Outcomes of Blacks Versus Whites with Cardiomyopathy.

Racial disparities in health outcomes have been widely documented in medicine, including in cardiovascular care. While some progress has been made, these disparities have continued to plague our healthcare system. Patients with cardiomyopathy are at an increased risk of death and cardiovascular hospitalizations. In the present analysis, we examined the baseline characteristics and outcomes of black and white men and women with cardiomyopathy. All patients with cardiomyopathy (left ventricular ejection fraction (LVEF) < 50%) cared for at University of Pittsburgh Medical Center (UPMC) between 2011 and 2017 were included in this analysis. Patients were stratified by race, and outcomes were compared between Black and White patients using Cox proportional hazard models. Of a total of 18,003 cardiomyopathy patients, 15,804 were white (88%), 1,824 were black (10%) and 375 identified as other (2%). Over a median follow-up time of 3.4 years, 7,899 patients died. Black patients were on average a decade younger (p <0.001) and demonstrated lower unadjusted all-cause mortality (hazard ratio [HR]: 0.83%; 95% CI 0.77 to 0.90; p < 0.001). However, after adjusting for age and other comorbidities, black patients had higher all-cause mortality compared to white patients (HR: 1.15, 95% CI 1.07 to 1.25; p < 0.001). These differences were seen in both men (HR:1.19, 95% CI 1.08 to 1.33; p < 0.001) and women (HR:1.12, 95% CI 0.99 to 1.25; p = 0.065). In conclusion, our data demonstrate higher all-cause mortality in black compared to white men and women with cardiomyopathy. These findings are likely explained, at least in part, by significantly higher rates of comorbidities in black patients. Earlier interventions targeting these comorbidities may mitigate the risk of progression to heart failure and improve outcomes.

Association between polymorphisms in the APOB gene and hyperlipidemia in the Chinese Yugur population.

We investigated the influence of apolipoprotein B gene (APOB) variants on the risk of hyperlipidemia (HL) in 631 middle-aged and elderly members of the Chinese Yugur population (HL, n=336; normolipidemia, n=295). APOB polymorphisms were identified using mass spectrometry, and five single nucleotide polymorphisms (rs1042034, rs2163204, rs512535, rs676210, and rs679899) and serum lipids were further analyzed. rs1042034 and rs676210 were significantly associated with HL (P<0.05). Compared with the GG or AA genotype, individuals with AG and AG+AA in rs1042034 and with AG and AG+GG in rs676210 had a 1.67-fold (95%CI=1.20-2.33),1.63-fold (95%CI=1.19-2.24), 1.72-fold (95%CI=1.24-2.40), and 1.67-fold (95%CI=1.21-2.291) increased risk of high HL, respectively. rs2163204 was in strong linkage disequilibrium with rs1042034, rs676210, and rs679899, and strong disequilibrium was observed between rs1042034 and rs676210 (D'>0.9). Compared with the GTGAA haplotype, haplotypes ATGGA and ATAGG were more strongly associated with HL [odds ratio (OR)=1.46, 95%CI=0.02-2.11; OR=1.63, 95%CI=1.03-2.60, respectively]. The risk factors age (P=0.008), body mass index (P<0.0001), GA+GG genotype in rs676210 (P=0.009), and alcohol consumption (P=0.056) contributed strongly to HL development. The A allele of rs1042034 and the G allele of rs676210 may thus predispose middle-aged and elderly members of the Chinese Yugur population to HL in combination with other genetic or nutritional factors, and could be used as new genetic markers for HL screening.

