Prevalencia de hiperinsulinismo patológico post carga de glucosa y su relación con factores de riesgo cardiovascular, en adultos no diabéticos con insulinemia basal normal / Prevalence of pathologic hyperinsulinism after a glucose load charge: its relation to cardiovascular risk factors

Introducción: 25% de personas con hiperinsulinismo desarrolla diabetes 3-5 años luego del primer diagnóstico y 70% lo hará en el resto de la vida. Intervenir los niveles de glicemia desde que se detecta hiperinsulinemia evita la progresión a diabetes y restaura el metabolismo glicémico. Objetivos: Determinar la prevalencia de hiperinsulinismo patológico post-carga de glucosa (HPPG) y su relación con factores de riesgo cardiovascular en adultos 100 UI/ml a las 2 horas), sexo, hipertensión arterial, dislipidemia, malnutrición por exceso, sedentarismo, tabaquismo, ateromatosis e infarto miocárdico documentado. Con STATA 17 se calculó la prevalencia de variables en población general y según categoría de HPPG y se evaluó la significancia con prueba exacta de Fisher. Se compararon medias con ANOVA y t-test con nivel de significancia <0,05. Se usó regresión binomial para estimar Razón de Prevalencia e intervalos de confianza en variables cuantitativas y cualitativas. Resultados: la prevalencia de HPPG fue 41%. La edad promedio 37,5 años, el sexo masculino 52,9%, la hipertensión-arterial 40,5% y la dislipidemia 74,4%. Al comparar las poblaciones con y sin HPPG existieron diferencia estadísticamente significativa en las variables dislipidemia, hipertensión-arterial, malnutrición por exceso y sexo-masculino. La razón de prevalencia alcanzó a un 62%, 37%, 59% y 20% respectivamente. Conclusión: Se encontró una alta prevalencia de HPPG. Los factores de riesgo asociados a ella fueron dislipidemia, hipertensión arterial, malnutrición por exceso y sexo masculino. Esto sugiere que encontrar HPPG puede ser de utilidad para detectar precozmente a la población con un mayor riesgo de enfermedad cardiovascular.

Introduction: 25% of people with hyperinsulinism develop diabetes 3-5 years after the first diagnosis and 70% will do so in the rest of their lives. To control glycemia levels as soon as hyperinsulinemia is detected, progression to diabetes is prevented and glycemic metabolism is restored. Aim: To determine the prevalence of post-glucose load pathological hyperinsulinism (HPPG) and its relationship with cardiovascular risk factors in adults 100 uIU/ ml at 2 hours), sex, hypertension, dyslipidemia, excess malnutrition due to, sedentary lifestyle, smoking, documented atheromatosis and myocardial infarction. The prevalence of variables in the general population was calculated and, in relation to the HPPG category, significance is evaluated with Fisher's exact test. Finally means are compared with ANOVA and t-test. With significance level <0.05. Binomial regression was used to estimate the prevalence ratio and confidence intervals in quantitative and qualitative variables. Statistical analysis was performed with the STATA 17 software. Results: HPPG prevalence was 41%, mean age 37.5 years, male sex 52.9%, arterial hypertension 40.5% and dyslipidemia 74.4%. Un relation to the presence of HPPG a statistically significant difference in the variables dyslipidemia, arterial hypertension, malnutrition due to excess and male sex was found. The prevalence ratios were 62%, 37%, 59% and 20%, respectively. Conclusion: A high prevalence of HPPG was found. Risk factors associated to HPPG were dyslipidemia, arterial hypertension, malnutrition due to excess and male sex. Thus, HPPG can play a role in the early detection of a higher risk of cardiovascular disease in the general population.

Relación del estado nutricional de las madres y la alteración de los factores de riesgo cardiovascular de sus hijos / Relationship between mothers' nutritional status and alterations in cardiovascular risk factors of their offsprings

