External Validation of Cardiovascular Risk Scores in the Southern Cone of Latin America: Which Predicts Better?

Introducción: La estimación inexacta del riesgo cardiovascular poblacional puede llevar a un manejo inadecuado de las intervenciones médicas preventivas, como, por ejemplo, el uso de estatinas. Objetivo: Evaluar la validez externa de ecuaciones de predicción de riesgo cardiovascular en población general del Cono Sur de Latinoamérica. Material y métodos: Se evaluaron ecuaciones que incluyen variables evaluadas en el estudio CESCAS y que predicen tanto morbilidad como mortalidad cardiovascular global (CUORE, Framingham, Globorisk y Pooled Cohort Studies Equations). Para cada ecuación se realizó un análisis independiente en el que se tuvieron en cuenta los eventos cardiovasculares relevados. Se evaluó la discriminación de cada ecuación a través del cálculo del estadístico-C y el índice Harrell C. Para evaluar la calibración se graficó la proporción de riesgos observados vs. estimados por quintilos de riesgo para cada ecuación y se calculó la pendiente β de regresión lineal para las estimaciones. Se calculó sensibilidad y especificidad para la detección de personas con elevado riesgo cardiovascular. Resultados: La mediana del tiempo de seguimiento de la cohorte al momento del análisis es de 2,2 años, con un rango intercuartilo de 1,9 a 2,8 años. Se incorporaron a los análisis 60 eventos cardiovasculares. Todos los valores de estadístico-C y del índice de Harrell fueron superiores a 0,7. El valor de la pendiente β más alejado de 1 fue el de Pooled Cohort Studies Euations. Conclusiones: Si bien los parámetros de validación externa evaluados fueron similares, CUORE, Globorisk y el índice de Framingham fueron las ecuaciones con mejores indicadores globales de predicción de riesgo cardiovascular.Background: Inaccurate estimates of demographic cardiovascular risk may lead to an inadequate management of preventive medical interventions such as the use of statins. Objectives: The aim of this study was to evaluate the external validity of cardiovascular risk equations in the general population of the Southern Cone of Latin America. Methods: Equations including variables evaluated in the CESCAS cohort study and that estimate overall cardiovascular mortality (CUORE, Framingham, Globorisk and Pooled Cohort Studies) were assessed. For each equation, an independent analysis was performed taking into account the cardiovascular events originally considered. Discrimination of each equation was evaluated through C-statistic and Harrell’s C-index. To assess calibration, a graph was built for each equation with the proportion of observed events vs. the proportion of estimated events by risk quintiles and the β slope of the resulting linear regression was calculated. Sensitivity and specificity were determined for the detection of people at high cardiovascular risk. Results: The median follow-up time of the cohort at the time of the analysis was 2.2 years, with an interquartile range of 1.9 to 2.8 years. Sixty cardiovascular events were incorporated into the analysis. All C-statistic and Harrell’s-C index values were greater than 0.7. The value of the β slope farthest from 1 was that of the Pooled Cohort Studies score. Conclusions: Although the external validation parameters evaluated were similar, CUORE, Globorisk and the Framingham equations showed the best global performance for cardiovascular risk estimation in our population.Fil: Gulayin, Pablo Elías. Universidad Nacional de La Plata; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Danaei, Goodarz. Harvard University. Harvard School of Public Health; Estados UnidosFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Ponzo, Jaqueline. Universidad de la República; UruguayFil: Lanas, Fernando. Universidad de La Frontera; ChileFil: Rubinstein, Adolfo Luis. Ministerio de Salud de la Nación; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Papel del Oxido Nítrico y Anión Superóxido en la esofagitis crónica experimental en conejos producida por ácido y pepsina

