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1.
J Clin Sleep Med ; 15(8): 1101-1106, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31482831

RESUMO

STUDY OBJECTIVES: Evidence of an association between atherosclerosis and sleep quality is limited and has not been studied in remote rural settings, where living conditions are different than in urban centers. We aimed to assess the relationship between the aortic pulse wave velocity (PWV) and sleep quality in older adults living in rural Ecuador. METHODS: Atahualpa residents aged 60 years or older identified during door-to-door surveys, who consented to participate, underwent face-to-face interviews with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Aortic PWV determinations were performed for arterial stiffness estimation (as a surrogate of atherosclerosis). RESULTS: A total of 303 individuals were included (mean age: 70.3 ± 7.8 years; 59% women). Univariate logistic regression showed a significant association between the aortic PWV and poor sleep quality (odds ratio [OR] 1.22; 95% confidence interval [CI] 1.07-1.39; P = .003). A multivariate logistic regression model, adjusted for demographics, cardiovascular risk factors, oily fish intake and psychological distress showed a significant association between increased PWV and poor sleep quality (OR 1.59; 95% CI 1.12-2.25; P = .009). Similar significance was noted when the model was adjusted for neuroimaging signatures of cerebral small-vessel disease and stroke (OR 1.47; 95% CI 1.07-2.03; P = .019). CONCLUSIONS: This study shows a significant independent association between the aortic PWV and poor sleep quality in older adults living in rural Ecuador. Results provide more insights into the relevance of the impact of sleep disorders on cardiovascular diseases. CLINICAL TRIAL REGISTRATION: The Atahualpa Project has been registered at ClinicalTrials.gov. The identifier number is NCT01627600, and the date was: 10/02/2012. CITATION: Del Brutto OH, Mera RM, Peñaherrera E, Costa AF, Peñaherrera R, Castillo PR. On the association between sleep quality and arterial stiffness: a population study in community-dwelling older adults living in rural ecuador (the atahualpa project). J Clin Sleep Med. 2019;15(8):1101-1106.

2.
Vasc Med ; : 1358863X18806583, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30426888

RESUMO

Information on the association between arterial stiffness and cerebral small vessel disease (cSVD) is limited and confined to white and Asian populations. More regional information is needed to confirm this association in different ethnic groups. Using the Atahualpa Project cohort, we aimed to assess whether the aortic pulse wave velocity (PWV) is associated with the total cSVD score, as well as with each of the neuroimaging signatures of cSVD, in a population of Amerindians living in rural Ecuador. Atahualpa residents aged ⩾ 60 years were offered a brain magnetic resonance imaging scan (MRI) and aortic PWV determination. An ordinal logistic regression model, adjusted for demographics and cardiovascular risk factors, was constructed to predict the total cSVD score by levels of aortic PWV. The association between the neuroimaging signatures of cSVD and the aortic PWV was assessed by adjusted logistic regression models. Of 437 candidates, 303 (69%) underwent a brain MRI and aortic PWV determinations. The total cSVD score was 0 points in 65% of individuals, 1 point in 18%, 2 points in 11%, and 3-4 points in 6%. The mean aortic PWV was 10.4 ± 1.8 m/s, which increased from 9.8 ± 1.2 to 12.3 ± 1.8 m/s in individuals with a cSVD score of 0 and 3-4, respectively ( p < 0.001). An ordinal logistic regression model showed significant association between the PWV and the cSVD score. A change of one unit of the aortic PWV increased the odds of having a higher total cSVD score by 1.73 (95% CI: 1.28-2.35; p < 0.001). In addition, individual neuroimaging signatures of cSVD, with the exception of lacunar infarcts, were associated with the aortic PWV. This study shows a significant association between the aortic PWV and total cSVD score and most of its individual components in older Amerindians.

4.
Lancet ; 391(10134): 2019-2027, 2018 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-29864018

RESUMO

BACKGROUND: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. METHODS: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. FINDINGS: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12-1·72) irrespective of other patient and service characteristics. INTERPRETATION: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes. FUNDING: Chest, Heart and Stroke Scotland.


