Prevalence of self-reported overweight-obesity and its association with socioeconomic and health factors among older Mexican adults

OBJECTIVE: To investigate the prevalence of obesity and its association with socioeconomic factors and comorbidities in a population-based study. MATERIAL AND METHODS: Data were examined from 4,605 persons ages 60 and older that participated in the 2001 Mexican Health and Aging Study, conducted in rural and urban communities in Mexico. The prevalence of obesity (according to self-reported weight and height) was obtained, stratified by age, and logistic regression was used to study cross-sectional associations between obesity and socioeconomic factors. RESULTS: Of the population studied, 20.9% were classified as obese and the prevalence diminishes with age. Overall, women were more likely than men to be obese. Lower educational level was associated with lower risk of overweight. In both men and women, obesity was more common between subjects with hypertension (OR 1.38 and 1.71, respectively) and long-distance walk limitation (OR 2.08 and 2.21, respectively). CONCLUSION: In older Mexican adults, hypertension and long-distance walk limitation were independent associated factors for higher prevalence of obesity. - Objetivo: Estudiar la prevalencia de obesidad y su asociación con factores socioeconómicos y comorbilidades. Material y métodos: Se analizaron los datos de 4 605 personas de 60 años y más que participaron en el Estudio Nacional sobre Salud y Envejecimiento en México 2001 (ENASEM 2001) en zonas rurales y urbanas. La prevalencia de obesidad (peso y talla autorreportados) se obtuvo estratificada por edad y mediante una regresión logística se asoció con factores socioeconómicos. Resultados: 20.9% se clasificaron como obesos y la prevalencia disminuyó con la edad. En general las mujeres tuvieron mayor probabilidad de ser obesas. Una baja escolaridad se asoció con menor riesgo de sobrepeso. En hombres y mujeres la obesidad se asoció con hipertensión (RM 1.38 y 1.71 respectivamente) y con dificultad para caminar (RM 2.08 y 2.21 respectivamente). Conclusión: En la población de edad avanzada en México la hipertensión y la dificultad para caminar varias cuadras se asoció con mayor prevalencia de obesidad

Changes in the arrhythmic profile of patients treated for heart failure are associated with modifications in their myocardial perfusion conditions

Background: Heart failure (HF) patients can benefit from a proper RS. We had observed that they show an increase in the number of arrhythmias during the first year of pharmacological treatment. Methods: We carried out a prospective observational study in which patients in an HF Clinic were included when they had follow-up Holter monitoring. Patients also had a baseline myocardial perfusion scan (Tc99 sestaMIBI/dypiridamole) and a control scan. Results: We included 90 patients with follow-up Holter and 35 with scintigraphy, for analysis. Fifty-six (62.2%) were men and the average age was 60.8 ± 14.6 years. Follow-up periods were divided by six-month intervals up to 18 months or more, an increase in premature ventricular contractions (PVCs) occurred in the six-month to one-year period (1915.4 ± ± 4686.9 vs. 2959 ± 6248.1, p = 0.09). In the one-year to 18-month control, PVCs went from 781.6 ± 1082.4 to 146.9 ± 184.1, p = 0.05. The increase in PVCs correlated with a reduction in scintigraphy-detected ischemic territories, 5.64 ± 5.9 vs. 3.18 ± 3 (p = 0.1) and a gain in those showing a reverse redistribution pattern (0.18 ± 0.6 vs. 2.09 ± 4.01, p = 0.1). Necrotic territories and time domain heart rate variability did not show significant changes. Conclusions: PVCs increase during the first year of HF treatment, and then they tend to diminish and stabilize. These changes seem to correlate with changes in the perfusion state of the patient. While ischemic territories decrease, reverse redistribution increases, showing that endothelial dysfunction could have a relevant role in arrhythmia generation, possibly because of membrane instability of recovered hibernating myocardium. (Cardiol J 2008; 15: 261-267

The effect of left ventricular dysfunction on right ventricle ejection fraction during exercise in heart failure patients: Implications in functional capacity and blood pressure response

Background: The aim of this study was to assess the effect of left ventricular dysfunction on right ventricular ejection fraction during exercise in heart failure patients and its implications in functional capacity and blood pressure response. Methods: In a cross-sectional study 65 patients with heart failure were included. Left and right ventricular ejection fractions were evaluated by radio-isotopic ventriculography. All subjects underwent an exercise treadmill test (Bruce modified protocol). Systolic and diastolic blood pressures were also recorded. Results: From the total population, 38 (58.46%) showed a significant increase (≥ 5%) in left ventricular ejection fraction (LVEF) and 27 (41.5%) showed a significant decrease in LVEF (≥ 5%) after the stress test. Patients with a significant reduction in LVEF during stress had lower exercise tolerance (4.1 ± 2.5 vs. 6.1 ± 2.5 METs, p = 0.009) compared to those who showed an increase in LVEF. Diastolic blood pressure was higher at rest among those who had a reduced LVEF during stress (83 ± 12.2 vs. 72.6 ± 12.2 mm Hg, p = 0.035) and during exercise (95 ± 31.3 vs. 76.9 ± 31.3 mm Hg, p = 0.057), as well as mean arterial pressure in the same group (97.1 ± 11.6 mm Hg, p = 0.05). In addition, this group decrease of –8.8 ± 51.6% in the right ventricular ejection fraction after exercise compared to an increase of 27.3 ± ± 49.1% (p = 0.007) among the patients with an increase in LVEF. Conclusions: Biventricular systolic dysfunction during exercise is associated with higher rest and stress blood pressure and worse functional capacity

