taking prescribed medications to lower their BP, and only 21.1% of all hypertensive patients (13.8% of men and 28.9% of women) and 43.3% of treated hypertensive patients (38.1% of men and 46.5% of women) achieved BP control. CONCLUSIONS: This study indicates that the prevalence of hypertension is high while awareness, treatment, and control are low in the general population in the Southern Cone of Latin America. These data call for bold actions at regional and national levels to implement effective, practical, and sustainable intervention programs aimed to improve hypertension prevention, detection, and control.

Prevalence, Patterns, and Correlates of Physical Activity Among the Adult Population in Latin America: Cross-Sectional Results from the CESCAS I Study.

BACKGROUND: Few data are available on population level regarding domain-specific correlates of physical activity (PA) in Latin America. OBJECTIVE: The aim of this study was to examine the relationships among PA patterns and their main sociodemographic determinants and cardiovascular risk factors in the Southern Cone of Latin America. METHODS: CESCAS I is a population-based prospective cohort study with a 4-stage stratified sampling of a general population of 7,524 adults aged 35 to 74 years from 4 midsized cities in Argentina, Chile, and Uruguay. PA was assessed using the transcultural adaptation of the International Physical Activity Questionnaire long form. The questionnaire asked about frequency (days per week) and duration (minutes per day) of moderate and vigorous intensity activities in 3 different domains: work, leisure time, and active transportation (walking and bicycling). PA levels of ≥600 metabolic equivalent tasks (MET) minutes per week was considered sufficiently active. Odds ratios for associations of sufficiently active status with sociodemographic determinants and cardiovascular risk factors were obtained using multivariable-adjusted logistic regression models. CONCLUSIONS: Almost 65%) of the participants reported ≥600 MET minutes per week. The lowest prevalence of sufficiently active individuals was seen in Temuco, Chile (58.0%), among women (58.7%), older individuals (55.4%), those with higher educational level (61.6%), and homemakers (53.4%). Approximately 22.8% of the population reported no PA. In multivariable analysis, PA levels were lower among women, individuals who were older, obese, university educated, with clerical work, retired/unemployed or homemakers, and those with physical limitations. Future interventions to increase PA levels in the Southern Cone of Latin America must take into account disparities by gender and socioeconomic status. The promotion of PA during leisure time in women--unemployed and homemakers--and of active transportation for those performing office or clerical work should be a priority in this population.

Prevalence, Distributions and Determinants of Obesity and Central Obesity in the Southern Cone of America.

BACKGROUND: Obesity is a major determinant of cardiovascular disease in South America. However, population-based data are limited. METHODS: A total of 7,524 women and men, aged 35 to 74 years old, were randomly selected from 4 cities in the Southern Cone of Latin America between February 2010 and December 2011. Obesity clinical measurements and cardiovascular risk factors were measured using standard methodology. RESULTS: The prevalence of obesity and central obesity were 35.7% and 52.9%, respectively. The prevalence of obesity and central obesity were higher in women, and even higher in women with lower education compared with women with higher education. In men and women obesity was associated with a higher prevalence of diabetes, odds ratio (OR) 2.38 (95% Confidence Interval [CI]: 1.86 to 3.05) and 3.01 (95%CI 2.42 to 3.74) respectively, hypertension (OR 2.79 (95%CI 2.32 to 3.36) and 2.40 (95%CI 2.05 to 2.80) respectively, dyslipidemia (OR 1.83 (95%CI 1.50 to 2.24) and 1.69 (95%CI 1.45 to 1.98), respectively, low physical activity (OR 1.38(95%CI 1.14 to 1.68) and 1.38 (95%CI 1.18 to 1.62) respectively and a lower prevalence of smoking (OR, 0.65 (95%CI 0.53 to 0.80) and 0.58(95%CI 0.48 to 0.70) respectively. CONCLUSIONS: Obesity and central obesity are highly prevalent in the general population in the Southern Cone of Latin America and are strongly associated with cardiovascular risk factor prevalence. These data suggest that efforts toward prevention, treatment, and control of obesity should be a public health priority in the Southern Cone of Latin America.