Assuntos
Padrões de Prática Médica , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Casos e Controles , Países Desenvolvidos , Países em Desenvolvimento , Medicina Baseada em Evidências , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Pobreza , Inquéritos e Questionários , Análise de Sobrevida , Resultado do Tratamento
5.
J Stroke Cerebrovasc Dis ; 27(9): 2494-2499, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29934138

RESUMO

BACKGROUND: Knowledge on the association between arterial stiffness and intracranial atherosclerosis is limited. Here, we aimed to assess whether the aortic pulse wave velocity (PWV)-used as a surrogate of arterial stiffness-might independently predict severity of carotid siphon calcifications (CSCs), used as a marker of atherosclerosis. METHODS: Of 437 Atahualpa residents aged 60 years or older, 300 (69%) underwent head computed tomography (CT) (for CSC assessment), brain magnetic resonance imaging (for identification of neuroimaging signatures of cerebral small vessel disease [SVD]), and aortic PWV determinations (for arterial stiffness estimation). Ordinal logistic regression models were constructed to predict severity of CSC (as the dependent variable) according to levels of aortic PWV after adjusting for demographics, cardiovascular risk factors, and neuroimaging signatures of SVD. RESULTS: Grade 1 CSC were noticed in 120 (40%) subjects, grade 2 in 84 (28%), grade 3 in 73 (24%), and grade 4 in 23 (8%). The mean PWV was 10.4 ± 1.8 m/s, which increased from 9.8 ± 1.3 to 11.1 ± 2.1 m/s in individuals with grades 1 and 4 CSC, respectively (P <.001). The most parsimonious ordinal logistic regression model adjusted for relevant confounders showed a significant association between aortic PWV and severity of CSC. In this model, a change of 1 unit of aortic PWV increased the odds of CSC severity by 1.22 (95% confidence interval 1.07-1.39; P = .004). CONCLUSIONS: The monotonically increased odds of aortic PWV among subjects with different grades of CSC, suggest that aortic PWV may be a marker for identifying candidates for CT screening in the search of CSC.


Assuntos
Aorta/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Rigidez Vascular , Idoso , Aorta/fisiopatologia , Calcinose/fisiopatologia , Transtornos Cerebrovasculares/fisiopatologia , Estudos de Coortes , Equador , Feminino , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Curr Hypertens Rev ; 14(2): 123-127, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29737254

RESUMO

The vascular endothelium plays an important role to maintain the functional integrity of the cardiovascular system. The synthesis and secretion of substances with biological activity such as prostacyclin and NO give endothelium the vasodilator, antithrombotic, and antiatherosclerotic properties. Endothelial dysfunction participates in the genesis of HTA, but also hypertension produces endothelial damage. The major class of antihypertensive drugs has beneficial effects in the recuperation of the endothelial function, actions that are contributing to explain the impact of the adequate control of HTA in the reduction of CV events.

7.
Aging Clin Exp Res ; 30(5): 539-542, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28762211

RESUMO

BACKGROUND: Information on the burden of atrial fibrillation (AF) in rural areas of developing countries is limited. Here, we aimed to assess AF prevalence in community-dwelling older adults living in rural Ecuador. METHODS: Atahualpa residents aged ≥60 years (mean age 70.5 ± 8.1 years) underwent 24-h Holter monitoring. Participants belong to the Amerindian ethnic group. The mean height in the study population was 147.9 ± 8.9 cm. Oily fish was a major source of food (mean intake: 8 ± 4 servings/week). RESULTS: Seven of 298 participants (2.3%) had AF. Persons with AF were older than those without (p = 0.051), but there were no differences in cardiovascular risk factors across groups. None of the seven AF cases had been detected in routine 12-lead ECGs taken at enrollment. CONCLUSIONS: Prevalence of AF in older Amerindians living in rural Ecuador is low. Both, racially-determined short stature and frequent dietary oily fish intake might explain the low prevalence of AF in this rural setting.


