Total adult cardiovascular risk in Central America.

OBJECTIVE: To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. METHODS: Risk factors were derived from a multi-national cross-sectional survey implemented in 2003-2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. RESULTS: Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30-40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. CONCLUSIONS: Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.

Long-term effects of a randomised trial of a 6-year lifestyle intervention in impaired glucose tolerance on diabetes-related microvascular complications: the China Da Qing Diabetes Prevention Outcome Study.

AIMS/HYPOTHESIS: We determined the effects of 6 years of lifestyle intervention in persons with impaired glucose tolerance (IGT) on the development of retinopathy, nephropathy and neuropathy over a 20 year period. METHODS: In 1986, 577 adults with IGT from 33 clinics in Da Qing, China were randomly assigned by clinic to a control group or one of three lifestyle intervention groups (diet, exercise, and diet plus exercise). Active intervention was carried out from 1986 to 1992. In 2006 we conducted a 20 year follow-up study of the original participants to compare the incidence of microvascular complications in the combined intervention group vs the control group. RESULTS: Follow-up information was obtained on 542 (94%) of the 577 original participants. The cumulative incidence of severe retinopathy was 9.2% in the combined intervention group and 16.2% in the control group (p = 0.03, log-rank test). After adjusting for clinic and age, the incidence of severe retinopathy was 47% lower in the intervention group than the control group (hazard rate ratio 0.53, 95% CI 0.29-0.99, p = 0.048). No significant differences were found in the incidence of severe nephropathy (hazard rate ratio 1.05, 95% CI 0.16-7.05, intervention vs control, p = 0.96) or in the prevalence of neuropathy (8.6% vs 9.1%, p = 0.89) among the 20 year survivors. CONCLUSIONS/INTERPRETATION: Lifestyle intervention for 6 years in IGT was associated with a 47% reduction in the incidence of severe, vision-threatening retinopathy over a 20 year interval, primarily due to the reduced incidence of diabetes in the intervention group. However, similar benefits were not seen for nephropathy or neuropathy.

Recent population changes in HbA(1c) and fasting insulin concentrations among US adults with preserved glucose homeostasis.

AIMS/HYPOTHESIS: Although diagnosed type 2 diabetes has increased in the past decade, little is known about accompanying changes in fasting plasma glucose (FPG), HbA(1c) and fasting serum insulin (FI) levels in the non-diabetic population. METHODS: Using population estimates from National Health and Nutrition Examination Surveys, we compared distribution of FPG, HbA(1c) and FI in non-diabetic US persons who were >or=20 years old in 1999 to 2006 with that in persons of the same age in 1988 to 1994. RESULTS: Age-, sex- and race-adjusted mean FPG levels between the two study periods did not change, but mean HbA(1c) and FI levels increased (0.10% and 4.8 pmol/l, respectively; p < 0.001 for both). The increased HbA(1c) level was driven largely by an upward shift in the lower end of the HbA(1c) distribution. In contrast, the increased FI level was driven primarily by an upward shift in the middle and higher end of FI distribution, especially among persons aged 20 to 44 years. After adjustments for BMI or waist circumference, the increase in the mean HbA(1c) level was attenuated (0.06%; p < 0.001), whereas the mean FPG level decreased by 0.1 mmol/l (p < 0.001) and the mean FI level no longer demonstrated significant change. CONCLUSIONS/INTERPRETATION: Despite little change in the distribution of FPG levels, HbA(1c) and FI levels increased in the non-diabetic population in the past decade. The increase in FI levels suggests that levels of insulin resistance were greater among US adults, especially young adults, than in the previous decade.

Ethnic Variations in Diabetes and Prediabetes Prevalence and the roles of Insulin Resistance and ß-cell Function: The CARRS and NHANES Studies.

