Prevalencia y extensión de la calcificación arterial coronaria en población mexicana asintomática cardiovascular: estudio Genética de la Enfermedad Aterosclerosa / Prevalence and extent of coronary artery calcification in an asymptomatic cardiovascular Mexican population: Genetics of Atherosclerotic Disease study

Resumen: Objetivo: La prevalencia de calcificación arterial coronaria (CAC), marcador específico de aterosclerosis, no es conocida en México. Nuestro objetivo fue investigar la prevalencia y extensión de CAC y su asociación con factores de riesgo cardiovascular en población mexicana. Métodos: La CAC fue medida por tomografía computarizada multidetector en individuos asintomáticos que participaron en el estudio Genética de la Enfermedad Aterosclerosa. Los factores de riesgo cardiovascular y los medicamentos fueron registrados. Resultados: La muestra incluyó 1,423 individuos (49.5% hombres), con una edad de 53.7 ± 8.4 años. Los portadores de CAC mostraron prevalencias más altas de dislipidemia, diabetes, hipertensión y otros factores de riesgo. La prevalencia de CAC > 0 unidades Agatston fue de 27%, significativamente más alta en hombres (40%) que en mujeres (13%). Los valores medios del puntaje de CAC aumentaron consistentemente con la edad y fueron más altos en hombres que en mujeres en todos los grupos etarios. La edad y el c-LDL elevado se asociaron de manera independiente con la prevalencia de CAC > 0 en hombres y mujeres, mientras que la presión arterial sistólica en las mujeres, y el incremento de la edad en ambos géneros mostró una asociación independiente con la severidad de CAC. Conclusiones: En población mexicana la prevalencia y la extensión de CAC fueron mucho más altas en hombres que en mujeres y aumentaron consistentemente con la edad. Los predictores independientes de la prevalencia de CAC fueron la edad y el c-LDL.

Abstract: Objective: The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and their association with cardiovascular risk factors in a Mexican population. Methods: CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. Results: The sample included 1,423 individuals (49.5% men), aged 53.7 ± 8.4 years. Those with CAC showed a higher prevalence of dyslipidaemia, diabetes, hypertension, and other risk factors. The prevalence of CAC > 0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC > 0 in men and women, while increasing systolic blood pressure in women and age in both genders showed an independent association with CAC extension. Conclusions: In the Mexican population the prevalence and extent of CAC were much higher in men than in women, and strongly increased with age. Independent predictors of CAC prevalence were age and low density lipoprotein cholesterol (LDL-C).

Prevalencia y asociación de la calcificación valvular aórtica con factores de riesgo y aterosclerosis coronaria en población mexicana / Aortic valve calcification prevalence and association with coronary risk factors and atherosclerosis in Mexican population

Resumen: Objetivo: La prevalencia de calcificación valvular aórtica (CVA) tiene influencia importante de la etnia y se desconoce en población mexicana. Nuestro objetivo fue investigar la prevalencia de CVA y sus asociaciones con factores de riesgo cardiovascular y calcificación arterial coronaria (CAC). Método: En 1,267 sujetos (53% mujeres) sin enfermedad coronaria conocida y con edad de 35 a 75 años, la CVA y la CAC se evaluaron mediante tomografía computada multidetector, utilizando el método de Agatston. Los factores de riesgo cardiovascular se documentaron en todos los participantes. Las asociaciones de CVA con CAC y factores de riesgo se estimaron usando el análisis de regresión logística múltiple. Resultados: La prevalencia global de CVA y CAC fue del 19.89% y del 26.5%, respectivamente. Ambas condiciones aumentaron con la edad y se encontraron con mayor frecuencia en hombres (25.5 y 37.1%, respectivamente) que en mujeres (14.9 y 13%, respectivamente). La CVA se observó en únicamente el 8.5% de los sujetos sin CAC, mientras que en aquellos con CAC 1-99, 100-399 y > 400 unidades Agatston, las prevalencias fueron del 36.8, 56.8 y 84%, respectivamente. El análisis de regresión logística múltiple ajustado por edad, género, obesidad, inactividad física, hipertensión, dislipidemia y valores altos de insulina, mostró que la presencia de CAC (RM [IC95%]: 3.23 [2.26-4.60]), obesidad (1.94 [1.35-2.79]), género masculino (1.44 [1.01-2.05]) y edad (1.08 [1.03-1.10]), fueron predictores independientes y significativos de la CVA. Conclusiones: La prevalencia de CVA es alta y se asocia significativamente con factores de riesgo aterosclerótico y CAC en población mexicana.

Abstract: Objetive: The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. Methods: In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. Results: The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects wit-hout CAC, while those with CAC 1-99, 100-399, and > 400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. Conclusion: Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.

