Aggregation and combination of cardiovascular risk factors and their association with 10-year all-cause mortality: the PERU MIGRANT Study.

OBJECTIVE: To estimate the association between the aggregation and pair-wise combination of selected cardiovascular risk factors (CVRF) and 10-year all-cause mortality. METHODS: Secondary data analysis of the PERU MIGRANT study, a prospective population-based cohort. Ten-year all-cause mortality was determined for participants originally enrolled in the PERU MIGRANT Study (baseline in 2007) through the National Registry of Identification and Civil Status. The CVRF included hypertension, type 2 diabetes mellitus, hypercholesterolemia, and overweight/obesity. Exposures were composed of both the aggregation of the selected CVRF (one, two, and three or more CVRF) and pair-wise combinations of CVRF. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI). FINDINGS: Of the 989 participants evaluated at baseline, 976 (98.8%) had information about vital status at 10 years of follow-up (9992.63 person-years), and 63 deaths were recorded. In the multivariable model, adjusting for sociodemographic and lifestyle variables, participants with two CVRF (HR: 2.48, 95% CI: 1.03-5.99), and those with three or more CVRF (HR: 3.93, 95% CI: 1.21-12.74) had higher all-cause mortality risk, compared to those without any CVRF. The pair-wise combinations associated with the highest risk of all-cause mortality, compared to those without such comorbidities, were hypertension with type 2 diabetes (HR: 11.67, 95% CI: 3.67-37.10), and hypertension with overweight/obesity (HR: 2.76, 95% CI: 1.18-6.71). CONCLUSIONS: The aggregation of two or more CVRF and the combination of hypertension with type 2 diabetes or overweight/obesity were associated with an increased risk of 10-year all-cause mortality. These risk profiles will inform primary and secondary prevention strategies to delay mortality from cardiovascular risk factors.

Cholesterol levels and the association of statins with in-hospital mortality of myocardial infarction patients insights from a Chilean registry of myocardial infarction.

BACKGROUND: Hypercholesterolemia is a strong risk factor for myocardial infarction (MI). There is scarce information regarding lipoprotein levels among patients with MI in Latin America as well as about the association of very early statin therapy during the course of acute MI. HYPOTHESIS: Very early statin prescription might be associated with a reduction on in-hospital mortality in MI patients with nearly normal lipid levels. METHODS: Prospective registry database analysis of MI patients admitted between 2001 and 2007 at a single university hospital from which demographics, treatments, clinical variables, and mortality were assessed. Patients naïve to statin therapy were divided in 2 groups, according to whether they received (group A) or did not receive (group B) statins during the first 24 hours after admission. RESULTS: In the 1465 patients analyzed, mean plasma levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C) were 197, 117, and 44 mg/dL, respectively, and 41.8% had HDL-C ≤40 mg/dL. Among statin naïve patients (n = 1272), 67% were classified in group A and 33% in group B. Overall in-hospital mortality was 4.1%: 1.8% in group A and 8.5% in group B. In the multivariate analysis, including propensity score for statin prescription, the odds ratio for in-hospital mortality for group A was 0.971 (95% confidence interval: 0.944-0.999, P = 0.04). CONCLUSIONS: In the Chilean registry of MI patients, low HDL-C was the main lipid disturbance. Very early statin use after MI appears to be associated with a borderline significant and independent reduction of in-hospital mortality.

Síndrome metabólica: aspectos históricos, prevalência, e morbidade e mortalidade / The metabolic syndrome: historic aspects, prevalence, morbity, and mortality

A associação de fatores de risco cardiovascular causa hoje grande preocupação nos órgãos de saúde pública nos vários países do mundo. A síndrome metabólica,caracterizada pela associação de vários fatores de risco para doença cardiovascular, resulta provavelmente de fatores genéticos e ambientais. Os primeiros relatos relacionados com a síndrome ocorreram na década de 20, embora tenha sido maisbem descrita a partir da década de 80. A prevalência da síndrome metabólica é alta nos Estados Unidos, porém são poucos os dados em relação à prevalência da síndrome em outros países do mundo. Dispomos hoje de três critérios propostos para classificar a síndrome metabólica: o da Organização Mundial da Saúde, o do "National Cholesterol Evaluation Program" -ATP III e o da "American Association of Clinical Endocrinologists". Como os índices de morbidade e de mortalidade em pacientes com síndrome metabólica são muito altos, essa síndrome deve ser vista hoje como uma das principais metas do ponto de vista terapêutico em termos de prevenção cardiovascular.