Analysis of the Chilean health promotion policy "Choose a Healthy Lifestyle".

BACKGROUND: Intersectoral health promotion initiatives in Chile to address obesity and non- communicable diseases have had a long history in Chile, but also a high degree of changes in their design, implementation, and financing. AIM: To analyze the "Choose a Healthy Lifestyle" enacted by Law 20,670 under Sabatier's "Advocacy Coalition Framework" (ACF), addressing the political discussion and its execution in the subsequent governing coalitions (2011-2022). MATERIAL AND METHODS: The ACF components are the following: external events, coalitions, policy subsystem (health promotion), and policy brokers. Policy change and learning occurs when a certain level of conflict exists between coalitions. We carried out a bibliographic and literature review, including history of the Law and notes in the media. RESULTS: We identified two coalitions. The first is pro-individual freedom and aims to solve the problem with education and health promotion. The second one defines the problem as structural and related to social determinants and health inequity. The first coalition launched the "Choose Healthy Liferstyle" program in 2011 when they were in executive power. After criticism from the opposition and the participation of policy brokers, the Program was institutionalized with an intersectoral vision. The lack of permanent financing affected the continuity of the policy, especially after a change in the governing coalition. CONCLUSIONS: Law 20,670 falls within the ACF. However, policy learning slowed down because the problem involved social aspects, conflict between deep beliefs of both coalitions, and lack of permanent funding, thus affecting the continuity of the policy.

Mobile-phone text messaging to promote ideal cardiovascular health in women.

OBJECTIVE: Ideal cardiovascular health (CVH) was developed to promote CVH as a key component of primordial prevention. Mobile short message service (SMS) is useful for improving health behaviours. We aim to test the effectiveness of SMS intervention in women to improve CVH. METHODS: In a single-blinded, randomised, controlled study, 620 women, aged 35-70 years, without cardiovascular disease, were enrolled in SMS intervention versus no SMS. CVH metrics by self-report, and biochemical laboratory, anthropometric and blood pressure measurements were collected during home visits at baseline and 9 months. Women were categorised as having poor (0-2), intermediate (3-4) or ideal (5-7) CVH according to the number of ideal CVH metrics. Participants were randomised 1:1 to SMS intervention versus control. SMS was sent every 5-6 days for 9 months. The primary outcome was the difference in the proportion of women with ideal CVH between SMS and control groups at 9 months. Rates of intermediate CVH, poor CVH and each of the seven ideal CV health metrics at 9 months were key secondary endpoints. RESULTS: At 9 months, there was no significant difference between groups for the primary outcome (16.3% at baseline and 13.3% at 9 months, and 10.1% and 11.1%, in SMS and control groups, respectively, adjusted RR 1.0; 95% CI 0.6 to 1.6). Similarly, there were no significant differences between groups for the key secondary endpoints. SMS had an acceptance rate of 94.9%. CONCLUSIONS: Behavioural SMS intervention did not improve rates of ideal CVH in women, despite being feasible and well received. TRIAL REGISTRATION NUMBER: 6377.

Analysis of the Chilean health promotion policy "Choose a Healthy Lifestyle" / Análisis de la política de promoción de salud chilena "Elige Vivir Sano"

BACKGROUND: Intersectoral health promotion initiatives in Chile to address obesity and non- communicable diseases have had a long history in Chile, but also a high degree of changes in their design, implementation, and financing. AIM: To analyze the "Choose a Healthy Lifestyle" enacted by Law 20,670 under Sabatier's "Advocacy Coalition Framework" (ACF), addressing the political discussion and its execution in the subsequent governing coalitions (2011-2022). MATERIAL AND METHODS: The ACF components are the following: external events, coalitions, policy subsystem (health promotion), and policy brokers. Policy change and learning occurs when a certain level of conflict exists between coalitions. We carried out a bibliographic and literature review, including history of the Law and notes in the media. RESULTS: We identified two coalitions. The first is pro-individual freedom and aims to solve the problem with education and health promotion. The second one defines the problem as structural and related to social determinants and health inequity. The first coalition launched the "Choose Healthy Liferstyle" program in 2011 when they were in executive power. After criticism from the opposition and the participation of policy brokers, the Program was institutionalized with an intersectoral vision. The lack of permanent financing affected the continuity of the policy, especially after a change in the governing coalition. CONCLUSIONS: Law 20,670 falls within the ACF. However, policy learning slowed down because the problem involved social aspects, conflict between deep beliefs of both coalitions, and lack of permanent funding, thus affecting the continuity of the policy.

