Comparison of two surrogate estimates of insulin resistance to predict cardiovascular disease in apparently healthy individuals.

BACKGROUND AND AIMS: Insulin resistance is associated with a cluster of abnormalities that increase cardiovascular disease (CVD). Several indices have been proposed to identify individuals who are insulin resistant, and thereby at increased CVD risk. The aim of this study was to compare the abilities of 3 indices to accomplish that goal: 1) plasma triglyceride × glucose index (TG × G); 2) plasma triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C); and 3) Metabolic Syndrome (MetS). METHODS AND RESULTS: In a population sample of 723 individuals (486 women and 237 men, 50 ± 16 and 51 ± 16 years old, respectively), baseline demographic and metabolic variables known to increase CVD risk and incident CVD were compared among individuals defined as high vs. low risk by: TG × G; TG/HDL-C; or MetS. CVD risk profiles appeared comparable in high risk subjects, irrespective of criteria. Crude incidence of CVD events was increased in high risk subjects: 12.2 vs. 5.3% subjects/10 years, p = 0.005 defined by TG/HDL-C; 13.4 vs. 5.3% subjects/10 years, p = 0.002 defined by TG × G; and 13.4% vs. 4.5% of subjects/10 years, p < 0.001 in subjects with the MetS. The area under the ROC curves to predict CVD were similar, 0.66 vs. 0.67 for TG/HDL-C and TG × G, respectively. However, when adjusted by age, sex and multiple covariates, hazard ratios for incident CVD were significantly increased in high risk patients classified by either TG/HDL-C ratio (2.18, p = 0.021) or MetS (1.93, p = 0.037), but not by TG × G index (1.72, p = 0.087). CONCLUSION: Although the 3 indices identify CVD risk comparably, the TG × G index seems somewhat less effective at predicting CVD.

Use of the triglyceride/high-density lipoprotein cholesterol ratio to identify cardiometabolic risk: impact of obesity?

There is evidence that the plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) identifies insulin resistance and increased cardiometabolic risk and outcome in apparently healthy individuals. Since use of the TG/HDL-C ratio to accomplish this task in persons over a wide range of adiposity has not been studied, the ability of previously defined sex-specific TG/HDL-C cut-points to identify increased cardiometabolic risk was evaluated in apparently healthy normal weight, overweight, and obese individuals. Data were analyzed from a population-based study of apparently healthy men (n=416) and women (n=893), subdivided into categories by body mass index (BMI, kg/m2): normal weight (BMI 20.0-24.9), overweight (BMI 25.0-29.9) and obese (BMI 30.0-34.9). The adiposity groups were further stratified on the basis of their TG/HDL-C ratio into groups defined as being either at 'high risk' versus 'low risk' of cardiometabolic disease. Multiple cardiometabolic risk factors were compared between these subgroups, as was their degree of insulin resistance assessed by fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. The proportion of high-risk individuals varied with BMI category, ranging from 14% (normal weight) to 36% (obese). However, within each BMI category high-risk individuals had a significantly more adverse cardiometabolic risk profile. Finally, the adjusted OR of being insulin resistant was significantly greater in those with a high TG/HDL-C ratio in the normal (3.02), overweight (2.86), and obese (2.51) groups. Thus, irrespective of differences in BMI, the TG/HDL-C ratio identified apparently healthy persons with a more adverse cardiometabolic risk profile associated with an increased prevalence of insulin resistance.

Should the first blood pressure reading be discarded?

We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1ΔSBP). SBP decreased through sequential readings, 3-1ΔSBP was -5.5 ± 9.7 mm Hg (P<0.001), -5.1 ± 10.4 mm Hg (P<0.001) and -6.1 ± 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1ΔSBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.

Identifying cardiovascular disease risk and outcome: use of the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio versus metabolic syndrome criteria.