AIMS: It is unclear how the prevalence of diabetes in Asian Indians in urban India compares to that of race/ethnic groups in the US that may have different underlying susceptibilities. Therefore we examined ethnic variations in the prevalence of type 2 diabetes, iIFG, iIGT, IFG+IGT, and the associated risk factors in Asian Indians in Chennai, India, and Whites, Blacks, and Hispanics in the United States. METHODS: Cross-sectional analyses, using representative samples of 4,867 Asian Indians aged 20-74 years from Chennai, India in the Centre for Cardiometabolic Risk Reduction in South-Asia study (CARRS) (2010-2011) and 6,512 US Whites, Blacks, and Hispanics aged 20-74 years from the National Health and Nutrition Examination Survey (NHANES) (2007-2012). RESULTS: The age-adjusted prevalence of type 2 diabetes was highest in Asian Indians (men; 29.0, 95% CI: 25.9, 31.0), women; (30.6, 95% CI, 27.5, 33.9)) and lowest in Caucasians (men; 12.2, 95% CI, 10.3, 14.4), women; 9.5 (7.9, 11.5). Asian Indians had the lowest prediabetes prevalence (men; 19.0 (17.2, 20.8); women 27.2, 95% CI, 22.8, 32.1)) and Caucasians had the highest (men; 46.5 (43.5, 49.6), women; 34.4, 95% CI, 31.7, 37.3). However, there were differences in prediabetes prevalence by gender and prediabetes state. The inclusion of HOMA-ß in standardized polytomous logistic regression models resulted in a greater odds of diabetes in Blacks and Hispanics compared to Asian Indians. CONCLUSIONS: The high prevalence of diabetes in Asian Indians may be due to innate susceptibilities for ß-cell dysfunction in this high risk population.

Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group.

BACKGROUND: The long-term effect of type 2 diabetes on cognitive function is uncertain. OBJECTIVE: To determine whether older women with diabetes have an increased risk of cognitive impairment and cognitive decline. DESIGN: Prospective cohort study. SETTING: Four research centers in the United States (Baltimore, Md; Portland, Ore; Minneapolis, Minn; and the Monongahela Valley, Pennsylvania). PARTICIPANTS: Community-dwelling white women 65 years and older (n = 9679). MEASUREMENTS: Physician-diagnosed diabetes and other aspects of health history were assessed by interview. Three tests of cognitive function, the Digit Symbol test, the Trails B test, and a modified version of the Mini-Mental State Examination (m-MMSE), were administered at baseline and 3 to 6 years later. Change in cognitive function was defined by the change in the score for each test. Major cognitive decline was defined as the worst 10th percentile change in the score for each test. RESULTS: Women with diabetes (n = 682 [7.0%]) had lower baseline scores than those without diabetes on all 3 tests of cognitive function (Digit Symbol and Trials B tests, P<.01; m-MMSE, P = .03) and experienced an accelerated cognitive decline as measured by the Digit Symbol test (P<.01) and m-MMSE (P = .03). Diabetes was also associated with increased odds of major cognitive decline as determined by scores on the Digit Symbol (odds ratio = 1.63; 95% confidence interval, 1.20-2.23) and Trails B (odds ratio, 1.74; 95% confidence interval, 1.27-2.39) tests when controlled for age, education, depression, stroke, visual impairment, heart disease, hypertension, physical activity, estrogen use, and smoking. Women who had diabetes for more than 15 years had a 57% to 114% greater risk of major cognitive decline than women without diabetes. CONCLUSION: Diabetes is associated with lower levels of cognitive function and greater cognitive decline among older women.

Relationship of locus of control to physical activity among people with and without diabetes.

OBJECTIVE: To examine the relationship between locus of control (LOC) (internal and external) and physical activity in Pima Indians and to determine whether this relationship is affected by the presence of diabetes. RESEARCH DESIGN AND METHODS: A population-based sample of 580 Pima Indians was recruited from an ongoing research study. LOC was measured on a 1-40 modified Rotter scale, and past year total physical activity (leisure and work physical activity levels combined) was measured by interviewer-administered questionnaire. RESULTS: Among both men and women without diabetes, individuals with an internal LOC (score 1-16) were significantly (P < 0.01) more active than those with an external (score 17-40) LOC (70 vs. 30 median metabolic equivalent [MET] hours per week for men: 12 vs. 5 median MET hours per week for women). Controlled for age and BMI, an internal LOC was significantly associated with a higher level of physical activity among men (P = 0.04) and women (P = 0.001) without diabetes, but not among those with diabetes. CONCLUSIONS: Nondiabetic Pima Indians with an internal LOC are more physically active than those with an external LOC. Enhancing perceptions of internal control may influence physical activity and thus have implications for diabetes prevention.

Diabetes and physical disability among older U.S. adults.

