Physical Activity and Obesity Risk in Adults in Colombia: The Prospective Urban Rural Epidemiology (PURE) Study.

PURPOSE: To investigate longitudinal associations between physical activity levels and obesity in adults in Colombia, where participation in large amounts of light-intensity physical activity is a necessity for many people. METHODS: Participation in moderate- and vigorous-intensity physical activity was assessed from 2005 to 2009 and obesity was assessed from 2011 to 2019 in men and women from the Prospective Urban Rural Epidemiology (PURE) study. Total physical activity level was categorized as low (<600 MET-min/week), medium (600-3,000 MET-min/week), or high (>3,000 MET-min/week) (600 MET-min/week is equivalent to 150 minutes of moderate activity or 75 minutes of vigorous activity per week). Obesity was defined as body mass index ≥30 kg/m2. Analyses were adjusted for age, sex, smoking, socioeconomic status, diet, alcohol, sedentary time, and sleep. RESULTS: The main analysis included 3,086 men and women aged 51 ± 9 years at baseline (mean ± SD). Compared to the low physical activity group, the odds ratio (95% confidence interval) for obesity was 0.67 (0.53, 0.85) in the medium physical activity group, and 0.78 (0.62, 0.98) in the high physical activity group after adjustment for potential confounders. Smoking is probably a major confounder and it is noteworthy that similar associations were observed in participants who reported never smoking. CONCLUSIONS: The PURE study is the only prospective cohort study in Colombia. The present analysis is important because it suggests that even the busy people of Colombia could substantially reduce their risk of obesity by participating in moderate- and vigorous-intensity physical activity.

Waist circumference cut-off points to identify major cardiovascular events and incident diabetes in Latin America: findings from the prospective Urban rural epidemiology study Colombia.

Background: Abdominal obesity (AO) indirectly represents visceral adiposity and can be assessed by waist circumference (WC) measurement. In Latin America, cut-off points for the diagnosis of AO are based on Asian population data. We aim to establish the WC cut-off points to predict major cardiovascular events (MACE) and incident diabetes. Methods: We analyzed data from the cohort PURE study in Colombia. WC cut-off points were defined according to the maximum Youden index. Multivariate logistic regression was used to obtain associations between WC and MACE, diabetes, and cumulative incidence of outcomes visualized using Kaplan-Meier curves. Results: After a mean follow-up of 12 years, 6,580 individuals with a mean age of 50.7 ± 9.7 years were included; 64.2% were women, and 53.5% were from rural areas. The mean WC was 85.2 ± 11.6 cm and 88.3 ± 11.1 cm in women and men, respectively. There were 635 cases of the MACE composite plus incident diabetes (5.25 events per 1,000 person-years). Using a cut-off value of 88.85 cm in men (sensitivity = 0.565) and 85.65 cm in women (sensitivity = 0.558) resulted in the highest value for the prediction of the main outcome. These values were associated with a 1.76 and 1.41-fold increased risk of presenting the composite outcome in men and women, respectively. Conclusions: We defined WC cut-off points of 89 cm in men and 86 cm in women to identify the elevated risk of MACE and incident diabetes. Therefore, we suggest using these values in cardiovascular risk assessment in Latin America.

Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review.

Background: Higher medication adherence reduces the risk of new cardiovascular events. However, there are individual and health system barriers that lead to lower adherence. The polypill has demonstrated benefits in cardiovascular morbidity and mortality mainly driven by an increase in adherence. We aim to evaluate the impact of the polypill on adherence to cardiovascular medication, its efficacy and safety in cardiovascular disease (CVD) prevention. Methods: A systematic review following PRISMA guidelines was conducted. Databases were searched from January 2003 to December 2022. We included randomized, pragmatic, or real-world clinical trials and observational studies. The primary outcome was medication adherence, secondary outcomes were efficacy in cardiovascular disease in primary and secondary prevention and safety. Results: From the 490 publications screened, 13 met the inclusion criteria and were incorporated into a comparative table Of those included, 70% were randomized controlled trials (RCTs) and 53.8% focused on secondary prevention. Most of the studies received a high and moderate quality rating. Self-report, pill counting and, the Morisky scale were the most frequent methods to evaluate adherence (84.6%). Compared with standard medication, the polypill improved overall medication adherence by 13%, with percentages ranging from 7.6% to 34.9%. Moreover, a potential benefit was also observed in reducing Major Adverse Cardiovascular Events (MACE), particularly in secondary prevention studies, with hazard ratios ranged between 0.43 to 0.76. Compared to standard care, the profile of side effects was similar. Conclusion: The polypill is an effective, safe, and practical strategy to improve adherence in people at risk of CVD. Although there is a demonstrated benefit in reducing MACE, predominantly in secondary prevention, there are still gaps in its efficacy in primary prevention and reducing total mortality. Therefore, the importance of obtaining long-term results of the polypill effect and how this strategy can be implemented in real practice.

