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1.
Cardiovasc Diabetol ; 19(1): 164, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004045

RESUMEN

BACKGROUND: Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity. METHODS: We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders. RESULTS: Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90-3.06, adjp = 0.10). CONCLUSIONS: Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.


Asunto(s)
Betacoronavirus , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/metabolismo , Infecciones por Coronavirus/metabolismo , Diabetes Mellitus/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Enfermedades Metabólicas/diagnóstico , Enfermedades Metabólicas/epidemiología , Enfermedades Metabólicas/metabolismo , Persona de Mediana Edad , Multimorbilidad/tendencias , Pandemias , Neumonía Viral/metabolismo , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
2.
Colomb Med (Cali) ; 51(2): e4320, 2020 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-33012891

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) has resulted in a global health crisis. Prior to the arrival of this viral pandemic, the world was already plagued with a significant burden of cardiovascular disease. With the introduction of the novel virus, the world now faces a double jeapordy. Early reports have suggested an increased risk of death in individuals with underlying cardio-metabolic disorders. The exact effects of COVID-19 on the cardiovascular system are not well determined, however lessons from prior viral epidemics suggest that such infections can trigger acute coronary syndromes, arrhythmias and heart failure via direct and indirect mechanisms. In this article, we aimed to discuss the effects and potential underlying mechanisms of COVID -19 as well as potential implications of treatments targeted against this virus on the cardiovascular system.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus/aislamiento & purificación , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/virología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Humanos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Factores de Riesgo
3.
Curr Atheroscler Rep ; 22(12): 72, 2020 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-33009957

RESUMEN

PURPOSE OF REVIEW: The review highlights selected studies related to cardiovascular disease (CVD) prevention that were presented at the 2020 European Society of Cardiology (ESC) Congress-The Digital Experience. RECENT FINDINGS: The studies reviewed include clinical trials on novel RNA interference-based lipid-lowering therapies AKCEA-APOCIII-LRx and vupanorsen (AKCEA-ANGPTL3-LRx); the EVAPORATE trial assessing the effects of icosapent ethyl on coronary plaque volume progression; the LoDoCo2 trial evaluating the efficacy of low-dose colchicine in cardiovascular disease risk reduction among patients with chronic coronary artery disease; as well as the EMPEROR-Reduced trial evaluating cardiovascular and renal outcomes with empagliflozin in patients with heart failure and reduced ejection fraction. In addition, we review the BPLTTC analysis on blood pressure treatment across blood pressure levels and CVD status and discuss findings from the BRACE CORONA study that examined continuing versus suspending angiotensin-converting enzyme inhibitor or angiotensin receptor blockers in patients on these antihypertensive medications who were hospitalized with COVID-19 infection. The studies presented at the 2020 digital ESC Congress highlight the continuing advancements in the field of CVD prevention.


Asunto(s)
Betacoronavirus/fisiología , Cardiología , Fármacos Cardiovasculares/farmacología , Enfermedades Cardiovasculares , Infecciones por Coronavirus , Reguladores del Metabolismo de Lípidos/farmacología , Pandemias , Neumonía Viral , Compuestos de Bencidrilo/farmacología , Cardiología/métodos , Cardiología/tendencias , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos como Asunto , Congresos como Asunto , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Ácido Eicosapentaenoico/análogos & derivados , Ácido Eicosapentaenoico/farmacología , Europa (Continente) , Glucósidos/farmacología , Humanos , Oligonucleótidos/farmacología , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Sociedades Médicas , Telecomunicaciones
5.
BMJ ; 370: m3342, 2020 09 23.
Artículo en Inglés | MEDLINE | ID: mdl-32967856

RESUMEN

OBJECTIVE: To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. DESIGN: Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-analysis. SETTING: Canadian Network for Observational Drug Effect Studies (CNODES), with administrative healthcare databases from seven Canadian provinces and the United Kingdom, 2013-18. POPULATION: 209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time conditional propensity score and followed for a mean of 0.9 years. MAIN OUTCOME MEASURES: The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. Cox proportional hazards models were used to estimate site specific adjusted hazards ratios and 95% confidence intervals, comparing use of SGLT2 inhibitors with use of DPP-4 inhibitors in an as treated approach. Site specific results were pooled using random effects meta-analysis. RESULTS: Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1 v 6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9 v 7.7; 0.60, 0.54 to 0.67), heart failure (3.1 v 7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7 v 17.3; 0.60, 0.54 to 0.67). SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6 v 3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with canagliflozin (0.79, 0.66 to 0.94), dapagliflozin (0.73, 0.63 to 0.85), and empagliflozin (0.77, 0.68 to 0.87). CONCLUSIONS: In this large observational study conducted in a real world clinical practice context, the short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939624.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido , Adulto Joven
7.
Adv Exp Med Biol ; 1268: 115-122, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32918215