Microalbuminuria in systolic and diastolic chronic heart failure patients

Background: Microalbuminuria is considered a major risk factor predisposing to cardiovascular morbidity and mortality. Microalbuminuria levels in patients with or without diabetes have been associated with a higher risk of chronic heart failure (HF). However, there are limited data regarding prevalence of microalbuminuria in chronic heart failure and its prognostic value. The aim of this study was to assess the occurence of microalbuminuria in chronic heart failure patients as well as its association with clinical, echocardiographic, and body composition markers. Methods: In a cross-sectional study, we included 72 chronic heart failure patients (NYHA I-III) on standard HF therapy. All patients had an echocardiogram and body composition by vector bioelectric impedance analysis (measured by Body Stat Quad Scan). Results: The studied population consisted of 64% men at mean age of 62.6 ± 15.1 years. Patients were divided into systolic and diastolic HF groups. Microalbuminuria was observed in 40% of diastolic and 24% systolic HF patients (p = 0.04). Microalbuminuria was present in more patients with volume overload (80 vs. 21.9%, p = 0.002), with a worse phase angle and lower serum albumin (4.7 vs. 5.9° and 3.5 vs. 4.0 mg/dl, p = 0.02) and higher pulmonary arterial pressure compared with patients without microalbuminuria in systolic HF patients. There was no significant association between frequency of microalbuminuria and ejection fraction. In the diastolic HF group, the presence of microalbuminuria was not associated with any known risk factor. Conclusions: Microalbuminuria was more frequent in diastolic than systolic HF patients. In systolic HF patients microalbuminuria was associated with factors known to be markers of worse prognosis. (Cardiol J 2008; 15: 143-149

Reversible changes of electrocardiographic abnormalities after parathyroidectomy in patients with primary hyperparathyroidism

Background: Several studies have reported that primary hyperparathyroidism is a risk factor of higher cardiovascular mortality, mainly because hyperparathyroidism is related to arterial hypertension, arrhythmias, structural heart abnormalities and activation of the renin–angiotensin– aldosterone system. However, very few studies have shown the electrocardiographic changes that occur after parathyroidectomy. That was the aim of this study. Methods: We studied 57 consecutive patients with primary hyperparathyroidism surgically treated. Electrocardiogram, serum electrolytes, parathyroid hormone, creatinine and albumin measures were obtained before and after surgery and were compared. Results: The most common basal electrocardiographic abnormalities were left ventricular hypertrophy (LVH, 24.6%), conduction disturbances (16.3%), and short QT and QTc intervals. After surgery, a QTc interval lengthening and a tendency of T wave shortening were observed, as well as an inverse association between QTc interval and serum levels of magnesium and corrected calcium. There were no differences in LVH and conduction disturbances after surgery. Conclusions: Primary hyperparathyroidism is an important factor in the development of electrocardiographic abnormalities in this population, some of which are not corrected after parathyroidectomy. Further studies are required to demonstrate what factors are associated with persistence of electrocardiographic disturbances after surgery

Improvement of ventricular function in systolic heart failure patients with oral L-citrulline supplementation

Background: The utility of L-arginine and L-citrulline in treatment of arterial hypertension by increasing vascular oxide nitric availability has been demonstrated. Photoplethysmography, a simple and low-cost optical technique, makes it possible to assess vascular function and to detect changes in blood flow, pulse and swelling of the microvascular tissular space. The aim of the study was to evaluate the effect of L-citrulline supplementation on functional class, ejection fraction and peripheral blood flow in patients with systolic heart failure. Methods: Thirty-five stable outpatients attending the Heart Failure Clinic at the INCMNSZ underwent clinical evaluation, radioisotopic ventriculography and photoplethysmography before and at the end of 4 months. They were randomized into two groups: experimental group, with oral L-citrulline supplementation (3 g/day, n = 20) and control group, without supplementation (n = 15). Results: In the experimental group the left ventricular ejection fraction (LVEF) increased 20.3% at rest and 12.7% with stress, as well as the right ventricular ejection fraction at rest of 15.10% and 14.88% with stress. In addition, functional class improved in 35%, and the maximum amplitude time/total time (MAT/TT) index decreased 23.1%. These changes were statistically significant compared with the control group. Conclusions: Citrulline supplementation significantly improved the LVEF, the endothelial function (MAT/TT index) and functional class. Citrulline can be an important co-adjuvant in the treatment of stable and stable systolic heart failure patients