Left-dominant arrhythmogenic cardiomyopathy due to desmoplakin mutation: a case report.

The case of a 49-year-old man with acute onset of heart failure is presented. The initial work-up showed a dilated cardiomyopathy with severely reduced left ventricular ejection fraction. In the differential diagnostic process, hypertensive, ischaemic, and valvular aetiologies were discarded. Subsequently, a cardiac magnetic resonance revealed global hypokinesis and inferior and anterior subepicardial fibrosis. Once differential diagnoses of subepicardial fibrosis (myocarditis, sarcoidosis, and Chagas disease) were discarded, a genetic panel was performed, resulting in a heterozygous mutation of desmoplakin (DSP) gene c.6697_6698del. A left-dominant DSP arrhythmogenic cardiomyopathy mutation was diagnosed. Structural myocardial abnormalities and ventricular arrhythmias characterize arrhythmogenic cardiomyopathy. Up to 50% of cases are associated with mutations in DSP genes (JUP, DSP, and PKP2). DSP is the fundamental component of the desmosome structure and provides structural support through intercellular adhesion. Therefore, when frequent differential diagnoses are discarded, genetic studies for dilated cardiomyopathy and DSP mutation should be considered.

Factores de riesgo y muerte cardiovascular en América del Sur / Cardiovascular risk factors and death in South America

Presentamos las tasas de incidencia y de mortalidad por enfermedades cardiovasculares (ECV) que se han reportado para Sudamérica estratificadas por país, por sexo y por ubicación urbana o rural en una cohorte multinacional incluida en el estudio Poblacional Urbano Rural Epidemiológico (PURE). Este estudio incluyó a 24.718 participantes de 51 comunidades urbanas y 49 rurales de Argentina, Brasil, Chile y Colombia, y el seguimiento medio fue de 10,3años. La incidencia de ECV y las tasas de mortalidad se calcularon para la cohorte total y en subpoblaciones. Se examinaron las razones de riesgo y las fracciones atribuibles a la población (FAP) para ECV y para muerte por 12 factores de riesgo modificables, agrupados como metabólicos (hipertensión, diabetes, obesidad abdominal y colesterol no HDL alto), conductuales (tabaco, alcohol, calidad de la dieta y actividad física) y otros (educación, contaminación del aire en el hogar, fuerza y depresión). Las principales causas de muerte fueron ECV (31,1%), cáncer (30,6%) y enfermedades respiratorias (8,6%). Aproximadamente el 72% de la FAP para ECV y el 69% de la FAP para muertes se atribuyeron a 12 factores de riesgo modificables. Para ECV los principales FAP se debieron a hipertensión (18,7%), obesidad abdominal (15,4%), tabaquismo (13,5%), baja fuerza muscular (5,6%) y diabetes (5,3%). Para muerte, los principales FAP fueron tabaquismo (14,4%), hipertensión (12,0%), baja escolaridad (10,5%), obesidad abdominal (9,7%) y diabetes (5,5%). Las ECV, el cáncer y las enfermedades respiratorias representan más de dos tercios de las muertes en Sudamérica. Los hombres tienen tasas de ECV y de mortalidad consistentemente más altas que las mujeres. Una gran proporción de ECV y muertes prematuras podrían evitarse mediante el control de los factores de riesgo metabólicos y el consumo de tabaco, que son los principales factores de riesgo en la región tanto para ECV como para mortalidad de cualquier causa.(AU)

