Hipertrigliceridemia grave en Argentina: prevalencia y características clínicas / Severe Hypertriglyceridemia in Argentina: Prevalence and Clinical Characteristics

RESUMEN Introducción : La hipertrigliceridemia grave (HTGG) es un desorden metabólico con múltiples causas e implicancias tera péuticas. Se desconocen hasta la fecha las características clínicas, la prevalencia y sus posibles causas en nuestra población. Objetivo : estimar la prevalencia, describir las características clínicas y causas subyacentes de la HTGG en un hospital de tercer nivel del municipio de General Pueyrredón. Materia y métodos : Estudio descriptivo y observacional realizado con pacientes ambulatorios e internados de un hospital provincial. Se incluyeron pacientes adultos con triglicéridos (TG) mayores que 885 mg/dL (10 mmol/L) evaluados desde enero de 2018 a diciembre de 2021. Se extrajeron sus historias clínicas y, luego, se los contactó para obtener medidas antro pométricas, variables sociodemográficas, antecedentes personales y familiares, causas secundarias de hipertrigliceridemia y el tratamiento recibido. Resultados : Se analizaron 16 029 muestras; 46 presentaron HTGG, lo que representa una prevalencia total del 0,28% (IC 95% 0,20-0,40%) (IC 95% 0,20-0,40%); se incluyeron 19 participantes en el análisis. La edad media fue de 48,47 años (DE ±16); el 84,2% de ellos eran hombres. La mediana de triglicéridos fue 1821 mg/dL (rango intercuartílico 917-7000 mg/dL); 17 participantes (84,97%) presentaban hipercolesterolemia (colesterol total mayor que 200 mg/dL). Casi el 50% refirió consumo de alcohol, el 55% presentaba obesidad y el 68% diabetes tipo II. Solo 9 participantes se encontraban en tratamiento, 4 con fibratos y 5 con estatinas. Conclusión : se encontró una prevalencia del 0,28%, más alta que la esperada y reportada en series previas. Por otro lado, se destaca la subutilización de medicación para el tratamiento de esta dislipidemia grave.

ABSTRACT Background : Severe hypertriglyceridemia (SHTG) is a metabolic disorder with multiple origins and management implications. Prevalence, clinical characteristics, and its possible causes are unknown in Argentina. Objective : The aim of this study was to estimate the prevalence and describe the clinical characteristics and underlying SHTG causes in a third level hospital in the municipality of General Pueyrredón. Methods : An observational, descriptive study was performed using an electronic database from a provincial Hospital. It included adult patients with triglyceride (TG) levels above 885 mg/dL (10 mmol/L) evaluated from January 2018 to December 2021. Medical records were collected, and patients were then contacted to obtain anthropometric measurements, sociodemographic variables, personal and family history, secondary causes of hypertriglyceridemia, and treatment received. Results : Among 16 029 patients analyzed, 46 presented SHTG, representing a total prevalence of 0.28% (95% CI 0.20-0.40%). Finally, 19 participants with mean age 48.47±16 years and 84.2% men were included in the analysis. Median TG level was 1821 mg/dL (interquartile range 917-7000 mg/dL), and 17 participants (84.97%) had hypercholesterolemia (total cholesterol >200 mg/dL). Almost 50% reported alcohol consumption, 55% were obese and 68% had type II diabetes. Nine participants were under pharmacological treatment, 4 with fibrates and 5 with statins. Conclusion : A prevalence of 0.28% SHTG was found, higher than that reported in other series. Another finding was the underuse of medication for this severe dyslipidemia.

Estudio prospectivo sobre uso y persistencia de tratamiento hipolipidemiante en pacientes con hipercolesterolemia severa / Use and persistence of lipid-lowering therapy in patients with severe hypercholesterolemia: A prospective study

Introducción: Las estatinas son la primera línea de tratamiento en pacientes con hipercolesterolemia severa (HS). A pesar de la evidencia disponible sobre su eficacia y seguridad para prevenir eventos cardiovasculares, el correcto tratamiento sigue siendo un desafío. Materiales y métodos: Estudio observacional prospectivo diseñado para determinar mediante entrevista telefónica la presencia de factores de riesgo, seguimiento clínico anual, persistencia/uso de estatinas y aparición de nuevos eventos cardiovasculares (ECV) después de 5 años, en pacientes con HS incluidos en un programa de Detección de Hipercolesterolemia Familiar. Resultados: Se evaluó a 115 participantes, la edad media fue de 56 ± 10, siendo el 74% mujeres. El 63,4% de las mujeres y el 43% de los hombres refirió estar en seguimiento y control clínico en el último año. El 38,8% de las mujeres recibió estatinas vs. el 26,7% de los hombres y solo 22 participantes (31,8%) fueron persistentes con el tratamiento desde 2015. El 15,5% de los participantes presentó un ECV no fatal y el 3,4% fatal. En el análisis multivariado no se detectaron predictores para presentar un ECV. Conclusiones: En nuestra población con HS encontramos un alto riesgo de presentar un ECV y una dramática baja tasa de uso y persistencia al tratamiento con estatinas.(AU)