The effect of L-arginine and citrulline on endothelial function in patients in heart failure with preserved ejection fraction

Background: To evaluate the effect of the amino acids L-arginine and citrulline on endothelial function in patients in stable diastolic and right heart failure using photoplethysmography. Methods: Thirty patients from the Heart Failure Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" underwent photoplethysmography using the hyperemia technique. Index finger flow was assessed at baseline and after ischemia every 30 s by maximum amplitude time (MAT), total time of the curve (TT) and the index of the two (MAT/TT < 30 = normal) before and after the administration of L-arginine (8 g/day in two doses, n = 15) or citrulline (3 g/day in one dose, n = 15) for 60 days in addition to optimal pharmacological treatment. Results: There were no statistically significant differences between the two groups at baseline. After the intervention, the MAT/TT index of all patients normalized in each evaluation period with statistically significant differences. Basal L-arginine group = 38.75 &#177; 11.52, final 23.32 &#177; 6.08, p = 0.007 and basal citrulline group = 41.4 &#177; 13.47, final 23.65 &#177; 6.74, p = 0.007 at 60&#8211;90 s. Post-ischemia: basal L-arginine 36.60 &#177; 11.51, final 18.81 &#177; 15.13, p = 0.004 and basal citrulline = 49.51 &#177; 15.17, final 27.13 &#177; 7.87, p = 0.003. Conclusions: The administration of L-arginine and citrulline has a beneficial effect on endothelial function as shown by the normalized MAT/TT index. It probably improves systemic and pulmonary hemodynamics, which could help in the treatment of diastolic heart failure. (Cardiol J 2010; 17, 5: 464-470

Prognostic value of cardiac troponin T elevation is independent of renal function and clinical findings in heart failure patients

Background: The aim of this study is to determine the prevalence and prognostic value of elevated cardiac troponin (cTnT) and its association with clinical characteristics according to renal function status in patients with stable heart failure. Methods: In a prospective observational study, 152 consecutive patients from the Heart Failure Clinic of the INCMNSZ were followed for a period of 42 months. All underwent clinical evaluation, echocardiography, and determination of body composition by electric bioimpedance to identify hypervolemia. Concentrations of cTnT were quantified by immunoassay with electrochemoluminescence and &#8805; 0.02 ng/mL levels were considered elevated. Also glomerular filtration rate (eGFR) was estimated using the Cockcroft-Gault equation. Results: Elevated cTnT was significantly associated with increased all-cause mortality in the observational period even after adjusting for eGFR < 60 mL/min/1.73 m2 and clinical findings such as hypertension, functional class, loop diuretics, angiotensin converting enzyme inhibitors, pulmonary pressure and hypervolemia in Cox regression analysis with a hazard ratio of 4.58 (95% confidence interval: 1.84&#8211;11.45). Conclusions: Heart failure patients with elevated cardiac-specific troponin T are at increased risk of death independently of the presence of chronic kidney disease. (Cardiol J 2010; 17, 1: 42-48

Effect of L-arginine or L-citrulline oral supplementation on blood pressure and right ventricular function in heart failure patients with preserved ejection fraction

Background: The effect of L-arginine and L-citrulline on blood pressure and right ventricular function in heart failure patients with preserved ejection fraction (HFpEF) is unknown. We have therefore evaluated, in a randomized clinical trial, the effect of these aminoacids in chronic outstanding and stable patients with HFpEF. Methods and results: All patients underwent an echocardiogram and radioisotopic ventriculography rest/exercise, and were randomized in a consecutive manner to the L-arginine group (n = 15; 8 g/day); and the citrulline malate group (n = 15; 3 g/day). The duration of follow-up was two months. The principal echocardiographic finding was a statistically significant decrease in pulmonary artery pressure in the L-arginine (56.3 &#177; 10 vs 44 &#177; 16.5 mm Hg, p < 0.05) and the citrulline (56.67 &#177; 7.96 vs 47.67 &#177; 8.59 mm Hg, p < 0.05) groups. Duration on treadmill and right ventricular ejection fraction post exercise increased, while diastolic and systolic artery pressure decreased significantly in both groups. There were no other statistically significant differences between the groups. Conclusions: Administration of L-arginine and citrulline to patients with HFpEF improved right ventricular function by increasing right ventricular ejection fraction, and probably decreasing systolic pulmonary artery pressure. (Cardiol J 2010; 17, 6: 612-618

Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence

Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC. Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping. Results The population (N = 513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, − 0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, − 0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC