Asociación de placa ateroesclerótica y prediabetes: Estudio observacional con apareamiento por puntaje de propensión / Association of atherosclerotic plaque and prediabetes: Observational study with propensity score matching

Introducción: Los sujetos con prediabetes, definida como glucemia alterada en ayunas (IFG), tienen un riesgo cardiovascular aumentado. El objetivo principal del estudio es establecer si la prediabetes se asocia con la presencia de placa ateroesclerótica subclínica (pATS) en forma independiente de la edad, el sexo, la hipertensión arterial y otros factores de riesgo cardiovascular. Materiales y métodos: Estudio observacional apareado por puntaje de propensión (PSM). Se incluyeron 481 sujetos con prediabetes (según los criterios de la Asociación Americana de Diabetes [ADA]) y 481 controles apareados por edad, sexo e hipertensión arterial. Se excluyeron sujetos con enfermedad coronaria y/o vascular periférica y/o diabetes. La pATS fue definida como la presencia de placa detectada por ecografía doppler carotídea. Resultados: La prevalencia de pATS fue del 34,7% en los sujetos prediabéticos comparado con el 28,8% en los controles. El odds ratio (OR) ajustado tras realizar el control por edad, sexo, hipertensión arterial y c-HDL fue de 1,29 (IC 95%: 1,12-1,48; p<0,001). La prevalencia de pATS fue del 42,3% en los sujetos prediabéticos hipertensos comparada con el 32,9% en los controles (OR: 1,49; IC 95%: 1,05-2,12; p: 0,02). También observamos mayor pATS (18,7%) en los sujetos más jóvenes (≤55 años) comparada con los controles (11,1%) de igual edad (OR: 1,83; IC 95%: 1,05-3,2; p: 0,03). Conclusiones: Los sujetos con prediabetes se asociaron con mayor prevalencia de pATS. La posibilidad (odds) de presentar ateroesclerosis subclínica fue del 29% mayor en los sujetos con prediabetes tras ajustar por edad, sexo, hipertensión arterial y c-HDL. (AU)

Introduction: Subjects with prediabetes, defined as impaired fasting blood glucose (IFG), have an increased cardiovascular risk. The main objective of the study is to establish whether prediabetes is associated with the presence of subclinical atherosclerotic plaque (pATS) regardless of age, sex, arterial hypertension and other cardiovascular risk factores. Material and methods: Observational study with propensity score matching (PSM). We included 481 subjects with prediabetes (according to the criteria of the American Diabetes Association) and 481 controls matched for age, sex, and hypertension. Subjects with coronary artery disease and/or peripheral vascular disease and/or diabetes were excluded. pATS was defined as the presence of plaque detected by carotid doppler ultrasound. Results: The prevalence of pATS was 34.7% in prediabetic subjects compared to 28.8% in controls. The adjusted odds ratio (OR) after controlling for age, sex, hypertension, and HDL-c was 1.29 (95% CI: 1.12-1.48; P<.001). The prevalence of pATS was 42.3% in hypertensive prediabetic subjects compared to 32.9% in controls (OR: 1.49; 95% CI: 1.05-2.12; P: .02). We also observed higher pATS (18.7%) in younger subjects (≤55 years) compared to controls (11.1%) of the same age (OR: 1.83; 95% CI: 1.05-3.2; P: .03). Conclusion: Subjects with prediabetes were associated with a higher prevalence of pATS. The possibility (odds) of presenting subclinical atherosclerosis was 29% higher in subjects with prediabetes after adjusting for age, sex, hypertension and HDL-c. (AU)

Association of atherosclerotic plaque and prediabetes. Observational study with propensity score matching. / Asociación de placa ateroesclerótica y prediabetes. Estudio observacional con apareamiento por puntaje de propensión.

INTRODUCTION: Subjects with prediabetes, defined as impaired fasting blood glucose (IFG), have an increased cardiovascular risk. The main objective of the study is to establish whether prediabetes is associated with the presence of subclinical atherosclerotic plaque (pATS) regardless of age, sex, arterial hypertension and other cardiovascular risk factores. MATERIAL AND METHODS: Observational study with propensity score matching (PSM). We included 481 subjects with prediabetes (according to the criteria of the American Diabetes Association) and 481 controls matched for age, sex, and hypertension. Subjects with coronary artery disease and/or peripheral vascular disease and/or diabetes were excluded. pATS was defined as the presence of plaque detected by carotid doppler ultrasound. RESULTS: The prevalence of pATS was 34.7% in prediabetic subjects compared to 28.8% in controls. The adjusted odds ratio (OR) after controlling for age, sex, hypertension, and HDL-c was 1.29 (95% CI: 1.12-1.48; P<.001). The prevalence of pATS was 42.3% in hypertensive prediabetic subjects compared to 32.9% in controls (OR: 1.49; 95% CI: 1.05-2.12; P: .02). We also observed higher pATS (18.7%) in younger subjects (≤55 years) compared to controls (11.1%) of the same age (OR: 1.83; 95% CI: 1.05-3.2; P: .03). CONCLUSION: Subjects with prediabetes were associated with a higher prevalence of pATS. The possibility (odds) of presenting subclinical atherosclerosis was 29% higher in subjects with prediabetes after adjusting for age, sex, hypertension and HDL-c.

Valores ecocardiográficos de referencia de las cavidades derechas en una población sana / Reference Values for Right-Sided Heart Chambers by Echocardiography in a Healthy Population

RESUMEN Introducción: La evaluación de las cavidades cardíacas derechas es de gran importancia diagnóstica y pronóstica en diversas patologías. Sin embargo, existen pocos datos bibliográficos acerca de los valores de referencia de sus dimensiones así como de la función del ventrículo derecho. Objetivo: Nuestro objetivo fue establecer dichos valores, identificar diferencias asociadas al sexo y a variables antropométricas y evaluar la variabilidad inter- e intraobservador en su determinación. Material y métodos: Se incluyeron prospectivamente personas sanas ≥ 16 años, de ambos sexos. Se aplicaron estrictos criterios de exclusión. Se realizó la evaluación ecocardiográfica con múltiples mediciones de cavidades derechas y la estimación de la variabilidad inter- e intraobservador en un subgrupo de 40 personas. Resultados: Se incluyeron 438 personas, el 55,2% (n = 242) fueron hombres. La media de edad fue 34 ± 9 años. Las variables analizadas mostraron diferencias significativas entre hombres y mujeres, que persistieron al indexarlas a superficie corporal. La fuerza de concordancia para la variabilidad interobservador fue excelente (CCI > 0,75) en el 50% de las variables estudiadas, regular a buena (CCI 0,4 a 0,75) en el 47,4% y pobre (CCI < 0,4) en el 2,6%. La concordancia intraobservador fue excelente en el 54,8% de las variables, regular a buena en el 42,8% de ellas y pobre en el 2,4%. Conclusión: Presentamos valores de referencia para la evaluación de las cavidades derechas. Las diferencias observadas entre sexos y según la superficie corporal hacen necesaria su discriminación acorde con dichos parámetros en la práctica diaria. La concordancia interobservador e intraobservador fue excelente a buena en la mayoría de las variables estudiadas.

ABSTRACT Background: The evaluation of right-sided heart chambers is extremely important for the diagnosis and prognosis of differ-ent conditions. However, there is little information in the bibliography about the reference values of the right-sided heart chambers dimensions and right ventricular function. Objective: The aim of this study was to establish the reference values of the right-sided heart chambers, to identify the dif-ferences associated with sex and anthropometric variables and to evaluate the interobserver and intraobserver variability in determining these values. Methods: The study included healthy men and women ≥16 years. Strict exclusion criteria were applied. A subgroup of 40 people underwent multiple measurementis of the right-sided heart chambers and interobserver and intraobserver variability was estimated. Resultis: A total of 438 persons were included; 55.2% (n=242) were men. Mean age was 34±9 years. There were significant differences in the variables analyzed between men and women that persisted after they were indexed to body surface area. Interobserver concordance (ICC>0.75) was excellent in 50% of the variables evaluated, fair to good (ICC 0.4 to 0.75) in 47.4% and poor (ICC<0.4) in 2.6%. Intraobserver concordance was excellent in 54.8% of the variables, fair to good in 42.8% and poor in 2.4%. Conclusion: The reference values for the evaluation of right-sided heart chambers are presented. The differences observed between sexes and related to body surface area emphasize the need for discriminating according to these parameters in daily practice. Interobserver and intraobserver concordance was excellent to good in most of the variables analyzed.

Patients' perceptions of argentine physicians' empathy based on the jefferson scale of patient's perceptions of physician empathy: Psychometric data and demographic differences.

BACKGROUND: The aim of this study was to evaluate the validity of a modified Spanish version of the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) in Argentine patients and to explore how local demographic characteristics influence patients' perceptions of their physicians' empathy. METHODS: A survey was conducted in March 2013 among 400 Spanish-speaking outpatients attending three different public or private hospitals of Buenos Aires. A principal component analysis (PCA) was used to identify the JSPPPE factor structure, and a confirmatory factor analysis (CFA) was employed to evaluate its construct validity. Demographic variables including age, gender, geographic origin, education, health coverage, regular physician-established and patient-perceived health status were used to find what factors may influence empathy rating. RESULTS: The PCA yielded a one-factor model that accounted for 77.5% of the variance, and an adequate model fit was observed with CFA indices. Male and elderly patients, South American descendants, less educated people, and public hospital attendants were associated with a higher JSPPPE score. Patients perceived a lower interest of physicians in their daily problems and a poorer capacity "to stand in their shoes." DISCUSSION: The JSPPPE provides a valid score to measure patients' perceptions of physician empathy in Argentina. These findings afford insight into Argentine patients' awareness of their doctors' empathic concern; however, JSPPPE scores may be alternatively interpreted in terms of patients' satisfaction or likeability.

Estudio TAMARA II. Tabaquismo en médicos de la República Argentina II / The tamara ii trial. smoking among physicians in argentina

background: Smoking is the leading cause of preventable morbidity and death. It is important to know the characteristics of smoking habits among physicians and their attitude toward patients who smoke. Objective: The aim of this study is to investigate the prevalence of smoking among physicians in Argentina, the factors associated with tobacco consumption and their attitude toward their patients who smoke. Methods: An observational cross- sectional study was performed between June and December 2013 in Argentine physicians of dif-ferent specialties. Using a structured survey, the following variables were analyzed: associated cardiovascular risk factors, charac-teristics of tobacco consumption, smoking cessation training and the attitude toward the patient who smokes. results: 3,033 physicians were surveyed, ; 57% were men, and mean age was 41.3±12 years; 19.7% were current smokers and 21.7% were former smokers. The probability of being a smoker was higher among surgeons (OR 1.29) or physicians working at the emergency room (OR 1.41). Undergraduate and postgraduate tobacco cessation training was achieved by 36.6% and 40.8% of physicians, respectively. Young physicians, clinical specialties or private practice were associated with higher level of training. Tobacco cessation counseling was more frequent in physicians with higher level of training than physicians who smoked or surgeons. Former smokers presented higher prevalence of risk factors and cardiovascular events. Family history of smoking habit was more common in former smokers and current smokers. Conclusions: The prevalence of smoking among Argentine physicians is high. Different factors are involved in the probability of smoking, tobacco cessation training or the possibility of medical counseling. Higher level of training in smoking cessation must be provided.

Diferencias en los estilos de aprendizaje desde la escuela primaria hasta el posgrado en medicina / Learning styles preferences from elementary school to medical postgraduate

Objetivos: Describir los estilos de aprendizaje de estudiantes de medicina al ingreso y en el posgrado inmediato, de acuerdo con las modalidades preferidas para usar la información, y comparar estos resultados con los estilos de alumnos de la escuela primaria, a fin de hallar diferencias generacionales. Sujetos y métodos: Se administró el cuestionario VARK a 73 alumnos de séptimo grado de una escuela primaria, 113 estudiantes de primer año de medicina y 141 residentes. Se realizó un análisis exploratorio para determinar conjuntos con características afines (análisis de conglomerados). El conteo y suma de los resultados de cada individuo representó el estilo preponderante de cada grupo, definiéndose como dominante cuando se elegía en más del 50% de las respuestas. Resultados: Los estilos preponderantes en los tres grupos fueron cinestésico (27,5%) y bimodal (37,3%), mientras que el lectoescritor creció desde la escuela primaria hasta el posgrado (1,4% a 10,7%; p = 0.037), con una tendencia de la caída del estilo auditivo desde la primaria hasta la universidad y posgrado (19,2% a 12,2%; p = 0.269). Para el estilo bimodal, la combinación preponderante fue auditivo-cinestésica, que disminuyó desde la primaria hasta el posgrado (65% a 31%; p = 0,002). Conclusiones: El análisis de correspondencia mostró que los alumnos de la escuela primaria preferían el estilo auditivo, los universitarios se acercaban al cinestésico y los de posgrado tenían una preferencia intermedia entre el visual y el lectoescritor. Este último perfil creció significativamente desde la escuela primaria hasta el posgrado, con una tendencia inversa del estilo auditivo y del bimodal auditivo-cinestésico entre los mismos grupos

