Aortic pulse wave velocity in individuals of Asian and African ancestry: the HELISUR study.

Aortic pulse wave velocity has emerged as an important predictor of cardiovascular events, but data on ethnic differences in pulse wave velocity remain scarce. We explored differences in pulse wave velocity between people of Asian and African ancestry. Data were used from the cross-sectional Healthy Life in Suriname (HELISUR) study. Pulse wave velocity was estimated oscillometrically with the Arteriograph. We included 353 Asians and 364 Africans, aged respectively 44.9 (SD 13.5) and 42.8 (SD 14.1) years (p = 0.05). Crude median PWV was higher in Asians than in Africans (8.1 [IQR 6.9-10.1] m/s vs. 7.7 [IQR 6.5-9.3] m/s, p = 0.03), which was mainly attributable to an increased PWV in Asians ≥ 50 years (10.1 [IQR 8.7-11.8] m/s vs. 9.1 [IQR 7.9-11.3] m/s in Africans ≥50 years, p < 0.01). After adjustment for age and MAP in multivariable linear regression, Asians had a 1.044 [95% CI 1.019-1.072] m/s higher PWV compared to Africans. Additional adjustment for sex, glucose, total cholesterol, HDL cholesterol, triglycerides, BMI, and waist circumference did not substantially change the difference in pulse wave velocity between Asians and Africans (+1.044 [95% CI 1.016-1.074] m/s for Asians vs. Africans). In conclusion, persons of Asian ancestry have a higher pulse wave velocity than those of African ancestry. This persisted after adjustment for important cardiovascular risk parameters, including age and blood pressure. The higher PWV found in Asians could be consistent with their increased coronary heart disease risk.

Physical activity and obesity: is there a difference in association between the Asian- and African- Surinamese adult population?

OBJECTIVE: The role of different physical activity (PA) characteristics, i.e. domain, duration and intensity in obesity prevention still requires investigation. Furthermore, ethnicity can modify the effect of PA on body composition. Therefore, we aim to describe the association between obesity and PA characteristics across the Asian- and African-Surinamese population, living in the capital of Suriname. DESIGN: Between February 2013 and July 2015, we included 1157 healthy subjects, 18-70 years, from the Healthy Life in Suriname (HELISUR) study. We measured height, weight, hip and waist circumference and defined general and central obesity according to World Health Organization (WHO) recommendations. The International Physical Activity Questionnaire was used to assess PA and to calculate the duration (minutes/week) and the total volume (METs-minutes/week) of activity. Ethnicity was self-reported. RESULTS: Out of 1157 participants we included 1079 (42.6% Asian-Surinamese, 40.1% African-Surinamese and 17.3% of other ethnicity), mean age 42.6 ± 13.6 years for analysis. Obesity prevalence ratio (PR) was significantly lower in participants meeting WHO PA recommendations [PR= 0.81 (0.68-0.97)], especially within the commuting [PR= 0.66 (0.47-0.91)] and leisure time domains [PR= 0.67 (0.47-0.94)], compared to participants that did not meet the recommendations. Active minutes/week and total volume of activity were inversely associated with obesity and waist circumference, in the overall (p < 0.05) and in the African-Surinamese population (p < 0.05), but not in the Asian-Surinamese population. CONCLUSION: Meeting PA recommendations, particularly within the commuting and leisure time domains, is associated with lower obesity prevalence in the total population. Among the African-Surinamese population, PA within the leisure time domain, more active minutes/week and higher levels of total volume are associated with a lower obesity prevalence. This is not found in the Asian-Surinamese population.

The risk of hypertension and cardiovascular disease in women with uterine fibroids.

Women with fibroids have a notably high hypertension risk. However, adjusted data regarding other cardiovascular disease (CVD) risk factors are scarce. In this cross-sectional study, CVD risk factors, hemodynamic parameters, and asymptomatic organ damage were analyzed between women with uterine fibroids and controls in a multi-ethnic population. In total, 104 women with self-reported fibroids and 624 controls were included. Women with fibroids had significantly higher odds to have hypertension (OR 3.4; 95% CI 2.2-5.2), diabetes (1.7; 1.0-2.9), and hypercholesterolemia (1.8; 1.1-3.2). After adjustment for confounders, only the odds ratio for hypertension was significant (1.8; 1.1-3.1). Asymptomatic organ damage occurred significantly more often in women with fibroids (66.7%; 95% CI 55.8%-77.6% vs 42.9%; 38.0-47.8 in controls), especially in the younger age group (respectively 48.5%; 31.1%-65.9% vs 22.1%; 17.0-27.2). In this study, women with fibroids had a remarkably high hypertension risk compared to controls, with more asymptomatic organ damage, in particular young women.

Hypertension and Cardiovascular Risk Profile in a Middle-Income Setting: The HELISUR Study.

BACKGROUND: Hypertension is the leading risk factor responsible for premature death worldwide, but its burden has shifted to low- and middle-income countries. Therefore, we studied hypertension and cardiovascular risk in the population of Suriname, a middle-income country with a predominantly urban population of African and Asian ancestry. METHODS: A random sample of 1,800 noninstitutionalized men and women aged 18-70 years was selected to be interviewed at home and examined at the local hospital for cardiovascular risk factors, asymptomatic organ damage, and cardiovascular disease. RESULTS: The 1,157 participants examined (37% men) were mainly of self-defined Asian (43%) or African (39%) ancestry, mean age 43 years (SD 14). The majority of the population (71%) had hypertension or prehypertension, respectively, 40% and 31%. Furthermore, 72% was obese or overweight, while 63% had diabetes or prediabetes. Only 1% of the adult population had an optimal cardiovascular risk profile. Hypertension awareness, treatment, and control were respectively 68%, 56%, and 20%. In line with this, 22% of the adult population had asymptomatic organ damage, including increased arterial stiffness, left ventricular hypertrophy, microalbuminuria, or asymptomatic chronic kidney disease. CONCLUSIONS: In this first extensive cardiovascular assessment in the general population of this middle-income Caribbean country, high prevalence of hypertension with inadequate levels of treatment and control was predominant. The findings emphasize the need for collaborative effort from national and international bodies to prioritize the implementation of affordable and sustainable public health programs that combat the escalating hypertension and cardiovascular risk factor burden.

Assessing the feasibility of the Healthy Life in Suriname Study: using advanced hemodynamics to evaluate cardiovascular risk.

OBJECTIVES: To determine the feasibility of assessing population cardiovascular risk with advanced hemodynamics in the Healthy Life in Suriname (HELISUR) study. METHODS: This was a preliminary study conducted in May - June 2012 using the Technical-Economic-Legal-Operational-Scheduling (TELOS) method to assess the feasibility of the HELISUR-a large-scale, cross-sectional population study of cardiovascular risk factors and disease in Suriname. Suriname, a middle-income country in South America with a population of mostly African and Asian ethnicity, has a high risk of cardiovascular disease. A total of 135 volunteers 18 - 70 years of age participated. A health questionnaire was tested in a primary health care center, and non-invasive cardiovascular evaluations were performed in an academic health center. The cardiovascular evaluation included sitting, supine, and standing blood pressure, and intermediate endpoints, such as cardiac output, peripheral vascular resistance, pulse wave velocity, and augmentation index. RESULTS: The TELOS testing found that communicating by cellular phone was most effective for appointment adherence, and that completion of the questionnaire often required assistance from a trained interviewer; modifications to improve the clarity of the questions are recommended. Regarding the extended cardiovascular assessments of peripheral and central hemodynamics, the findings showed these to be technically and operationally feasible and well tolerated by participants, in terms of burden and duration. CONCLUSIONS: Findings of this feasibility assessment indicate that large-scale, detailed evaluations of cardiovascular risk, including a questionnaire and advanced central and peripheral hemodynamics, are feasible in a high-risk population in a middle-income setting.

Health literacy in Suriname.