RESUMEN

Increasing sun exposure is related to lower prevalence of death in cardiovascular disease (CVD), type 2 diabetes, and other noncancer non-CVD. In this chapter we aim to make a short update on the knowledge regarding sun exposure and all-cause mortality. Data support the hypothesis that low sun exposure habits are a major risk factor for all-cause mortality. Low sun exposure is related to an increased risk of death due to CVD and noncancer/non-CVD, and a minor reduction in risk of cancer. Active sun exposure habits have a dual effect; it increases the incidence of skin cancer, but also improves the prognosis in terms of all-cause mortality. In a low solar intensity region, we should carefully assess both risk and benefits of sun exposure in order to obtain balanced recommendations.


Asunto(s)
Causas de Muerte , Luz Solar , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Humanos , Factores de Riesgo , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología
8.
Acta Biomed ; 91(3): e2020018, 2020 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-32921715

RESUMEN

SARS-CoV-2 has shown its potential to cause severe manifestations among individuals with underlying cardiovascular disease (CVD). The patients infected with SARS-CoV-2 with pre-existing CVD are more likely to relapse. There are several reasons, including the prolonged hospitalization time as a consequence of their more severe illness and aberrant expression of angiotensin-converting enzyme 2 (ACE2) - the cell surface receptor of SARS-COV2 that is present on cardiac cells - and using drugs such as ACE inhibitors and angiotensin receptor blockers (ARBs) that alter the expression of ACE2. Besides, SARS-CoV-2 shares structural similarities with SARS-CoV-1, and that patients recovered from SARS-CoV1 have shown an increased risk of developing inflammatory, metabolic, and cardiac diseases. It makes some concerns that people who recovered from SARS-CoV2 are also liable to develop these chronic conditions later. Further studies should investigate the probability of recurrence of COVID-19 in patients with CVD and the development of approaches for the prevention of chronic inflammatory conditions in patients with CVD who recovered from COVID-19.


Asunto(s)
Betacoronavirus , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Medición de Riesgo , Comorbilidad , Salud Global , Humanos , Factores de Riesgo
9.
Acta Biomed ; 91(3): e2020021, 2020 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-32921718

RESUMEN

The COVID-19 epidemic initially started in Wuhan, China in December 2019 due to SARS-CoV-2. SARS-CoV-2 is genetically similar to the bat beta-coronavirus genus, but the novel specie of this genus can infect humans. The most common clinical features of COVID-19 are fever, cough, myalgia, fatigue, expectoration, and dyspnea. The primary reported mortality rate was about 2-3% in China; however, it reached up to 10% among patients with underlying cardiovascular diseases. The primary epidemiological investigations showed a high prevalence of underlying cardiovascular diseases in more than 40% of infected patients. A high prevalence of hypertension, ischemic heart disease, and diabetes were reported among deceased patients in Italy. Previous experiments in different pandemic situations showed that the cardiovascular system has been affected in many ways. Previous studies on SARS-CoV and MERS-CoV reported that cardiovascular co-morbidities had a direct correlation with the risk of infection, the severity of disease, and the mortality rate. Therefore, brief and available protocols for controlling the negative effects of this novel respiratory infection on the cardiovascular system, especially in a high-risk populations with underlying cardiovascular conditions, is one of the most serious concerns among healthcare providers. Herein, we aimed to review the available data on the cardiac manifestation of COVID-19. Besides, we described useful maps for the better treatment of COVID-19 infection in patients with underlying cardiovascular conditions, as a high-risk group of patients.


Asunto(s)
Betacoronavirus , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Medición de Riesgo/métodos , Causas de Muerte/tendencias , Comorbilidad , Salud Global , Humanos , Tasa de Supervivencia/tendencias
10.
Ann Ist Super Sanita ; 56(3): 373-377, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32959804