Encuesta sobre el manejo del infarto agudo de miocardio con elevación del segmento ST en hospitales de zonas rurales de Río Negro / Survey on the Management of ST-Segment Elevation Myocardial Infarction in Hospitals from Rural Areas of Rio Negro, Argentina

RESUMEN Introducción: Es escasa la información del manejo del infarto agudo de miocardio con supradesnivel del segmento ST (IAM-CEST) en zonas rurales de nuestro país. Objetivo: Conocer la disponibilidad y utilización de recursos diagnósticos y terapéuticos en la atención del infarto agudo de miocardio con supradesnivel del segmento ST en centros médicos rurales de la provincia de Río Negro. Material y métodos: Se realizó una encuesta telefónica, estructurada, de respuesta abierta, a médicos de guardia de los 8 hospitales de la Línea Sur, todos de nivel entre 2 y 4 (sin áreas intensivas). Resultados: Los casos con infarto agudo de miocardio con supradesnivel del segmento ST son atendidos por generalistas, que en la mitad de los casos no tienen con quién consultar los electrocardiogramas. En general, no cuentan con sistemáticas ni redes de derivación. A pesar de que el 75% de los centros tienen más de 2 horas de derivación, la mayoría no disponen de estreptoquinasa. La mitad de las derivaciones son a ciudades que no disponen de hemodinamia para casos sin cobertura. Conclusión: Es escasa la organización y la disponibilidad de recursos en la atención del infarto agudo de miocardio con supradesnivel del segmento ST en zonas rurales de la provincia de Río Negro.

SUMMARY Introduction: information on the management of AMI with a ST-segment elevation (IAMCEST) in rural areas of our country is scarce. Objective: To know about the availability and use of diagnostic and therapeutic resources in the care of IAMCEST in rural medical centers in Río Negro province Methods: A structured, open-response, telephone survey was conducted, to on-call doctors from 8 hospitals of the South Line, all between 2 and 4 level (without intensive areas). Results: The IAMCEST patients are attended by generalists, who in half of the cases have no one to consult the ECG. Broadly they do not have systematic systems or referral networks. Although 75% of the centers have more than 2 hours of derivation, most do not have streptokinase. Half of the referrals are cities that do not have hemodynamics for cases without coverage. Conclusion: The organization and availability of resources in IAMCEST care in rural areas of the province of Río Negro is scarce.

Multiple cardiometabolic risk factors in the Southern Cone of Latin America: a population-based study in Argentina, Chile, and Uruguay.

BACKGROUND: Cardiovascular disease is a major cause of death, and its mortality is increasing in Latin America. However, population-based data on cardiovascular disease risk factors are sparse in these countries. METHODS: A total of 7524 men and women, aged 35 to 74 years old, were recruited between February 2010 and December 2011 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay) in the Southern Cone of Latin America. Cardiovascular risk factors were measured using standard methods by trained and certified observers. RESULTS: Approximately 85.5% of adults ate less than five servings of fruit or vegetables per day, 35.2% engaged in low physical activity, and 29.7% currently smoked cigarettes. The prevalences of obesity, central obesity, hypertension, chronic kidney disease, dyslipidemia, diabetes, and metabolic syndrome were 35.7%, 52.9%, 40.8%, 2.0%, 58.4%, 12.4%, and 37.4%, respectively. The proportion of individuals with ≥3 cardiovascular risk factors, including low intake of fruit and vegetables, low physical activity, current cigarette smoking, obesity or central obesity, hypertension, chronic kidney disease, dyslipidemia, and diabetes, was 68.3%, and the proportion of individuals with ≥3 cardiometabolic risk factors, including obesity or central obesity, hypertension, chronic kidney disease, dyslipidemia, and diabetes, was 22.9%. CONCLUSIONS: Cardiovascular disease risk factors are highly prevalent in the general population in the Southern Cone of Latin America. These data suggest that national efforts on the prevention, treatment, and control of cardiovascular risk factors should be a public health priority in the Southern Cone of Latin America.