ANECEDENTES: Las iniciativas intersectoriales de promoción de salud en Chile han tenido una larga historia en el país, pero también un alto grado de cambios en su diseño, implementación y financiamiento. OBJETIVOS: Analizar el "Sistema Elige Vivir Sano" (Ley 20.670) bajo el marco de "Coaliciones de Causa" (ACF), abordando la discusión política y su ejecución durante cambios de coaliciones gobernantes (2011-2022). MATERIAL Y MÉTODOS: Los componentes de ACF incluyen eventos externos, coaliciones, subsistema de políticas (promoción de salud) e intermediarios de políticas. El cambio y aprendizaje de políticas ocurre cuando existe cierto nivel de conflicto entre coaliciones. Realizamos una revisión de literatura, incluyendo historia de la Ley y notas en los medios de comunicación. RESULTADOS: Identificamos dos coaliciones. La primera es pro-libertad individual y pretende resolver el problema con educación y promoción de la salud. La segunda es pro-determinantes sociales y define el problema como estructural. La primera coalición lanzó el programa "Elige Vivir Sano" en 2011 cuando estaban en el poder ejecutivo. Luego de las críticas de la oposición y la participación de intermediarios de políticas, el Programa se institucionalizó con una visión intersectorial. La falta de financiamiento permanente afecta la continuidad de la política, especialmente luego de un cambio en la coalición gobernante. CONCLUSIONES: La Ley 20.670 se enmarca dentro de la ACF. Sin embargo, el aprendizaje de políticas se ralentizó porque el problema involucra aspectos sociales, conflicto entre creencias profundas de ambas coaliciones y falta de financiamiento permanente, afectando la continuidad de la política.

Smoking Ban Law in Chile: Impact in Newborns' Birth Weight by Women's Age Groups and by City Population Density.

Objectives: We examined the short-term impact of the Smoking Ban Law (SBL) enacted in Chile in 2013 on low birth weight (LBW) rates in cities and its differential effects by different maternal age groups and city density. Methods: We included 885,880 live births from 21 Chilean cities of ≥100,000 inhabitants. We examined the smoking and LBW prevalence distribution before and after the SBL. Through Poisson mixed effect models, we determined whether a meaningful change in LBW rate occurred after SBL implementation in the whole sample and stratified by city population density and maternal age group. Results: LBW prevalence remained stable before and after the SBL implementation (6.1% and 6.3%, respectively), while women's smoking prevalence had a relative reduction of 25.9% (p < 0.00001). No significant changes in LBW rate occurred after the implementation of SBL in the total sample or stratified by city density tertiles or maternal age groups. Conclusion: SBL implementation did not show short-term impact on LBW rate in Chile. Further studies need to examine long-term impact of SBL on low birthweight.

Conciencia de enfermedad cardiovascular y conocimiento sobre factores de riesgo y prevención cardiovascular: resultados chilenos de encuesta SIAC cono sur / Awareness of risk factors and prevention of cardiovascular disease in chile: SIAC cono sur survey