Introduction: Statins are the first line of treatment in patients with severe hypercholesterolemia (SH). However, despite the knowledge regarding its effectiveness and security for preventing cardiovascular diseases, treatment is a major challenge. Material and methods: A prospective observational study was conducted by telephone survey to determine cardiovascular risk factors, annual monitoring, statins use and persistence and new-onset cardiovascular events (CVE) after 5 years in patients with SH including in a program for detection of familial hypercholesterolemia. Results: 115 participants were analysed, the median age was 56 ±10 being 74% females. 63.4% of women and 43% of men had been correctly controlled in the last year. Patients on lipid lowering drugs stratified by sex was 38.8% in women and 26.7% in men, however, only 22 participants (31.8%) were persistence with statins since 2015.Overall, 48% of the patients presented a CVE and 3.4% died. Multivariate analysis did not reveal predictors for CVE. Conclusions: In our population with SH we found a high risk to present a CVE and a dramatic low use and persistence with the treatment.(AU)

Use and persistence of lipid-lowering therapy in patients with severe hypercholesterolemia: A prospective study. / Estudio prospectivo sobre uso y persistencia de tratamiento hipolipidemiante en pacientes con hipercolesterolemia severa.

INTRODUCTION: Statins are the first line of treatment in patients with severe hypercholesterolemia (SH). However, despite the knowledge regarding its effectiveness and security for preventing cardiovascular diseases, treatment is a major challenge. MATERIAL AND METHODS: A prospective observational study was conducted by telephone survey to determine cardiovascular risk factors, annual monitoring, statins use and persistence and new-onset cardiovascular events (CVE) after 5 years in patients with SH including in a program for detection of familial hypercholesterolemia. RESULTS: 115 participants were analysed, the median age was 56 ±10 being 74% females. 63.4% of women and 43% of men had been correctly controlled in the last year. Patients on lipid lowering drugs stratified by sex was 38.8% in women and 26.7% in men, however, only 22 participants (31.8%) were persistence with statins since 2015.Overall, 48% of the patients presented a CVE and 3.4% died. Multivariate analysis did not reveal predictors for CVE. CONCLUSIONS: In our population with SH we found a high risk to present a CVE and a dramatic low use and persistence with the treatment.

Prevalence, Patterns, and Correlates of Physical Activity Among the Adult Population in Latin America: Cross-Sectional Results from the CESCAS I Study.

BACKGROUND: Few data are available on population level regarding domain-specific correlates of physical activity (PA) in Latin America. OBJECTIVE: The aim of this study was to examine the relationships among PA patterns and their main sociodemographic determinants and cardiovascular risk factors in the Southern Cone of Latin America. METHODS: CESCAS I is a population-based prospective cohort study with a 4-stage stratified sampling of a general population of 7,524 adults aged 35 to 74 years from 4 midsized cities in Argentina, Chile, and Uruguay. PA was assessed using the transcultural adaptation of the International Physical Activity Questionnaire long form. The questionnaire asked about frequency (days per week) and duration (minutes per day) of moderate and vigorous intensity activities in 3 different domains: work, leisure time, and active transportation (walking and bicycling). PA levels of ≥600 metabolic equivalent tasks (MET) minutes per week was considered sufficiently active. Odds ratios for associations of sufficiently active status with sociodemographic determinants and cardiovascular risk factors were obtained using multivariable-adjusted logistic regression models. CONCLUSIONS: Almost 65%) of the participants reported ≥600 MET minutes per week. The lowest prevalence of sufficiently active individuals was seen in Temuco, Chile (58.0%), among women (58.7%), older individuals (55.4%), those with higher educational level (61.6%), and homemakers (53.4%). Approximately 22.8% of the population reported no PA. In multivariable analysis, PA levels were lower among women, individuals who were older, obese, university educated, with clerical work, retired/unemployed or homemakers, and those with physical limitations. Future interventions to increase PA levels in the Southern Cone of Latin America must take into account disparities by gender and socioeconomic status. The promotion of PA during leisure time in women--unemployed and homemakers--and of active transportation for those performing office or clerical work should be a priority in this population.

Eliminating artificial trans fatty acids in Argentina: estimated effects on the burden of coronary heart disease and costs.

OBJECTIVE: To estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs. METHODS: We estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted. FINDINGS: We estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually. CONCLUSION: Even under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.

Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies.

OBJECTIVE: The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality. DESIGN: We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject Eleven prospective studies with 229 785 participants and average follow-up period of 13.37 years (range 5.5-19 years). RESULTS: Higher Na intake was significantly associated with higher CVD mortality (relative risk=1.12; 95 % CI 1.06, 1.19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1.08; 95 % CI 1.01, 1.15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0.016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality. CONCLUSIONS: Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.