Encuesta sobre factores de riesgo de enfermedad cardiovascular en la mujer, su percepción, conocimiento y conducta de prevención / Survey on Women's Perception and Awareness of Cardiovascular Risk Factors and How They Are Managed

RESUMEN Introducción : La enfermedad cardiovascular (ECV) es la principal causa de muerte en la mujer. A pesar de esto, las mujeres reciben menos frecuentemente que los hombres asesoramiento y/o tratamiento preventivo con el objetivo de disminuir la ECV. Objetivo : Detectar la prevalencia de factores de riesgo cardiovascular (FRC) y pesquisar el nivel de percepción y conocimiento de la mujer sobre FRC y ECV. Material y métodos : Estudio observacional, de corte transversal realizado en julio 2021, mediante una encuesta en formato digital de participación anónima y voluntaria. Se recabó información sobre edad, FRC, ECV, percepción de riesgo, implemen tación de hábitos y conductas saludables. Resultados : Participaron 3338 mujeres. El 50,1% tenía entre 46 y 65 años. El 34,1% tenía sobrepeso, el 43,6% perímetro de cintura mayor que 80 cm, el 24,2% hipertensión (HTA), el 19,6% colesterol mayor que 200 mg/dL, el 5,4% diabetes (DBT); 44,3% eran sedentarias, 11,3% fumaban y 34,5% eran exfumadoras. El 82,1% tuvo al menos un embarazo y el 26,9% refirió alguna complicación. Entre las pacientes con antecedentes de complicaciones del embarazo fueron significativamente más frecuentes la HTA (34% vs 24%, p <0,01), la DBT (7% vs 5%, p = 0,04) y la ECV (14% vs 11%, p <0,01). Del total de encuestadas 10,9% refirió ECV, el antecedente de infarto de miocardio fue el más frecuente (51,1%). El 62% de las encuestadas consideró que la principal causa de muerte en la mujer es el cáncer, particularmente de mama (53,4%). Conclusiones : Se encontró una alta prevalencia de FRC modificables con baja percepción del riesgo cardiovascular. El antecedente de complicaciones del embarazo se asoció con mayor prevalencia de FRC.

ABSTRACT Background : Cardiovascular disease (CVD) is the leading cause of death in women. Nevertheless, women are less likely than men to receive guidance or preventive treatment to reduce it. Objective : The aim of this study was to detect the prevalence of cardiovascular risk factors (CRF) and detect the level of women's perception and awareness of CRF and CVD. Methods : We conducted an observational, cross-sectional study in July 2021 using a voluntary, anonymous, and online survey. The information collected included age range, CRF, CVD, risk perception and implementation of healthy habits and behaviors. Results : A total of 3888 women participated (with age range between 46 and 65 years in 50.1%); 34.1% had excess weight and 43.6% had a waist circumference > 80 cm. Hypertension (HTN) was reported by 24.2%; total cholesterol was > 200 mg/ dL in 19.6%; 5,4% were diabetics (DM); 44.3% had sedentary lifestyle; 11.3% were current smokers and 34.5% were former smokers; 82.1% had been pregnant at least once and 26.9% reported a complication during pregnancy. A bad obstetric history was more commonly associated with HTN (34% vs. 24%, p < 0.01), DM (7% vs. 5%, p = 0.04) and CVD (14% vs. 11%, p <0.01). Among the 10.9% who reported a history of CVD, myocardial infarction was the most common condition (51.1%). Sixty-two percent of survey respondents considered that cancer, and particularly breast cancer (53.4%), is the main cause of death in women (53.4%). Conclusions : We found a high prevalence of modifiable CRFs with low perception of cardiovascular risk. A bad obstetric history was associated with higher prevalence of CRF.

Current status of nuclear cardiology practice in Latin America and the Caribbean, in the era of multimodality cardiac imaging approach: 2022 update.