Resumen La conciencia de la enfermedad cardiovascular (ECV) en mujeres es crucial para prevenir futuros eventos cardiovasculares. En Chile, la percepción sobre ECV es baja. Objetivo: Actualizar el grado de conocimiento de las chilenas sobre ECV. Método: Estudio de corte transversal realizado a través de encuesta online a mujeres entre 20 y 70 años de edad, residentes en Chile durante marzo 2020. La invitación se efectuó a través de redes sociales. La muestra fue no probabilística, ponderándose por edad, nivel socioeconómico y región de residencia (Región Metropolitana, Coquimbo, Valparaíso, Bío-Bío). Resultados: Se obtuvieron 1227 cuestionarios validados. La muestra ponderada correspondió a 900 mujeres. La percepción de ECV como principal causa de muerte fue de 8%, menor que las correspondientes a cáncer de mama (44%) y muerte violenta / homicidio (20%). Como principal problema de salud, la opción más percibida fue cáncer general (39%), seguido de diabetes (18%). Sólo 6 % refirió la ECV como el principal problema. Los principales accesos a la información sobre ECV fueron la internet y las redes sociales (64%, mayor en <30 años), y en el consultorio (32%). La opresión o dolor en el pecho fueron los síntomas más reconocidos asociados al infarto, siendo más seleccionado por mujeres con nivel educacional alto (p< 0.05). Conclusión: Persiste una baja percepción del riesgo de la ECV como principal causa de muerte y problema de salud en mujeres chilenas, aunque tienen acceso a la información y reconocen síntomas de infarto. Es necesario adaptar las estrategias comunicacionales para incrementar la percepción de riesgo CV.

Abstract Awareness of cardiovascular disease (CVD) in women is crucial to prevent cardiovascular events. According to prior information the perception and knowledge about CVD in Chile is extremely low. The aim of this study was to update the information about awareness of CVD in Chilean women. Method: Cross-sectional study carried out through an online survey. Data was obtained from women between 20 and 70 years old during March 2020. Social networks were used to recruit participants. The sample was non-probabilistic, weighted by age, socio-economic level and region of residence (Metropolitan Region, Coquimbo, Valparaíso, Bío-Bío). Results: 1227 validated surveys were obtained. The weighted sample corresponded to 900 women. CVD was perceived as the main cause of death in 8% of women, compared to higher degrees of perception for breast cancer (44%) and violent death/homicide (20%). CVD was perceived as the main health problem by only 6% of women, compared to cancer (39%) and diabetes (18%). The primary source of information about CVD were the internet and social networks (64%,higher in women <30 years old), and the doctor's office (32%). Chest tightness or pain as symptoms associated with a heart attack were significantly more recognized by respondents with a high educational level (p<0.05). Conclusion: An extremely low awareness about CVD as the main cause of death and health problem is persistent in Chilean women, notwithstanding that they have access to information and recognize symptoms of a heart attack. It is necessary to modify our communication strategies to increase the perception of CV risk in Chilean women.

Recomendaciones en la prevención secundaria de cardiopatía isquémica en la mujer / Secondary prevention of ischemic heart disease in women

Resumen: La enfermedad cardiovascular en la mujer es la principal causa de muerte en Chile. La mujer con cardiopatía isquémica coronaria representa un riesgo de mortalidad dos veces mayor que el del hombre. Desgraciadamente, las mujeres han sido subrepresentadas en la mayoría de los estudios clínicos randomizados en prevención secundaria, y más aún, son pocos los que presentan análisis específicos de género en cuanto a la terapia y los puntos finales duros. Así, la evidencia que existe ha sido dirigida especialmente a hombres. Para reducir esta brecha, presentamos una revisión de la información en las distintas terapias en prevención secundaria de cardiopatía isquémica, destacando los resultados de trabajos en que se hizo análisis género-específico.

Abstract: Cardiovascular disease is the main cause of death in Chilean women. Ischemic heart disease mortality rate in women is two times that of in men. Unfortunately, there have been less enrollment of women in clinical cardiovascular trials and a lack of gender-specific analysis of clinical trial data. Therefore, the evidence for secondary preventive recommendations have been focused on men. To bridge this gap, in this review we address the data for secondary preventive therapies for ischemic heart disease in women assessing the available gender-specific data.

Cardiorespiratory fitness improves prediction of mortality of standard cardiovascular risk scores in a Latino population.