Association between polymorphisms in the APOB gene and hyperlipidemia in the Chinese Yugur population

We investigated the influence of apolipoprotein B gene (APOB) variants on the risk of hyperlipidemia (HL) in 631 middle-aged and elderly members of the Chinese Yugur population (HL, n=336; normolipidemia, n=295). APOB polymorphisms were identified using mass spectrometry, and five single nucleotide polymorphisms (rs1042034, rs2163204, rs512535, rs676210, and rs679899) and serum lipids were further analyzed. rs1042034 and rs676210 were significantly associated with HL (P<0.05). Compared with the GG or AA genotype, individuals with AG and AG+AA in rs1042034 and with AG and AG+GG in rs676210 had a 1.67-fold (95%CI=1.20-2.33),1.63-fold (95%CI=1.19-2.24), 1.72-fold (95%CI=1.24-2.40), and 1.67-fold (95%CI=1.21-2.291) increased risk of high HL, respectively. rs2163204 was in strong linkage disequilibrium with rs1042034, rs676210, and rs679899, and strong disequilibrium was observed between rs1042034 and rs676210 (D′>0.9). Compared with the GTGAA haplotype, haplotypes ATGGA and ATAGG were more strongly associated with HL [odds ratio (OR)=1.46, 95%CI=0.02-2.11; OR=1.63, 95%CI=1.03-2.60, respectively]. The risk factors age (P=0.008), body mass index (P<0.0001), GA+GG genotype in rs676210 (P=0.009), and alcohol consumption (P=0.056) contributed strongly to HL development. The A allele of rs1042034 and the G allele of rs676210 may thus predispose middle-aged and elderly members of the Chinese Yugur population to HL in combination with other genetic or nutritional factors, and could be used as new genetic markers for HL screening.

Implications of the New US Cholesterol Guidelines in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: The new US guidelines for the primary prevention of cardiovascular disease have substantially changed the approach to hyperlipidemia treatment. However, the impact of those recommendations in other populations is limited. In the present study, we evaluated the potential implications of those recommendations in the Brazilian population. HYPOTHESIS: The new U.S. recommendations may increase the proportion of individuals who are candidates for statin therapy. METHODS: We included all participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) without known cardiovascular disease. We calculated the indication for statin therapy according to the current Brazilian recommendations and the new US guidelines, using both the 5.0% and the 7.5% risk cutoffs to recommend treatment, and compared their impact in the Brazilian population stratified by age, sex, and race. RESULTS: Although the current guidelines would recommend treatment for 5499 (39.1%) individuals, the number of individuals eligible for statin therapy increased to 6014 (42.7%) and to 7130 (50.7%) using the 7.5% and 5% cutoffs, respectively (P < 0.001). This difference is more pronounced for older individuals, and virtually all individuals age >70 years would be eligible for statins, whereas the new guidelines would reduce the number of candidates for statin therapy in individuals age <45 years. CONCLUSIONS: The application of the new US guidelines for the use of lipid-lowering medications in a large middle-aged Brazilian cohort would result in a significant increase in the population eligible for statins. This is largely driven by males and older individuals. Additional cost-effectiveness analyses are needed to define the appropriateness of this strategy in the Brazilian population.

Direct effects of fatty meals and adiposity on oxidised low-density lipoprotein.

High-fat intake and high adiposity contribute to hyperlipaemia. In a hyperlipaemic state, lipoproteins infiltrate arterial wall where they are modified and cause an immune response characteristic of atherosclerosis. A small fraction of modified lipoproteins including oxidised low-density lipoprotein (ox-LDL) returns to circulation. The present study tracked high-fat meals during four weeks as to find effects of sustained frequency change on adiposity and ox-LDL. The findings indicated that changes in frequency of consumption of high-fat eating episodes correlated directly with changes in adiposity and ox-LDL. Hence the number of fatty meals consumed by people with overweight or obesity in few weeks could affect the atherogenic process.

Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States.