BACKGROUND: Low health literacy is an independent predictor of cardiovascular mortality. However, data on health literacy in low- and middle-income countries are scarce. Therefore, we assessed the level of health literacy in Suriname, a middle-income country with a high cardiovascular mortality. METHODS: We estimated health literacy in a convenience sample at an urban outpatient center in the capital and at a semirural health center, using the validated Rapid Estimate of Adult Literacy in Medicine adapted for the Dutch language (REALM-D) instrument. REALM-D scores vary from 0 to 66 (all correct). The primary outcome was the level of health literacy. Furthermore, we assessed the effect of age, sex, ethnicity, disease history, research location, and level of education on health literacy with multivariable linear regression. RESULTS: We included 99 volunteers (52% men; 51% urban research location) with a mean age of 44.9 years (SD 13.4). The mean REALM-D score was moderate: 48.6 (SD 8.1). Greater health literacy was associated with male sex, an urban research location, and a higher educational level. CONCLUSION: Health literacy was moderate in these Surinamese participants. Health care workers should take health literacy into account, and targeted interventions should be developed to improve health literacy in Suriname.

Assessing the feasibility of the Healthy Life in Suriname Study: using advanced hemodynamics to evaluate cardiovascular risk / Evaluación de la factibilidad del estudio Vida Sana en Suriname: uso de hemodinámica avanzada para evaluar el riesgo de enfermedades cardiovasculares / Avaliação da viabilidade do Estudo de Vida Saudável no Suriname: uso de hemodinâmica avançada para avaliar o risco cardiovascular

Objectives. To determine the feasibility of assessing population cardiovascular risk with advanced hemodynamics in the Healthy Life in Suriname (HELISUR) study. Methods. This was a preliminary study conducted in May – June 2012 using the Technical-Economic-Legal-Operational-Scheduling (TELOS) method to assess the feasibility of the HELISUR—a large-scale, cross-sectional population study of cardiovascular risk factors and disease in Suriname. Suriname, a middle-income country in South America with a population of mostly African and Asian ethnicity, has a high risk of cardiovascular disease. A total of 135 volunteers 18 – 70 years of age participated. A health questionnaire was tested in a primary health care center, and non-invasive cardiovascular evaluations were performed in an academic health center. The cardiovascular evaluation included sitting, supine, and standing blood pressure, and intermediate endpoints, such as cardiac output, peripheral vascular resistance, pulse wave velocity, and augmentation index. Results. The TELOS testing found that communicating by cellular phone was most effective for appointment adherence, and that completion of the questionnaire often required assistance from a trained interviewer; modifications to improve the clarity of the questions are recommended. Regarding the extended cardiovascular assessments of peripheral and central hemodynamics, the findings showed these to be technically and operationally feasible and well tolerated by participants, in terms of burden and duration. Conclusions. Findings of this feasibility assessment indicate that large-scale, detailed evaluations of cardiovascular risk, including a questionnaire and advanced central and peripheral hemodynamics, are feasible in a high-risk population in a middle-income setting.