BACKGROUND: Cardiorespiratory fitness (CRF) is a powerful predictor of mortality. This study evaluated the predictive value of CRF for mortality in Chilean subjects without atherosclerotic disease compared with the Framingham, European Systematic Coronary Risk Evaluation (SCORE), and 2013 ACC/AHA risk scores and determined the incremental predictive value of CRF when added to these scores. HYPOTHESIS: CRF improves prediction of all-cause and cardiovascular disease (CVD)-related mortality of the standard international risk scores. METHODS: Cross-sectional study, which evaluated 4064 subjects between 2002 and 2016. Cardiovascular (CV) risk factors, anthropometric and biochemical parameters, and blood pressure were measured. CRF was determined by metabolic equivalents during maximum stress test. The Framingham, SCORE, and ACC/AHA risk scores were calculated for all subjects. After a median follow-up of 9 years, all-cause and CVD-related mortality were assessed. Receiver operating curves were built to determine mortality prediction for CRF, the risk scores, and CRF added to the scores. RESULTS: As of August 2016, 99 deaths were reported, 33 of which were CVD-related. All risk scores and CRF predicted CVD-related mortality, with CRF identified as the best predictor: CRF: C = 0.88 (95% CI: 0.82-0.93) vs Framingham: C = 0.68 (95% CI: 0.60-0.76), SCORE: C = 0.76 (95% CI: 0.70-0.83), and ACC/AHA: C = 0.79 (95% CI: 0.73-0.85). Predictive power of the three scores improved when CRF was added to the model, but this was only significant for the Framingham score. CONCLUSIONS: CRF is a good predictor of both, all-cause and CV mortality and a better predictor of CVD-related deaths than standard risk scores in this population.

Urinary sodium-to-potassium ratio and body mass index in relation to high blood pressure in a national health survey in Chile.

Several lifestyle and sociodemographic factors are associated with blood pressure (BP). The authors conducted a retrospective study of 4870 subjects from the National Health Survey 2009 in Chile to identify exposure factors associated with increasing BP levels. Subjects with isolated urinary excretion of sodium (n = 2873), potassium, and creatinine were included to estimate daily salt intake and urinary sodium/potassium (Na/K) ratio. Hypertension was defined according to European guidelines 2018 and American guidelines ACC/AHA 2017. Proportional odds models were developed to analyze education level, sedentarism, smoking, alcohol intake, estimated urinary Na/K ratio, estimated daily salt intake, and body mass index (BMI) as factors associated with increasing BP levels (from high-normal BP to hypertension). Logistic regression models were checked for overdispersion. Mean age and BMI of the population were 42 years old and 27 kg/m2 , respectively; 19% had low education level and 27% had hypertension according to European guidelines, whereas 47% according to ACC/AHA criteria. Mean estimated urinary Na/K ratio was 4 ± 2, and mean salt consumption was 10 ± 2 g/day. Estimated urinary Na/K ratio (OR, 1.11; 95% CI, 1.01-1.21), BMI (OR, 1.10; 95% CI, 1.07-1.13), estimated daily salt intake (OR, 1.10; 95% CI, 1.03-1.17), and alcohol intake (OR, 1.03; 95% CI, 1.01-1.05) were significantly associated with hypertension. This study highlights that a healthy diet and weight control should be important components of BP management plans, and it suggests that public policies should include close monitoring of these factors to reduce hypertension prevalence and improve its management in a Latino population.

NMR-Based Plant Metabolomics in Nutraceutical Research: An Overview.

Few topics are able to channel the interest of researchers, the public, and industries, like nutraceuticals. The ever-increasing demand of new compounds or new sources of known active compounds, along with the need of a better knowledge about their effectiveness, mode of action, safety, etc., led to a significant effort towards the development of analytical approaches able to answer the many questions related to this topic. Therefore, the application of cutting edges approaches to this area has been observed. Among these approaches, metabolomics is a key player. Herewith, the applications of NMR-based metabolomics to nutraceutical research are discussed: after a brief overview of the analytical workflow, the use of NMR-based metabolomics to the search for new compounds or new sources of known nutraceuticals are reviewed. Then, possible applications for quality control and nutraceutical optimization are suggested. Finally, the use of NMR-based metabolomics to study the impact of nutraceuticals on human metabolism is discussed.