Aims: To describe learning styles observed in first-year medical students and in postgraduates, regarding sensory preferences to use information, and to compare the results with the learning styles of last-year elementary school pupils, in order to find out generational differences. Subjects and methods:The VARK questionnaire was administered to 73 last-year elementary school pupils, 113 first-year medical students and 141 residents of cardiology (postgraduate). The questionnaire consists of 16 questions and each answer was associated to a particular learning style, corresponding to visual, aural, reading/writing or kinaesthetic. Results: Most common styles were kinaesthetic (27.5%) and bimodal (37.3%) in the three groups, with some differences in reading/writing profile that increased from elementary school up to postgraduate (1.4% to 10.7%; p = 0.037), and a slight tendency to decrease aural style from that educational level to the university and the postgraduate (19.2% to 12.2%; p = 0.269). Within bimodal styles, the most common combination was aural-kinaesthetic, that decreased from the elementary school to the postgraduate (65% to 31%; p = 0.002). Conclusions: Correspondence analysis showed last-year elementary school pupils preferred aural style, medical students were nearer to kinaesthetic mode, and postgraduates had an intermediate preference between visual and reading/writing styles. The last profile significantly increased from elementary school to postgraduate, with an inverse tendency of aural and aural-kinaesthetic bimodal styles among the two same levels

Estratificación del riesgo cardiovascular en pacientes con sobrepeso u obesidad en prevención primaria. Implicaciones en la utilización de estatinas / Cardiovascular risk stratification in overweight or obese patients in primary prevention. Implications for use of statins

ANTECEDENTES Y OBJETIVOS: La estimación del riesgo cardiovascular en pacientes con sobrepeso/obesidad no está estandarizada. Nuestros objetivos fueron: estratificar el riesgo cardiovascular mediante distintos puntajes, analizar la indicación de estatinas, describir la prevalencia de placa aterosclerótica carotídea (PAC) y determinar el punto de corte óptimo (PCO) de los puntajes que discriminen entre sujetos con o sin PAC. Material y métodos Incluimos a pacientes no diabéticos con sobrepeso u obesidad en prevención primaria. Calculamos los puntajes de Framingham (PF) y europeo (PE), y el propuesto por las nuevas guías norteamericanas (NP), evaluando la indicación de estatinas. Determinamos la prevalencia de PAC mediante ultrasonido. Realizamos un análisis ROC. RESULTADOS: Se incluyó a 474 pacientes (67% con sobrepeso y 33% obesos). El PF fue el que más sujetos clasificó como «bajo riesgo». La prevalencia de PAC fue mayor en los obesos en comparación con los sujetos con sobrepeso (44.8% vs. 36.1%, p = 0,04). Basándose en el PF, PE y NP, el 26,7, el 39,1 y el 39,1% de los sujetos con sobrepeso y el 28,6, el 39,0 y el 39,0% de los obesos tenían indicación absoluta de estatinas. Los 3 puntajes mostraron discriminar aceptablemente entre sujetos con o sin PAC (área bajo la curva > 0,7). Los PCO evaluados no necesariamente coincidieron con los valores que determinan las categorías de riesgo. CONCLUSIONES: En esta población con sobrepeso/obesidad, la estratificación de riesgo y la indicación de estatinas variaron según la función utilizada. Conocer la relación entre los puntajes y la presencia de PAC podría optimizar la estimación de riesgo

BACKGROUND AND OBJECTIVES: Cardiovascular risk estimation in patients with overweight/obesity is not standardized. Our objectives were to stratify cardiovascular risk using different scores, to analyze use of statins, to report the prevalence of carotid atherosclerotic plaque (CAP), and to determine the optimal cut-off point (OCP) of scores that discriminate between subjects with or without CAP. MATERIAL AND METHODS: Non-diabetic patients with overweight or obesity in primary prevention were enrolled. The Framingham score (FS), the European score (ES), and the score proposed by the new American guidelines (NS) were calculated, and statin indication was evaluated. Prevalence of CAP was determined by ultrasound examination. A ROC analysis was performed. RESULTS: A total of 474 patients (67% with overweight and 33% obese) were enrolled into the study. The FS classified the largest number of subjects as low risk. PAC prevalence was higher in obese as compared to overweight subjects (44.8% vs. 36.1%, P = .04). According to the FS, ES, and NS respectively, 26.7%, 39.1%, and 39.1% of overweight subjects and 28.6%, 39.0%, and 39.0% of obese subjects had an absolute indication for statins. All three scores were shown to acceptably discriminate between subjects with and without CAP (area under the curve > 0.7). The OCPs evaluated did not agree with the risk category values. CONCLUSIONS: Risk stratification and use of statins varied in the overweight/obese population depending on the function used. Understanding of the relationship between scores and presence of CAP may optimize risk estimate

Cardiovascular risk stratification in overweight or obese patients in primary prevention. Implications for use of statins.

BACKGROUND AND OBJECTIVES: Cardiovascular risk estimation in patients with overweight/obesity is not standardized. Our objectives were to stratify cardiovascular risk using different scores, to analyze use of statins, to report the prevalence of carotid atherosclerotic plaque (CAP), and to determine the optimal cut-off point (OCP) of scores that discriminate between subjects with or without CAP. MATERIAL AND METHODS: Non-diabetic patients with overweight or obesity in primary prevention were enrolled. The Framingham score (FS), the European score (ES), and the score proposed by the new American guidelines (NS) were calculated, and statin indication was evaluated. Prevalence of CAP was determined by ultrasound examination. A ROC analysis was performed. RESULTS: A total of 474 patients (67% with overweight and 33% obese) were enrolled into the study. The FS classified the largest number of subjects as low risk. PAC prevalence was higher in obese as compared to overweight subjects (44.8% vs. 36.1%, P=.04). According to the FS, ES, and NS respectively, 26.7%, 39.1%, and 39.1% of overweight subjects and 28.6%, 39.0%, and 39.0% of obese subjects had an absolute indication for statins. All three scores were shown to acceptably discriminate between subjects with and without CAP (area under the curve>0.7). The OCPs evaluated did not agree with the risk category values. CONCLUSIONS: Risk stratification and use of statins varied in the overweight/obese population depending on the function used. Understanding of the relationship between scores and presence of CAP may optimize risk estimate.