Assuntos
Fibrilação Atrial/epidemiologia , Dieta , Peixes , Índios Sul-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Animais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etnologia , Estudos de Coortes , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos
8.
Rev. ecuat. neurol ; 26(2): 101-110, may.-ago. 2017. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003972

RESUMO

RESUMEN Las enfermedades vasculares son consideradas como las nuevas epidemias de salud en América Latina debido al aumento en la expectativa de vida y a cambios en el estilo de vida de sus habitantes. El conocimiento del estado de salud cardiovascular (SCV) de estas poblaciones es mandatorio para implementar estrategias costo-efectivas dirigidas a reducir la prevalencia de estas enfermedades en la región. En el Proyecto Atahualpa se ha valorado el estado de SCV de los participantes, utilizando los marcadores de salud propuestos por la Asociación Americana del Corazón. El estudio basal incluyó 616 sujetos libres de enfermedad cerebrovascular y cardiopatía isquémica, con edad ≥40 años. De estos, el 2.1% tuvieron un estado de salud ideal, el 28.1% intermedio y el 69.8% pobre. Los peores marcadores incluyeron presión arterial, glucosa en ayunas e índice de masa corporal. La posibilidad de tener un estado de SCV pobre estuvo aumentada en sujetos ≥60 años y en aquellos con escolaridad primaria. Luego, comparamos el estado de SCV de nuestra población con la de hispanos enrolados en el NOMAS, y encontramos que los residentes de Atahualpa tuvieron mejores marcadores de salud, con excepción de los niveles de glucosa en ayunas. La posibilidad de tener 5-7 marcadores en rango ideal fue más elevada en los residentes de Atahualpa, independientemente de la edad. También realizamos un estudio para valorar la SCV dependiendo del aislamiento social y encontramos que el vivir solo se asoció con un peor estado de SCV. Otros estudios mostraron relación entre ciertas patologías del sueño y un peor estado de SCV. Finalmente, hemos empezado el programa "conoce tus números", el cual sumado a charlas comunitarias, se encuentra dirigido a mejorar la SCV de los residentes de Atahualpa y reducir la incidencia de eventos vasculares en la región.


ABSTRACT Stroke and cardiovascular diseases will be the next epidemics in Latin America due to changes in lifestyle and increased life expectancy. Knowledge of cardiovascular health (CVH) status of the population is mandatory to implement cost-effective strategies directed to reduce the burden of vascular diseases in the region. In the Atahualpa Project, we assessed the CVH status of participants using the metrics proposed by the American Heart Association. The basal study included 616 subjects free of stroke and ischemic heart disease aged ≥40 years. Of these, 2.1% had ideal, 28.1% had intermediate and 69.8% had poor CVH status. Poorest metrics were blood pressure, fasting glucose, and BMI. The odds for having a poor CVH status were increased in persons aged ≥ 60 years and in those with only primary school education. Then, we compared our results with the Hispanic population of the Northern Manhattan Stroke Study (NOMAS), and found that Atahualpa residents had significantly better metrics than those enrolled in the NOMAS, with the exception of fasting glucose levels. Likewise, the odds for having 5 to 7 ideal metrics were also better in Atahualpa residents, irrespective of age. We also conducted a case-control study to assess the CVH status of Atahualpa residents according to their living arrangements, and found that social isolation was associated with a worse CVH status in this population. A couple of studies showed correlation between some sleep related disorders and poor CVH status. We have also started an ongoing program called "known your numbers", which, together with community talks, is directed to improve the CVH status and to reduce the burden of vascular diseases in the region.