OBJECTIVE: To estimate the prevalence of physical disability associated with diabetes among U.S. adults > or =60 years of age. RESEARCH DESIGN AND METHODS: We analyzed data from a nationally representative sample of 6,588 community-dwelling men and women > or =60 years of age who participated in the Third National Health and Nutrition Examination Survey. Diabetes and comorbidities (coronary heart disease, intermittent claudication, stroke, arthritis, and visual impairment) were assessed by questionnaire. Physical disability was assessed by self-reported ability to walk one-fourth of a mile, climb 10 steps, and do housework. Walking speed, lower-extremity function, and balance were assessed using physical performance tests. RESULTS: Among subjects > or =60 years of age with diabetes, 32% of women and 15% of men reported an inability to walk one-fourth of a mile, climb stairs, or do housework compared with 14% of women and 8% of men without diabetes. Diabetes was associated with a 2- to 3-fold increased odds of not being able to do each task among both men and women and up to a 3.6-fold increased risk of not being able to do all 3 tasks. Among women, diabetes was also associated with slower walking speed, inferior lower-extremity function, decreased balance, and an increased risk of falling. Of the >5 million U.S. adults > or =60 years of age with diabetes, 1.2 million are unable to do major physical tasks. CONCLUSIONS: Diabetes is associated with a major burden of physical disability in older U.S. adults, and these disabilities are likely to substantially impair their quality of life.

Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence.

OBJECTIVES: Assess the relationship between physical activity and risk for falls and osteoporotic fractures among older adults. DESIGN: Review and synthesis of published literature. MEASUREMENTS: We searched the literature using MEDLINE, Current Contents, and the bibliographies of articles identified. We included randomized controlled trials (RCT) of the effects of physical activity on the incidence of falls and case-control and prospective cohort studies of the association of physical activity with osteoporotic fracture risk. We also summarized mechanisms whereby physical activity may influence risk for falls and fractures. RESULTS: Observational epidemiologic studies and randomized clinical trials evaluating the effectiveness of physical activity programs to prevent falls have been inconclusive. However, many studies have lacked adequate statistical power, and recent trials suggest that exercise, particularly involving balance and lower extremity strength training, may reduce risk of falling. There is consistent evidence from prospective and case-control studies that physical activity is associated with a 20-40% reduced risk of hip fracture relative to sedentary individuals. The few studies that have examined the association between physical activity and risk of other common osteoporotic fractures, such as vertebral and wrist fractures, have not found physical activity to be protective. CONCLUSIONS: Epidemiologic studies suggest that higher levels of leisure time physical activity prevent hip fractures and RCTs suggest certain exercise programs may reduce risk of falls. Future research needs to evaluate the types and quantity of physical activity needed for optimal protection from falls and identify which populations will benefit most from exercise.

Use of diabetes preventive care and complications risk in two African-American communities.

BACKGROUND: We examined levels of diabetes preventive care services and glycemic and lipid control among African Americans with diabetes in two North Carolina communities. METHODS: Cross-sectional, population-based study of 625 African-American adults with diagnosed diabetes. Participants had a household interview to determine receipt of preventive care services including glycosylated hemoglobin (HbA(1c)), blood pressure, lipid, foot, dilated eye, and dental examinations; diabetes education; and health promotion counseling. A total of 383 gave blood samples to determine HbA(1c) and lipid values. RESULTS: Annual dilated eye, foot, and lipid examinations were reported by 70% to 80% of the population, but only 46% reported HbA(1c) tests. Rates of regular physical activity (31%) and daily self-monitoring of blood glucose (40%) were low. Sixty percent of the population had an HbA(1c) level >8% and one fourth had an HbA(1c) level >10%. Half of the population had a low-density lipoprotein value >130 mg/dL. Lack of insurance was the most consistent correlate of inadequate care (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.3-3.9), having HbA(1c) >9.5% (OR=2.1, 95% CI=1.1-4.2), and LDL levels >130 mg/dL (OR=2.1; 95% CI=1.0-4.5). CONCLUSIONS: Levels of diabetes preventive care services were comparable to U.S. estimates, but glycemic and lipid control and levels of self-management behaviors were poor. These findings indicate a need to understand barriers to achieving and implementing good glycemic and lipid control among African Americans with diabetes.

Prevalence of type 2 diabetes mellitus in Taiwan: ethnic variation and risk factors.