BACKGROUND: Metabolic syndrome (MetS) has been shown to predict both risk and CVD events. We have identified sex-specific values for the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio associated with an unfavourable cardio-metabolic risk profile, but it is not known whether it also predicts CVD outcome. METHODS: To quantify risk for CVD outcomes associated with a high TG/HDL-C ratio and to compare this risk with that predicted using MetS, a population longitudinal prospective observational study was performed in Rauch City, Buenos Aires, Argentina. In 2003 surveys were performed on a population random sample of 926 inhabitants. In 2012, 527 women and 269 men were surveyed again in search of new CVD events. The first CVD event was the primary endpoint. Relative risks for CVD events between individuals above and below the TG/HDL-C cut-points, and with or without MetS, were estimated using Cox proportional hazard. MAIN OUTCOME: The first CVD event was the primary endpoint. Relative risks for CVD events between individuals above and below the TG/HDL-C cut-points, and with or without MetS, were estimated using Cox proportional hazard. RESULTS: The number of subjects deemed at 'high' CVD risk on the basis of an elevated TG/HDL-C ratio (30%) or having the MetS (35%) was relatively comparable. The unadjusted hazard risk was significantly increased when comparing 'high' versus 'low' risk groups no matter which criteria was used, although it was somewhat higher in those with the MetS (HR = 3.17, 95% CI:1.79-5.60 vs. 2.16, 95% CI:1.24-3.75). However, this difference essentially disappeared when adjusted for sex and age (HR = 2.09, 95% CI:1.18-3.72 vs. 2.01, 95% CI:1.14-3.50 for MetS and TG/HDL-C respectively). CONCLUSIONS: An elevated TG/HDL-C ratio appears to be just as effective as the MetS diagnosis in predicting the development of CVD.

Decrease of blood pressure by community-based strategies

La ciudad de Rauch presentaba en 1997 alta prevalencia de hipertensión arterial (HA) y bajos niveles de tratamiento y control. Para evaluar el impacto de actividades de intervención comunitarias sobre la presión arterial (PA) reencuestamos en el año 2003 a una cohorte de 1526 habitantes de 15-75 años. Las actividades de intervención fueron el estudio inicial, la indicación de concurrir a su médico cuando se hallaban alteraciones, la provisión gratuita de antihipertensivos y la difusión por medios masivos de los resultados del estudio y de hábitos saludables de vida. La PA fue medida en el domicilio por enfermeras especialmente entrenadas, considerando PA sistólica y diastólica (PAS y PAD) a los promedios de tres registros en una ocasión. Se reencuestaron 1307 individuos (85.65%). La PAS descendió de 137.98 ± 0.57 a 132.49 ± 0.53 mm Hg (p<0.01) y la PAD de 88.73 ± 0.38 a 81.87 ± 0.33 mm Hg (p<0.01). La PA disminuyó en ambos sexos, en todos los grupos etáreos y en el subgrupo sin antihipertensivos. El porcentaje de sujetos con antihipertensivos aumentó de 12.2 a 20.4 (p<0.01) y se observó una relación significativa entre los percentilos de los cambios de la PA y los cambios del peso en sujetos con y sin antihipertensivos. Las estrategias de intervención comunitaria fueron efectivas para controlar la PA y, probablemente, para disminuir el riesgo cardiovascular en una comunidad con alta prevalencia de HA.

In a cross section study performed in Rauch in 1997 we found a high prevalence of hypertension and low levels of treatment and control. To evaluate the impact of the community-based intervention activities on blood pressure (BP), we made a cohort study in 1526 inhabitants aged between 15 and 75 years in 2003. The initial study, the advice to consult the family doctor when alterations were found, the free provision of antihypertensive drugs, the press diffusion of the study results and a healthy lifestyle were included among the intervention activities. BP was measured in the subjects' residence by especially trained nurses, considering systolic BP (SBP) and diastolic BP (DBP) as the average of three measurements in one occasion. A total of 1307 subjects (85.65%) were re-interviewed. SBP decreased from 137.98 +/- 0.57 to 132.49 +/- 0.53 mm Hg (p < 0.01) and DBP from 88.73 +/- 0.38 to 81.87 +/- 0.33 mm Hg (p < 0.01). Pressure decrease was observed in all the age groups, in both sexes and in the subgroup without receiving antihypertensive drugs. The percentage with antihypertensive drugs increased from 12.2 to 20.4 (p < 0.01). A significant relationship was observed between the percentiles of the BP changes and weight changes in subjects with and without antihypertensive drugs. Community-based intervention strategies were effective to BP control and, probably, to decrease the cardiovascular risk in a community with high prevalence of hypertension.

[Associated variables to hypertension in a region of Argentina]. / Variables asociadas a hipertensión arterial en una región de la Argentina.

