Statin and Aspirin Use Among Hispanic and Latino Adults at High Cardiovascular Risk: Findings From the Hispanic Community Health Study/Study of Latinos

BACKGROUND: Despite variations in the prevalence of cardiovascular disease and related risk factors among US Hispanic/Latino adults of diverse backgrounds, there is little information on whether disparities exist in the use of medications for the primary and secondary prevention of cardiovascular disease. We examined the prevalence of statin and aspirin use among diverse US Hispanic/Latino adults at high cardiovascular risk. METHODS AND RESULTS: A multicenter population-based study, the Hispanic Community Health Study/Study Of Latinos, included a total of 16 415 participants of Mexican, Puerto Rican, Cuban, Dominican, South American, and Central American backgrounds who were aged 18 to 74 years and enrolled between March 2008 and June 2011. Our analyses were limited to 4139 participants considered to be at high cardiovascular risk. Age-adjusted prevalence of statin and aspirin use was 25% and 44%, respectively, overall but varied by Hispanic/Latino background among those at high cardiovascular risk; statin use was significantly higher (P<0.001) among adults of Puerto Rican (33%) and Dominican (28%) backgrounds compared with adults of other backgrounds (Mexican, 24%; Cuban, 22%; Central American, 20%; South American, 22%). There was no difference in aspirin use. After adjusting for health insurance coverage, the difference in prevalence of statin use was substantially reduced among participants with a Puerto Rican background, from an odds ratio of 1.73 (95% CI 1.30-2.31) to 1.30 (95% CI 0.97-1.75), and with a Dominican background, from an odds ratio of 1.45 (95% CI 1.04-2.02) to 1.07 (95% CI 0.75-1.52), in comparison to their counterparts. CONCLUSIONS: Among Hispanic/Latino adults of diverse backgrounds, statin use was more prevalent among adults with Puerto Rican and Dominican backgrounds at high cardiovascular risk. These differences in statin use were explained, in part, by differences in insurance coverage. These findings have important implications for the prevention of disparities in cardiovascular outcomes within the growing US Hispanic/Latino population

Influencias del paisaje, climatología y manejo agrícola sobre la biodiversidad asociada a viña: efectos sobre servicios ecosistémicos y sostenibilidad frente a cambio global (Proyecto BA C O)

Dentro de un contexto dominado por el cambio rápido y frecuente, es básico analizar sus efectos sobre la biodiversidad y los servicios ecosistémicos que ésta provee. El cultivo de la viña es uno de los sistemas agrícolas más antiguos de la región Mediterránea, con una interacción muy estrecha entre el manejo humano y el ambiente natural circundante. El proyecto BA C O pretende, desde un enfoque multidisciplinar, evaluar el papel del clima, paisaje y manejo sobre la biodiversidad y los servicios ecosistémicos asociados a viñedos. Se proponen los siguientes objetivos: i) caracterizar el paisaje, ambiente, clima y tipo de manejo de las principales explotaciones de vid; ii) evaluar la influencia del paisaje, ambiente y manejo en la biodiversidad de los viñedos y iii) estimar los servicios ecosistémicos que esta diversidad aporta. Se usarán tres escalas espaciales de resolución: a) Regional, considerando todos los viñedos y sistemas de manejo (convencional/ ecológico; variedades de uva) presentes en Andalucía; b) F inca, situadas en un gradiente altitudinal (proxi de Tª) y de paisaje, en las que se realizarán medidas de biodiversidad, servicios ecosistémicos, productividad, funcionalidad y sostenibilidad del viñedo frente a cambio global y c) Cepa, en las que se tomarán muestras de suelo, sarmientos, hojas, raíces, estado fisiológico, afectación por plagas, productividad y calidad. Los resultados esperamos que sirvan para: 1) mejorar predicciones y tomas de decisiones de gestión; 2) generar documentos de transferencia identificando las prácticas de manejo y uso agrícola más sostenibles que optimicen la conservación de los recursos naturales y los beneficios socioeconómicos y 3) el desarrollo de herramientas que permitan predecir efectos futuros derivados de cambio climático y de usos de suelo, así como su interacción y sus efectos sobre la biodiversidad, servicios ecosistémicos asociados y su capacidad de resiliencia.Dentro de un contexto dominado por el cambio rápido y frecuente, es básico analizar sus efectos sobre la biodiversidad y los servicios ecosistémicos que ésta provee. El cultivo de la viña es uno de los sistemas agrícolas más antiguos de la región Mediterránea, con una interacción muy estrecha entre el manejo humano y el ambiente natural circundante. El proyecto BA C O pretende, desde un enfoque multidisciplinar, evaluar el papel del clima, paisaje y manejo sobre la biodiversidad y los servicios ecosistémicos asociados a viñedos. Se proponen los siguientes objetivos: i) caracterizar el paisaje, ambiente, clima y tipo de manejo de las principales explotaciones de vid; ii) evaluar la influencia del paisaje, ambiente y manejo en la biodiversidad de los viñedos y iii) estimar los servicios ecosistémicos que esta diversidad aporta. Se usarán tres escalas espaciales de resolución: a) Regional, considerando todos los viñedos y sistemas de manejo (convencional/ ecológico; variedades de uva) presentes en Andalucía; b) F inca, situadas en un gradiente altitudinal (proxi de Tª) y de paisaje, en las que se realizarán medidas de biodiversidad, servicios ecosistémicos, productividad, funcionalidad y sostenibilidad del viñedo frente a cambio global y c) Cepa, en las que se tomarán muestras de suelo, sarmientos, hojas, raíces, estado fisiológico, afectación por plagas, productividad y calidad. Los resultados esperamos que sirvan para: 1) mejorar predicciones y tomas de decisiones de gestión; 2) generar documentos de transferencia identificando las prácticas de manejo y uso agrícola más sostenibles que optimicen la conservación de los recursos naturales y los beneficios socioeconómicos y 3) el desarrollo de herramientas que permitan predecir efectos futuros derivados de cambio climático y de usos de suelo, así como su interacción y sus efectos sobre la biodiversidad, servicios ecosistémicos asociados y su capacidad de resiliencia

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Abstract P035: Association Between Caregiver and Child Metabolic Risk Factors: Hispanic Community Health Study/Study of Latino (SOL) Youth

Background: There is limited prior research on the association of metabolic risk factors between youth and their caregivers within Latino families despite the high burden of obesity and the young age of onset of metabolic disorders. Hypothesis: Obesity and metabolic risk factors are correlated between youth and their caregivers. Methods: SOL Youth is a cross-sectional ancillary study of boys and girls ages 8 to 16 years old whose parents/caregivers participated in the HCHS/SOL. We studied 728 boys, 738 girls and 1,020 caregivers (86% women) who completed a clinical examination. Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, fasting glucose, hemoglobin A1c (HbA1c) and lipids (total-, HDL-, and LDL- cholesterol and triglycerides) were measured. Obesity was determined as > 95 th age- and gender- specific percentile of BMI in youth and BMI > 30 kg/m 2 in adults. We used weighted logistic regression to determine the odds of obesity in youth when caregivers were obese and we tested the association of each individual risk factor in caregivers with the same risk factor among youth using weighted linear regression. All models were adjusted for field center, youth age and ancestry and adult age, gender and education levels. Results: On average, boys and girls were 12 years old and caregivers were 41 years old. When caregivers were obese (vs. normal weight), girls and boys were 1.5 (95% CI: 0.92, 2.43) and 3.9 (95% CI: 2.44, 6.29) times more likely to be obese, respectively. Among girls, measures of adiposity, HbA1c, SBP and lipids (except triglycerides) were each positively associated with those same measures among caregivers (Table). Among boys, all measures except glucose and HbA1c were positively associated with caregiver measures. Conclusions: There were notable differences by gender in the odds of obesity among youth when a caregiver was also obese. Strong correlations between caregiver and youth metabolic risk factors underscore the need for family based interventions