RESUMEN

We aimed to compare COVID-19-specific and all-cause mortality rates among natives and migrants in Italy and to investigate the clinical characteristics of individuals dying with COVID-19 by native/migrant status. The mortality rates and detailed clinical characteristics of natives and migrants dying with COVID-19 were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2,687) between February 21st and April 29th, 2020. The migrant or native status was assigned based on the individual's country of birth. The expected all-cause mortality among natives and migrants living in Italy was derived by the last available (2018) dataset provided by the Italian National Institute of Statistics. Overall, 68 individuals with a migration background were identified. The proportions of natives and migrants among the COVID-19-related deaths (97.5% and 2.5%, respectively) were similar to the relative all-cause mortality rates estimated in Italy in 2018 (97.4% and 2.6%, respectively). The clinical phenotype of migrants dying with COVID-19 was similar to that of natives except for the younger age at death. International migrants living in Italy do not have a mortality advantage for COVID-19 and are exposed to the risk of poor outcomes as their native counterparts.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Pandemias , Neumonía Viral/mortalidad , Migrantes/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Albania/etnología , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte , Comorbilidad , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Francia/etnología , Efecto del Trabajador Sano , Registros de Hospitales , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Neoplasias/epidemiología , Obesidad/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Renal Crónica/epidemiología
11.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32883943

RESUMEN

BACKGROUND The rapid worldwide spread of the coronavirus disease 2019 (COVID-19) epidemic has placed patients with pre-existing conditions at risk of severe morbidity and mortality. The present study investigated the clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS This study enrolled 336 consecutive patients with confirmed severe COVID-19, including 28 diagnosed with COPD, from January 20, 2020, to April 1, 2020. Demographic data, symptoms, laboratory values, comorbidities, and clinical results were measured and compared in survivors and non-survivors. RESULTS Patients with severe COVID-19 and COPD were older than those without COPD. The proportions of men, of patients admitted to the intensive care unit (ICU) and of those requiring invasive ventilation were significantly higher in patients with than without COPD. Leukocyte and neutrophil counts, as well as the concentrations of NT-proBNP, hemoglobin, D-dimer, hsCRP, ferritin, IL-2R, TNF-alpha and procalcitonin were higher, whereas lymphocyte and monocyte counts were lower, in patients with than without COPD. Of the 28 patients with COPD, 22 (78.6%) died, a rate significantly higher than in patients without COPD (36.0%). A comparison of surviving and non-surviving patients with severe COVID-19 and COPD showed that those who died had a longer history of COPD, more fatigue, and a higher ICU occupancy rate, but a shorter average hospital stay, than those who survived. CONCLUSIONS COPD increases the risks of death and negative outcomes in patients with severe COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Distribución por Edad , Anciano , Biomarcadores , Enfermedades Cardiovasculares/epidemiología , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiología , Fatiga/etiología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Neumonía Viral/sangre , Neumonía Viral/terapia , Enfermedad Pulmonar Obstructiva Crónica/sangre , Enfermedad Pulmonar Obstructiva Crónica/terapia , Insuficiencia Renal Crónica/epidemiología , Respiración Artificial , Distribución por Sexo , Sobrevivientes , Resultado del Tratamiento
12.
Cent Eur J Public Health ; 28(3): 208-218, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32997477

RESUMEN

OBJECTIVES: Fruit and vegetable intake has been reported as one of the significant protective factors against the development of cardiovascular diseases (CVD). This study aimed to assess the possible preventive effect of fruit and vegetable consumption on developing CVD. METHODS: A total of 398 participants (205 cases and 193 controls) referred for elective coronary angiography with clinical suspicion of coronary artery disease to Prince Hamza Hospital in Amman were enrolled in this case-control study. Dietary data were collected separately from each patient using interview-based food frequency questionnaire. RESULTS: The findings of the present study revealed that a total consumption of 3 servings of vegetable per day decreased significantly the risk of CVD to about 54% (OR = 0.46, 95% CI: 0.22-0.97, p = 0.033). Consumption of banana was found to reduce the risk of CVD to about 44% and 62% when consuming 1-2 and 3-6 servings/week, respectively, with p-value for trend 0.004. For the vegetables, the consumption of grape leaves and stuffed vegetables in general was significantly associated with lower risk of CVD. Increasing cauliflower consumption of 1-2 servings per week decreased CVD risk to about 37% (OR = 0.63, 95% CI: 0.38-0.98). Consuming up to 3-6 servings per week of mixed vegetables (OR = 0.10, 95% CI: 0.01-0.83) and onion (OR = 0.42, 95% CI: 0.22-0.80) revealed an inverse association with CVD development. CONCLUSIONS: Adding to the present evidence, consumption of some fruits and vegetables could be considered as preventive factor against developing CVD. However, the association of consuming vegetables with preventing CVD was higher than the fruit consumption.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Dieta/estadística & datos numéricos , Frutas , Verduras , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Humanos , Jordania/epidemiología , Factores Protectores
13.
BMJ Open ; 10(9): e041079, 2020 09 16.
Artículo en Inglés | MEDLINE | ID: mdl-32938604