RESUMEN: ANTECEDENTES: La obesidad infantil es uno de los principales problemas de salud pública, y es el mejor predictor de obesidad adulta, que conlleva a futuras consecuencias, como enfermedades cardiovasculares. OBJETIVO: Este estudio pretende relacionar el estado nutricional de las madres con los factores de riesgo cardiovascular (FRCV) de sus hijos con malnutrición por exceso (MNPE). MÉTODOS: Estudio descriptivo de corte transversal y muestreo de tipo no probabilístico por conveniencia, se efectuó en 100 diadas madres/hijos con MNPE. En cada diada se efectuaron mediciones antropométricas, peso, talla, estado nutricional según índice de masa corporal (IMC) y perímetro cintura (PC). En escolares se determinó presión arterial (PA), glicemia y consumo alimentario. El análisis estadístico incluyó Riesgo relativo (RR) y regresión logística. Su usó el software Stata 14. RESULTADOS: Los promedios encontrados en los hijos fueron: edad 8.8 años, IMC/edad 21.1 kg/mt2. En las madres, la edad promedio fue 36,9 años y el IMC 29,0 kg/mt2. En relación con los FRCV, los escolares presentaron glicemias y presión arterial alteradas y obesidad abdominal. La malnutrición por exceso y la alteración de la percepción de las madres sobre el estado nutricional de sus hijos aumentó el RR de presentar alteración de la glicemia en 1,31 veces. La obesidad según IMC/edad presentó un RR de 1,5 y una relación positiva OR de 5,73. CONCLUCIONES: Existe una asociación positiva entre la MNPE de las madres y la obesidad de sus hijos. Se observó un aumento en los factores de riesgo cardiovascular de los escolares, quienes presentaban obesidad abdominal y presión arterial y glicemia alteradas.

ABSTRACT: BACKGROUP: Childhood obesity is one of the main public health problems. It is the best predictor of adult obesity, leading to adverse consequences, especially in relation to cardiovascular diseases. OBJETIVE: This study aims to relate the nutritional status of mothers to the cardiovascular risk factors (CVRF) of their offsprings with excess MNPE. Methods: A descriptive, cross-sectional study with non-probabilistic convenience sampling included 100 mother/child dyads with MNPE. Anthropometric measurements and determination of weight, height, nutritional status (body mass index (BMI) and waist circumference (WC)), as well as blood pressure (BP), glycemia and food consumption were evaluated in schoolchildren. The statistical analysis included Relative Risk (RR) and logistic regression, using the Stata 14 software. RESULTS: Average results in children included: age 8.8 years, BMI/age 21.1 kg/mt2. In mothers, mean age was 36.9 years and BMI 29.0 kg/mt2. In relation to CVRF, schoolchildren presented altered glycemia, higher blood pressure and abdominal obesity. The MNPE and the alteration of mothers' perception of the nutritional status of their children increased the RR of altered glycemia 1.31 fold. Obesity according to BMI/age presented a RR of 1.5 and a positive OR 5.73. CONCLUSIONS: There was a positive association between the mothers' MNPE and elevated cardiovascular risk factors in school children including abdominal obesity, higher blood pressure and altered glycemia.

Alteración de la percepción materna sobre el estado nutricional de sus hijos ¿nuevo factor de riesgo cardiovascular? / Perception of child nutritional status by their mothers: a new cardiovascular risk factor?

ANTECEDENTES: La obesidad infantil es un trastorno de prevalencia creciente que predispone a la obesidad, diabetes y enfermedades cardiovasculares en el adulto. Investigaciones recientes relacionan la percepción materna con el estado nutricional real de los niños, encontrando una distorsión entre imagen corporal de sus hijos con malnutrición por exceso (MNPE). MÉTODOS: Estudio descriptivo de corte transversal. La población objetivo fue 320 madres de escolares de 6 a 10 años y se utilizó un muestreo por conveniencia. Se incluyeron madres de hijos con MNPE. Se evaluó la percepción de las madres a través de un pictograma. Se efectuaron mediciones antropométricas de peso, talla y perímetro de cintura (PC), presión arterial (PA), glicemia y colesterol total. En el análisis estadístico se usó Stata 14 y Epidat 4.2. RESULTADOS: La muestra fue conformada por 100 díadas madre/hijo con MNPE. 69% de las madres presentaron escolaridad de enseñanza media, y 68% tenían nivel socioeconómico bajo. Respecto de los niños, 52% eran de sexo femenino, 38% presentaban riesgo de obesidad abdominal y el 47% tenían obesidad abdominal. La glicemia en ayunas estaba alterada en 35%, el colesterol total alterado en 12% y 31% presentaban PA elevada. El 60% de las madres de niños con MNPE subestimaron el estado nutricional de sus hijos. CONCLUSIONES: En relación a los factores de riesgo cardiovascular de los escolares, un alto porcentaje presenta índices de riesgo cardiovascular elevado: obesidad abdominal, PA alterada, colesterol total y glicemias alteradas. La alteración de la percepción materna sobre el estado nutricional de sus hijos, puede repercutir en forma significativa para el desarrollo y mantenimiento de la MNPE y, por consiguiente, constituye un factor de riesgo cardiovascular, estableciendo un punto clave de intervención.

BACKGROUND: Overnutrition in children is increasingly more prevalent and leads to obesity, diabetes and cardiovascular disease in adults. Recent research links distorted maternal perception of nutritional status in their children with the presence of obesity in adulthood). METHODS: A descriptive cross-sectional study was performed on mothers and their schoolchildren aged 6 to 10 years old. A basic inclusion criteria was the presence of overnutrition in children and the study related maternal perception with the actual degree of overnutrition in her child. Perception was evaluated using a pictogram. Weight, height, waist circumference, blood pressure (BP), blood sugar level and total cholesterol were measured in children Stata 14 and Epidat 2.0 were used for statistical analysis. RESULTS: 100 mother-child pairs were studied. All children had overnutrition. 69% of mothers had high-school level education and 68% belonged in the low socio-economic stratum. There were 52% of girls. According to waist circumference 38% were at risk of malnutrition and 47% already had abdominal obesity. 35% had an altered fasting blood sugar level, 12% an elevated total cholesterol, 31% an increased blood pressure. 60% of mothers of children with overnutrition underestimated the actual nutritional status (overnutrion) of their children. CONCLUSIONS: The presence of overnutrition and obesity indicators were high in this population. This occurred along with increased levels of BP, total cholesterol and altered blood sugar levels. The maternal perception of their children severely under estimated the level of overnutrition. This fact can have a significant impact on the development and maintenance of the excess type malnutrition and subsequent development of other cardiovascular risk factors. Therefore, improving the perception of mothers regarding the nutritional status of their children should be an important element for diminishing cardiovascular risk longterm.

Factores de riesgo cardiovascular en población adolescente aymara. Rol de la occidentalización de la nutrición / Risk factors in Aymara adolescents: influence of western type nutrition

RESUMEN ANTECEDENTES: La obesidad es una epidemia mundial que provoca una alta frecuencia de factores de riesgo cardiovascular (FRCV). Se ha observado que la aculturación está incidiendo en los pueblos originarios, como consecuencia de una dieta occidentalizada, lo cual predispone la obesidad, desarrollo de enfermedades cardiovasculares (ECV) y diabetes. En general la población aymara adulta presenta un bajo riesgo cardiovascular innato, lo cual lleva a una baja incidencia de ECV. Objetivos: Conocer la influencia de la occidentalización de la nutrición y evaluar riesgo cardiovascular de la población adolescente aymara de la comuna de Camiña. Método: Estudio descriptivo de corte transversal, en población aymara entre 11 y 18 años de la comuna de Camiña. Muestra probabilística aleatoria simple constituida por 94 individuos. Se aplica una encuesta alimentaria de tendencia de consumo cuantificada, medición antropométrica y exámenes de glicemia y perfil lipídico. Resultados: Se evaluaron 94 participantes 57,4 % mujeres. Malnutrición por exceso presenta 41%; riesgo cardiovascular según medición de perímetro de cintura (PC) 55,2%; colesterol total alterado 52,6% y triglicéridos alterados 89,5%. Mediante encuesta alimentaria se pudo conocer que 71,7% mantenían una dieta hipercalórica, 69,8 % una dieta hiperglucídica, 45% una dieta hiperlipídica. Conclusión: En la población adolescente aymara estudiada se encontraron factores de riesgo cardiovascular alterados, como malnutrición por exceso, PC aumentado, Colesterol total y Triglicéridos elevados. Su alimentación era "de tipo occidental", consumiendo alimentos procesados y elaborados con dietas hipercalóricas, hiperglucídicas e hiperlipídicas.

ABSTRACT BACKGROUND. Obesity is widely known to lead to increased cardiovascular risk factors (RF). Cultural changes observed in native populations, including the adoption of a western type nutrition, leads to obesity, increased levels of RF ,cardiovascular diseases and diabetes. Aim: To determine the influence of a western type nutrition on RF among adolescent Aymaras in northern Chile. Methods: A cross sectional descriptive study was performed in Camiña (northern Chile), including Aymaras aged 11 to 18 years-old. A quantified alimentary consumption questionnaire, anthropometric measurements, blood glucose levels and lipid profile were obtained. Results: 94 subjects (57% women) were studied. Excess malnutrition (obesity) was present in 41%, abnormally high waist circumference in 55%, high cholesterol levels in 53%, and high triglycerides in 90% of subjects. The contents of the diet being consumed was high in calories in 72%, high in sugar in 70% and high in lipids in 45%. Conclusion: A high prevalence of cardiovascular RF was present in adolescent Aymaras of northern Chile. This finding was related to the consumption of a western type diet, rich in calories, lipids and sugar, leading to obesity

Ejercicio: una herramienta clave en la prevención cardiovascular: Consenso de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular y de la Sociedad Chilena de Kinesiología en Cardiología y Cirugía Cardiovascular / Excercise, a key intervention in Cardiovascular Prevention: Consensus of the Chilean Society of Cardiology and Cardiovascular Surgery and the Chilean Society of Kinesiology in Cardiology and Cardiovascular Surgery

This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.

Adherencia farmacológica y prevención secundaria cardiovascular: una de las principales barreras en el tratamiento de la enfermedad ateroesclerótica: posición del Departamento de Prevención Cardiovascular de SOCHICAR en el uso de la polipíldora en prevención secundaria / Adherence to pharmacologic treatment in secondary prevention of cardiovascular disease

This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.

[Current status of cardiac rehabilitation in Chile]. / Situación actual de la rehabilitación cardiaca en Chile.

BACKGROUND: Cardiac rehabilitation (CR) programs play an important role in the control and prevention of new cardiac events. AIM: A survey was performed to evaluate the current situation of CR programs in Chile. MATERIAL AND METHODS: A questionnaire evaluating the structure of rehabilitation centers, characteristics of the rehabilitation programs and patients, management of risk factors, reimbursement methods, human resources and potential barriers for an efficient rehabilitation, was mailed to centers dedicated to CR in Chile. RESULTS: Eight centers were contacted and seven responded. Coronary heart disease is the most common underlying disease of attended patients and CR is carried out mainly during phases II and III. All CR centers perform an initial assessment, stratify patients, plan and provide tips on physical activity and nutrition. Only three centers provide help to quit smoking. Lipid profile and blood sugar are assessed in 62% of centers. Most practitioners involved are cardiologists, nurses, physiotherapists and nutritionists, all trained in cardiopulmonary resuscitation. The main barrier for their development is the lack of patient referral from practitioners. CONCLUSIONS: Despite the recognized value of CR in the care of patients after a cardiac event, this study reveals the need for further development of such programs and improvement of patient referrals.

Situación actual de la rehabilitación cardiaca en Chile / Current status of cardiac rehabilitation in Chile

Background: Cardiac rehabilitation (CR) programs play an important role in the control and prevention of new cardiac events. Aim: A survey was performed to evaluate the current situation of CR programs in Chile. Material and Methods: A questionnaire evaluating the structure of rehabilitation centers, characteristics of the rehabilitation programs and patients, management of risk factors, reimbursement methods, human resources and potential barriers for an efficient rehabilitation, was mailed to centers dedicated to CR in Chile. Results: Eight centers were contacted and seven responded. Coronary heart disease is the most common underlying disease of attended patients and CR is carried out mainly during phases II and III. All CR centers perform an initial assessment, stratify patients, plan and provide tips on physical activity and nutrition. Only three centers provide help to quit smoking. Lipid profile and blood sugar are assessed in 62% of centers. Most practitioners involved are cardiologists, nurses, physiotherapists and nutritionists, all trained in cardiopulmonary resuscitation. The main barrier for their development is the lack of patient referral from practitioners. Conclusions: Despite the recognized value of CR in the care of patients after a cardiac event, this study reveals the need for further development of such programs and improvement of patient referrals.

[Major depression as a new risk factor for coronary heart disease in Chile]. / La depresión mayor como nuevo factor de riesgo en la cardiopatía coronaria en Chile.

BACKGROUND: Major depression, a frequent psychiatric disease, is associated with ischemic heart disease. It is usually subdiagnosed and subtreated. AIM: To study the prevalence of major depression among survivors of an acute myocardial infarction. PATIENTS AND METHODS: Retrospective study of 42 survivors of an acute myocardial infarction treated at a regional Chilean Hospital. The presence of major depression in the 6 months previous to the acute myocardial infarction, was investigated using the diagnostic instruments CIDI (Composite International Diagnostic Interview) and DIS (Diagnostic Interview Schedule), psychiatric diagnoses were based on DSMIII-R. The prevalence of depression was compared with that observed in a group of 156 healthy subjects participating in a psychiatric epidemiological study. RESULTS: Major depression was diagnosed in 12 male subjects with an acute myocardial infarction. The prevalence in the control group was significantly lower (15%, p < 0.049). Patients with depression were older and required longer hospital stay than patients without depression. CONCLUSIONS: Patients with acute myocardial infarction, had a significantly greater prevalence of major depression in the previous 6 months, than the general population. Thus, major depression could be an independent and modifiable coronary risk factor.