Objetivos. Determinar la factibilidad de evaluar el riesgo de enfermedades cardiovasculares en la población utilizando hemodinámica avanzada en el estudio Vida Sana en Suriname (HELISUR por su sigla en inglés). Métodos. Este fue un estudio preliminar realizado de mayo a junio del 2012 empleando el método de factibilidad técnica, económica, legal, operativa y de programación (TELOS) para evaluar la factibilidad del HELISUR, un estudio poblacional transversal a gran escala de factores de riesgo y enfermedades cardiovasculares en Suriname. Suriname, un país de ingresos medianos de América del Sur, con una población de etnicidad principalmente africana y asiática, presenta un riesgo alto de enfermedades cardiovasculares. En el estudio participó un total de 135 voluntarios de 18 a 70 años de edad. Se puso a prueba un cuestionario de salud en un centro de atención primaria de salud, y se realizaron evaluaciones cardiovasculares no invasoras en un centro de salud académico. La evaluación cardiovascular incluyó mediciones de presión arterial en posición sentada, supina y de pie, y los criterios de valoración intermedios, como el gasto cardíaco, la resistencia vascular periférica, la velocidad de la onda de pulso y el índice de aumento. Resultados. En las pruebas del método TELOS se encontró que la comunicación por teléfono celular era la más eficaz para asegurar la asistencia a las citas y que a menudo se requería la presencia de un entrevistador capacitado para ayudar a los voluntarios a llenar el cuestionario; se recomienda modificar las preguntas para que sean más claras. Con respecto a las evaluaciones cardiovasculares prolongadas de hemodinámica periférica y central, los resultados demostraron que eran técnica y operativamente factibles, y bien toleradas por los participantes en cuanto a la carga y duración. Conclusiones. Los resultados de esta evaluación de factibilidad indican que las evaluaciones detalladas y a gran escala del riesgo de enfermedades cardiovasculares, que incluyen un cuestionario y hemodinámica central y periférica avanzada, son factibles para una población de alto riesgo en un país de ingresos medianos.

Objetivos. Determinar a viabilidade de avaliar o risco cardiovascular da população por meio de avaliação hemodinâmica avançada no Estudo de Vida Saudável no Suriname (HELISUR). Métodos. Estudo preliminar realizado em maio-junho de 2012 com o uso da metodologia TELOS (análise técnica, financeira, jurídica, operacional e do cronograma) para avaliar a viabilidade do HELISUR – estudo transversal de base populacional em grande escala dos fatores de risco e doenças cardiovasculares no Suriname. O Suriname é um país sul-americano de renda média de população majoritariamente de origem afro-asiática com alto risco da doença cardiovascular. Participaram do estudo 135 voluntários com 18 a 70 anos de idade. O questionário sobre saúde foi testado em uma unidade básica de saúde e avaliações cardiovasculares não invasivas foram realizadas em um centro de saúde acadêmico. A avaliação cardiovascular consistiu da medida da pressão arterial em posição sentada, supino e em pé, e da medida de parâmetros (endpoints) intermediários como débito cardíaco, resistência vascular periférica, velocidade da onda de pulso e índice de amplificação. Resultados. A análise TELOS indicou maior eficiência na adesão às consultas com a comunicação por celular e a necessidade frequente de auxílio de um entrevistador treinado para o preenchimento do questionário. Modificações para melhorar a compreensão das perguntas são recomendadas. Também se demonstrou que o amplo estudo da hemodinâmica central e periférica é viável do ponto de vista técnico e operacional e que os participantes toleram bem o incômodo e o tempo de avaliação. Conclusões. Os resultados da avaliação de viabilidade indicam que a avaliação aprofundada do risco cardiovascular em grande escala, incluindo a administração de questionário e estudos de hemodinâmica avançada central e periférica, é viável em uma população de renda média com alto risco.

Creatine kinase as a marker of obesity in a multi-ethnic population.

OBJECTIVE: Creatine kinase (CK), the central regulatory enzyme of energy metabolism, is particularly high in type II skeletal muscle fibers, which are associated with insulin resistance and obesity. As resting plasma CK is mainly derived from skeletal muscle, we assessed whether plasma CK is associated with markers of obesity. METHODS: In this cross-sectional study, we analyzed a random sample of the multi-ethnic population of Amsterdam, the Netherlands, consisting of 1444 subjects aged 34-60 years. The primary outcome was the independent association between plasma CK after rest and waist circumference. Other outcomes included waist-to-hip ratio and body mass index. RESULTS: Mean waist circumference increased from the first through the third CK tertile, respectively 90.3 (SD 13.4), 93.2 (SD 14.3), and 94.4 (SD 13.3) cm (p < 0.001 for differences between tertiles). The increase in waist circumference was 8.91 (95% CI 5.35 to 12.47) cm per log CK increase after adjustment for age, sex, African ethnicity, educational level, physical activity and plasma creatinine. Similarly, CK was independently associated with waist-to-hip ratio and body mass index, with an increase of respectively 0.05 (95% CI 0.03 to 0.07) and 3.6 (95% CI 2.3 to 5.0) kg/m2 per log CK increase. CONCLUSIONS: Plasma CK is independently associated with measures of obesity in a multi-ethnic population. This is in line with the central role of type II skeletal muscle fibers in energy metabolism and obesity. Prospective studies should assess whether resting plasma CK could be an easy accessible marker of CK rich type II fiber predominance that helps identify individuals at risk for obesity.