Errores de medicación en pacientes críticos adultos de un hospital universitario: Estudio prospectivo y aleatorio / Prospective assessment of medication errors in critically ill patients in a university hospital

Background: Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. Aim: To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. Patients and Methods: During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. Results: In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. Conclusions: We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

Intervencionismo en oclusiones crónicas: evaluación de la efectividad cruce de distintas guías y balones según complejidad / Percutaneous coronary interventions in chronic coronary occlusions: effectiveness of different guides and balloons according to complexity of total coronary artery occlusion

Antecedentes: El intervencionismo en las oclusiones totales crónicas (OTC) requiere técnicas complejas y el éxito es poco predecible. Es útil identificar la efectividad de las guías de cruce y del balón para el intervencionismo en distintos niveles de complejidad de OTC. Objetivos: Evaluar la efectividad de cruce de distintas guías y balones en el tratamiento de OTC. Métodos: Se revisa en forma retrospectiva la efectividad de distintos tipos de guías y balones de cruce utilizados en intervencionismo de OTC efectuados entre agosto de 2007 y agosto de 2009. Se define "efectividad" como la capacidad de avanzar y cruzar la oclusión crónica con la guía y el balón, ambas necesarias para efectuar la angioplastia de la OTC. Se agrupan los resultados según el nivel de complejidad de la OTC de acuerdo a score propio, distinguiendo entre OTC simples, complejas y de alta complejidad. Resultado: En el período estudiado se revisan 90 OTC. Se utilizan 148 guías (1,6 guía/proc.) y se utilizan 92 balones en 76 procedimiento que logran paso efectivo de guía. (1,2 bal/proc). Se realiza una tabla con la tasa de efectividad de distintas guías y balones de cruce. Destaca la utilidad de guía PT2 en lesiones simples y complejas, como la utilidad de la guía Miracle 6 en OTC de alta complejidad. Conclusiones: En OTC se obtiene un éxito de 67 por ciento en nuestro medio, con mayor efectividad de la guía PT2 en lesiones simples y complejas y de Miracle 6 en lesiones de alta complejidad. En cuanto a balones se obtiene mayor efectividad en los tipo Maverick, Mercury y Voyaguer de 1,5 mm en lesiones simples y complejas, como del Balón Maverick de 1,5 mm en lesiones de alta complejidad. Es de gran utilidad un registro de la efectividad de balones y guías en el tratamiento de OTC, lo que permite al intervencionista una adecuada elección del material con el consecuente ahorro de tiempo y mayor efectividad del procedimiento.

Background.: PCI in chronic coronary occlusions requires complex techniques and is associated to less predictable results. It is important to evaluate the effectiveness of different guides and balloons in PCI for total coronary occlusion (TCO). Aim: To evaluate the effectiveness of different guides and balloons in the treatment of TCO. Methods: A retrospective review of the effectiveness of different guides and balloons in the treatment of TCO performed from 2007 to 2009 was carried out Effectiveness was defined as the ability to traverse the occlusion with the guide and the balloon. The analysis was performed according to groups defined by the complexity of the TCO as assessed by a locally developed score. Occlusions were classified as simple, complex or highly complex. Results: 90 procedures were analyzed 148 guides were utilized (mean of 1.6 per procedure) and 92 balloons were used in 76 cases were the guide successfully crossed the occlusion. The PT2 guide was effective for simple and complex lesions, whereas de Miracle 6 guide was effective in the treatment of highly complex lesions. Regarding balloons, the Maverick, Mercury and Voyageur 1.5 mm were satisfactory in simple and complex lesions, while the Maverick 1.5mm was more effective in highly complex lesions Conclusion: TCO was successfully treated by PCI in 67 percent of cases. PT2 guides and all types of balloons were effective for treatment of simple and complex lesions. In contrast, the Miracle 6 guide and the Maverick 1.5 balloon were more effective in highly complex lesions. These findings may be useful to help de proper selection of angioplasty materials when treating.