Cardiovascular diseases (CVDs) are the leading cause of mortality in Latin America and the Caribbean (LAC), with the risk in men being slightly higher than in women. The coronavirus disease 2019 (COVID-19) pandemic caused a significant reduction in the number of cardiac diagnostic procedures globally and in particular in LAC. Nuclear cardiology is available in the region, but there is variability in terms of existing technology, radiopharmaceuticals, and human resources. In the region, there are 2385 single photon emission computed tomography (SPECT) and 315 PET scanners, Argentina and Brazil have the largest number. There is an increasing number of new technologies such as cadmium-zinc-telluride (CZT) cardiac-dedicated gamma cameras, SPECT/computed tomography (CT), and PET/CT. All countries performed myocardial perfusion imaging studies, mainly gated-SPECT; the rest are multi-gated acquisition, mainly for cardiac toxicity; detection of viability; rest gated SPECT in patients with dilated cardiomyopathy, and bone-avid tracer cardiac scintigraphy for transthyretin cardiac amyloidosis diagnosis. Regarding other non-nuclear cardiac imaging modalities, Argentina, Colombia, and Chile have the highest ratio of CT scanners, while Brazil, Argentina, and Chile show the highest ratio of MRI scanners. The development of nuclear cardiology and other advanced imaging modalities is challenged by the high cost of equipment, lack of equipment maintenance and service, insufficient-specific training both for imaging specialists and referring clinicians, and lack of awareness of cardiologists or other referring physicians on the clinical applications of nuclear cardiology. Another important aspect to consider is the necessity of implementing cardiac imaging multimodality training. A joint work of nuclear medicine specialists, radiologists, cardiologists, and clinicians, in general, is mandatory to achieve this goal. National, regional, and international cooperation including support from scientific professional societies such as the American Society of Nuclear Cardiology and Latin American Association of Biology and Nuclear Medicine Societies, cardiological societies, and organizations such as the International Atomic Energy Agency, and Pan American Health Organization, as well as government commitment are key factors in the overall efforts to tackle the burden of cardiovascular diseases in the region.

Interleukin 10 Polymorphisms as Risk Factors for Progression to Chagas Disease Cardiomyopathy: A Case-Control Study and Meta-Analysis.

Background: Chagas disease is a lifelong infection caused by the protozoa Trypanosoma cruzi endemic in Latin-America and emergent worldwide. Decades after primary infection, 20-30% of infected people develop chronic Chagas cardiomyopathy (CCC) while the others remain asymptomatic. CCC pathogenesis is complex but associated with sustained pro-inflammatory response leading to tissue damage. Hence, levels of IL-10 could have a determinant role in CCC etiology. Studies with Latin-American populations have addressed the association of genetic variants of IL-10 and the risk of developing CCC with inconsistent results. We carried out a case control study to explore the association between IL-10-1082G>A (rs18008969), -819C>T (rs1800871), -592A>C (rs1800872) polymorphisms and CCC in a population attending a hospital in Buenos Aires Argentina. Next, a systematic review of the literature and a meta-analysis were conducted combining present and previous studies to further study this association. Methods: Our case control study included 122 individuals with chronic T. cruzi infection including 64 patients with any degree of CCC and 58 asymptomatic individuals. Genotyping of IL-10 -1082G>A, -819C>T, -592A>C polymorphisms was performed by capillary sequencing of the region spanning the three polymorphic sites and univariate and multivariate statistical analysis was undertaken. Databases in English, Spanish and Portuguese language were searched for papers related to these polymorphisms and Chagas disease up to December 2021. A metanalysis of the selected literature and our study was performed based on the random effect model. Results: In our cohort, we found a significant association between TT genotype of -819 rs1800871 and AA genotype of -592 rs1800872 with CCC under the codominant (OR=5.00; 95%CI=1.12-23.87 P=0,04) and the recessive models (OR=5.37; 95%CI=1.12-25.68; P=0,03). Of the genotypes conformed by the three polymorphic positions, the homozygous genotype ATA was significantly associated with increased risk of CCC. The results of the meta-analysis of 754 cases and 385 controls showed that the TT genotype of -819C>T was associated with increased CCC risk according to the dominant model (OR=1.13; 95% CI=1.02-1.25; P=0,03). Conclusion: The genotype TT at -819 rs1800871 contributes to the genetic susceptibility to CCC making this polymorphism a suitable candidate to be included in a panel of predictive biomarkers of disease progression.