We present cardiovascular disease (CVD) incidence and mortality rates reported for South America stratified by country, sex, and urban/rural location in a multinational cohort included in the Population Urban Rural Epidemiological Study (PURE). This study included 24,718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia and the mean follow-up was 10.3years. CVD incidence and mortality rates were calculated for the total cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and death were examined for 12 modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (smoking, alcohol, diet quality, and physical activity) and other (education, household air pollution, strength, and depression). The leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). Approximately 72% of the PAFs for CVD and 69% of the PAFs for deaths were attributed to 12 modifiable risk factors. For CVD, the main PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), smoking (13.5%), low muscle strength (5.6%), and diabetes (5.3%). For death, the main PAFs were smoking (14.4%), hypertension (12.0%), low educational level (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). Cardiovascular diseases, cancer, and respiratory diseases account for more than two-thirds of deaths in South America. Men have consistently higher CVD rates and mortality than women. A large proportion of CVD and premature deaths could be avoided by controlling metabolic risk factors and smoking, which are the main risk factors in the region for both CVD and all-cause mortality.(AU)

Increasing muscular strength to improve cardiometabolic risk factors / Incrementar la fuerza muscular para mejorar los factores de riesgo cardiometabólico

Cardiovascular diseases (CVDs) remain the leading cause of worldwide death, accounting for significant morbidity, mortality, disability, and reduced quality of life. The global prevalence of cardiovascular (CV) risk factors, such as type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity, has grown exponentially in the last decades, particularly in low-medium income countries, and it's projected to increase rapidly in the coming years as the population progressively ages, leading to increased cardiovascular disease (CVD) and associated mortality. In fact, data from the global burden of disease study shows that CV mortality, associated disability-adjusted life years (DALYs), and years of life lost (YLL) have increased steadily, nearly doubling from 1990 to 2019.Recent evidence proves the existence of an inverse association between hand grip strength (HGS), as a proxy for global muscle strength, with all-cause mortality, CV mortality, and the development of several chronic diseases. These associations have been demonstrated recurringly across the entire lifespan, beginning in childhood, and carrying on throughout adult life. Mounting evidence strongly indicates that HGS is an early predictor of chronic disease in premorbid populations and a therapeutic target for CVD prevention. Recent clinical trials have consistently shown that resistance exercise, which increases strength and potentially muscle mass, significantly improves the control of known CVD risk factors, reduces the risk of all-cause death and cardiovascular mortality.In this review, we explore the latest evidence regarding the association between low muscle strength and diverse metabolic alterations, along with the interventions that could improve cardiometabolic risk factors, while simultaneously increasing muscle fitness.(AU)

Las enfermedades cardiovasculares (ECV) siguen siendo la causa principal de muerte a nivel mundial, con una gran significación en términos de morbilidad, mortalidad, incapacidad y reducción de la calidad de vida. La prevalencia global de factores de riesgo cardiovascular (CV), tales como diabetes mellitus tipo 2, hipertensión, dislipidemia y obesidad ha crecido exponencialmente en las últimas décadas, particularmente en los países con rentas bajas-medias, previéndose que se incremente rápidamente en los años venideros a medida que la población envejezca, originando un incremento de las ECV y la mortalidad asociada. De hecho, los datos procedentes del estudio sobre carga global de la enfermedad muestran que la mortalidad CV, los años de vida ajustados por discapacidad (DALY), y los años de vida perdidos (YLL) asociados se han incrementado de manera constante, y casi doblándose desde 1990 a 2019.La evidencia reciente prueba la existencia de una asociación inversa entre la fuerza de agarre (HGS), como indicador de la fuerza muscular global, y la mortalidad por todas las causas, la mortalidad CV y el desarrollo de diversas enfermedades crónicas. Estas asociaciones han sido demostradas recurrentemente durante todo el periodo de vida, comenzando en la escuela, y prosiguiendo durante toda la vida adulta. La evidencia creciente indica enfáticamente que la HGS es un factor predictivo temprano de enfermedades crónicas en poblaciones premórbidas, y un objetivo terapéutico para la prevención de las ECV. Los ensayos clínicos recientes han reflejado de manera consistente que el ejercicio de resistencia, que incrementa la fuerza, y potencialmente la masa muscular, mejora considerablemente el control de los factores conocidos de ECV, reduce el riesgo de muerte por todas las causas, y la mortalidad cardiovascular. En esta revisión exploramos la última evidencia relativa a la asociación entre la fuerza muscular baja y las diversas alteraciones metabólicas, junto con las...(AU)

Reductions in systolic blood pressure achieved by hypertensives with three isometric training sessions per week are maintained with a single session per week.

Isometric handgrip or (wall) squat exercise performed three times per week produces reductions in systolic blood pressure (SBP) in adults with hypertension. We aimed to compare these interventions and the potential to retain benefits with one exercise session per week. We compared blood pressure changes following handgrip and squat isometric training interventions with controls in a randomized controlled multicentre trial in 77 unmedicated hypertensive (SBP ≥ 130 mmHg) adults. Exercise sessions were performed in the workplace and consisted of four repetitions-three sessions per week for the first 12 weeks (phase 1), and one session per week for the subsequent 12 weeks (phase 2). Office blood pressure (BP) was measured at baseline, post-phase 1 and post-phase 2. Post-phase 1, mean reductions in SBP were significantly greater in handgrip (-11.2 mmHg, n = 28) and squat (-12.9 mmHg, n = 27) groups than in controls (-.4 mmHg; n = 22) but changes in DBP were not. There were no significant within-group changes during phase 2 but SBP was 3.8 mmHg lower in the wall squat than the handgrip group-a small magnitude but clinically important difference. While both interventions produced significant SBP reductions, the wall squat appears to be more effective in maintaining benefits with a minimal training dose. The low time investment to achieve and retain clinically significant SBP reductions-42 and 12 min, respectively-and minimal cost, particularly of the wall squat, make it a promising intervention for delivery in public health settings.

Cardiovascular risk factors and death in South America. / Factores de riesgo y muerte cardiovascular en América del Sur.

We present cardiovascular disease (CVD) incidence and mortality rates reported for South America stratified by country, sex, and urban/rural location in a multinational cohort included in the Population Urban Rural Epidemiological Study (PURE). This study included 24,718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia and the mean follow-up was 10.3years. CVD incidence and mortality rates were calculated for the total cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and death were examined for 12 modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (smoking, alcohol, diet quality, and physical activity) and other (education, household air pollution, strength, and depression). The leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). Approximately 72% of the PAFs for CVD and 69% of the PAFs for deaths were attributed to 12 modifiable risk factors. For CVD, the main PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), smoking (13.5%), low muscle strength (5.6%), and diabetes (5.3%). For death, the main PAFs were smoking (14.4%), hypertension (12.0%), low educational level (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). Cardiovascular diseases, cancer, and respiratory diseases account for more than two-thirds of deaths in South America. Men have consistently higher CVD rates and mortality than women. A large proportion of CVD and premature deaths could be avoided by controlling metabolic risk factors and smoking, which are the main risk factors in the region for both CVD and all-cause mortality.

Increasing muscular strength to improve cardiometabolic risk factors.

Cardiovascular diseases (CVDs) remain the leading cause of worldwide death, accounting for significant morbidity, mortality, disability, and reduced quality of life. The global prevalence of cardiovascular (CV) risk factors, such as type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity, has grown exponentially in the last decades, particularly in low-medium income countries, and it's projected to increase rapidly in the coming years as the population progressively ages, leading to increased cardiovascular disease (CVD) and associated mortality. In fact, data from the global burden of disease study shows that CV mortality, associated disability-adjusted life years (DALYs), and years of life lost (YLL) have increased steadily, nearly doubling from 1990 to 2019. Recent evidence proves the existence of an inverse association between hand grip strength (HGS), as a proxy for global muscle strength, with all-cause mortality, CV mortality, and the development of several chronic diseases. These associations have been demonstrated recurringly across the entire lifespan, beginning in childhood, and carrying on throughout adult life. Mounting evidence strongly indicates that HGS is an early predictor of chronic disease in premorbid populations and a therapeutic target for CVD prevention. Recent clinical trials have consistently shown that resistance exercise, which increases strength and potentially muscle mass, significantly improves the control of known CVD risk factors, reduces the risk of all-cause death and cardiovascular mortality. In this review, we explore the latest evidence regarding the association between low muscle strength and diverse metabolic alterations, along with the interventions that could improve cardiometabolic risk factors, while simultaneously increasing muscle fitness.