La enfermedad por reflujo gastro-esofágico además de ser muy frecuente, encierra un importante potencial de gravedad en sus complicaciones. No se conocen demasiado los mecanismos de defensa de la mucosa esofágica frente al ácido y pepsina regulando el flujo mucoso así como el mecanismo de adaptación. El anión superóxido es el principal radical libre involucrado en la lesión con exposición única de la mucosa esofágica a acido y pepsina. En nuestro trabajo nos planteamos describir el papel del NO, ya que puede desempeñar funciones defensivas y tambien lesivas, y el del anión superóxido en la agresión crónica con acido y pepsina que se asemejaria bastante a lo que ocurre en la esofagitis humana. Para esto producimos una esofagitis crónica en conejos siguiendo un modelo descrito por nuestro grupo para conseguir dos tipos diferenciados de lesión; de bajo y de alto grado, con perfusiones de ácido y pepsina a través de una sonda colocada en el esófago proximal. Con perfusiones de 30 min cada 12 h durante 7 dias se consiguen lesiones de bajo grado similar a la esofagitis leve humana y con perfusiones de 45 min/12 h durante 5 dias se consigue una esofagitis de alto grado similar a las más graves en el humano. Para estudiar el papel del NO se administró en un grupo L-NNA que inhibe su síntesis y en otro nitroprusiato para aumentar su concentración al mismo tiempo que se produce la esofagitis con las pefusiones. Para valorar el anión superóxido se administró a un grupo superóxido dismutasa que elimina el anión producido. Además de cuantificar la lesión en cada grupo medimos la actividad de las enzimas NO-sintasa y su isoforma constitutiva(cNOS) en la mucosa, la producción de anión superóxido en celulas de cada grupo asi como la produccion de peroxinitritos. En la esofagitis de bajo grado, la mucosa responde a la agresión ácido-peptica con un aumento de la enzima NOS(principalmente cNOS) como mecanismo de defensa

Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study.

BACKGROUND: The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS are mostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS values in non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS ranges for healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions. METHODS: HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged 35-70 years from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. RESULTS: HGS values differed among individuals from different geographic regions. HGS values were highest among those from Europe/North America, lowest among those from South Asia, South East Asia and Africa, and intermediate among those from China, South America, and the Middle East. Reference ranges stratified by geographic region, age, and sex are presented. These ranges varied from a median (25th-75th percentile) 50 kg (43-56 kg) in men \u3c40 years from Europe/North America to 18 kg (14-20 kg) in women \u3e60 years from South East Asia. Reference ranges by ethnicity and body-mass index are also reported. CONCLUSIONS: Individual HGS measurements should be interpreted using region/ethnic-specific reference ranges

Clinical Impact of the Polypill for Cardiovascular Prevention in Latin America: A Consensus Statement of the Inter-American Society of Cardiology.

The burden of cardiovascular diseases (CVD) is increasing, particularly in low-middle-income countries such as most of Latin America. This region presents specific socioeconomic characteristics, generating a high incidence of CVD despite efforts to control the problem. A consensus statement has been developed by Inter-American Society of Cardiology with the aim of answering some important questions related to CVD in this region and the role of the polypill in cardiovascular (CV) prevention as an intervention to address these issues. A multidisciplinary team composed of Latin American experts in the prevention of CVD was convened by the Inter-American Society of Cardiology and participated in the process and the formulation of statements. To characterize the prevailing situation in Latin American countries, we describe the most significant CV risk factors in the region. The barriers that impair the use of CV essential medications are also reviewed. The role of therapeutic adherence in CV prevention and how the polypill emerges as an effective strategy for optimizing adherence, accessibility, and affordability in the treatment of CVDs are discussed in detail. Clinical scenarios in which the polypill could represent an effective intervention in primary and secondary CV prevention are described. This initiative is expected to help professionals involved in the management of CVD and public health policymakers develop optimal strategies for the management of CVDs

Effect of intermediate-term firewood smoke air pollution on cardiometabolic risk factors and inflammatory markers