Prevalencia de factores de riesgo y riesgo cardiovascular global en la población de Tres Lomas / Prevalence of Risk Factors and Global Cardiovascular Risk in the Population of Tres Lomas

Introducción La mortalidad atribuida a las enfermedades cardiovasculares se encuentra en primer lugar y en aumento en los países en vías de desarrollo. En la Argentina, las enfermedades cardiovasculares producen, junto con el cáncer, más del 50% de las muertes anuales. En contraposición a las enfermedades infecciosas, éstas se denominan genéricamente enfermedades no transmisibles y se ha demostrado que son prevenibles en gran medida a través del control y el manejo de los llamados factores de riesgo para el desarrollo de enfermedades cardiovasculares. Es por ello que la información sobre la prevalencia y la variación en el tiempo de estos factores de riesgo es fundamental para realizar una vigilancia epidemiológica del problema de las enfermedades cardiovasculares en la población y, a su vez, para proponer acciones comunitarias preventivas. Objetivos Obtener información sobre los factores de riesgo cardiovascular en la población de Tres Lomas (Buenos Aires), calcular el riesgo cardiovascular global (RCG) y comparar estos resultados con los descriptos para toda la Argentina. Material y métodos Se entrevistaron al azar 522 adultos de Tres Lomas. Se utilizó el cuestionario para vigilancia epidemiológica de la OPS y se realizaron mediciones antropométricas. En 100 individuos se determinaron lípidos y glucemia para estimar el RCG, definido como probabilidad de desarrollar un evento no fatal o muerte coronaria en los próximos 10 años. Por último, estas prevalencias se compararon con las estimadas a nivel nacional. Resultados Hubo menor prevalencia de diabetes (7,7% versus 11,9%; p < 0,0001), tabaquismo (27,7% versus 33,4%; p < 0,0054) y depresión (14,4% versus 22,8%; p < 0,0001), aunque más sobrepeso y obesidad que el promedio país (58,4% versus 49,1%; p < 0,0001). Aunque la medición de la tensión arterial fue más frecuente que el promedio (82,2% versus 68,4%; p< 0,0001), las determinaciones de glucemia (50,2% versus 69,3%; p < 0,0001) y de colesterol (60,3% versus 72,8%; p < 0,0001) fueron menos frecuentes que las esperadas. El consumo de frutas y verduras fue mayor que a nivel nacional (82,6% versus 64,7%; p < 0,0001). Por lo menos un quinto de la población presentaría un RCG moderado [21% (13,1-28,9%)] a alto [12% (5,4-18,6%)]. Conclusiones En Tres Lomas se observó una prevalencia menor de diabetes, tabaquismo y depresión y más sobrepeso y obesidad que el promedio país. El control de la tensión arterial fue más frecuente que el promedio, aunque las determinaciones de glucemia y colesterol fueron más bajas que las esperadas. Por lo menos un quinto de la población presentaría un RCG moderado a alto de sufrir un evento coronario o muerte en los próximos 10 años.

Background Cardiovascular diseases are the first cause of mortality in developing countries and deaths attributed to these conditions are increasing. In Argentina, cardiovascular diseases and cancer account for more than 50% of annual deaths. Unlike infectious diseases, these conditions are generically called non-communicable diseases, and it has been demonstrated that they can be prevented through an adequate control and management of cardiovascular risk factors. Thus, it is essential to report the prevalence of these risk factors and how they change over time in order to perform an epidemiological surveillance of the problem of cardiovascular diseases in the population and, in turn, propose preventive community actions. Objectives To obtain information on cardiovascular risk factors in the population of Tres Lomas (Buenos Aires), estimate the global cardiovascular risk (GCR) and compare these results with those described for the whole Argentina. Material and Methods Five hundred and twenty two adults from Tres Lomas were randomly surveyed. The PAHO questionnaire for epidemiological surveillance was used and anthropometric measurements were estimated. Lipid levels and glycemia were determined in 100 subjects in order to estimate GCR, defined as the probability to develop a new non-fatal event or coronary death over the next 10 years. Finally, these prevalence rates were compared to the national estimations. Results The prevalence of diabetes (7.7% versus 11.9%; p<0.0001), smoking habits (27.7% versus 33.4%; p<0.0054) and depression (14.4% versus 22.8%; p<0.0001), was lower than the country's average; however, the rate of overweight and obesity was greater (58.4% versus 49.1%; p<0.0001). Although blood pressure measurement was more frequent than the average (82.2% versus 68.4%; p<0.0001), determinations of glycemia and cholesterol levels were less frequent than expected (50.2% versus 69.3%; p<0.0001 and 60.3% versus 72.8%; p < 0.0001, respectively). Fruit and vegetable consumption was greater than in the whole country (82.6% versus 64.7%; p<0.0001). At least one fifth of the population presented a moderate [21% (13.1-28.9%)] to high [12% (5.4-18.6%)] GCR. Conclusions The prevalence of diabetes, smoking habits and depression was lower in Tres Lomas, although overweight and obesity were more frequent than the country's average. Blood pressure control was more frequent and determinations of glycemia and cholesterol levels were lower than expected. At least one fifth of the population presented a moderate to high GCR of developing a coronary event or death over the next 10 years.

Características métricas de un cuestionario para evaluar la calidad de vida profesional de los médicos cardiólogos / Metric Characteristics of a Professional Quality of Life Questionnaire in Cardiologists

Introducción La calidad de la atención médica de los sistemas de salud parece relacionarse con la satisfacción de los profesionales que los integran; es por ello que el estudio del estrés y la insatisfacción laboral de los profesionales es de especial interés. Por otra parte, es sabido que la medición de la calidad de vida profesional (CVP) puede variar de acuerdo con el instrumento que se utilice, con el entorno organizativo del sistema de salud y con el tipo de profesional o la especialidad que ejerza. Objetivo Evaluar la factibilidad, la consistencia interna, la capacidad discriminativa y la composición factorial de un cuestionario de CVP aplicado a una población de médicos cardiólogos en la Argentina. Material y métodos Entre abril y junio de 2007 se propuso un cuestionario anónimo a 717 cardiólogos a fin de evaluar distintos aspectos de la CVP, a saber: percepción de la situación laboral, posibilidad de realización personal y expectativa de futuro. Se realizó un análisis de factores y se midieron la validez de construcción y la confiabilidad del cuestionario. Resultados El análisis identificó los tres dominios antes señalados. En conjunto, estos tres componentes explicaron el 46% de la variabilidad total del instrumento, nivel exigible para una validez estructural adecuada. Por su parte, el α de Cronbach total del cuestionario fue 0,76. Por último, la confiabilidad se demostró con una buena correlación entre el puntaje total del instrumento y los parciales obtenidos en cada dominio (factor 1: rho = 0,806, p < 0,0001; factor 2: rho = 0,726, p < 0,0001 y factor 3: rho = 0,754, p < 0,0001). Conclusiones El análisis de las características métricas de este cuestionario demostró la fiabilidad y la validez del instrumento para evaluar la CVP del médico cardiólogo en la Argentina.

Background Health care systems quality seems to be related with the professional satisfaction of health care providers; for this reason there is a special interest in studying occupational stress and job dissatisfaction among physicians. In addition, it is well known that measuring the professional quality of life (PQL) may vary according to the instrument used, to the organizational environment of the health care system and to the type of professional or medical specialty practiced. Objective To assess the feasibility, internal consistency, discriminative capacity and factorial composition of a PQL questionnaire used in a population of cardiologists in Argentina. Material and Methods Between April and June 2007 we offered an anonymous questionnaire to 717 cardiologists in order to assess different aspects related to the PQL: perception of their working situation, personal accomplishment and expectancy in the future. An analysis of factors was performed and the validity of construction and the reliability of the questionnaire were measured. Results The analysis identified the three aforementioned domains. These three components altogether explained the 46% of the total variability of the instrument, a level considered necessary for an adequate structural validity. The Cronbach’s α for the total questionnaire was 0.76. Finally, a good correlation was observed between the total score of the instrument and the partial score in each domain (factor 1: rho=0.806, p<0.0001; factor 2: rho=0.726, p<0.0001 and factor 3: rho=0.754, p<0.0001). Conclusions The analysis of the metric characteristics of this questionnaire demonstrated the feasibility and validity of the instrument as a tool to measure the QPL among cardiologists in Argentina.