[Five o'clock tea and the risk of metabolic syndrome]. / La ingesta de "once", en reemplazo de la cena, se asocia al riesgo de presentar síndrome metabólico.

BACKGROUND: Seventy four percent of Chileans replaced the traditional dinner for the consumption of "five o'clock tea" (5CT), a mealtime that includes bread and is simliar to western breakfast. The latter favors the intake of unhealthy foods. AIM: To study whether the consumption of "5CT", instead of dinner, could be a risk factor for the development of metabolic syndrome (MetSyn). MATERIAL AND METHODS: Anthropometric parameters, mean blood pressure, lipid profile, thyroid stimulating hormone and fasting glucose were measured in 489 subjects aged 39 ± 12 years (33% women) who attended a primary cardiovascular prevention (CV) program. A 24-hour recall and usual meal times were registered during a dietary interview. To determine the association between the consumption of "5CT" or dinner and the probability of presenting two or more components of MetSyn, we built an odds proportional model adjusted by age and sex. In addition, severity for MetSyn was calculated. RESULTS: Nineteen percent of participants had MetSyn and 39%, two or more MetSyn components. Those who consumed "5CT" instead of dinner, had 54% more probability of having 2 or more MetSyn components (Odds ratio = 1.54, confidence intervals 1.032.32, p = 0.04). Participants who included processed carbohydrates in their last meal had a higher probability of having components of MetSyn. This probability decreased among participants who ate dinner with a low proportion of refined carbohydrates. CONCLUSIONS: Subjects who eat "5CT", instead of dinner as the last meal, have a higher cardiometabolic risk and MetSyn severity.

Conocimiento sobre enfermedad coronaria en familiares de pacientes con evento cardiovascular / Knowledge about coronary disease in relatives of patients with cardiovascular event

Objetivo: describir los conocimientos que refieren los familiares de sujetos con enfermedad cardiovascular, previo a la asistencia a un taller educativo. Materiales y métodos: estudio descriptivo en 103 familiares de pacientes con enfermedad cardiovascular, que participaron en talleres educativos relacionados con enfermedad coronaria entre marzo y agosto de 2013. Los talleres eran los siguientes: 1. La enfermedad coronaria; 2. Ejercicio en enfermedad cardiovascular; 3. Adherencia a medicamentos y 4. Factores psicosociales y enfermedad cardiovascular. Se compararon diferencias entre proporción de sujetos con conocimiento informal y formal en cada taller. Resultados:103 familiares participaron en los talleres (80% mujeres; edad promedio 49± 1.55años). El 39% refiere no tener ningún conocimiento respecto al tema a tratar. El 28% sí tiene conocimientos sobre el tema y la obtiene de fuentes informales como internet, diarios o revistas. Existió una proporción significativamente mayor de sujetos con conocimiento informal sobre ejercicio y adherencia a medicamentos. Conclusiones: estos resultados muestran que: hay poco conocimiento formal de enfermedad cardiovascular y del manejo de sus factores de riesgo, y alto nivel de apoyo del sexo femenino. La necesidad de educar, reforzar y aclarar el conocimiento para mejorar la adherencia al tratamiento y la prevención de nuevos eventos cardiovasculares, es un trabajo importante de enfermería, que debe desarrollarse prestando especial atención al entorno familiar del paciente..(AU)

Objective: to describe the knowledge referred by relatives of subjects with cardiovascular disease prior to attending an educational workshop. Materials and methods:descriptive study in 103 relatives of patients with cardiovascular disease, who participated in educational workshops related to coronary disease between March and August 2013. The workshops were the following: 1. Coronary disease; 2. Exercise in cardiovascular disease; 3. Adherence to medications and 4. Psychosocial factors and cardiovascular disease. Differences were compared between proportion of subjects with informal and formal knowledge in each workshop. Results: 103 relatives participated in the workshop (80% women, average age 49 ± 1.55 years). 39% report having no knowledge about the subject to be treated. 28% do have knowledge about the subject and get it from informal sources such as the internet, newspapers or magazines. There was a significantly higher proportion of subjects with informal knowledge about exercise and medication adherence. Conclusions: these results show that: there is little formal knowledge of cardiovascular disease and the management of its risk factors, and high level of support of the female sex. The need to educate, reinforce and clarify knowledge to improve adherence to treatment and the prevention of new cardiovascular events, is an important work of nursing, which should be developed paying special attention to the patient's family environment..(AU)