9.
Diabetes Metab Syndr ; 11(3): 199-202, 2017 Jul - Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27612397

RESUMO

BACKGROUND: Metabolic syndrome increases cardiovascular risk, and causes damage to the vascular wall. Through this mechanism, it might increase arterial rigidity, leading to further complications and heart strain. The use of a device that measures arterial rigidity can help determine if metabolic syndrome is related to a higher vascular stiffness and changes in estimated arterial age. METHODOLOGY: Cross-sectional study at Luis Vernaza hospital of Guayaquil, Ecuador. Inpatients and outpatients from the Department of Cardiology with a full blood panel and echocardiogram were included. We used the IDF criteria to diagnose metabolic syndrome and measured arterial rigidity parameters in all of them, including augmentation indexes, central blood pressure, pulse wave velocity and arterial age. RESULTS: 95 patients were included for analysis, 44.2% were females and 55.8% were males. Mean age was 61.7 years (±13.1). Metabolic syndrome was diagnosed in 49.5% of our patients and it was significantly more prevalent in women. We found significant differences in PWV, augmentation indexes, and peripheral and central blood pressure between metabolic and non-metabolic syndrome patients. There was a non-significant relationship between estimated arterial age and metabolic syndrome (p=0.32). CONCLUSION: Patients with metabolic syndrome have an increased arterial rigidity. This, added to the high prevalence of the disease we found in our sample, shows the high cardiovascular risk these patients are at. A multidisciplinary approach to management is needed, along with patient collaboration. The introduction of these devices to measure arterial stiffness in developing countries can improve diagnosis and therapy of patients with cardio-metabolic conditions.


Assuntos
Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Rigidez Vascular/fisiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Análise de Onda de Pulso/métodos , Fatores de Risco
10.
Lancet ; 388(10046): 761-75, 2016 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-27431356

RESUMO

BACKGROUND: Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. METHODS: We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. FINDINGS: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05-1·30; 3·9%, 1·9-7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). INTERPRETATION: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. FUNDING: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.


Assuntos
Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Comportamento de Redução do Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto , África/epidemiologia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Apolipoproteína A-I/sangue , Apolipoproteínas B/sangue , Ásia/epidemiologia , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Austrália/epidemiologia , Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/complicações , Estudos de Casos e Controles , Hemorragia Cerebral/sangue , Hemorragia Cerebral/complicações , China/epidemiologia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/prevenção & controle , Europa (Continente)/epidemiologia , Medicina Baseada em Evidências , Comportamento Alimentar , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hipertensão/sangue , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Atividade Motora , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Razão de Chances , Fatores de Risco , Autorrelato , Fumar/efeitos adversos , Fumar/epidemiologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Relação Cintura-Quadril
11.
Stroke ; 47(3): 652-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26846866

RESUMO

BACKGROUND AND PURPOSE: A limitation when making early decisions on stroke management is the lack of rapid diagnostic and prognostic testing. Our study sought to identify peripheral blood RNA biomarkers associated with stroke. The secondary aims were to assess the discriminative capacity of RNA biomarkers for primary stroke type and stroke prognosis at 1-month. METHODS: Whole-blood gene expression profiling was conducted on the discovery cohort: 129 first-time stroke cases that had blood sampling within 5 days of symptom onset and 170 control participants with no history of stroke. RESULTS: Through multiple regression analysis, we determined that expression of the gene MCEMP1 had the strongest association with stroke of 11 181 genes tested. MCEMP1 increased by 2.4-fold in stroke when compared with controls (95% confidence interval, 2.0-2.8; P=8.2×10(-22)). In addition, expression was elevated in intracerebral hemorrhage when compared with ischemic stroke cases (P=3.9×10(-4)). MCEMP1 was also highest soon after symptom onset and had no association with stroke risk factors. Furthermore, MCEMP1 expression independently improved discrimination of 1-month outcome. Indeed, discrimination models for disability and mortality that included MCEMP1 expression, baseline modified Rankin Scale score, and primary stroke type improved discrimination when compared with a model without MCEMP1 (disability Net Reclassification Index, 0.76; P=3.0×10(-6) and mortality Net Reclassification Index, 1.3; P=1.1×10(-9)). Significant associations with MCEMP1 were confirmed in an independent validation cohort of 28 stroke cases and 34 controls. CONCLUSIONS: This study demonstrates that peripheral blood expression of MCEMP1 may have utility for stroke diagnosis and as a prognostic biomarker of stroke outcome at 1-month.


Assuntos
Perfilação da Expressão Gênica/métodos , Internacionalidade , Proteínas de Membrana/sangue , Proteínas de Membrana/genética , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/genética , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Acidente Vascular Cerebral/diagnóstico
12.
Clín. investig. arterioscler. (Ed. impr.) ; 28(1): 9-18, ene.-feb. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-148441

RESUMO

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 (AU)


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 (AU)


Assuntos
Humanos , Hiperglicemia/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Diabetes Mellitus/epidemiologia , Estado Pré-Diabético/epidemiologia , Prognóstico , América Latina/epidemiologia , Estudos de Coortes , Tempo de Internação/estatística & dados numéricos
13.
Clin Investig Arterioscler ; 28(1): 9-18, 2016 Jan-Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-26596523

RESUMO

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.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/complicações , Infarto do Miocárdio/complicações , Estado Pré-Diabético/complicações , Idoso , Estudos de Coortes , Colômbia/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Equador/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Estado Pré-Diabético/epidemiologia , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
14.
Lancet ; 388(1046): 761-775, 2016. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-34758

RESUMO

Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifi able risk factors for stroke in diff erent regions of the world,and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute fi rst stroke (within 5 days of symptom onset and72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke,and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks(PARs) were calculated, with 99% confi dence intervals...(AU)


Assuntos
Acidente Vascular Cerebral , Controle , Risco
15.
Arq Bras Endocrinol Metabol ; 58(3): 205-25, 2014 Apr.
Artigo em Português | MEDLINE | ID: mdl-24863082

RESUMO

The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Hipertensão/diagnóstico , Hipertensão/terapia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/terapia , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Meio Ambiente , Epigenômica , Humanos , Hipertensão/epidemiologia , América Latina/epidemiologia , Estilo de Vida , Síndrome Metabólica/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , População Urbana/estatística & dados numéricos
16.
Arq. bras. endocrinol. metab ; 58(3): 205-225, abr. 2014. tab
Artigo em Português | LILACS | ID: lil-709357

RESUMO

O presente documento foi preparado por um grupo de especialistas, membros das Sociedades de Cardiologia, Endocrinologia, Medicina Interna, Nefrologia e Diabetes dos países da América Latina, para que sirva de diretriz para médicos que cuidam de pacientes com diabetes, hipertensão e fatores de risco concomitantes ou complicações de ambas as condições. Embora o conceito de síndrome metabólica seja atualmente muito discutido, a alta prevalência na América Latina do conjunto de alterações metabólicas que a compõem sugere que a síndrome metabólica é uma entidade nosográfica útil no contexto da medicina latino-americana. Devido a isso, no presente documento presta-se especial atenção a essa síndrome com a finalidade de alertar aos médicos sobre uma população particularmente de alto risco, que, por ser subestimada, não é tratada de forma adequada para os fatores de risco que constituem a síndrome metabólica. As recomendações deste documento são o resultado de apresentações e debates que ocorreram durante um encontro de dois dias em Bucaramanga (Colômbia), em outubro de 2012. Todos os participantes aprovaram as decisões finais. Os autores reconhecem que a publicação e difusão das diretrizes não serão suficientes para alcançar as mudanças recomendadas tanto em estratégias diagnósticas como terapêuticas, por isso programaram intervenções que permitirão identificar as barreiras do conhecimento, as atitudes e comportamento, o que permitirá tanto aos médicos como aos pacientes uma adequada adesão às recomendações sugeridas nestas diretrizes. Arq Bras Endocrinol Metab. 2014;58(3):205-25.


The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations. Arq Bras Endocrinol Metab. 2014;58(3):205-25.


