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.

Self-Reported Prevalence of Chronic Non-Communicable Diseases in Relation to Socioeconomic and Educational Factors in Colombia: A Community-Based Study in 11 Departments.

Background: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%-23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%-6.2%, 95% CI), asthma 2.7% (2.2%-3.0%, 95% CI), coronary heart disease 2.4% (2.0%-2.7%, 95% CI), stroke and heart failure 1.5% (1.2%-1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%-1.5%, 95% CI), and cancer 1.2% (1.0%-1.5%, 95% CI). Among the study sample, 23.3% (22.4%-24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%-7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education.The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.

The spectrum of the dyslipidemia in Colombia: The PURE study.

BACKGROUND: Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). Worldwide, a third of ischemic heart disease is due to abnormal cholesterol levels and it is the most common cause of cardiovascular deaths in Colombia. In Colombia, no representative, large-scale study has assessed the prevalence of dyslipidemia. The aim of the present analysis was to identify the magnitude of the problem in Colombia, a middle-income-country with large regional, geographic, and socio-economical differences. MATERIAL AND METHODS: The sample comprised 6628 individuals aged 35 to 70 years (mean age 50.7 years, 64.1% women) residing in the four Colombian regions. RESULTS: The overall prevalence of dyslipidemia was 87.7% and was substantially higher among participants older than 50 years, male, rural residents, and those with a lower level of education (66.8%), and with a lower income (66.4%). High non HDL-c was the most common abnormality (75.3%). The values of total cholesterol and non-HDL-cholesterol were higher in areas with the lowest health needs index than in the areas with intermediate and highest health need index, the isolated HDL-c value was much lower. CONCLUSION: Colombia has a high prevalence of abnormalities of the lipid profile. The causes of the high rates of dyslipidemia were not well define in this study, but were more common in rural and poorer regions and among those with lower socio-economical status. Strategies to tackle the adverse lipid profile to reduce CVD are needed in Colombia, particularly in rural areas and among the areas with the higher health need index.

Social disparities explain differences in hypertension prevalence, detection and control in Colombia.

OBJECTIVE: Hypertension is the principal risk factor for cardiovascular diseases. The global Prospective Urban Rural Epidemiology study showed that the levels of awareness, treatment and control of this condition are very low worldwide and show large regional variations related to a country's income index. The aim of the present analysis was to identify associations between sociodemographic, geographic, anthropometric, behavioral and clinical factors and the awareness, treatment and control of hypertension within Colombia - a high-middle income country which participated in the global Prospective Urban Rural Epidemiology study. METHODS AND RESULTS: The sample comprised 7485 individuals aged 35-70 years (mean age 50.8 years, 64% women). Mean SBP and DBP were 129.12 ±â€Š21.23 and 80.39 ±â€Š11.81 mmHg, respectively. The overall prevalence of hypertension was 37.5% and was substantially higher amongst participants with the lowest educational level, who had a 25% higher prevalence (<0.001). Hypertension awareness, treatment amongst those aware, and control amongst those treated were 51.9, 77.5 and 37.1%, respectively. The prevalence of hypertension was higher amongst those with a higher BMI (<0.001) or larger waist-hip ratio (<0.001). Being male, younger, a rural resident and having a low level of education was associated with significantly lower hypertension awareness, treatment and control. The use of combination therapy was very low (27.5%) and was significantly lower in rural areas and amongst those with a low income. CONCLUSION: Overall Colombia has a high prevalence of hypertension in combination with very low levels of awareness, treatment and control; however, we found large variations within the country that appear to be associated with sociodemographic disparities.

Hiperglucemia se asocia a mayor número de desenlaces adversos en individuos latinoamericanos con infarto agudo de miocardio / Hyperglycaemia is associated with worse outcomes in Latin-American individuals with acute myocardial infarction