Alterations in intestinal microbial flora and human disease.

PURPOSE OF REVIEW: To highlight the evidence supporting the role of altered commensal gut flora in human disease. While the contribution of the indigenous gut microbial community is widely recognized, only recently has there been evidence pointing to indigenous flora in disease. RECENT FINDINGS: This review discusses recent evidence pointing to the role of altered commensal gut flora in such common conditions as irritable bowel syndrome and inflammatory bowel disease. Recent studies document the intricate relationship between the vast population of microbes that live in our gut and the human host. Since increased intestinal permeability and immune activation are consequences of an altered host-gut microbial relationship, what are the clinical effects of this shift in relationship? SUMMARY: We focus on the example of an abnormal expansion of gut microbial flora into the small bowel or small intestinal bacterial overgrowth and discuss the effects of bacterial overgrowth on the human host in acute pancreatitis, bacterial gastroenteritis, irritable bowel syndrome, inflammatory bowel disease, hepatic encephalopathy, and fibromyalgia and burn injury. The identification of the underlying role of altered commensal gut microbiota in these and other human diseases could lead to novel diagnostic and therapeutic strategies that would improve clinical outcome.

The influence of collection site and methods on postmortem morphine concentrations in a porcine model.

This study was to determine the relationship of antemortem to postmortem morphine concentrations in heart and femoral blood in a porcine model following acute intravenous opiate overdose. The study involved 20 swine; each was sacrificed 10 min after injection of 2 mg/kg body weight of morphine. Drug concentrations were assayed from vitreous humor and blood isolated from the femoral vein and artery and left and right ventricles at various times postmortem. Comparisons were made between antemortem and postmortem values to determine agreement and reliability. Both free and total postmortem values varied significantly among animals, sampling sites, and over time. Free postmortem values were generally higher in comparison with antemortem values, whereas postmortem total morphine values were similar to or slightly lower than antemortem values. The effect of time on postmortem values was small. These results demonstrate a significant amount of variability in free and total morphine measurements both over time and within and between sites. Furthermore, a comparison of antemortem to postmortem values demonstrates a lack of consistency relative to the dose of morphine administered. Concentrations of morphine in the femoral vein were typically the lowest observed. This observation is not surprising given the transformation that occurs prior to the drug reaching the femoral vein. Values associated with diffuse tissues, relative to femoral veins, demonstrate more stochastic variation.

Subsequent suicide mortality among emergency department patients seen for suicidal behavior.

OBJECTIVES: To determine whether suicide mortality rates for a cohort of patients seen and subsequently discharged from the ED for a suicide-related complaint were higher than for ED comparison groups. METHODS: This was a nonconcurrent cohort study set at a university-affiliated urban ED and Level 1 trauma center. All ED patients 10 years and older, with at least one ED visit between February 1994 and November 2004, were eligible. ED visit characteristics defined the cohort exposure. Patients with visits for suicide attempt or ideation, self-harm, or overdose (exposed) were compared with patients without these visits (unexposed). Exposure classification was determined from billing diagnoses, E-codes (E950-E959), and free-text searching of the ED tracking system data for suicide, overdose, and spelling variants. Emergency department patient data were probabilistically linked to state mortality records. The principal outcome was suicide death. Suicide mortality rates were calculated by using person-year (py) analyses. Relative rates (RR) and 95% confidence intervals (95% CIs) were calculated from Cox proportional hazards models. RESULTS: Among the 218,304 patients, the average follow-up was 6.0 years; there were 408 suicide deaths (incidence rate [IR]: 31.2 per 100,000 py). Males (IR: 48.3) had a higher rate than females (IR: 13.5; RR: 3.6; 95% CI = 2.8 to 4.6). A single ED visit for overdose (RR: 5.7; 95% CI = 4.5 to 7.4), suicidal ideation (RR: 6.7; 95% CI = 5.0 to 9.1), or self-harm (RR: 5.8; 95% CI = 5.1 to 10.6) was strongly associated with increased suicide risk, relative to other patients. CONCLUSIONS: The suicide rate among these ED patients is higher than population-based estimates. Rates among patients with suicidal ideation, overdose, or self-harm are especially high, supporting policies that mandate psychiatric interventions in all cases.