Estratificación del riesgo cardiovascular con diferentes puntajes de riesgo en prevención primaria y sus implicaciones en la indicación de estatinas / Use of Different Scores for Cardiovascular Risk Stratification in Primary Prevention and Their Implications in Statin Indication

Introducción: En nuestro medio no contamos con un puntaje de riesgo cardiovascular surgido de un estudio epidemiológico local, por lo que habitualmente se emplean puntajes desarrollados a partir de grandes estudios epidemiológicos de otras regiones que, si bien resultan herramientas muy útiles en la práctica clínica, tienen limitaciones relacionadas con la calibración y la capacidad de discriminación. Objetivos: 1) Estratificar el riesgo cardiovascular de una población en prevención primaria utilizando diferentes puntajes. 2) Estimar la concordancia entre dichos puntajes. 3) Analizar la recomendación de estatinas. 4) Estimar la prevalencia de placa aterosclerótica carotídea (PAC) y el punto de corte óptimo (PCO) del nuevo puntaje americano (NP) que discrimine entre sujetos con PAC o sin PAC. Material y métodos: Se incluyeron pacientes en prevención primaria, sin diabetes ni tratamiento hipolipemiante. Se calcularon los puntajes de Framingham (PF), europeo (PE), el recomendado por la OMS (POMS) y el propuesto por las nuevas guías americanas y se analizó la concordancia entre los diferentes puntajes. La indicación de estatinas se consideró en base a cada función de riesgo. La prevalencia de PAC se determinó mediante ultrasonido. Se realizó un análisis ROC. Resultados: Se analizaron 772 pacientes (edad 52 ± 11 años, 66% mujeres), de los cuales de acuerdo con los puntajes P F, PE y POMS se clasificaron de "riesgo bajo" el 76,8%, el 50,9% y el 91,7%, respectivamente. La concordancia fue pobre entre los tres puntajes (kappa 0,14). El 23,6%, el 7% y el 33% de los casos tenían indicación absoluta de estatinas en base al P F, el PE y el N P, respectivamente. Cuando no existía dicha indicación y utilizando los mismos puntajes, el 23,5%, el 50% y el 18% de los sujetos tenían una recomendación opcional. Aplicando el POMS, solo se trataría al 3% de los pacientes. La prevalencia de PAC fue más alta en los estratos de mayor riesgo, aunque no despreciable en sujetos con riesgo bajo. El PCO del NP fue 5,2%. Conclusiones: La estratificación del riesgo y la indicación de estatinas varían según la función de riesgo utilizada. Conocer la relación entre la presencia de PAC y los puntajes podría mejorar la estimación del riesgo en nuestra población.

Background: Our setting lacks a cardiovascular risk score arising from a local epidemiological study, and so scores developed from great epidemiological studies in other regions are used. However, although these scores are very useful in clinical practice, they have limitations associated to calibration and discrimination capacity. Objectives: The purpose of this study was to 1) to stratify cardiovascular risk in a primary prevention population using different scores; 2) to estimate the concordance between these scores; 3) to analyze statin use recommendations; and 4) to estimate the prevalence of carotid atherosclerotic plaque (CAP) and the optimal cut-off point (OCP) of the new American score (NS) to discriminate between subjects with or without CAP. Methods: Primary prevention patients without diabetes or lipid-lowering therapy were included in the study. The Framingham score (FS), the European score (ES), the score recommended by the World Health Organization (WHOS) and the NS proposed by the new American guidelines were calculated, analyzing the concordance among them. The indication of statins was based on each score. Ultrasound was used to assess CAP occurrence. A ROC analysis was performed to analyze results. Results: The study included 772 patients. Mean age was 52 ± 11 years and 66% were women. According to FS, ES and WHOS, 78.8%, 50.9% and 91.7% of the population were respectively classified at "low risk". A poor level of agreement between scores was found (kappa 0.14). The percentage of cases with absolute indication for statins based on FS, ES and NS was 23.6%, 7% and 33%, respectively. When there was no such indication and using the same scores, 23.5%, 50% and 18% of subjects had an optional recommendation. Applying WHOS, only 3% of patients would have been treated. The prevalence of CAP was greater in higher risk strata, though not negligible in low risk subjects. The OCP for NS was 5.2%. Conclusions: Risk stratification and the use of statins vary according to the cardiovascular score used. Knowledge of the relationship between presence of CAP and scores could improve the estimation of risk in our population.

Ejercicio en médicos argentinos: encuesta sobre hábitos y actitudes frente a la actividad física / Physical Exercise in Argentine Physicians: a Survey on Their Habits and Attitudes Towards Physical Activity

Introducción La inactividad física se asocia con mayor morbimortalidad cardiovascular y está en aumento en la población general. Los médicos serían los mejor preparados para brindar asesoramiento sobre actividad física a los pacientes; no obstante ello, no existen datos locales validados relativos a los hábitos y las actitudes de los médicos frente al ejercicio. Objetivos Analizar las características de la actividad física en una población de médicos, determinar la actitud del médico frente al paciente con respecto al ejercicio, estudiar la relación entre la actividad física y la edad, el sexo y la especialidad y evaluar los factores de riesgo de esta población. Material y métodos Se realizó una encuesta a médicos de la Ciudad Autónoma de Buenos Aires y del Conurbano bonaerense. Se utilizó el International Physical Activity Questionnaire (Cuestionario Internacional de Actividad Física). Para evaluar el nivel de actividad física se empleó una escala basada en los MET semanales ( 3.000 MET = actividad física vigorosa). Resultados Se incluyeron 550 médicos (53% hombres, edad media 38 años). El 37,5%, el 57,5% y el 5% realizan actividad física baja, moderada o vigorosa, respectivamente. Al 80% de la población le gusta hacer ejercicio, el 92% recomienda hacer ejercicio a sus pacientes y el 97% lo considera beneficioso para la salud. El principal motivo para no realizar ejercicio es la falta de tiempo. Los hombres realizan más actividad física vigorosa 3 o más veces por semana (20% vs. 15%; p < 0,01) que las mujeres. La especialidad cardiología es en la que se indica más frecuentemente realizar ejercicio (75%). Conclusiones En esta población médica, independientemente del sexo, el grupo etario o la especialidad analizada, se observó una prevalencia menor de actividad física baja en comparación con la población general. La recomendación de ejercicio a los pacientes fue globalmente elevada, aunque mayor en las especialidades clínicas.