Assessing the feasibility of the Healthy Life in Suriname Study: using advanced hemodynamics to evaluate cardiovascular risk / Evaluación de la factibilidad del estudio Vida Sana en Suriname: uso de hemodinámica avanzada para evaluar el riesgo de enfermedades cardiovasculares / Avaliação da viabilidade do Estudo de Vida Saudável no Suriname: uso de hemodinâmica avançada para avaliar o risco cardiovascular

ABSTRACT Objectives To determine the feasibility of assessing population cardiovascular risk with advanced hemodynamics in the Healthy Life in Suriname (HELISUR) study. Methods This was a preliminary study conducted in May – June 2012 using the Technical-Economic-Legal-Operational-Scheduling (TELOS) method to assess the feasibility of the HELISUR—a large-scale, cross-sectional population study of cardiovascular risk factors and disease in Suriname. Suriname, a middle-income country in South America with a population of mostly African and Asian ethnicity, has a high risk of cardiovascular disease. A total of 135 volunteers 18 – 70 years of age participated. A health questionnaire was tested in a primary health care center, and non-invasive cardiovascular evaluations were performed in an academic health center. The cardiovascular evaluation included sitting, supine, and standing blood pressure, and intermediate endpoints, such as cardiac output, peripheral vascular resistance, pulse wave velocity, and augmentation index. Results The TELOS testing found that communicating by cellular phone was most effective for appointment adherence, and that completion of the questionnaire often required assistance from a trained interviewer; modifications to improve the clarity of the questions are recommended. Regarding the extended cardiovascular assessments of peripheral and central hemodynamics, the findings showed these to be technically and operationally feasible and well tolerated by participants, in terms of burden and duration. Conclusions Findings of this feasibility assessment indicate that large-scale, detailed evaluations of cardiovascular risk, including a questionnaire and advanced central and peripheral hemodynamics, are feasible in a high-risk population in a middle-income setting.

RESUMEN Objetivos Determinar la factibilidad de evaluar el riesgo de enfermedades cardiovasculares en la población utilizando hemodinámica avanzada en el estudio Vida Sana en Suriname (HELISUR por su sigla en inglés). Métodos Este fue un estudio preliminar realizado de mayo a junio del 2012 empleando el método de factibilidad técnica, económica, legal, operativa y de programación (TELOS) para evaluar la factibilidad del HELISUR, un estudio poblacional transversal a gran escala de factores de riesgo y enfermedades cardiovasculares en Suriname. Suriname, un país de ingresos medianos de América del Sur, con una población de etnicidad principalmente africana y asiática, presenta un riesgo alto de enfermedades cardiovasculares. En el estudio participó un total de 135 voluntarios de 18 a 70 años de edad. Se puso a prueba un cuestionario de salud en un centro de atención primaria de salud, y se realizaron evaluaciones cardiovasculares no invasoras en un centro de salud académico. La evaluación cardiovascular incluyó mediciones de presión arterial en posición sentada, supina y de pie, y los criterios de valoración intermedios, como el gasto cardíaco, la resistencia vascular periférica, la velocidad de la onda de pulso y el índice de aumento. Resultados En las pruebas del método TELOS se encontró que la comunicación por teléfono celular era la más eficaz para asegurar la asistencia a las citas y que a menudo se requería la presencia de un entrevistador capacitado para ayudar a los voluntarios a llenar el cuestionario; se recomienda modificar las preguntas para que sean más claras. Con respecto a las evaluaciones cardiovasculares prolongadas de hemodinámica periférica y central, los resultados demostraron que eran técnica y operativamente factibles, y bien toleradas por los participantes en cuanto a la carga y duración. Conclusiones Los resultados de esta evaluación de factibilidad indican que las evaluaciones detalladas y a gran escala del riesgo de enfermedades cardiovasculares, que incluyen un cuestionario y hemodinámica central y periférica avanzada, son factibles para una población de alto riesgo en un país de ingresos medianos.