The purpose of this study was to compare the prevalence of diabetes and risk factors for the disease in three ethnic groups in Taiwan; the Hakaas, Fukienese, and aborigines. A cross-sectional study of men and women aged 50-79 years were invited to attend a standardized interview and physical examination. Diabetes mellitus was defined as a fasting plasma glucose (concentration of greater than or = 126) or a previous diagnosis of diabetes. Demographic, socioeconomic, and risk factor data were obtained. A total of 1293 persons (468 Hakaas, 440 Fukienese, and 385 aborigines) completed the examination. Hakaas had the highest age-adjusted prevalence of diabetes, 17.9% in men and 15.5% in women, followed by Fukienese, 14.5% in men and 12.8% in women. Aborigines had a prevalence of 10.0% in men and 13.3% in women. Diabetes prevalence was positively associated with family history of diabetes, obesity, hypertension, and hypertriglyceridemia. The ethnic variation in diabetes prevalence was reduced after adjustment for age, sex and significant factors. The multivariate-adjusted odds ratios (95% confidence interval) were 1.27 (0.76-2.12) for Fukienese and 1.44 (0.89-2.33) for Hakaas compared with aborigines. Diabetes mellitus is a major public health problem in Taiwan and warrants prevention efforts tailored to the country's different ethnic groups.

Diabetes--a common, growing, serious, costly, and potentially preventable public health problem.

An estimated 135 million people worldwide had diagnosed diabetes in 1995, and this number is expected to rise to at least 300 million by 2025. The number of people with diabetes will increase by 42% (from 51 to 72 million) in industrialized countries between 1995 and 2025 and by 170% (from 84 to 228 million) in industrializing countries. Several potentially modifiable risk factors are related to diabetes, including insulin resistance, obesity, physical inactivity and dietary factors. Diabetes may be preventable in high-risk groups, but results of ongoing clinical trials are pending. Several efficacious and economically acceptable treatment strategies are currently available (control of glycemia, blood pressure, lipids; early detection and treatment of retinopathy, nephropathy, foot-disease; use of aspirin and ACE inhibitors) to reduce the burden of diabetes complications. Diabetes is a major public health problem and is emerging as a pandemic. While prevention of diabetes may become possible in the future, there is considerable potential now to better utilize existing treatments to reduce diabetes complications. Many countries could benefit from research aimed at better understanding the reasons why existing treatments are under-used and how this can be changed.

High prevalence of impaired fasting glucose and type 2 diabetes mellitus in Penghu Islets, Taiwan: evidence of a rapidly emerging epidemic?

The purpose of this study was to estimate the prevalence of type 2 diabetes and impaired fasting glucose (IFG) in Penghu, Taiwan and compare these estimates with those of the US (NHANES III). Diabetes and IFG (American Diabetes Association criteria, 1997) were assessed among a stratified random sample of 2500 residents of Penghu Islands, Taiwan. The prevalence (age-adjusted to world adult population) of diabetes and IFG were 16.8% (95% CI 15.0-18.6) and 21.0% (95% CI 19.0-23.0), respectively, among Penghu Islanders in Taiwan. Age sex-specific diabetes prevalence ranged from 10.0% in men aged 40-49 years to 29.4% in women aged 60-69 years. Prevalence of IFG ranged from 14.7% in women aged 40-49 years to 30.7% in men aged 50-59 years. Age, body mass index (BMI), and family history of diabetes were each independently associated with both diabetes and IFG. In addition, female gender, apolipoprotein B and triglyceride concentrations were associated with diabetes, and hypertension and apolipoprotein B concentration with IFG. Among persons > or = 40 years in Penghu, Taiwan, the prevalence of diabetes is up to a third higher and the prevalence of IFG is up to three times higher than comparably aged Americans, despite their having a mean BMI 2.2-3.2 kg/m2 lower than Americans. The alarmingly high prevalence of IFG in Taiwan may indicate an emerging diabetes epidemic.

Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia.

Background. The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries. Methods. We extracted data from the World Health Organization's STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM). We used these data to estimate associations for socioeconomic position (education, income, and employment) and demographics (age, sex, and urban/rural) with CVD risk factors and with healthcare access, among a sample of 1638 adults (25-64 years). Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (<9 years) than among those with postsecondary education (>12 years). Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men. Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends.

Total adult cardiovascular risk in Central America / Riesgo cardiovascular total en adultos en América América

Objective. To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. Methods. Risk factors were derived from a multi-national cross-sectional survey implemented in 2003–2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. Results. Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30–40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. Conclusions. Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.