La ingesta de "once", en reemplazo de la cena, se asocia al riesgo de presentar síndrome metabólico / Five o'clock tea and the risk of metabolic syndrome

Background: Seventy four percent of Chileans replaced the traditional dinner for the consumption of "five o'clock tea" (5CT), a mealtime that includes bread and is simliar to western breakfast. The latter favors the intake of unhealthy foods. Aim: To study whether the consumption of "5CT", instead of dinner, could be a risk factor for the development of metabolic syndrome (MetSyn). Material and Methods: Anthropometric parameters, mean blood pressure, lipid profile, thyroid stimulating hormone and fasting glucose were measured in 489 subjects aged 39 ± 12 years (33% women) who attended a primary cardiovascular prevention (CV) program. A 24-hour recall and usual meal times were registered during a dietary interview. To determine the association between the consumption of "5CT" or dinner and the probability of presenting two or more components of MetSyn, we built an odds proportional model adjusted by age and sex. In addition, severity for MetSyn was calculated. Results: Nineteen percent of participants had MetSyn and 39%, two or more MetSyn components. Those who consumed "5CT" instead of dinner, had 54% more probability of having 2 or more MetSyn components (Odds ratio = 1.54, confidence intervals 1.032.32, p = 0.04). Participants who included processed carbohydrates in their last meal had a higher probability of having components of MetSyn. This probability decreased among participants who ate dinner with a low proportion of refined carbohydrates. Conclusions: Subjects who eat "5CT", instead of dinner as the last meal, have a higher cardiometabolic risk and MetSyn severity.

Cintura e índice de masa corporal: los mejores predictores antropométricos en la reducción y progresión de la agregación de factores de riesgo cardiometabólicos / Waist and body mass index: The best anthropometric predictors in the reduction and progression of the aggregation of cardiometabolic risk factor

El objetivo de este estudio fue determinar el impacto de la variación de distintas mediciones antropométricas en la evolución del síndrome metabólico (SM). El estudio fue prospectivo en 178 sujetos que asistieron a un programa de salud cardiovascular entre el año 2013 y 2016. Se recolectaron datos demográficos, historia médica, factores de riesgo cardiovascular, y se midió perfil lipídico, glicemia de ayuno, presión arterial y medidas antropométricas (IMC, perímetro de cintura y cadera y % de grasa corporal). Se consideró la agregación de 2 o más componentes de síndrome metabólico (SM), excluyendo cintura y se determinó la probabilidad de reversión del SM, considerándose como la reducción desde 2 o más componentes a 1 o ninguno. El tiempo de seguimiento promedio fue de 2 años. La edad promedio fue de 40 años y 37% eran mujeres. Según los modelos de odds proporcionales, ajustados por edad, sexo y tiempo de seguimiento, aquellos sujetos con 2 o más componentes de SM triplicaron su probabilidad de revertir el SM por cada reducción de 1 Kg/m2 de IMC por año (OR IMC = 3,03; 1,74-5,28; p<0,001). En el caso de cintura, esta probabilidad aumentó en 52% por la reducción de 1 cm por año (ORcintura =1,52; 1,28-1,81; p<0,001). Finalmente una reducción de 0,01 en el índice cintura/cadera aumentó en 26% la probabilidad de revertir el SM (ORcintura/cadera =1,26; 1,06-1,491; p<0,01); sin embargo, el % de grasa corporal no tuvo un efecto significativo Los cambios en IMC y circunferencia de cintura serían los parámetros antropométricos más confiables para monitorear la evolución del SM(AU)