Introducción: Las alteraciones en el metabolismo de la glucosa son un factor de riesgo y de peor pronóstico para infarto agudo de miocardio (IAM), pero esta información en población latinoamericana es limitada. Por tanto, evaluamos la asociación del estado glucémico con desenlaces a corto y largo plazo en pacientes con un primer IAM. Métodos: Estudio observacional de cohorte, multicéntrico, prospectivo, conducido en 8 hospitales de Colombia y Ecuador. Resultados: Se incluyeron en total 439 pacientes con diagnóstico confirmado de IAM, de los cuales 305 (69,5%) presentaron prediabetes o diabetes mellitus tipo 2 (DM2). En comparación con el grupo de normoglucemia, los pacientes con DM2 conocida presentaron mayor riesgo de estancia hospitalaria prolongada (HR: 2,60, IC 95%: 1,38-4,92, p = 0,003), de Killip clase iii/iv (HR: 9,46, IC 95%: 2,20-40,62, p = 0,002) y de insuficiencia cardiaca intrahospitalaria (HR: 10,76, IC 95%: 3,37-34,31, p < 0,001). Los pacientes con prediabetes, DM2 conocida y DM2 nueva tuvieron tasas más altas de episodios adversos cardiovasculares mayores en el seguimiento a 3 años. Conclusión: Alteraciones en el metabolismo de la glucosa tienen una importante significación pronóstica a corto y a largo plazo en pacientes latinoamericanos sobrevivientes a un primer IAM

Background: Alterations in glucose metabolism have been reported as risk and poor prognostic factors for acute myocardial infarction (AMI); however in Latin-American population this information is limited. Thus, an evaluation was performed on the association between glycaemic status and short- and long-term outcomes in patients with a first AMI. Methods: A multicentre, prospective, observational, cohort study was conducted in 8 hospitals from Colombia and Ecuador. Results: A total of 439 patients with confirmed AMI were included, of which 305 (69.5%) had prediabetes or type 2 diabetes mellitus (DM2). Compared with normal glycaemia group, patients with known DM2 had greater risk of prolonged hospital stay (HR: 2.60, 95% CI: 1.38-4.92, P = .003), Killip class iii/iv (HR: 9.46, 95% CI: 2.20-40.62, P = .002), and in-hospital heart failure (HR: 10.76, 95% CI: 3.37-34.31, P < .001). Patients with prediabetes, new DM2, and known DM2 showed higher rates of major adverse cardiovascular events after 3 years follow-up. Conclusion: Glucose metabolism abnormalities have an important significance in the short- and long-term prognosis in Latin-American patients that survive a first AMI

[Hyperglycaemia is associated with worse outcomes in Latin-American individuals with acute myocardial infarction]. / Hiperglucemia se asocia a mayor número de desenlaces adversos en individuos latinoamericanos con infarto agudo de miocardio.

BACKGROUND: Alterations in glucose metabolism have been reported as risk and poor prognostic factors for acute myocardial infarction (AMI); however in Latin-American population this information is limited. Thus, an evaluation was performed on the association between glycaemic status and short- and long-term outcomes in patients with a first AMI. METHODS: A multicentre, prospective, observational, cohort study was conducted in 8 hospitals from Colombia and Ecuador. RESULTS: A total of 439 patients with confirmed AMI were included, of which 305 (69.5%) had prediabetes or type2 diabetes mellitus (DM2). Compared with normal glycaemia group, patients with known DM2 had greater risk of prolonged hospital stay (HR: 2.60, 95%CI: 1.38-4.92, P=.003), Killip class iii/iv (HR: 9.46, 95%CI: 2.20-40.62, P=.002), and in-hospital heart failure (HR: 10.76, 95%CI: 3.37-34.31, P<.001). Patients with prediabetes, new DM2, and known DM2 showed higher rates of major adverse cardiovascular events after 3years follow-up. CONCLUSION: Glucose metabolism abnormalities have an important significance in the short- and long-term prognosis in Latin-American patients that survive a first AMI.

Grosor de la íntima-media de las carótidas en pacientes con VIH / Thickness of the carotid arteries intimae-media in patients with HIV

Objetivo: los pacientes con VIH pueden tener mayor riesgo de enfermedad coronaria. El propósito del presente estudio fue determinar el grosor de la intima-media (GIM) de la arteria carótida común como marcador de aterosclerosis temprana en pacientes con VIH, en comparación con sujetos sanos sin infección por VIH. Métodos: se realizó un estudio de casos y controles donde se hizo medición del GIM en las arterias carótidas a 25 pacientes con VIH y 31 pacientes sanos. Al grupo de pacientes con VIH se les realizó medición de glucemia, perfil lipídico, carga viral y recuento de CD4; se subdividieron en dos grupos, pacientes que recibían o no inhibidores de proteasa (IP), y se compararon los resultados obtenidos. Resultados: el GIM fue de 0,76 mm en los pacientes con VIH y 0,79 mm en los sanos (p=0,24). En los pacientes con VIH, el GIM de los que recibieron o no IP fue: 0,76 y 0,75 mm respectivamente p=0,79. Los pacientes que recibieron IP tenían más frecuencia de dislipidemia, principalmente disminución de las HDL-colesterol (12 pacientes, contra cinco pacientes en el grupo que no los recibía; p=0,04). Conclusiones: estos datos sugieren que no hay mayor riesgo de aterosclerosis en los pacientes con infección por VIH, aunque se necesitan estudios longitudinales para establecer con claridad. El hallazgo de mayor frecuencia de dislipidemia en los que reciben IP puede ser debido a la terapia o a niveles previos al inicio del tratamiento, los cuales no fueron medidos en este estudio.