CONTEXT: Major cardiovascular diseases (CVDs) are leading causes of mortality among US Hispanic and Latino individuals. Comprehensive data are limited regarding the prevalence of CVD risk factors in this population and relations of these traits to socioeconomic status (SES) and acculturation. OBJECTIVES: To describe prevalence of major CVD risk factors and CVD (coronary heart disease [CHD] and stroke) among US Hispanic/Latino individuals of different backgrounds, examine relationships of SES and acculturation with CVD risk profiles and CVD, and assess cross-sectional associations of CVD risk factors with CVD. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos including individuals of Cuban (n = 2201), Dominican (n = 1400), Mexican (n = 6232), Puerto Rican (n = 2590), Central American (n = 1634), and South American backgrounds (n = 1022) aged 18 to 74 years. Analyses involved 15,079 participants with complete data enrolled between March 2008 and June 2011. MAIN OUTCOME MEASURES: Adverse CVD risk factors defined using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. Prevalence of CHD and stroke were ascertained from self-reported data. RESULTS: Age-standardized prevalence of CVD risk factors varied by Hispanic/Latino background; obesity and current smoking rates were highest among Puerto Rican participants (for men, 40.9% and 34.7%; for women, 51.4% and 31.7%, respectively); hypercholesterolemia prevalence was highest among Central American men (54.9%) and Puerto Rican women (41.0%). Large proportions of participants (80% of men, 71% of women) had at least 1 risk factor. Age- and sex-adjusted prevalence of 3 or more risk factors was highest in Puerto Rican participants (25.0%) and significantly higher (P < .001) among participants with less education (16.1%), those who were US-born (18.5%), those who had lived in the United States 10 years or longer (15.7%), and those who preferred English (17.9%). Overall, self-reported CHD and stroke prevalence were low (4.2% and 2.0% in men; 2.4% and 1.2% in women, respectively). In multivariate-adjusted models, hypertension and smoking were directly associated with CHD in both sexes as were hypercholesterolemia and obesity in women and diabetes in men (odds ratios [ORs], 1.5-2.2). For stroke, associations were positive with hypertension in both sexes, diabetes in men, and smoking in women (ORs, 1.7-2.6). CONCLUSION: Among US Hispanic/Latino adults of diverse backgrounds, a sizeable proportion of men and women had adverse major risk factors; prevalence of adverse CVD risk profiles was higher among participants with Puerto Rican background, lower SES, and higher levels of acculturation.

A comparison of blood pressure, body mass index, and acanthosis nigricans in school-age children.

The purpose of this retrospective quantitative study was to examine the relationships among acanthosis nigricans (AN), body mass index (BMI), blood pressure (BP), school grade, and gender in children attending elementary school located in South West Texas. Data were collected by attending school district nurses. Researchers reviewed 7,026 previously collected records from a state mandated public school health screening program in elementary school Grades 3, 5, 7, and 9, conducted by school nurses. Of 7,026 records, 6,867 were included for the secondary analysis. A logistic regression analysis was carried out with the AN marker as the dependant variable and school grade, gender, BMI, and BP as the independent variables. The results of the study suggest that a direct relationship exists between the AN marker, BMI, and BP in school-age children. Further study is warranted based on the number of school-age children who are now found to be obese.

Addressing low-density lipoprotein (LDL) in Mexican Americans with diabetes in the NHANES (1999-2000 and 2001-2002).

The National Health and Nutrition Examination Survey (1999-2000 and 2001-2002) was utilized to examine and compare low-density lipoprotein levels in Mexican Americans with diabetes.

Identification of two common variants contributing to serum apolipoprotein B levels in Mexicans.

BACKGROUND AND PURPOSE: Although the Mexican population has a high predisposition to dyslipidemias and premature coronary artery disease, this population is underinvestigated for the genetic factors conferring the high susceptibility. This study attempted to determine these genetic factors. METHODS AND RESULTS: First, we investigated apolipoprotein B (apoB) levels in Mexican extended families with familial combined hyperlipidemia using a two-step testing strategy. In the screening step, we screened 5721 single-nucleotide polymorphisms (SNPs) for linkage signals with apoB. In the test step, we analyzed the 130 SNPs residing in regions of suggestive linkage signals for association with apoB. We identified significant associations with two SNPs (ie, rs1424032 [P=6.07x10(-6)] and rs1349411 [P=2.72x10(-4)]) that surpassed the significance level for the number of tests performed in the test step (P<3.84x10(-4)). Second, these SNPs were tested for replication in Mexican hyperlipidemic case-control samples. The same risk alleles as in the families with familial combined hyperlipidemia were significantly associated (P<0.05) with apoB in the case-control samples. The rs1349411 resides near the apoB messenger RNA editing enzyme (APOBEC1) involved in the processing of APOB messenger RNA in the small intestine. The rs1424032 resides in a highly conserved noncoding region predicted to function as a regulatory element. CONCLUSIONS: We identified two novel variants, rs1349411 and rs1424032, for serum apoB levels in Mexicans.

BMI and lipid levels in Mexican American children diagnosed with type 2 diabetes.

PURPOSE: The purpose of this study was to determine potential associations between obesity as measured by body mass index (BMI) and lipid values in Mexican American (MA) children diagnosed with type 2 diabetes. BACKGROUND: Obesity in children is considered to be an emerging epidemic that is accompanied by an increase in prevalence of type 2 diabetes. Literature shows that there is a direct and strong relationship between abnormal lipid levels and obesity in Caucasian and African American children without type 2 diabetes. However, it was unknown whether Mexican American children diagnosed with type 2 diabetes have abnormal lipid levels. METHOD: A retrospective medical-record review was conducted on paediatric patients who received medical care from a military medical centre in the Southwest region of the United States. A convenience sample of records was used to study the relationship between obesity as measured by BMI and lipid levels in 49 Mexican American children diagnosed with type 2 diabetes. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and BMI were reviewed. Data were analysed using descriptive and logistic regression statistics. FINDINGS: Ninety percent of the sample was obese and 75% had two or more abnormal lipid values. Abnormal levels of total cholesterol, HDL, and triglycerides were found to be statistically significant. CONCLUSIONS: The main findings indicate that MA children diagnosed with type 2 diabetes had significant associations between obesity as measured by BMI and abnormal total cholesterol, HDL, and triglyceride levels. As the BMI increased, the probability of abnormal total cholesterol and triglyceride levels increased. Similarly, as the BMI increased, the probability of abnormal HDL values increased. Mexican American children in this study had obesity levels similar to those in a study by the National Center for Health Statistics. In this study a step has been taken toward understanding a physiologic marker for cardiovascular disease in children.

Association of increased levels of homocysteine and peripheral arterial disease in a Japanese-Brazilian population.

OBJECTIVES: Our aim was to evaluate the possible association between homocysteine levels and peripheral arterial disease (PAD) in a population-based study of Japanese-Brazilians. MATERIALS AND METHODS: This cross-sectional study was derived from a population-based survey on the prevalence of diabetes and associated diseases conducted in Japanese-Brazilians. A total of 1330 male and female subjects aged>or=30 years were submitted to clinical examination and laboratory procedures including homocysteine measurement. The ankle-brachial index (ABI) was calculated; subjects with ABI values <0.9 were diagnosed with PAD. The evaluable population included 1008 subjects. Logistic regression was used taking PAD as the dependent variable. RESULTS: Mean age of the population was 56.5 years and overall prevalence of PAD was 20%. A worse cardiovascular profile was found in male patients, including significantly higher homocysteine levels (11.9+/-1.8 vs. 9.1+/-1.1micromol/L, p<0.001). Men with PAD had higher prevalence rates of hyperhomocysteinemia compared to women (22.7% vs 7.6%). Univariate analysis showed an odds ratio of hyperhomocysteinemia for PAD of 1.51 [1.02-2.25] in men and 1.69 [1.06-2.68] in women. After adjustment for other cardiovascular risk factors, higher levels of homocysteine were only significantly related to PAD in men. CONCLUSION: In a Japanese-Brazilian population, elevated levels of homocysteine are associated with PAD in men. Prospective studies are necessary to confirm this finding.

Cardiovascular risk among older Hispanic women: a pilot study.

This study used a descriptive correlational design to describe the relationship between cardiovascular risk and anxiety, spirituality, acculturation, and the objective indices of cardiac risk among a sample of 21 adult Hispanic women. Objective indices of risk included weight, blood pressure, blood lipids, and glucose. Four survey instruments were used to assess anxiety, spirituality, acculturation, and perceived risk. Findings revealed that all study participants had 3 or more risk factors, placing them in the moderate risk category for developing heart disease or having a heart attack within 10 years. State and trait anxiety scores were lower than the normative samples for adult women. Spirituality scores were higher than average; individuals with higher anxiety scores had lower spirituality scores. More research is needed to determine the health needs of unskilled workers with limited education in employment settings.

Microalbuminuria and abnormal ambulatory blood pressure in adolescents with type 2 diabetes mellitus.

OBJECTIVE: To determine whether risk factors for cardiovascular disease and diabetic nephropathy, as evidenced by abnormalities of ambulatory blood pressure (ABP), dyslipidemia, and microalbuminuria (MA), are present in adolescents with type 2 diabetes mellitus (T2DM). STUDY DESIGN: We enrolled 26 minority adolescents recently diagnosed with T2DM and 13 obese control subjects without diabetes mellitus. ABP monitoring was performed, and a 24-hour urine, a fasting lipid profile, blood urea nitrogen, creatinine, homocysteine, and hemoglobin A 1 c levels were obtained. The patients with T2DM underwent echocardiograms. RESULTS: Forty percent of the patients with T2DM had MA (> or = 30 mg of microalbumin/day), compared with none of the control subjects ( P < .05). There were no significant differences between patients with T2DM who had MA and patients with T2DM who didn't have MA in demographics, characteristics, casual BP, echocardiographic findings, and hemoglobin A 1 c levels. Average daytime systolic BP was greater in patients with T2DM with MA than patients without MA (129 versus 121 mm Hg, P = .03) and compared with the control subjects (113 mm Hg, P = .01). Patients with MA had an average daytime systolic BP load that was higher than patients without MA (37.1 versus 5.1%, P = .008) and compared with the control subjects (2.6%, P < .001). CONCLUSION: As in adults, adolescents with T2DM exhibit abnormalities of ABP, dyslipidemia, and microalbuminuria.

Hipotireoidismo e doença aterosclerótica coronariana / Hypothyroidism and atherosclerosis

O hipotireoidismo tem importância clínica na etiologia de dislipidemia e no desenvolvimento da aterosclerose. Mais comumente dependente da falência primária da glândula que tem maior prevalência em populações idosas, particularmente do sexo feminino, podendo apresentar-se na forma clínica manifesta ou subclínica, que cursa assintomática, com alteração discreta do TSH sérico. O tratamento do hipotireoidismo está vinculado à forma clínica: na forma manifesta é indiscutível. Também está indicado na forma subclínica acompanhada de dislipidemia secundária. A reposição de hormônios tireoidianos deve ser gradual e lenta, com cuidado especial em pacientes com coronariopatia manifesta, controlando-se os níveis séricos de TSH, que idealmente devem ser mantidos abaixo de 2mU/l.

[Cardiovascular risk factors for Surinamese in the Netherlands: a literature review]. / Cardiovasculaire risicofactoren bij Surinamers in Nederland: een literatuuroverzicht.

OBJECTIVE: To obtain an overview of the prevalence of cardiovascular risk factors in Surinamese (Hindustani and Creoles) individuals in the Netherlands and the implications of this for secondary prevention. DESIGN: Literature study. METHOD: A Medline literature search was carried out for the period 1985-2001 with the keywords 'cardiovascular risk factor' or 'cardiovascular risk factors', and 'Surinamese'. In addition to this, so-called grey literature was searched and the reference lists of articles found were also checked. A total of 7 studies were selected. RESULTS: Smoking is less frequent among Surinamese individuals in the Netherlands compared to the indigenous population, especially in women. The prevalence of both hypertension and diabetes is higher among the Surinamese. Data on dyslipidaemia are almost absent; it is only known that hypercholesterolaemia is less prevalent among the Surinamese. Ethnicity is not included in the risk cards used in the secondary treatment of cardiovascular diseases. CONCLUSION: The lack of research with respect to the cardiovascular risk profile of Surinamese (Hindustani and Creoles) in the Netherlands indicates an unfavourable profile compared to the indigenous Dutch population. This difference justifies further research into the differentiation of prevention and treatment according to ethnic origin.

Elderly Japanese emigrants to Brazil before World War II: I. Clinical profiles based on specific historical background.

OBJECTIVE: To research the demographic and clinical profiles of elderly Japanese emigrants, who arrived in Brazil before World War II, in order to give them appropriate psychogeriatric care. DESIGN: Elderly Japanese immigrants aged 65 years and over, belonging to the Miyagi Association in the São Paulo Metropolitan Area, were targeted. They emigrated from Miyagi Prefecture to Brazil and are now living in the area. We were able to interview 166 respondents. All data were gathered using standardized interview methods covering (a) free interview about the immigration history, (b) demographics, and (c) physical status. RESULTS: Through the free interview, we found their immigration histories, which affected their clinical profiles. The mean age and educational level were 77.5 years and 6.3 years, respectively. Sixty per cent of them immigrated when they were younger than 14. Ninety-four per cent of them still keep Japanese nationality. Fifty-seven per cent of them usually use Japanese, while 10% of them use Portuguese. Although their emigration histories were hard, 76% of them perceived their health as being excellent or relatively good. The percentages of subjects with histories of disease were hypertension, 52.5%; cardiac disease, 20.8%; diabetes mellitus, 24.2%; and hyperlipidemia, 25.0%, which were affected by the Brazilian environment. CONCLUSION: The elderly Japanese who emigrated to Brazil before World War II have a unique historical and demographic background. Their clinical profiles cannot be fully understood without knowing their histories. They definitely need high quality international psychogeriatric care.

Low prevalence of type 2 diabetes despite a high average body mass index in the Aymara natives from Chile.

The aim of this study was to estimate the prevalence of type 2 diabetes mellitus (DM2), impaired glucose tolerance (IGT), and the frequency of dyslipidemia, obesity, and hypertension in the rural Aymara population from Northern Chile. In this cross-sectional study, 196 Aymara adult subjects were characterized with respect to their reported physical activity, fasting plasma glucose levels, insulin concentrations, blood pressures, body mass indexes, and plasma lipid profiles. The participants also underwent a 2-h oral glucose tolerance test. The diagnostic criteria for DM2 and IGT followed those of the World Health Organization. The overall prevalence of DM2 was estimated as 1.5% (95% confidence interval: 0.3--4.5). Overall prevalence of IGT was calculated as 3.6% (1.5--7.3). The occurrence of obesity and dyslipidemia was relatively high in the Aymara population, although the frequency of sedentary habits, and the prevalence of hypertension were low. In conclusion, the prevalence of DM2 in the rural Aymara population living at high altitudes in Northern Chile, was much lower than that of other Amerindian groups that adopted lifestyles from industrialized Western societies. Despite a relatively high prevalence of a body mass index of at least 30 kg/m(2), especially in women (23.5%), high physical activity levels and low plasma-insulin concentrations may have been responsible in part for the low prevalence of DM2 in the Aymara population.

[Relation between ethnicity and reason for referral of new patients to the Internal Medicine outpatient clinic of the Academic Hospital Rotterdam-Dijkzigt, 1997]. / Samenhang tussen etniciteit en verwijsreden bij nieuwe patiënten op de polikliniek Inwendige Geneeskunde van het Academisch Ziekenhuis Rotterdam-Dijkzigt, 1997.

OBJECTIVE: To inventory the ethnic composition of the patients referred to an internal medicine outpatient clinic of a Dutch academic hospital and to determine to what extent ethnic minorities differ from Dutch patients in terms of referral reasons, taking relevant background characteristics into account. DESIGN: Cross-sectional analysis. METHOD: Data were collected on all new patients referred in 1997 for the first time to the internal medicine outpatient clinic of the Academic Hospital Dijkzigt, Rotterdam, the Netherlands, using the hospital information system (n = 3205). Patients were categorised into ethnic groups based on country of birth or name. Ethnic differences in referral reasons were tested for the 4 largest ethnic groups by means of logistic regression analysis with adjustment for age, sex, mean income of the zipcode area of the patients' residence and type of health insurance. RESULTS: The percentage of ethnic minorities amongst all referred patients was 22% (696/3205). The percentage of ethnic minorities among the patients referred from the catchment area of the outpatient clinic was 48% (209/440). Compared with Dutch patients Turkish patients were referred more often with stomach ache (odds ratio (OR): 4.26) and joint problems (OR: 7.16) as reasons. Moroccans were more often referred with stomach ache (OR: 4.10) and diabetes (OR: 4.51). Ethnic minorities were referred less often with dyslipidemia (Turks: OR: 0.11; Surinamese: OR: 0.17; Moroccans: 0 patients).

Development and initial evaluation of a culturally sensitive cholesterol-lowering diet program for Mexican and African American patients with systemic lupus erythematosus.

OBJECTIVE: To develop and evaluate acceptability of an intensive and ethnic-specific cholesterol-lowering diet program with a strong behavioral component in patients with systemic lupus erythematosus (SLE). METHOD: A comprehensive program with a behavioral component and culturally sensitive menus was developed in an effort to alter dietary behavior in patients with SLE. Four SLE patients, 2 African American and 2 Mexican American, enrolled in this program. Data on food intake (3-day food record), acceptability of the program (subjective response), and physiologic variables were collected at baseline, 6 weeks, and 12 weeks. RESULTS: The program was highly rated by all patients and found to be informative, easy to understand, ethnically sensitive, and to contain useful behavioral maintenance strategies. All 4 patients surpassed or were close to their diet goals at both 6 and 12 weeks. In this small group of patients, there was a statistically significant reduction in low-density lipoprotein cholesterol (P = 0.04) and body weight (P = 0.001), as assessed by repeated measures analysis of variance. CONCLUSION: The culturally specific cholesterol-reducing diet program was highly rated and appeared to be effective in changing the diet of this small group of SLE patients, as determined by their food records and body weight. The impact of this program, including the individual components on cardiovascular disease risk factors, needs to be evaluated in a larger multiple-arm study with a lengthier intervention.

Prevalencia de obesidad, hipertensión arterial y dislipidemia en grupos aborígenes rurales de Chile / Prevalence of obesity, hypertension and serum lipid profiles in chilean rural aboriginal communities

Background: Chilean aboriginal ethnic groups (mapuche and aymaras) have a very low prevalence rate of type 2 diabetes. The investigation of a possible relationship between this low prevalence of diabetes and obesity, hypertension and serum lipid profiles in both groups is worthwhile. Aim: To study the prevalence of obesity, hypertension and lipid profile in two chilean aboriginal communities. Subjects and Methods: The prevalence of obesity, hypertension, fasting serum total cholesterol, HDL cholesterol, triglycerides, glucose, insulin, leptin and oral glucose tolerance test were measured in 345 mapuche (106 male) and 247 aymara (100 male) individuals. Results: Sixty three percent of mapuche women, 37.9 percent of mapuche men, 39.7 percent of the aymara women and 27.0 percent of aymara men had a body mass index over 27 kg/m2. Twenty percent of mapuche men, 18.0 percent of mapuche women, 9.0 percent of aymara men and 4.8 percent of the aymara women had high blood pressure values. Serum HDL cholesterol was below 35 mg/dl in 16 percent of mapuche women, 14 percent of mapuche men, 25 percent of the aymara women and 27 percent of aymara men. No differences in total cholesterol levels were observed between mapuches and aymaras. Conclusion: Mapuche women have higher prevalence of obesity and high blood pressure than aymara women. Low serum HDL cholesterol has a higher prevalence among aymara individuals