The objective of this study was to determine the impact of variation of different anthropometric parameters at follow-up in the evolution of the metabolic syndrome (MetS). Prospective study in 178 subjects who attended a cardiovascular health program between 2013 and 2016. Demographical data, medical history and cardiovascular (CV) risk factors (RFs) were collected. In addition, fasting lipid profile, blood glucose, blood pressure and anthropometrical parameters (BMI, WC, hip, and fat percentage) were measured. To determine the evolution of MetS, the clustering of 2 or more of the MetS components were considered, excluding WC. Odds proportional models adjusted by age, sex and time of follow-up were built to determine the probability of reverting the MetS. MetS reversion was considered as the reduction to 1 or 0 components in subjects with 2 or more. Mean follow-up time was 2 years. Mean age was 40 years old and 37% were women. According to the odds proportional models, subjects tripled their chance of reverting MetS for each 1 kg/m2 of BMI reduction (ORBMI=3.03; 1.74-5.28; p<0.001). For WC, the chance of reverting MetS increased 52% for each reduction of 1 cm of waist (ORwaist =1.52; 1.28-1.81; p<0.001). A reduction of 0.01 in the waist to hip ratio increased in 26% the chance of reverting MetS (ORwaist/hip=1.26; 1.06-1.491; p<0.01); however, fat percentage did not have a significant effect on the evolution of the MetS. BMI and WC are the most reliable anthropometrical parameters for monitoring the evolution of MetS aggregation in the out-patient clinical setting(AU)

[Evaluation the American College of Cardiology and American Heart Association Predictive score for cardiovascular diseases]. / Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago.

BACKGROUND: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. AIM: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. MATERIAL AND METHODS: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3,284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the Death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. RESULTS: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p < 0.01) and diabetes (p < 0. 01) and tended to be older (p = 0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p = 0.09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p = 0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. CONCLUSIONS: The new ACC/AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Does Good Aerobic Capacity Attenuate the Effects of Aging on Cardiovascular Risk Factors? Results from a Cross-Sectional Study in a Latino Population.

Background. High aerobic capacity is associated with low cardiovascular (CV) risk. The aim of this study was to determine the CV RF burden in subjects with aerobic capacity ≥10 METs and compare it with those having <10 METs. Methods. Cross-sectional study in 2646 subjects (mean age 48 ± 12 years). Demographics, medical history, physical activity, cardiovascular RFs, fasting lipids and blood glucose levels, blood pressure, and anthropometric measurements were collected. Aerobic capacity was determined by exercise stress test. The ACC/AHA 2013 pooled cohort equation was used to calculate CV risk. Logistic models were built to determine the probability of having ≥2 RFs versus 0-1 RF, by age and sex, according to aerobic capacity. Results. 15% of subjects had aerobic capacity < 10 METs. The ACC/AHA scores were 15% in men and 6% in women with <10 METs and 5% and 2%, respectively, in those with ≥10 METs. The probability of having ≥2 RFs increased with age in both groups; however, it was significantly higher in subjects with <10 METs (odds ratio [OR]: 2.54; 95% CI: 1.92-3.35). Conclusions. Aerobic capacity ≥ 10 METs is associated with a better CV RF profile and lower CV risk score in all age groups, regardless of gender.

Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago / Evaluation the American College of Cardiology and American Heart Association Predictive score for cardiovascular diseases

Background: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. Aim: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. Material and Methods: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3,284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the Death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. Results: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p < 0.01) and diabetes (p < 0. 01) and tended to be older (p = 0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p = 0.09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p = 0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. Conclusions: The new ACC/AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Impacto de un programa de rehabilitación cardiovascular fase II sobre la calidad de vida de los pacientes / Quality of life: impact of a phase II cardiovascular rehabilitation program