Aim: the patients with HIV may be at higher risk of coronary disease. The purpose of this study was to determine the thickness of the intimae media (IMT) of the common carotid artery as a marker of early atherosclerosis in patients with HIV, as compared to healthy subjects without HIV infection.Methods: a case study and controls was carried out taking measurements of the (IMT) in the carotid arteries in 25 patients with HIV and 31 healthy patients. Glycemia, lipids profile, virus load and CD4 count were measured in HIV patients: they were divided into two groups, patients receiving or not protease inhibitors (PI), and the results obtained were compared. Results: the IMT was 0,76 mm in patients with HIV and 0,79 mm in healthy patients (p=0,24). In patients with HIV, the IMT, regardless if they received PI or not was: 0,76 and 0,75 mm respectivelyp=0,79. The patients that received PI had dislipidemia more frequently, mainly a decrease of HDL cholesterol (12 patients against 5 in the group that did received them; p=0,04). Conclusions: these data suggest that there is no high risk of atherosclerosis in patients with HIV, although longitudinal studies will be needed for further clarification. Higher frequency of dislipidemiain those receiving PI may be due to the therapy or to high levels before the treatment and that were not measured in this study.

Evaluación de estudios clínicos de recuperación de la función endotelial con fármacos hipotensores

El endotelio cumple un papel crucial en el mantenimiento de la integridad del sistema cardiovascular, a través de sus funciones vasodilatadoras, antitrombóticas y antiaterogénicas. La disfunción endotelial ha sido implicada en la génesis de importantes enfermedades como la hipertensión arterial, la aterosclerosis, la enfermedad arterial coronaria, la insuficiencia cardiaca crónica, la diabetes mellitus, etc. Varios métodos clínicos han sido descritos para valorar la función endotelial; entre los mejor estandarizados están el de la respuesta vasomotora coronaria a la infusión de acetilcolina o bradicinina en arterias de conducción evaluada por pletismografía, y la vasodilatación dependiente de flujo (VDF) en arterias de conducción del antebrazo, valorada por el cambio en el diámetro de la arteria braquial de frente a la hiperemia reactiva, determinado por eco-doppler. En el presente artículo revisamos los diferentes estudios dirigidos a investigar el efecto de diferentes drogas hipotensoras en la recuperación de la función endotelial en pacientes con hipertensión esencial, enfermedad arterial coronaria e insuficiencia cardíaca crónica. Los inhibidores de la enzima convertidora de la angiotensina (ECA-I) son los fármacos que con más consistencia ejercen un efecto beneficioso en la recuperación de la función vasodilatadora dependiente de endotelio. Existen diferencias en la capacidad de mejorar la función endotelial entre los diferentes componentes

Sindrome de inmunodeficiencia adquirida

Se presenta el caso de una prostituta con signos clínicos y evaluación inmunológica compatibles con el Síndrome de Inmunodeficiencia Adquirida (S.I.D.A). La paciente es drogadicta y presenta severa infección por micobacteria, candidiasis oral, herpes genital y elevados títulos de anticuerpos contra Toxoplasma gondii y Herpes virus. La evaluación inmunológica muestra anergía cutanea, inversión de la relación linfocitos T estimuladores/linfocitos T supresores (OKT4/OKT8) e hipergammaglobulinemia policlonal. No hay antecedentes de administración de drogas inmunosupresoras ni evidencia de enfermedad maligna u otro padecimiento debilitante. Este caso llama la atención debido a que el S.I.D.A. es poco frecuente en mujeres, a que las prostitutas no han sido consideradas como población de alto riesgo, así como también por sus implicaciones epidemiológicas en un puerto marítimo como Cartagena