RESUMEN

OBJECTIVES: Our research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19. DESIGN: We conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020. SETTING: Studies conducted in any setting and any country were included. PARTICIPANTS: Studies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2. RESULTS: In total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants' age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%-99%), cough (4%-92%), dyspnoea/shortness of breath (1%-90%), fatigue (4%-89%), myalgia (3%-65%) and pharyngalgia (2%-61%), while regarding comorbidities, we found cardiovascular disease (1%-40%), hypertension (0%-40%) and cerebrovascular disease (1%-40%). Such heterogeneity impaired the conduction of meta-analysis. CONCLUSIONS: The infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/fisiopatología , Tos/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Fiebre/fisiopatología , Neumonía Viral/fisiopatología , Betacoronavirus , Enfermedades Cardiovasculares/epidemiología , Trastornos Cerebrovasculares/epidemiología , Comorbilidad , Infecciones por Coronavirus/epidemiología , Humanos , Hipertensión/epidemiología , Mialgia/fisiopatología , Pandemias , Faringitis/fisiopatología , Neumonía Viral/epidemiología
15.
Medicine (Baltimore) ; 99(39): e22413, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991472

RESUMEN

Stroke is the acute onset of neurological deficits and is associated with high morbidity, mortality, and disease burden. In the present study, we aimed to develop a scientific, nomogram for non-invasive predicting risk for early ischemic stroke, in order to improve stroke prevention efforts among high-risk groups. Data were obtained from a total of 2151 patients with early ischemic stroke from October 2017 to September 2018 and from 1527 healthy controls. Risk factors were examined using logistic regression analyses. Nomogram and receiver operating characteristic (ROC) curves were drawn, cutoff values were established. Significant risk factors for early ischemic stroke included age, sex, blood pressure, history of diabetes, history of genetic, history of coronary heart disease, history of smoking. A nomogram predicting ischemic stroke for all patients had an internally validated concordance index of 0.911. The area under the ROC curve for the logistic regression model was 0.782 (95% confidence interval [CI]: 0.766-0.799, P < .001), with a cutoff value of 2.5. The nomogram developed in this study can be used as a primary non-invasive prevention tool for early ischemic stroke and is expected to provide data support for the revision of current guidelines.


Asunto(s)
Isquemia Encefálica/epidemiología , Nomogramas , Accidente Cerebrovascular/epidemiología , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología
17.
Medicine (Baltimore) ; 99(38): e22036, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32957321

RESUMEN

Studies about the effects of metabolically healthy obesity on cardiovascular disease (CVD) have yielded conflicting results. These heterogeneous results could be due to the limited usefulness of BMI in measuring general adiposity, as body mass index (BMI) does not accurately reflect body composition. This study aimed to evaluate the effect of body shape on CVD outcomes across different obesity phenotypes, and to provide an explanation for the heterogeneous effects of metabolically healthy obese (MHO) phenotype on CVD.We analyzed data from the Korean Genome and Epidemiology Study, a population-based cohort study conducted between 2001 and 2012. We divided the participants into 4 groups: metabolically healthy non-obese (MHNO), MHO, metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). To assess body shape, we calculated the z-score of the log-transformed a body shape index (LBSIZ). We computed Pearson correlation coefficients to examine the association of LBSIZ with muscle mass index, percentage of total fat mass (%Total FM), and percentage of abdominal fat mass (%Abdominal FM). We also used Cox proportional hazards regression to evaluate the effect of LBSIZ on CVD events according to the obesity phenotypes.A total of 9460 participants were assessed in this study. The incidence of CVD was 8.53 cases per 1000 person-year. LBSIZ showed strong positive correlation with %Total FM and %Abdominal FM, but negative correlation with muscle mass index. In Cox regression, MHO individuals did not show increased risk of CVD compared with MHNO individuals (hazard ratio [HR], 1.29; 95% confidence interval [CI], 0.96-1.73). However, MHO individuals in the 3rd (HR, 2.40; 95% CI, 1.28-4.51) and 4th (HR, 3.67; 95% CI, 1.99-6.74) quarters of LBSIZ showed significantly higher risk of CVD compared with MHNO individuals in the 1st quarter of LBSIZ. Moreover, LBSIZ showed a linear relationship with CVD among MHO individuals.While the MHO individuals showed similar CVD risk to the MHNO individuals, CVD risk increases with LBSIZ among the MHO individuals. LBSIZ appears to be a useful measure for CVD risk assessment in clinical practice and epidemiologic studies, especially for MHO patients.