Background Sedentarism is associated with higher cardiovascular morbidity and mortality and is increasing in the general population. Physicians should have the best preparation to instruct patients on physical activity. There are, however, no validated local data regarding physician’s habits and attitudes towards physical exercise. Objectives The aim of the study was to analyze the characteristics of physical activity in a medical population, determine the attitude towards patients regarding exercise, study the relationship between physical activity and age, gender and specialty and evaluate the risk factors of this population. Methods We surveyed physicians from the Autonomous City of Buenos Aires and the Greater Buenos Aires using the International Physical Activity Questionnaire (IPAQ). To assess the physical activity level a scale based on weekly METS ( 3000 METS = vigorous physical activity) was applied. Results Five hundred and fifty physicians were included (53% male, mean age 38 years). Physical activity levels were low, moderate or vigorous in 37.5%, 57.5%, and 5% of cases, respectively. Eighty percent of the medical population liked to exercise, 92% recommended exercise to their patients and 97% saw it as beneficial for health. The main reason for not performing exercise was lack of time. Men performed more vigorous physical activity than women (20 vs. 15%, p <0.01). Cardiology was the specialty which recommended exercise more frequently to patients (75%). Conclusions In this medical population there was a lower prevalence of low physical activity than in the general population, independently of gender, age group or specialty analyzed. Exercise recommendation to patients was generally high, though more elevated in clinical specialties.

Respuesta a las estatinas en prevención cardiovascular: evaluación de los hiporrespondedores / Response to Statins in Cardiovascular Prevention: Hypo-Responders’ Evaluation

Introducción En numerosos ensayos clínicos se demostró que las estatinas reducen los eventos cardiovasculares, tanto en prevención primaria como secundaria. Sin embargo, existe una variación individual considerable en la respuesta esperada para cada dosis y tipo de estatina, por lo que detectar al paciente hiporrespondedor a las estatinas permitiría considerar un tratamiento hipolipemiante adicional. Objetivos Evaluar la respuesta a las estatinas en pacientes en prevención cardiovascular y analizar las características de los sujetos hiporrespondedores. Material y métodos Se incluyeron en forma consecutiva pacientes ambulatorios con indicación de estatinas. El médico tratante definía la estatina y la dosis utilizada. Se analizaron los valores basales y postratamiento (6-24 semanas) del perfil lipídico. Se analizó la distribución de la reducción del C-LDL para cada tipo y dosis de estatina y se definió “baja respuesta” según dos estrategias: si el porcentaje de reducción se encontraba por debajo de la mediana o por debajo del percentil 25. Se realizaron análisis univariados y multivariados. Resultados Se incluyeron 446 pacientes (52% mujeres, 25% diabéticos, 80% prevención primaria, edad 58 ± 11 años). La reducción del C-LDL promedio fue del 27%, 38% y 43% para simvastatina 10 mg, 20 mg y 40 mg, respectivamente, del 36% y 43% para atorvastatina 10 mg y 20 mg, respectivamente, y del 44% y 49% para rosuvastatina 10 mg y 20 mg, respectivamente. Definiendo hiporrespuesta por ambas estrategias (mediana y percentil 25), el sexo masculino (OR 2,54 y 2,31), la diabetes (OR 2,0 y 3,85), la edad (cada 5 años, OR 0,87 y 0,83) y el nivel basal de C-LDL (cada 10 mg/dl, OR 0,78 y 0,77) se asociaron independientemente con una chance mayor de ser hiporrespondedor. Conclusiones La reducción del C-LDL por las diferentes estatinas fue similar a lo previamente publicado. Los hombres, los diabéticos, los sujetos más jóvenes o con niveles basales más bajos de C-LDL tuvieron mayor probabilidad de mostrar baja respuesta a las estatinas.

Introduction Numerous clinical trials have shown that statins reduce cardiovascular events, both in primary and secondary prevention. There is, however, considerable individual variation in the expected response for each dose and type of statin; therefore, detection of hypo-responder patients would allow considering additional hypolipidemic treatment. Objectives The aims of this study were to evaluate the response to statins in cardiovascular prevention patients and to analyze the characteristics of hyporesponder subjects. Methods Consecutive outpatients receiving statins were included. The treating physician defined the type and dose of statin used. The lipid profile was assessed at baseline and post-treatment (6-24 weeks). The distribution of LDL-C reduction for each type and dose of statin was analyzed and “low response” was defined according to two strategies: if the percent reduction was below the median or below the 25th percentile. Univariate and multivariate analyses were performed. Results A total of 446 patients (52% female, 25% diabetic, 80% primary prevention, age 58 ± 11 years) were included in the study. Mean LDL-C reduction was 27%, 38% and 43% for simvastatin 10, 20 and 40 mg, respectively, 36% and 43% for atorvastatin 10 and 20 mg, respectively, and 44% and 49% for rosuvastatin 10 and 20 mg, respectively. Hypores-ponsiveness defined by both strategies (median and 25th percentile) showed that male gender (OR 2.54 and 2.31), diabetes (OR 2.0 and 3.85), age (every 5 years, OR 0.87 and 0.83) and baseline LDL-C (every 10 mg/dL, OR 0.78 and 0.77) were independently associated with greater chance of being hypo-responder. Conclusions LDL-C reduction by different statins was similar to previous reports. Men, diabetics, younger subjects or with lower baseline LDL-C were more likely to show poor response to statins.

Ejercicio en médicos argentinos: encuesta sobre hábitos y actitudes frente a la actividad física / Physical Exercise in Argentine Physicians: a Survey on Their Habits and Attitudes Towards Physical Activity

Introducción La inactividad física se asocia con mayor morbimortalidad cardiovascular y está en aumento en la población general. Los médicos serían los mejor preparados para brindar asesoramiento sobre actividad física a los pacientes; no obstante ello, no existen datos locales validados relativos a los hábitos y las actitudes de los médicos frente al ejercicio. Objetivos Analizar las características de la actividad física en una población de médicos, determinar la actitud del médico frente al paciente con respecto al ejercicio, estudiar la relación entre la actividad física y la edad, el sexo y la especialidad y evaluar los factores de riesgo de esta población. Material y métodos Se realizó una encuesta a médicos de la Ciudad Autónoma de Buenos Aires y del Conurbano bonaerense. Se utilizó el International Physical Activity Questionnaire (Cuestionario Internacional de Actividad Física). Para evaluar el nivel de actividad física se empleó una escala basada en los MET semanales ( 3.000 MET = actividad física vigorosa). Resultados Se incluyeron 550 médicos (53% hombres, edad media 38 años). El 37,5%, el 57,5% y el 5% realizan actividad física baja, moderada o vigorosa, respectivamente. Al 80% de la población le gusta hacer ejercicio, el 92% recomienda hacer ejercicio a sus pacientes y el 97% lo considera beneficioso para la salud. El principal motivo para no realizar ejercicio es la falta de tiempo. Los hombres realizan más actividad física vigorosa 3 o más veces por semana (20% vs. 15%; p < 0,01) que las mujeres. La especialidad cardiología es en la que se indica más frecuentemente realizar ejercicio (75%). Conclusiones En esta población médica, independientemente del sexo, el grupo etario o la especialidad analizada, se observó una prevalencia menor de actividad física baja en comparación con la población general. La recomendación de ejercicio a los pacientes fue globalmente elevada, aunque mayor en las especialidades clínicas.(AU)

Background Sedentarism is associated with higher cardiovascular morbidity and mortality and is increasing in the general population. Physicians should have the best preparation to instruct patients on physical activity. There are, however, no validated local data regarding physicianÆs habits and attitudes towards physical exercise. Objectives The aim of the study was to analyze the characteristics of physical activity in a medical population, determine the attitude towards patients regarding exercise, study the relationship between physical activity and age, gender and specialty and evaluate the risk factors of this population. Methods We surveyed physicians from the Autonomous City of Buenos Aires and the Greater Buenos Aires using the International Physical Activity Questionnaire (IPAQ). To assess the physical activity level a scale based on weekly METS ( 3000 METS = vigorous physical activity) was applied. Results Five hundred and fifty physicians were included (53% male, mean age 38 years). Physical activity levels were low, moderate or vigorous in 37.5%, 57.5%, and 5% of cases, respectively. Eighty percent of the medical population liked to exercise, 92% recommended exercise to their patients and 97% saw it as beneficial for health. The main reason for not performing exercise was lack of time. Men performed more vigorous physical activity than women (20 vs. 15%, p <0.01). Cardiology was the specialty which recommended exercise more frequently to patients (75%). Conclusions In this medical population there was a lower prevalence of low physical activity than in the general population, independently of gender, age group or specialty analyzed. Exercise recommendation to patients was generally high, though more elevated in clinical specialties.(AU)

Respuesta a las estatinas en prevención cardiovascular: evaluación de los hiporrespondedores / Response to Statins in Cardiovascular Prevention: Hypo-RespondersÆ Evaluation

Introducción En numerosos ensayos clínicos se demostró que las estatinas reducen los eventos cardiovasculares, tanto en prevención primaria como secundaria. Sin embargo, existe una variación individual considerable en la respuesta esperada para cada dosis y tipo de estatina, por lo que detectar al paciente hiporrespondedor a las estatinas permitiría considerar un tratamiento hipolipemiante adicional. Objetivos Evaluar la respuesta a las estatinas en pacientes en prevención cardiovascular y analizar las características de los sujetos hiporrespondedores. Material y métodos Se incluyeron en forma consecutiva pacientes ambulatorios con indicación de estatinas. El médico tratante definía la estatina y la dosis utilizada. Se analizaron los valores basales y postratamiento (6-24 semanas) del perfil lipídico. Se analizó la distribución de la reducción del C-LDL para cada tipo y dosis de estatina y se definió ôbaja respuestaö según dos estrategias: si el porcentaje de reducción se encontraba por debajo de la mediana o por debajo del percentil 25. Se realizaron análisis univariados y multivariados. Resultados Se incluyeron 446 pacientes (52% mujeres, 25% diabéticos, 80% prevención primaria, edad 58 ± 11 años). La reducción del C-LDL promedio fue del 27%, 38% y 43% para simvastatina 10 mg, 20 mg y 40 mg, respectivamente, del 36% y 43% para atorvastatina 10 mg y 20 mg, respectivamente, y del 44% y 49% para rosuvastatina 10 mg y 20 mg, respectivamente. Definiendo hiporrespuesta por ambas estrategias (mediana y percentil 25), el sexo masculino (OR 2,54 y 2,31), la diabetes (OR 2,0 y 3,85), la edad (cada 5 años, OR 0,87 y 0,83) y el nivel basal de C-LDL (cada 10 mg/dl, OR 0,78 y 0,77) se asociaron independientemente con una chance mayor de ser hiporrespondedor. Conclusiones La reducción del C-LDL por las diferentes estatinas fue similar a lo previamente publicado. Los hombres, los diabéticos, los sujetos más jóvenes o con niveles basales más bajos de C-LDL tuvieron mayor probabilidad de mostrar baja respuesta a las estatinas.(AU)

Introduction Numerous clinical trials have shown that statins reduce cardiovascular events, both in primary and secondary prevention. There is, however, considerable individual variation in the expected response for each dose and type of statin; therefore, detection of hypo-responder patients would allow considering additional hypolipidemic treatment. Objectives The aims of this study were to evaluate the response to statins in cardiovascular prevention patients and to analyze the characteristics of hyporesponder subjects. Methods Consecutive outpatients receiving statins were included. The treating physician defined the type and dose of statin used. The lipid profile was assessed at baseline and post-treatment (6-24 weeks). The distribution of LDL-C reduction for each type and dose of statin was analyzed and ôlow responseö was defined according to two strategies: if the percent reduction was below the median or below the 25th percentile. Univariate and multivariate analyses were performed. Results A total of 446 patients (52% female, 25% diabetic, 80% primary prevention, age 58 ± 11 years) were included in the study. Mean LDL-C reduction was 27%, 38% and 43% for simvastatin 10, 20 and 40 mg, respectively, 36% and 43% for atorvastatin 10 and 20 mg, respectively, and 44% and 49% for rosuvastatin 10 and 20 mg, respectively. Hypores-ponsiveness defined by both strategies (median and 25th percentile) showed that male gender (OR 2.54 and 2.31), diabetes (OR 2.0 and 3.85), age (every 5 years, OR 0.87 and 0.83) and baseline LDL-C (every 10 mg/dL, OR 0.78 and 0.77) were independently associated with greater chance of being hypo-responder. Conclusions LDL-C reduction by different statins was similar to previous reports. Men, diabetics, younger subjects or with lower baseline LDL-C were more likely to show poor response to statins.(AU)

Estimación del riesgo cardiovascular y detección de ateromatosis carotídea subclínica en mujeres posmenopáusicas de mediana edad / Estimation of Cardiovascular Risk and Detection of Subclinical Carotid Atheromatosis in Middle-aged Postmenopausal Women

Introducción La incidencia de enfermedad cardiovascular en la mujer aumenta luego de la menopausia.Los puntajes de riesgo tradicionales subestiman el riesgo en la mujer posmenopáusica. El diagnóstico de placa aterosclerótica carotídea (PAC) podría mejorar la estratificación del riesgo. Objetivos 1) Estimar el riesgo cardiovascular en mujeres posmenopáusicas de mediana edad en prevención primaria. 2) Conocer la prevalencia de PAC. 3) Calcular la precisión de los puntajes de riesgo para detectar PAC. Material y métodos Se calcularon el puntaje de Framingham a 10 años (PF10) y el puntaje recomendado por la Organización Mundial de la Salud (POMS), evaluando la concordancia entre ellos. Se determinó la prevalencia de PAC mediante ultrasonido. Se realizó un análisis ROC. Resultados Se incluyeron 334 mujeres (edad 57 ± 5 años). El 96% y el 91% de la población se clasificó como de "riesgo bajo" según el PF10 y el POMS, respectivamente. La concordancia entre los dos puntajes fue regular (kappa 0,31). La prevalencia de PAC fue del 29%. Se observó una correspondencia entre el riesgo estimado por los puntajes y la prevalencia de PAC. Las mujeres con PAC presentaron una prevalencia mayor de hipertensión arterial y tabaquismo, mostrando más frecuentemente un patrón "metabólico" que las mujeres sin PAC. El área bajo la curva del PF10 para detectar PAC fue de 0,79 (IC 95% 0,73-0,84), siendo el punto de corte óptimo = 3%. Conclusiones En esta población clasificada en su mayoría como de riesgo bajo, la prevalencia de PAC fue considerable. Ante un PF10 = 3%, la solicitud de una ecografía carotídea podría optimizar la estratificación del riesgo cardiovascular.

Background Cardiovascular disease in women increases after menopause. Traditional risk scores underestimate the risk in postmeno-pausal women. The diagnosis of carotid atherosclerotic plaque (CAP) could improve risk stratification. Objectives The aim of the study was: 1) To estimate cardiovascular risk in middle-aged postmenopausal women in primary preven-tion. 2) To find CAP prevalence. 3) To assess the precision of risk scores used to detect CAP. Methods The level of agreement between the 10-year Framingham risk score (10-FRS) and the score recommended by the World Health Organization (WHOS) was assessed. Ultrasound was used to determine CAP occurrence. A ROC analysis was performed. Results The study included a total of 334 women with mean age 57 ± 5 years. According to 10-FRS and WHOS, 96% and 91% of the population were respectively classified as "low risk". An adequate level of agreement between both scores was found (kappa 0.31). CAP occurred in 29% of cases. Score estimated risk correlated with CAP prevalence. Women with CAP presented higher incidence of hypertension and smoking, evidencing a more frequent "metabolic" pattern than women without CAP. The area under the curve of 10-FRS to detect CAP was 0.79 (95% CI 0.73-0.84), with an optimal cut-off point = 3%. Conclusions In this population, mostly classified as low risk, there was considerable CAP prevalence. A carotid ultrasound might help to stratify cardiovascular risk when 10-FRS is = 3%.

Estimación del riesgo cardiovascular y detección de ateromatosis carotídea subclínica en mujeres posmenopáusicas de mediana edad / Estimation of Cardiovascular Risk and Detection of Subclinical Carotid Atheromatosis in Middle-aged Postmenopausal Women

Introducción La incidencia de enfermedad cardiovascular en la mujer aumenta luego de la menopausia.Los puntajes de riesgo tradicionales subestiman el riesgo en la mujer posmenopáusica. El diagnóstico de placa aterosclerótica carotídea (PAC) podría mejorar la estratificación del riesgo. Objetivos 1) Estimar el riesgo cardiovascular en mujeres posmenopáusicas de mediana edad en prevención primaria. 2) Conocer la prevalencia de PAC. 3) Calcular la precisión de los puntajes de riesgo para detectar PAC. Material y métodos Se calcularon el puntaje de Framingham a 10 años (PF10) y el puntaje recomendado por la Organización Mundial de la Salud (POMS), evaluando la concordancia entre ellos. Se determinó la prevalencia de PAC mediante ultrasonido. Se realizó un análisis ROC. Resultados Se incluyeron 334 mujeres (edad 57 ± 5 años). El 96% y el 91% de la población se clasificó como de "riesgo bajo" según el PF10 y el POMS, respectivamente. La concordancia entre los dos puntajes fue regular (kappa 0,31). La prevalencia de PAC fue del 29%. Se observó una correspondencia entre el riesgo estimado por los puntajes y la prevalencia de PAC. Las mujeres con PAC presentaron una prevalencia mayor de hipertensión arterial y tabaquismo, mostrando más frecuentemente un patrón "metabólico" que las mujeres sin PAC. El área bajo la curva del PF10 para detectar PAC fue de 0,79 (IC 95% 0,73-0,84), siendo el punto de corte óptimo = 3%. Conclusiones En esta población clasificada en su mayoría como de riesgo bajo, la prevalencia de PAC fue considerable. Ante un PF10 = 3%, la solicitud de una ecografía carotídea podría optimizar la estratificación del riesgo cardiovascular.(AU)

Background Cardiovascular disease in women increases after menopause. Traditional risk scores underestimate the risk in postmeno-pausal women. The diagnosis of carotid atherosclerotic plaque (CAP) could improve risk stratification. Objectives The aim of the study was: 1) To estimate cardiovascular risk in middle-aged postmenopausal women in primary preven-tion. 2) To find CAP prevalence. 3) To assess the precision of risk scores used to detect CAP. Methods The level of agreement between the 10-year Framingham risk score (10-FRS) and the score recommended by the World Health Organization (WHOS) was assessed. Ultrasound was used to determine CAP occurrence. A ROC analysis was performed. Results The study included a total of 334 women with mean age 57 ± 5 years. According to 10-FRS and WHOS, 96% and 91% of the population were respectively classified as "low risk". An adequate level of agreement between both scores was found (kappa 0.31). CAP occurred in 29% of cases. Score estimated risk correlated with CAP prevalence. Women with CAP presented higher incidence of hypertension and smoking, evidencing a more frequent "metabolic" pattern than women without CAP. The area under the curve of 10-FRS to detect CAP was 0.79 (95% CI 0.73-0.84), with an optimal cut-off point = 3%. Conclusions In this population, mostly classified as low risk, there was considerable CAP prevalence. A carotid ultrasound might help to stratify cardiovascular risk when 10-FRS is = 3%.(AU)

[Diffusion and adoption of health care innovations in cardiology, in Argentina]. / Perfil de difusión y adopción de innovaciones de los cardiólogos en Argentina.

BACKGROUND: Medicine is changing rapidly and diagnostic and therapeutic innovations are common. Not all professionals adopt these innovations in the same way. AIM: To survey the physicians' opinions on adopting innovations in cardiovascular health care, to classify individuals from an innovative to a conservative behavior, and to individualize opinion leaders among them, in order to build a social network of influence. MATERIAL AND METHODS: Between November and December 2008, 765 Argentine cardiologists were surveyed via e-mail in Argentina, to assess the way they adopt and disseminate innovations in cardiovascular health care. RESULTS: The survey was answered by 537 professionals (70.2%). Fifty three percent of respondents were "Early adopters". However, 63 to 79.3% of respondents preferred to wait for a full demonstration of the usefulness of innovation before adopting it. The opinion leaders' distribution adopted a scale-free network pattern, where few leaders had many connections and influence on the whole network. The giant component of the network included 41% of physicians; growth simulation of the network showed that the four most popular leaders influenced over 44% of the giant component. CONCLUSIONS: Among surveyed physicians there was an attitude towards rapid acceptance of innovations in health care. However, when analyzing the direct opinion of physicians, most cases preferred usefulness demonstrated before accepting innovations. The social network including respondents and opinion leaders showed a scale-free topology with a big influence of a few over the whole network.

Perfil de difusión y adopción de innovaciones de los cardiólogos en Argentina / Diffusion and adoption of health care innovations in cardiology, in Argentina

Background: Medicine is changing rapidly and diagnostic and therapeutic innovations are common. Not all professionals adopt these innovations in the same way. Aim: To survey the physicians' opinions on adopting innovations in cardiovascular health care, to classify individuals from an innovative to a conservative behavior, and to individualize opinion leaders among them, in order to build a social network of influence. Material and Methods: Between November and December 2008, 765 Argentine cardiologists were surveyed via e-mail in Argentina, to assess the way they adopt and disseminate innovations in cardiovascular health care. Results: The survey was answered by 537professionals (70.2%). Fifty three percent of respondents were "Early adopters". However, 63 to 79.3% of respondents preferred to wait for a full demonstration of the usefulness of innovation before adopting it. The opinion leaders' distribution adopted a scale-free network pattern, where few leaders had many connections and influence on the whole network. The giant component of the network included 41% ofphysicians; growth simulation of the network showed that the four most popular leaders influenced over 44% of the giant component. Conclusions: Among surveyed physicians there was an attitude towards rapid acceptance of innovations in health care. However, when analyzing the direct opinion ofphysicians, most cases preferred usefulness demonstrated before accepting innovations. The social network including respondents and opinion leaders showed a scale-free topology with a big influence of a few over the whole network.

[Patients' preferences for information in health care decision-making]. / Preferencias de los pacientes sobre la información de su enfermedad.

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (or: 0.64), giving less freedom to family involvement (or: 1.31). people with a lower social and economical level claim fewer options (or: 0.48) and gave less family participation (or = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (or: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (or: 1.81), demanded fewer options (or: 0.45) and chose not to know the severity of the disease (or: 0.56). the analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Preferencias de los pacientes sobre la información de su enfermedad / Patients' preferences for information in health care decision-making

Se realizó una encuesta a pacientes que concurrían a servicios de cardiología para conocer cómo preferían ser informados sobre su estado de salud, y las características sociodemográficas asociadas con estas preferencias, considerando los siguientes ítems: conocimiento sobre la enfermedad, información sobre opciones terapéuticas y toma de decisiones. De 770 encuestados, 738 (95.8%) respondieron completamente el formulario. Se observó una tendencia a confiar sólo en el médico para obtener información (81.7%), a querer conocer las opciones de tratamiento y poder opinar (85.9%) y en menor medida, a la participación de la familia en las decisiones (63.2%). El 9.6% deseaba recibir la información mínima necesaria o "no saber nada" sobre una presunta enfermedad grave. Los varones fueron menos proclives a solicitar opciones y dar opinión (OR: 0.64), dando menos libertad a la participación familiar (OR: 1.31). Los de menor nivel socioeconómico reclamaron menos opciones (OR: 0.48) y dieron menor participación familiar (OR: 1.79). Los provenientes de otros países de Sudamérica tuvieron una menor tendencia a reclamar opciones y manifestar opinión (OR: 0.60); y los de menor nivel educativo confiaron menos en el conocimiento del médico (OR: 1.81), exigieron menos opciones (OR: 0.45) y prefirieron no conocer la gravedad de la enfermedad (OR: 0.56). El análisis de las variables demográficas permitió definir distintas preferencias de información asociadas a la edad, sexo, procedencia, educación, religión y estado de salud. Se concluye que, aunque es imperativo promover la autonomía del paciente, se deben conocer las preferencias individuales antes de informar y comprometer al paciente en el proceso de toma de decisiones sobre su enfermedad.

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64), giving less freedom to family involvement (OR: 1.31). People with a lower social and economical level claim fewer options (OR: 0.48) and gave less family participation (OR = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (OR: 1.81), demanded fewer options (OR: 0.45) and chose not to know the severity of the disease (OR: 0.56). The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Preferencias de los pacientes sobre la información de su enfermedad / Patients preferences for information in health care decision-making

Se realizó una encuesta a pacientes que concurrían a servicios de cardiología para conocer cómo preferían ser informados sobre su estado de salud, y las características sociodemográficas asociadas con estas preferencias, considerando los siguientes ítems: conocimiento sobre la enfermedad, información sobre opciones terapéuticas y toma de decisiones. De 770 encuestados, 738 (95.8%) respondieron completamente el formulario. Se observó una tendencia a confiar sólo en el médico para obtener información (81.7%), a querer conocer las opciones de tratamiento y poder opinar (85.9%) y en menor medida, a la participación de la familia en las decisiones (63.2%). El 9.6% deseaba recibir la información mínima necesaria o "no saber nada" sobre una presunta enfermedad grave. Los varones fueron menos proclives a solicitar opciones y dar opinión (OR: 0.64), dando menos libertad a la participación familiar (OR: 1.31). Los de menor nivel socioeconómico reclamaron menos opciones (OR: 0.48) y dieron menor participación familiar (OR: 1.79). Los provenientes de otros países de Sudamérica tuvieron una menor tendencia a reclamar opciones y manifestar opinión (OR: 0.60); y los de menor nivel educativo confiaron menos en el conocimiento del médico (OR: 1.81), exigieron menos opciones (OR: 0.45) y prefirieron no conocer la gravedad de la enfermedad (OR: 0.56). El análisis de las variables demográficas permitió definir distintas preferencias de información asociadas a la edad, sexo, procedencia, educación, religión y estado de salud. Se concluye que, aunque es imperativo promover la autonomía del paciente, se deben conocer las preferencias individuales antes de informar y comprometer al paciente en el proceso de toma de decisiones sobre su enfermedad.(AU)

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctors knowledge to obtain information (81.7%), in wanting to know the options of treatment and express ones point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64), giving less freedom to family involvement (OR: 1.31). People with a lower social and economical level claim fewer options (OR: 0.48) and gave less family participation (OR = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60); and the ones with lower education level trusted less in the doctors knowledge (OR: 1.81), demanded fewer options (OR: 0.45) and chose not to know the severity of the disease (OR: 0.56). The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patients autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.(AU)