RESUMO Objetivos Determinar a viabilidade de avaliar o risco cardiovascular da população por meio de avaliação hemodinâmica avançada no Estudo de Vida Saudável no Suriname (HELISUR). Métodos Estudo preliminar realizado em maio-junho de 2012 com o uso da metodologia TELOS (análise técnica, financeira, jurídica, operacional e do cronograma) para avaliar a viabilidade do HELISUR – estudo transversal de base populacional em grande escala dos fatores de risco e doenças cardiovasculares no Suriname. O Suriname é um país sul-americano de renda média de população majoritariamente de origem afro-asiática com alto risco da doença cardiovascular. Participaram do estudo 135 voluntários com 18 a 70 anos de idade. O questionário sobre saúde foi testado em uma unidade básica de saúde e avaliações cardiovasculares não invasivas foram realizadas em um centro de saúde acadêmico. A avaliação cardiovascular consistiu da medida da pressão arterial em posição sentada, supino e em pé, e da medida de parâmetros (endpoints) intermediários como débito cardíaco, resistência vascular periférica, velocidade da onda de pulso e índice de amplificação. Resultados A análise TELOS indicou maior eficiência na adesão às consultas com a comunicação por celular e a necessidade frequente de auxílio de um entrevistador treinado para o preenchimento do questionário. Modificações para melhorar a compreensão das perguntas são recomendadas. Também se demonstrou que o amplo estudo da hemodinâmica central e periférica é viável do ponto de vista técnico e operacional e que os participantes toleram bem o incômodo e o tempo de avaliação. Conclusões Os resultados da avaliação de viabilidade indicam que a avaliação aprofundada do risco cardiovascular em grande escala, incluindo a administração de questionário e estudos de hemodinâmica avançada central e periférica, é viável em uma população de renda média com alto risco.

Exploring cardiovascular health: the Healthy Life in Suriname (HELISUR) study. A protocol of a cross-sectional study.

INTRODUCTION: Obesity, hypertension and diabetes are on a dramatic rise in low-income and middle-income countries, and this foretells an overwhelming increase in chronic disease burden from cardiovascular disease. Therefore, rapid action should be taken through preventive population-based programmes. However, in these regions, data on the population distribution of cardiovascular risk factors, and of intermediate and final end points for cardiovascular disease are scarce. The Healthy Life in Suriname (HELISUR) study is a cardiovascular population study in Suriname, which is part of the Caribbean Community. The HELISUR study is dedicated to provide data on risk factors and prevalent cardiovascular disease in the multiethnic population, which is mainly of African and Asian descent. METHODS AND ANALYSIS: In a cross-sectional, observational population-based setting, a random representative sample of 1800 citizens aged between 18 and 70 years will be selected using a cluster household sampling method. Self-reported demographic, socioeconomic and (cardiovascular) health-related data will be collected. Physical examination will include the assessment of cardiovascular risk factors and prevalent cardiovascular disease. In addition, we will study cardiovascular haemodynamics non-invasively, as a novel intermediate outcome. Finally, fasting blood and overnight urine samples will be collected to monitor cardiometabolic risk factors. The main outcome will be descriptive in reporting the prevalence of risk factors and measures of (sub) clinical end organ damage, stratified for ethnicity and sex-age groups. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the State Secretary of Health. Data analysis and manuscript submission are scheduled for 2016. Findings will be disseminated in peer-reviewed journals, and at national, regional and international scientific meetings. Importantly, data will be presented to Surinamese policymakers and healthcare workers, to develop preventive strategies to combat the rapid rise of cardiovascular disease.