BackgroundTemuco is a city in Southern Chile with elevated levels of air pollution (AP), mainly due to using wood as combustion throughout the cold season. The study aimed to assess the differences in cardiometabolic risk factors, estimated cardiovascular risk, and blood level of inflammatory markers between high AP (HAP) and low AP (LAP) periods.MethodsA prospective panel study was conducted between January to September 2018. Air pollution was assessed by PM2.5 concentration. Ninety individuals from the general population were included in the study. Measurements were performed in the HAP and LAP, including medical history and lifestyle, physical activity assessment, physical exam, and fasting blood samples for glucose, lipids, and circulatory inflammatory mediators.ResultsIn the high air pollution period, systolic blood pressure was 3 mmHg higher (p = 0.05). HDL-cholesterol was 14.2 mg/dl lower (p < 0.001), Framingham risk score increased from 14.5 to 18.0 (p < 0.001), and highly significant lower levels of interleukins, MCP1, MMP1, MMP2, sICAM, and svCAM were observed.ConclusionsHAP was associated with increased cardiometabolic risk factors and estimated cardiovascular risk. However, a lower level of circulating acute inflammatory molecules was observed. Inflammatory molecules blood levels were not associated with changes in cardiometabolic risk factors

Association of ultra-processed food intake with risk of inflammatory bowel disease: Prospective cohort study

Objective: To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).Design: Prospective cohort study.Setting: 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).Participants: 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years.Main outcome measures: The main outcome was development of IBD, including Crohn\u27s disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals.Results: Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn\u27s disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with \u3c1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn\u27s disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD.Conclusions: Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods.Study registration: ClinicalTrials.gov NCT03225586

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America

Background: Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. Methods: CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. Results: A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ∼40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. Conclusions: A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.Fil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Elorriaga, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Lanas, Fernando. Universidad de La Frontera; ChileFil: Mores, Nora Cecilia. Municipalidad de Marcos Paz (buenos Aires).; ArgentinaFil: Ponzo, Jaqueline. Universidad de la Republica. Facultad de Medicina; UruguayFil: Calandrelli, Matías Enrique. Sociedad Rural de San Carlos de Bariloche.; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America

Background Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. Methods CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. Results A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. Conclusions A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.Facultad de Ciencias Médica

Global Prospective Safety Analysis of Rivaroxaban.

BACKGROUND: The efficacy of direct oral anticoagulants (DOACs) for stroke prevention in patients with atrial fibrillation (AF) has been established in clinical trials. However, well-conducted, prospective, real-world observational studies of the safety and effectiveness of DOACs are needed. OBJECTIVES: This study sought to assess the real-world safety profile of rivaroxaban through a pooled analysis of patients with AF enrolled in the XANTUS (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation) program worldwide. METHODS: A pre-planned pooled analysis of the XANTUS, XANAP (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Asia), and XANTUS-EL (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Latin America and EMEA Region) registries was performed. Patients with AF newly starting rivaroxaban for stroke prevention were followed for 1 year. Primary outcomes were treatment-emergent major bleeding, adverse events (AEs)/serious AEs, and all-cause death. Secondary outcomes included treatment-emergent thromboembolic events and nonmajor bleeding. Major outcomes were centrally adjudicated. RESULTS: Overall, 11,121 patients were included (mean age 70.5 ± 10.5 years; female 42.9%). Comorbidities included heart failure (21.2%), hypertension (76.2%), and diabetes (22.3%). Event rates were: events/100 patient-years: major bleeding 1.7 (95% confidence interval [CI]: 1.5 to 2.0; lowest: Latin America 0.7; highest: Western Europe, Canada, and Israel 2.3); all-cause death 1.9 (95% CI: 1.6 to 2.2; lowest: Eastern Europe 1.5; highest: Latin America, Middle East, and Africa 2.7); and stroke or systemic embolism 1.0 (95% CI: 0.8 to 1.2; lowest: Latin America 0; highest: East Asia 1.8). One-year treatment persistence was 77.4% (lowest: East Asia 66.4%; highest: Eastern Europe 84.4%). CONCLUSIONS: This large, prospective, real-world analysis in 11,121 patients from 47 countries showed low bleeding and stroke rates in rivaroxaban-treated patients with AF, with low treatment discontinuation in different regions of the world. Results were broadly consistent across regions. (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation [XANTUS]; NCT01606995; Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Latin America and EMEA Region [XANTUS-EL]; NCT01800006; and Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Asia [XANAP]; NCT01750788)