Muscular Strength in Risk Factors for Cardiovascular Disease and Mortality: A Narrative Review.

Cardiovascular disease is the leading cause of death globally, accounting for approximately 32% of all deaths in 2019. There has been increasing interest in understanding the role of low muscular strength as a risk factor for cardiovascular disease, given its association with other cardiovascular risk factors such as hypertension, diabetes mellitus, and metabolic syndrome. An inverse association between muscle strength, chronic disease, all-cause mortality, and cardiovascular-related death has been reported. Recent clinical trials have consistently shown that resistance exercise, which increases strength, and potentially muscle mass, significantly improves the control of known cardiovascular disease risk factors and reduces the risk of all-cause death and cardiovascular mortality. In the present article, we review the growing body of evidence that supports the need for future research to evaluate the potential of handgrip strength as a screening tool for cardiovascular disease and its risk factors in the clinical medical setting, as part of routine care using an affordable handgrip strength device. Moreover, it is crucial to devise largescale interventions driven by governmental health policies to educate the general population and healthcare professionals about the importance of muscular strengthening activities and to promote access to these activities to improve cardiometabolic health and reduce incidence of cardiovascular disease and mortality.

Insulin Resistance Markers to Detect Nonalcoholic Fatty Liver Disease in a Male Hispanic Population.

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease and is closely associated with cardiometabolic disorders, being insulin resistance (IR) the common pathogenic mechanism. The triglycerides/glucose (TyG) index and triglycerides/HDL-c (TG/HDL) ratio are markers correlated with IR. We compared the capacity of these two indexes, alongside IR, to detect NAFLD. Methods: In a cross-sectional cohort study, we examined 263 active military personnel from the Colombian Air Force, aged between 29 and 54 years. Anthropometric measurements and biochemical determinations (glycemia, lipid profile, and insulin) were obtained, and ultrasound studies were performed to evaluate the presence of NAFLD. HOMA-IR index was calculated as (fasting insulin (µIU/mL) × fasting glucose (mmol/L)/22.5), the TyG index as Ln (triglycerides (mg/dL) × fasting glucose (mg/dL)/2), and the TG/HDL ratio as (triglycerides (mg/dL)/HDL-c (mg/dL)). Results: NAFLD ultrasound criteria were met in 70 individuals (26.6%). Subjects with NAFLD had significantly higher values of HOMA-IR (2.55 ± 1.36 vs. 1.51 ± 0.91), TyG (9.17 ± 0.53 vs. 8.7 ± 0.51), and TG/HDL (6.6 ± 4.54 vs. 3.52 ± 2.32) compared to those without NAFLD (p < 0.001). A TyG cutoff point of 8.92 showed an AUC of 0.731, while cutoff points of 3.83 for TG/HDL and 1.68 for HOMA-IR showed an AUC of 0.766 and 0.781, respectively. Conclusion: Our study shows that novel and lower-cost markers of IR are useful for detecting NALFD, with a performance comparable to the HOMA-IR index. These markers should be used as the first step when screening patients for NAFLD.

Ethnic Differences in the Prevalence of Hypertension in Colombia: Association With Education Level.