We conducted a study in a random sample of 1523 inhabitants (15-75 years old) of Rauch city to determine risk factors prevalence to development hypertension and cardiovascular diseases. We measured blood pressure, weight, height, waist circumference, cholesterol and glucose levels, sodium excretion, and alcohol and tobacco consumption. We found a high prevalence of hypertension (43.20% in men and 28.50% in women), and obesity-overweight (54.81% in men and 44.65% in women), both of them augmented with aging. Only 4% of hypertensive subjects were being controlled and only 32% of them were aware of their condition. Men showed a marked increment of prevalence of hypertension and obesity-overweight between groups of 15-24 years and 25-34 years. Women had delayed and more gradual increments. In male and female respectively, the prevalence of hypercholesterolemia was 26.86 and 13.81, the prevalence of diabetes was 3.42 and 1.53, and the prevalence of tobacco consumption was 34.61 and 20.83. Higher BMI and waist circumference identified subjects with higher blood pressure up to 54 and 65 years, in men and women, respectively. Age and waist circumference in the whole group, and alcohol consumption in men, were independently correlated with blood pressure; sodium excretion had no correlation. High prevalence of hypertension and obesity-overweight and their association suggest that the most important primary prevention measure in this community should be to prevent obesity. Low levels of awareness indicate the need of ongoing detection programs, and low grade to control of hypertension could be modified with education programs for health providers.

Ten-year blood pressure trends in nonhypertensive inhabitants of La Plata, Argentina.

OBJECTIVES: To compare, according to blood pressure (BP) categories, 10-year trends in BP measurements in nonhypertensive subjects and the relative risk of developing hypertension. DESIGN: Population study. BP was recorded as the average of two measures taken on a single occasion with a mercury sphygmomanometer and the auscultation method. SETTING: Residents of La Plata, aged 15 to 64 years. PARTICIPANTS: The study was based on randomly chosen individuals who, during a previous survey in 1985, were 15 to 64 years old and whose BP was below 140/90 mmHg. They were grouped according to sex and BP categories. Random age- and sex-stratified sampling of 151 men and 193 women was performed. Categories were high normal BP, optimal BP (as defined by the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure) and normal but not optimal BP defined as BP 120 to 129/80 to 84 mmHg. RESULTS: BP increased in all categories; this increase was significant (P < 0.01) except for diastolic BP in women with high normal BP. BP increases were higher in optimal BP subjects and lower in high normal BP subjects (P < 0.01 for women and not significant for men). The relative risk of developing hypertension in high normal BP subjects was triple that in optimal BP subjects (P < 0.01). CONCLUSIONS: Increases in BP observed in optimal BP subjects stress the importance of monitoring BP changes and recommending primary prevention in the whole population.

Optimal blood pressure and high normal blood pressure in La Plata, Argentina.

OBJECTIVE: To determine the prevalence of optimal blood pressure (BP) and high normal BP according to the definition of the Joint National Committee (JNC)-V. DESIGN: A population survey was used. BP was measured with mercury sphygmomanometers using the auscultatory method. BP was obtained as the average of two BP readings on a single occasion. SETTING: Population, ages 15 to 75, living in La Plata. PARTICIPANTS: For sampling purposes, census areas were taken as units chosen randomly with proportional probability to the number of houses. Six thousand three hundred and eighty-six inhabitants were screened in these census areas. Individuals were screened who were not under hypertensive treatment; had BP less than 120/80 mmHg (optimal BP); and systolic BP between 130 and 139 mmHg and/or diastolic BP between 85 and 89 mmHg (high normal BP). RESULTS: The prevalence of optimal BP was 32%. It was higher in women (39%) than in men (21%) (P < 0.0005) and decreased with age in both sexes. The prevalence of high normal BP was 18%. It was higher in men (24%) than in women (14%) (P < 0.0005). CONCLUSIONS: Due to the low prevalence of optimal BP and the high prevalence of high normal BP, the population of La Plata has a high cardiovascular risk. Studies of primary prevention of hypertension have shown that some changes in life style are effective in lowering not only the BP but also the incidence of hypertension.

[Prevalence of high normal blood pressure and progression to hypertension in a population sample of La Plata]. / Prevalencia de presión sanguínea normal alta y progresión a hipertensión arterial en una muestra poblacional de La Plata.