Prevalence of high blood pressure and associated coronary risk factors in an adult population of Mexico city

Background. Several studies have addressed arterial hypertension prevalence in Mexico. However, few include an anlysis of other types of hypertension and their associated risk factors. The present work describes the prevalence of high blood pressure (HBP), isolated systolic hypertension (ISH) and diastolic hypertension (DH) and their association to certain risk factors of cardiovascular disease in an adult population of Mexico City. Methods. A cross-sectional study was performed on 825 subjects age between 20 and 90 years, selected by multistage cluster sampling. HBP was diagnosed by previous history if systolic blood pressure was =140 mmHg and/or diastolic blood pressure =90 mmHg. The measurements taken included body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, levels of insulin, glucose, triglycerides, total cholesterol, high and low density hipoprotein cholesterol, and lipoprotein(a). Results. Prevalence adjusted by age for HBP was 19.4 percent, for ISH, 4.7 percent, and for DH, 4.1 percent. Age had an important influence on HBP and ISH with highly significant X²t. The profile of metabolic variables was modified according to sex and type of hypertension. Thus, in DH, metabolic variables were more affected than in other types of hypertension. Conclusions. Results in HBP prevalence in the present study were lower than in other surveys performed in Mexico. It must be noted, however, that much care should be taken to choose the strategy of subject selection, since results of the prevalence of a disease depend on it to a great extent. The ISH and DH and their association to risk factor must be studied thoroughly because they constitute different clinical entities

Lipoproteína(a) y lípidos en insuficiencia renal crónica y en trasplante renal / Lipoprotein(a) and lipid abnormalities in chronic renal insufficiency and renal transplantation

Objetivo. Establecer la prevalencia de las anormalidades de lípidos y lipoproteína(a) en pacientes tratados con hemodiálisis y en trasplantados. Métodos. Se estudiaron 40 dializados, 64 trasplantados y un grupo de comparación de 77 sujetos de población abierta pareados por edad y género. Resultados. En el grupo de hemodiálisis la atención más prevalente fue la hipoalfalipoproteinemia seguida de exceso de Lp(a) y la de menor frecuencia fue la hipercolesterolemia. Contrariamente, los trasplantados tuvieron la prevalancia más baja de exceso de Lp(a), y una proporción de hipercolesterolemia más alta que la de pacientes hemodializados y semenjantes a los controles. Conclusión. Nuestros resultados confirman algunas observaciones de otros pero en nuestro estudio fue la hipoalfalipoproteinemia y no la hipertrigliceridemia la anormalidad predominante en los pacientes hemodializados

Lipoprotein(a) and cardiovascular risk in adult Mexicans

De 1991 a 1992 se realizó un estudio epidemiológico transversal en una muestra aleatoria de la población adulta de la ciuda de México en la que se analizaron los factores de riesgo de enfermedad arterial coronaria (EAC). La concentración plasmática de lipoproteína(A) (Lp(a)) se midió por ELISA en 404 hombres y 311 mujeres de 20 a 90 años de edad. La mediana de Lp(a) fue de 6.9 mg/dL y la prevalencia de valores elevados (> 30 mg/dL) de 14 por ciento. El nivel de Lp(a) correlacionó positivamente con el de colesterol total (rs = 0.16) y con el colesterol de lipoproteína de baja densidad (C-LDL) (rs = 0.21), y en forma negativa con la insulina (rs = 0.13). La insulina y el C-LDL fueron las variables que mejoro explicaron las concentraciones de Lp(a) en la población. La distribución de Lp(a) en la ciudad de México es similar a la descrita para otras poblaciones y nuestros resultados sugieren, aunque sin alcanzar significancia estadística, que las cifras elevadas de Lp(a) pudieran estar asociadas con la EAC en nuestra población

High Blood pressure and cardiovascular risk factors in an adult population of Mexico City: characteristics of the studies population

The present report is a description of the characteristics of a studied population and of the methodology used in a study performed to investigate high blood pressure prevalence and cardiovascular risk factors among the adult population of Mexico City. A cross-sectional study was conducted from January 1991 to March 1992. Random samplings of multiple stages was used and 825 adult subjects were studied in Mexico City. The following measurements were registered: blood pressure, body mass index (BMI), waist-hip ratio (WHR), total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL-C) and low density lipoproteins (LDL-C), lipoprotein(a) (Lp(a)), glucose and insulin. Personal and family history of cardiovascular illness were investigated, as well as exposure to some risk factor such as smoking, alcohol consumption and sedentarism. The response rate was 86.6 percent. The prevalence of high blood pressure was 21.1 percent, and of non-insulin dependent diabetes mellitus was 8.7 percent. Frequency of dyslipidemia in the studied sample was 24.4 percent for high TG, 23.6 percent for low HDL-C, 23.6 percent for high LDL-C, 14.9 percent for Lp(a) excess (lp(a) > or = 30 mg/dl; overweight and obesity were more prevalent among women. The diversity of living conditions among the population of Mexico City was included in the sampling strategy design, not only to register the high blood pressure (HBP) frequency in each stratum but to identify other cardiovascular risk factors which could be decisive in the development of HBP. Regarding the features of the studied population, BMI did not reveal differences among men, but their TG levels were higher and HDL levels lower than those of other populations. In women, the results obtained for BMI, WHR, lipids and lipoproteins were also higher compared with the mean reported for other populations