Asunto(s)
Composición Corporal/fisiología , Enfermedades Cardiovasculares/epidemiología , Obesidad Metabólica Benigna/epidemiología , Obesidad Metabólica Benigna/patología , Adiposidad , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Glucemia , Índice de Masa Corporal , Pesos y Medidas Corporales , Fumar Cigarrillos/epidemiología , Femenino , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Incidencia , Lípidos/sangre , Masculino , Persona de Mediana Edad , Fenotipo , Modelos de Riesgos Proporcionales , República de Corea/epidemiología , Factores de Riesgo , Factores Socioeconómicos
18.
BMC Public Health ; 20(1): 1475, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993606

RESUMEN

BACKGROUND: In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS: We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS: In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS: The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.


Asunto(s)
Enfermedad Crónica/tendencias , Personas con Discapacidad/estadística & datos numéricos , Promoción de la Salud/organización & administración , Años de Vida Ajustados por Calidad de Vida , Cloruro de Sodio Dietético/efectos adversos , Adulto , Enfermedades Cardiovasculares/epidemiología , Dieta/estadística & datos numéricos , Predicción , Humanos , Japón , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Insuficiencia Renal Crónica/epidemiología , Factores de Riesgo , Cloruro de Sodio Dietético/administración & dosificación
19.
N Z Med J ; 133(1521): 14-27, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994634

RESUMEN

AIM: In Aotearoa, New Zealand, cardiovascular disease (CVD) burden is greatest among Indigenous Maori, Pacific and Indian people. The aim of this study was to describe CVD risk profiles by ethnicity. METHODS: We conducted a cross-sectional analysis of a cohort of people aged 35-74 years who had a CVD risk assessment in primary care between 2004 and 2016. Primary care data were supplemented with linked data from regional/national databases. Comparisons between ethnic groups were made using age-adjusted summaries of continuous or categorical data. RESULTS: 475,241 people (43% women) were included. Fourteen percent were Maori, 13% Pacific, 8% Indian, 10% Other Asian and 55% European. Maori and Pacific people had a much higher prevalence of smoking, obesity, heart failure, atrial fibrillation and prior CVD compared with other ethnic groups. Pacific and Indian peoples, and to a lesser extent Maori and Other Asian people, had markedly elevated diabetes prevalence compared with Europeans. Indian men had the highest prevalence of prior coronary heart disease. CONCLUSIONS: Maori and Pacific people experience the most significant inequities in exposure to CVD risk factors compared with other ethnic groups. Indians have a high prevalence of diabetes and coronary heart disease. Strong political commitment and cross-sectoral action to implement effective interventions are urgently needed.


Asunto(s)
Enfermedades Cardiovasculares/etnología , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica , Atención Primaria de Salud , Factores de Riesgo
20.
Medicine (Baltimore) ; 99(35): e21468, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871869

RESUMEN

Saline is a commonly used intravenous solvent, however, its excessive infusion may increase drug-induced sodium intake. To investigate the effects of saline infusion on blood pressure variability (BPV) in patients with hypertension, a retrospective study was performed in 1010 patients with hypertension. The patients who received saline infusion before surgery for continuous 3 to 5 days were divided into 2 groups according to the saline infusion volume during the hospitalization, which are >500 mL per day group and <500 mL per day group. The overall incidence of abnormal BPV was 11.58%. As for the incidence of abnormal BPV in the <500 mL per day group with 698 patients was 9.17%, while that in the >500 mL per day group with 312 patients was as high as 16.99%. Additionally, >500 mL of daily saline infusion for continuous 3 to 5 days (P for trend = .004, odds ratio [OR] = 1.911, 95% confidence interval [CI] for OR 1.226-2.977), medical history of diabetes mellitus (P < .001, OR = 4.856, 95% CI for OR 3.118-7.563) and cardiovascular diseases (P < .001, OR = 2.498, 95% CI for OR 1.549-4.029) may be risk factors of abnormal BPV; while anti-hypertensive therapy with diuretics (P < .001, OR = 0.055, 95% CI for OR 0.024-0.125) may be the protective factor. Our study suggests that >500 mL of daily saline infusion for continuous 3 to 5 days may have disadvantages in the blood pressure control for hypertensive patients, especially for the patients with diabetes mellitus and cardiovascular diseases.


Asunto(s)
Variación Biológica Poblacional/fisiología , Presión Sanguínea/efectos de los fármacos , Hipertensión/epidemiología , Solución Salina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/tendencias , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , China/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Incidencia , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Procedimientos Ortopédicos/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Solución Salina/administración & dosificación
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