Objetivo. Evaluar la prevalencia del riesgo de padecer enfermedades cardiovasculares en adultos de 40 años de edad o mayores mediante el uso de muestras poblacionales obtenidas de seis países de América Central. Métodos. Se tomaron los factores de riesgo de una encuesta transversal multinacional realizada entre 2003 y 2006, que incluyó una muestra de 4 202 participantes de 40 años de edad o mayores. Se usaron gráficos producidos por la Organización Mundial de la Salud y la Sociedad Internacional para la Hipertensión de la Región de las Américas, subregión B, para predecir el riesgo sobre la base de factores como la edad, el sexo, la presión arterial, las concentraciones totales de colesterol sérico, y la situación con respecto al tabaquismo y la diabetes. Resultados. En términos generales, 85,9% de la población quedó clasificada en el grupo con un riesgo menor de 10% de sufrir episodios cardiovasculares en el transcurso de los 10 años siguientes. La probabilidad de pertenecer a este grupo de riesgo disminuyó con la edad, tanto en los hombres como en las mujeres. Se determinó que 4% de los encuestados tenían un riesgo mayor de 20%. Más de 75% de los que tenían un riesgo de 30% a 40% ya habían sido identificados por los servicios de salud y otro 23% fue identificado durante el estudio, lo cual indica que los diagnósticos pueden hacerse mediante un tamizaje oportunista para la detección de diabetes, hipertensión e hipercolesterolemia. Según los resultados del análisis bivariado, los entrevistados de sexo masculino, de edad más avanzada, obesos o con poca escolaridad tenían un mayor riesgo de sufrir episodios cardiovasculares, pero un análisis multivariado que abarcó el nivel educativo reveló que los riesgos más altos los tienen las mujeres mayores, obesas y con poca instrucción. Conclusiones. El cálculo del riesgo cardiovascular permite identificar la mayoría de los casos (o personas con riesgo de presentar) diabetes, hipertensión e hipercolesterolemia en adultos de 40 años de edad o mayores. Esta estrategia puede facilitar la puesta en práctica de los programas de control, así como reducir la discapacidad y la mortalidad prematura.

Total adult cardiovascular risk in Central America / Riesgo cardiovascular total en adultos en América Central

OBJECTIVE:To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. METHODS: Risk factors were derived from a multi-national cross-sectional survey implemented in 2003-2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. RESULTS: Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30-40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. CONCLUSIONS: Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.

RESUMEN OBJETIVO:Evaluar la prevalencia del riesgo de padecer enfermedades cardiovasculares en adultos de 40 años de edad o mayores mediante el uso de muestras poblacionales obtenidas de seis países de América Central. MÉTODOS: Se tomaron los factores de riesgo de una encuesta transversal multinacional realizada entre 2003 y 2006, que incluyó una muestra de 4 202 participantes de 40 años de edad o mayores. Se usaron gráficos producidos por la Organización Mundial de la Salud y la Sociedad Internacional para la Hipertensión de la Región de las Américas, subregión B, para predecir el riesgo sobre la base de factores como la edad, el sexo, la presión arterial, las concentraciones totales de colesterol sérico, y la situación con respecto al tabaquismo y la diabetes. RESULTADOS: En términos generales, 85,9% de la población quedó clasificada en el grupo con un riesgo menor de 10% de sufrir episodios cardiovasculares en el transcurso de los 10 años siguientes. La probabilidad de pertenecer a este grupo de riesgo disminuyó con la edad, tanto en los hombres como en las mujeres. Se determinó que 4% de los encues-tados tenían un riesgo mayor de 20%. Más de 75% de los que tenían un riesgo de 30% a 40% ya habían sido identificados por los servicios de salud y otro 23% fue identificado durante el estudio, lo cual indica que los diagnósticos pueden hacerse mediante un tami-zaje oportunista para la detección de diabetes, hipertensión e hipercolesterolemia. Según los resultados del análisis bivariado, los entrevistados de sexo masculino, de edad más avanzada, obesos o con poca escolaridad tenían un mayor riesgo de sufrir episodios cardiovasculares, pero un análisis multivariado que abarcó el nivel educativo reveló que los riesgos más altos los tienen las mujeres mayores, obesas y con poca instrucción. CONCLUSIONES: El cálculo del riesgo cardiovascular permite identificar la mayoría de los casos (o personas con riesgo de presentar) diabetes, hipertensión e hipercolesterolemia en adultos de 40 años de edad o mayores. Esta estrategia puede facilitar la puesta en práctica de los programas de control, así como reducir la discapacidad y la mortalidad prematura.