Assuntos
Humanos , /diagnóstico , /terapia , Hipertensão/diagnóstico , Hipertensão/terapia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/terapia , Comorbidade , /epidemiologia , Meio Ambiente , Epigenômica , Hipertensão/epidemiologia , Estilo de Vida , América Latina/epidemiologia , Síndrome Metabólica/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , População Urbana/estatística & dados numéricos
17.
Clín. investig. arterioscler. (Ed. impr.) ; 26(2): 85-103, mar.-abr. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-121527

RESUMO

El presente documento ha sido preparado por un grupo de expertos, miembros de las sociedades de Cardiología, Endocrinología, Medicina Interna, Nefrología y Diabetes de los países de América Latina, para que sirva de guía a los médicos que cuidan a pacientes con diabetes, hipertensión y enfermedades concomitantes o complicaciones de ambas condiciones. Aunque el concepto de síndrome metabólico actualmente es discutido, la alta prevalencia en América Latina del conjunto de alteraciones metabólicas que lo conforman sugiere que el síndrome metabólico es una entidad nosográfica útil en el contexto de la medicina latinoamericana. Por lo tanto, en el presente documento se presta especial atención a este síndrome con el fin de alertar a los médicos de una particular población de alto riesgo que por lo general es subestimada y en la que no se tratan en forma óptima los factores de riego que constituyen el síndrome metabólico. Las presentes recomendaciones son el resultado de las presentaciones y los debates en los paneles de discusión durante una reunión de 2 días celebrada en Bucaramanga en octubre de 2012. Todos los participantes han aprobado las conclusiones finales. Los autores reconocen que la publicación y la difusión de las guías no serán suficientes para alcanzar los cambios recomendados tanto en las estrategias diagnósticas como terapéuticas, por lo que se han programado intervenciones que permitan identificar las barreras del conocimiento, de las actitudes y del comportamiento, lo que permitirá tanto a los médicos como a los pacientes una adecuada adherencia a las recomendaciones de las guías (AU)


The present document has been prepared by a group of experts, members of Cardiology, Endocrinology, Internal Medicine, Nephrology and Diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high- risk population, usually underestimated and undertreated. These recommendations results from presentation and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming both physicians and patients from effectively adhering to guideline recommendations (AU)


Assuntos
Humanos , Hipertensão/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Síndrome Metabólica/complicações , Padrões de Prática Médica , Sobrepeso/epidemiologia , Obesidade/epidemiologia
19.
Int J Stroke ; 9(3): 365-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23981505

RESUMO

Stroke will be South America's next epidemic. Therefore, information on stroke particularities in the region will help to overcome its impact burden. We evaluated prevalence, pattern of sub-types, and pathogenic mechanisms underlying stroke in Atahualpa, a village representative of rural coastal Ecuador. In a three-phase epidemiologic study, suspected cases were detected by a door-to-door survey (Phase I). Then, neurologists evaluated suspected cases and randomly selected negative persons (Phase II), and confirmed patients underwent complementary exams (Phase III). We found 20 stroke patients (mean age 70 years, 60% men) among 642 persons aged ≥40 years. Stroke prevalence was 31.15‰ that increased with age. Most patients had sub-cortical infarctions associated with leukoaraiosis or microbleeds. Hypertensive arteriolopathy was the most likely mechanism underlying strokes (55% patients). Intracranial arterial lesions were found in 47% cases. Extracranial atherosclerotic lesions or cardiac sources of emboli were not found in any case. Comparison of our findings with a previous survey performed in the same village showed an alarming increase in stroke prevalence (from 14.08‰ in 2003 to 31.15‰ in 2012, P = 0.03).


Assuntos
População Rural/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Países em Desenvolvimento , Equador/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Fatores de Risco
20.
Clin Investig Arterioscler ; 26(2): 85-103, 2014 Mar-Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-24365579

RESUMO

The present document has been prepared by a group of experts, members of Cardiology, Endocrinology, Internal Medicine, Nephrology and Diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high- risk population, usually underestimated and undertreated. These recommendations results from presentation and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming both physicians and patients from effectively adhering to guideline recommendations.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Hipertensão/terapia , Síndrome Metabólica/terapia , Consenso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , América Latina/epidemiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Fatores de Risco
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