BACKGROUND: A higher prevalence of hypertension is reported among Afro-descendants compared with other ethnic groups in high-income countries; however, there is a paucity of information in low- and medium-income countries. METHODS: We evaluated 3,745 adults from 3 ethnic groups (552 White, 2,746 Mestizos, 447 Afro-descendants) enrolled in the prospective population-based cohort study (PURE)-Colombia. We assessed associations between anthropometric, socioeconomic, behavioral factors, and hypertension. RESULTS: The overall prevalence of hypertension was 39.2% and was higher in Afro-descendants (46.3%) than in Mestizos (37.6%) and Whites (41.5%), differences that were due to the higher prevalence in Afro-descendant women. Hypertension was associated with older age, increased body mass index, waist circumference and waist-to-hip ratio, independent of ethnicity. Low education was associated with hypertension in all ethnic groups, and particularly in Afro-descendants, for whom it was the factor with the strongest association with prevalence. Notably, 70% of Afro-descendants had a low level of education, compared with 52% of Whites-26% of Whites were university graduates while only 7% of Afro-descendants were. We did not find that education level alone had a mediator effect, suggesting that it is not a causal risk factor for hypertension but is an indicator of socioeconomic status, itself an important determinant of hypertension prevalence. CONCLUSIONS: We found that a higher prevalence of hypertension in Colombian Afro-descendants than other ethnic groups. This was principally associated with their lower mean educational level, an indicator of lower socioeconomic status.

Risk factors, cardiovascular disease, and mortality in South America: a PURE substudy.

AIMS: In a multinational South American cohort, we examined variations in CVD incidence and mortality rates between subpopulations stratified by country, by sex and by urban or rural location. We also examined the contributions of 12 modifiable risk factors to CVD development and to death. METHODS AND RESULTS: This prospective cohort study included 24 718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia. The mean follow-up was 10.3 years. The incidence of CVD and mortality rates were calculated for the overall cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and for death were examined for 12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (tobacco, alcohol, diet quality, and physical activity), and others (education, household air pollution, strength, and depression). Leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). The incidence of CVD (per 1000 person-years) only modestly varied between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates (per 1000 person-years) between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07). Men had a higher incidence of CVD (4.48 vs. 2.60 per 1000 person-years) and a higher mortality rate (6.33 vs. 3.96 per 1000 person-years) compared with women. Deaths were higher in rural compared to urban areas. Approximately 72% of the PAF for CVD and 69% of the PAF for deaths were attributable to 12 modifiable risk factors. For CVD, largest PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), tobacco use (13.5%), low strength (5.6%), and diabetes (5.3%). For death, the largest PAFs were from tobacco use (14.4%), hypertension (12.0%), low education (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). CONCLUSIONS: Cardiovascular disease, cancer, and respiratory diseases account for over two-thirds of deaths in South America. Men have consistently higher CVD and mortality rates than women. A large proportion of CVD and premature deaths could be averted by controlling metabolic risk factors and tobacco use, which are common leading risk factors for both outcomes in the region.

May Measurement Month 2019: an analysis of blood pressure screening results from Colombia.

Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.

The prediction of Metabolic Syndrome alterations is improved by combining waist circumference and handgrip strength measurements compared to either alone.

BACKGROUND: Adiposity is a major component of the metabolic syndrome (MetS), low muscle strength has also been identified as a risk factor for MetS and for cardiovascular disease. We describe the prevalence of MetS and evaluate the relationship between muscle strength, anthropometric measures of adiposity, and associations with the cluster of the components of MetS, in a middle-income country. METHODS: MetS was defined by the International Diabetes Federation criteria. To assess the association between anthropometric variables (waist circumference (WC), waist-to-hip ratio (W/H), body mass index (BMI)), strength (handgrip/kg bodyweight (HGS/BW)) and the cluster of MetS, we created a MetS score. For each alteration (high triglycerides, low HDLc, dysglycemia, or high blood pressure) one point was conferred. To evaluate the association an index of fat:muscle and MetS score, participants were divided into 9 groups based on combinations of sex-specific tertiles of WC and HGS/BW. RESULTS: The overall prevalence of MetS in the 5,026 participants (64% women; mean age 51.2 years) was 42%. Lower HGS/BW, and higher WC, BMI, and W/H were associated with a higher MetS score. Amongst the 9 HGS/BW:WC groups, participants in the lowest tertile of HGS/BW and the highest tertile of WC had a higher MetS score (OR = 4.69 in women and OR = 8.25 in men;p < 0.01) compared to those in the highest tertile of HGS/BW and in the lowest tertile of WC. CONCLUSION: WC was the principal risk factor for a high MetS score and an inverse association between HGS/BW and MetS score was found. Combining these anthropometric measures improved the prediction of metabolic alterations over either alone.