Antecedentes: La rehabilitación cardiovascular (RCV) ha demostrado mejorar la capacidad física (CF) y la calidad de vida. La relación de estos aspectos ha sido escasamente reportada en Chile. Objetivos: 1) Determinar el impacto de la RCV fase II sobre la calidad de vida, medida por la encuesta SF36 y, 2) determinar qué factores, relacionados con el paciente, pueden incidir en esta relación. Método: Estudio prospectivo en sujetos que completaron 36 sesiones de un programa de RCV y Prevención Secundaria (PREV2). Se registraron al ingreso y final de la RCV: antecedentes médicos, factores de riesgo cardiovascular (CV), parámetros antropométricos, previsión de salud, CF (determinada por los metros caminados en test de marcha de 6 minutos-TM6) y puntaje en la encuesta SF36. Resultados: 277 sujetos (78% hombres, edad 59 años). Hubo una mejoría significativa en: a) los metros caminados (diferencia final/inicial= 56 metros, p<0.0001), b) puntaje de salud física (68 vs 79; p<0.0001), c) salud emocional (68 vs 78, p<0.0001) del SF36. Los hombres caminaron más metros promedio (p<0.0001). Hubo una asociación significativa entre los deltas del TM6 final-inicial y SF36 final-inicial, sólo para salud física (p<0.01). Por un aumento de 10 metros caminados en el TM6 final se incrementa el puntaje de la SF36 para salud física (Hombres: 0.38/ Mujeres: 1.52). La mejoría en la salud emocional sólo se asoció significativamente con los cambios en la salud física (p<0.0001). Conclusion: Los pacientes que asisten a un programa de RCV mejoran significativamente su capacidad aeróbica, y su percepción de salud física y emocional.

Background: Cardiovascular rehabilitation (CVR) has been shown to improve functional capacity (FC) and quality of life. The relation between these aspects has been scarcely reported in Chile. Objectives: 1) To determine the impact of the CVR phase II program on quality of life as measured by the SF36 survey and 2) to determine which patient related factors can influence this relationship. Method: Prospective study in subjects who completed 36 sessions of an RCV and Secondary Prevention program (PREV2). Medical records, cardiovascular risk factors (CV), anthropometric parameters, health forecast, functional capacity (FC) (determined by meters walked on 6-minute Walking test-TM6) and SF36 scores were recorded at the beginning and end of the CVR. Results: Data on 277 subjects (78% men, age 59 years) was analyzed. There was a significant improvement in: a) walking meters (final / initial difference = 56 meters, p <0.0001), b) physical health score (68 vs 79, p <0.0001), c) emotional health (68 vs 78, p <0.0001) of the SF36. The men walked more meters (p <0.0001). There was a significant association between delta TM6 final-initial and SF36 final-initial only for physical health (p <0.01). For an increase of 10 meters walked in the final TM6, SF36 score for physical health increased 0.38 points in men ad 1.52 in women. Improvement in emotional health was significantly associated only with changes in physical health (p <0.0001). Conclusion: Patients attending a phase II cardiovascular rehabilitation program significantly improve their aerobic capacity, and their perception of physical and emotional health.

Impaired Fasting Glucose in Nondiabetic Range: Is It a Marker of Cardiovascular Risk Factor Clustering?

BACKGROUND: Impaired fasting glucose (IFG) through the nondiabetic range (100-125 mg/dL) is not considered in the cardiovascular (CV) risk profile. AIM: To compare the clustering of CV risk factors (RFs) in nondiabetic subjects with normal fasting glucose (NFG) and IFG. MATERIAL AND METHODS: Cross-sectional study in 3739 nondiabetic subjects. Demographics, medical history, and CV risk factors were collected and lipid profile, fasting glucose levels (FBG), C-reactive protein (hsCRP), blood pressure (BP), anthropometric measurements, and aerobic capacity were determined. RESULTS: 559 (15%) subjects had IFG: they had a higher mean age, BMI, waist circumference, non-HDL cholesterol, BP, and hsCRP (p < 0.0001) and lower HDL (p < 0.001) and aerobic capacity (p < 0.001). They also had a higher prevalence of hypertension (34% versus 25%; p < 0.001), dyslipidemia (79% versus 74%; p < 0.001), and obesity (29% versus 16%; p < 0.001) and a higher Framingham risk score (8% versus 6%; p < 0.001). The probability of presenting 3 or more CV RFs adjusted by age and gender was significantly higher in the top quintile of fasting glucose (≥98 mg/dL; OR = 2.02; 1.62-2.51). CONCLUSIONS: IFG in the nondiabetic range is associated with increased cardiovascular RF clustering.