In 1985 we investigated the prevalence of high normal blood pressure in 6387 inhabitants (range 15-75 years old) of the city of La Plata and its progression to arterial hypertension after four years. High normal blood pressure was defined as a systolic blood pressure (BP) < 140 mmHg and diastolic BP between 85-89 mmHg (average value of two measurements) on one occasion. Arterial hypertension was defined as a systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg, both as an average of two measurements on two occasions. High normal BP prevalence was 6.62%, being higher in men than in women (p < 0.0005, Table 1). General progression to hypertension was 41.79%, being higher in the older individuals (p < 0.0005). Of the 423 individuals with high normal BP (Table 2), 268 (63.36%) were found in 1989 (Table 3). They had an incidence of hypertension of 10.45% per year, also higher in older subjects (Table 4). There were no differences between sexes. Subjects with high normal BP who subsequently developed hypertension had higher systolic BP in 1985 than those who remained normotensive (p < 0.001, Table 5). Most of them progressed to mild diastolic hypertension (29.48%) or borderline isolated systolic hypertension (6.72%, Fig. 1). In this study, progression to arterial hypertension was higher than that reported in similar studies for general population in other countries.

Prevalencia de presion sanguinea normal alta y progresion a hipertension arterial en una muestra poblacional de La Plata / Prevalence of high normal blood pressure and progression to hypertension in a population sample of La Plata

En una muestra de 6386 habitantes de 15 a 75 años del radio urbano de la ciudad de La Plata, se investigó la prevalencia de presión sanguínea (PS) normal alta en 1985 y su progresión a hipertensión arterial (HA) luego de cuatro años. Se definió PS normal alta cuando el promedio de dos mediciones de la PS en el domicilio fue menor de 140 mmHg de sistólica y mayor o igual a 85 y menor de 90 mmHg de diastólica. Se diagnosticó HA cuando, en dos visitas separadas, los promedios de dos mediciones de la PS fueron en cada oportunidad iguales o mayores a 140 mmHg de sistólica y/o iguales o mayores a 90 mm%; fue mayor en varones (8,49%) vs 5,35%, p < 0,005). De los 423 individuos con PS normal alta fueron hallados 286 en 1989. El 41,79% progresó a HA en los sujetos con PS normal alta fue 10,45% por año; fue mayor en los grupos etários más viejos y no mostró diferencias entre los sexos. Los individuos con PS normal alta tenían en 1985 la PS sistólica más alta que la de los que se mantuvieron normotensos (p < 0,0001). La mayoria progresó a HA diastólica pregresó a HA diastólica leve y sistólica limítrofe. Esta evolución a HA supera a la señalada en otros países para la población general, motivo por el cual, se debería tener en cuenta a la PS normal alta en a prevención primaria de esta enfermedad

[Knowledge and treatment of hypertension in La Plata, Argentina]. / Conocimiento y tratamiento de la hipertensión en La Plata.

Hypertensive subjects, aged 15-75 years, detected by the survey of Prevalence of Hypertension in La Plata, were evaluated to settle the rates of awareness, treatment, control status and the efficacy of pharmacologic therapy (EPT). The survey was composed of 2,090 subjects when the threshold of hypertension was equal to blood pressure (BP) greater than or equal to 140-90 mm Hg and of 1,203 subjects with a BP threshold greater than or equal to 160-95 mm Hg (Table I). The rates of awareness, treatment and control for the 140-90 mm Hg threshold were 43.97%, 33.06%, 4.9%, respectively, and the EPT was 15.03%. For the 160-95 mm Hg threshold the rates were 69.41%, 54.44% and 27.76% and the EPT was 48.32% (Table 2 and Fig. 1). The awareness and treatment rates for women were greater than those for men (p less than 0.0005) (Table 2). The EPT was similar in both sexes when the 140-90 mm Hg threshold was used while it was greater in women than in men with the 160-95 threshold (p less than 0.014) (Table 2). The rates of awareness and treatment increased with age and with the severity of the disease (Table 3-5). The EPT decreased from 85.71% in the 15-24 yr. age group to 10.56% in the 65-75 yr. age group (Table 4). Although the rates of awareness and treatment of hypertension found in La Plata were similar to those found in USA, the control of the disease was lower.(ABSTRACT TRUNCATED AT 250 WORDS)

Conocimiento y tratamiento de la hipertension en la Plata / Knowledge and treatment of hypertension in la Plata

Se evaluaron los porcentajes de conocimiento, tratamiento farmacológico y control y la eficacia del tratamiento farmecológico (ETF) de los hipertensos de La Plata para dos umbrales de hipertensión arterial (HA). La muestra fueron 2090 hipertensos para el umbral de HA con presión sanguínea (PS) > ou = 140/90 mm Hg y 1203 sujetos para el umbral > ou = 160/90 mm Hg. Los porcentajes de conocimiento, tratamiento farmacológico y ETF fue 15,03. Para el umbral > ou = 160/95 mm Hg los porcentajes de conocimiento, tratamiento farmacológico y control fueron 69,41, 57,44 y 27,76, respectivamente, y la ETF fue 48,32. Los porcentajes de conocimiento y de tratamiento farmacológico fueron significantivamente mayores en las mujeres (p < 0,005). La ETF, para el umbral de HA > ou = 160/95 mm Hg, también fue significativamente mayor en las mujeres (p < 0,014). El conocimiento y el tratamiento farmacológico aumentaron con la edad y con la severidad de la HA. La ETF disminuyó, para el umbral de HA > ou = 140/90 mmHg, de 85,71 en el grupo de 15 a 24 años a 10,56 en el grupo de 65 a 75 años. El conocimiento y el tratamiento fueron muy bajos en los grupos más jovenes y la ETF disminuyó abruptamente a partir del grupo de 35 a 44 años. El bajo porcentaje de control y la alta prevalencia ya comunicada pueden explicar la elevada tasa de mortalidad por enfermedades cardiovasculares hipertensivas que detenta La Plata

Prevalencia de la hipertensión arterial en La Plata / Prevalence of systemic hypertension in La Plata, Argentina

Estudiamos una muestra aleatroizada de 6386 habitantes del radio urbano de la ciudad de La Plata, con un rango de edad de 15 a 75 años, para averiguar la prevalencia de hipertensión arterial (HA). Se consideró hipertensos a los sujetos con presión sanguínea (PS) > ou = 140/90 mmHg y a los individuos con valores de PS inferiores al mencionado y bajo tratamiento con fármacos antihipertensivos. Las prevalencias de HA global, sistólica aislada, sistólica limítrofe y diastólica fueron de 32,7, 2,21, 9,58 y 19,31 por 100 habitantes, respectivamente. La prevalencia de HA aumentó con la edad. La HA y la hipertensión diastólica fueron significativamente más prevalente en los varones. De los hipertensos diastólicos 77,7% tenían hipertensión leve, 15,57% moderada y 6,73% severa. Las PS sistólicas aumentaron linealmente con la edad. Las PS distólicas también se incrementaron con la edad hasta los 55 años y en el de 65-74 o más descendieron. La alta prevalencia de HA en La Plata podría explicar la elevada tasa anual de mortalidad por enfermedades cardíacas hipertensivas de la población de esta ciudad

Efectos del ejercicio dinamico sobre la presión sanguinea de los hipertensos tratados com atenolol y enalapril / The effects of dynamic exercise on blood pressure of hypertensive patients treated with atenolol and enalapril maleate

Se realizó este estudio cruzado en hipertensos eseciales, sin entrenamiento, para comparar los efectos de enalapril y atenolol sobre la precisión sanguínea (PS), la frecuencia cardíaca y los niveles ergométricos máximos durante el ejercicio dinámico. Fueron investigados 6 mujeres y 11 varones con una media de edades de 47,9 años (rango 27 a 60). Las dosis fueron las necesarias para lograr normotensión en reposo (PS < 160/95 mmHg). Las medias de las PS sistólicas fueron inferiores, en cada nivel ergométrico, cuando recibieron atenolol y no hubo diferencias significativas en el comportamiento de las PS diastólicas. Bajo tratamiento con atenolol fueron inferiores las medias de la frecuencias cardíacas en reposo y en todos los niveles ergométricos (p < 0,001). Con ambos tratamientos 15 individuos llegaron a 600 Kgm/min. Once con enalapril y 8 con atenolol alcançaron los 750 Kgm/min, y 4 con enalapril y 3 atenolol los 900 Kgm/min (NS). Estos resultados evidencian que atenolol controla mejor que enalapril la PS sistólica durante el esfuerzo ergométrico y que no existieron diferencias significativas en los niveles ergométricos máximos. Las cargas utilizadas equivalen a las requeridas para actividades cotidianas y deporte no competitivo. Los resultados podrían defirir en atletas entrenados