Elucidating the Multidimensionality of Socioeconomic Status in Relation to Metabolic Syndrome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Socioeconomic (SES) factors underlying disparities in the prevalence of metabolic syndrome (MetSyn) and consequently, type 2 diabetes among Hispanics/Latino populations are of considerable clinical and public health interest. However, incomplete and/or imprecise measurement of the multidimensional SES construct has impeded a full understanding of how SES contributes to disparities in metabolic disease. Consequently, a latent-variable model of the SES-MetSyn association was investigated and compared with the more typical proxy-variable model. A community-based cross-sectional probability sample (2008-2011) of 14,029 Hispanic/Latino individuals of Puerto Rican, Cuban, Dominican, Central American, South American, and Mexican ancestry living in the USA was used. SES proxy's education, income, and employment were examined as effect indicators of a latent variable, and as individual predictors. MetSyn was defined using 2009 harmonized guidelines, and MetSyn components were also examined individually. In multivariate regression analyses, the SES latent variable was associated with 9% decreased odds of MetSyn (95% confidence interval: 0.85, 0.96, P < .001) and was associated with all MetSyn components, except diastolic blood pressure. Additionally, greater income, education, and employment status were associated with 4%, 3%, and 24% decreased odds of having MetSyn, respectively (Ps < .001). The income-MetSyn association was only significant for women and those with current health insurance. Hispanic/Latinos exhibit an inverse association between SES and MetSyn of varying magnitudes across SES variables. Public health research is needed to further probe these relationships, particularly among Hispanic/Latina women, to ultimately improve healthcare access to prevent diabetes in this underserved population

HEMOGLOBIN A1C, BLOOD PRESSURE, AND LDL-CHOLESTEROL CONTROL AMONG HISPANIC/LATINO ADULTS WITH DIABETES: RESULTS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL)

To determine the prevalence of Hispanic/Latino adults with diabetes who meet target hemoglobin A1c, blood pressure (BP), and low-density-lipoprotein cholesterol (LDL-C) recommendations, and angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blocker (ARB) and statin medication use by heritage and sociodemographic and diabetes-related characteristics. Data were cross-sectional, collected between 2008 and 2011, and included adults age 18 to 74 years who reported a physician diagnosis of diabetes in the Hispanic Community Health Study/Study of Latinos (N = 2,148). Chi-square tests compared the prevalence of hemoglobin A1c, BP, and LDL-C targets and ACE/ARB and statin use across participant characteristics. Predictive margins regression was used to determine the prevalence adjusted for sociodemographic characteristics. The overall prevalence of A1c <7.0% (53 mmol/mol), BP <130/80 mm Hg, and LDL-C <100 mg/dL was 43.0, 48.7, and 36.6%, respectively, with 8.4% meeting all three targets. Younger adults aged 18 to 39 years with diabetes were less likely to have A1c <7.0% (53 mmol/mol) or LDL-C <100 mg/dL compared to those aged 65 to 74 years; younger adults were more likely to have BP <130/80 mm Hg (P<.05 for all). Individuals of Mexican heritage were significantly less likely to have A1c <7.0% (53 mmol/mol) compared to those with Cuban heritage, but they were more likely to have BP <130/80 mm Hg compared to those with Dominican, Cuban, or Puerto Rican heritage (P<.05 for all); there was no difference in LDL-C by heritage. Overall, 38.2% of adults with diabetes were taking a statin, and 50.5% were taking ACE/ARB medications. Hemoglobin A1c, BP, and LDL-C control are suboptimal among Hispanic/Latinos with diabetes living in the U.S. With 8.4% meeting all three recommendations, substantial opportunity exists to improve diabetes control in this population. A1c = hemoglobin A1c; ABC = hemoglobin A1c, blood pressure, low-density-lipoprotein cholesterol; ACE = angiotensin-converting enzyme; ADA = American Diabetes Association; ARB = angiotensin receptor blocker; BMI = body mass index; BP = blood pressure; CHD = coronary heart disease; CVD = cardiovascular disease; HCHS/SOL = Hispanic Community Health Study/Study of Latinos; LDL-C = low-density-lipoprotein cholesterol; NHANES = National Health and Nutrition Examination Survey; PAD = peripheral artery disease

Association of cardiovascular risk factors between Hispanic/Latino parents and youth: the Hispanic Community Health Study/Study of Latino Youth

Hispanic/Latinos have a high burden of cardiovascular disease (CVD) risk factors which may begin at young ages. We tested the association of CVD risk factors between Hispanic/Latino parents and their children. We conducted a cross-sectional study in the Hispanic Community Health Study/Study of Latinos Youth study. Girls (n = 674) and boys (n = 667) aged 8 to 16 years (mean age 12.1 years) and their parents (n = 942) had their CVD risk factors measured. CVD risk factors in parents were significantly positively associated with those same risk factors among youth. After adjustment for demographic characteristics, diet and physical activity, obese parents were significantly more likely to have youth who were overweight (odds ratios [ORs], 2.39; 95% confidence interval [CI], 1.20–4.76) or obese (OR, 6.16; 95% CI, 3.23–11.77) versus normal weight. Dyslipidemia among parents was associated with 1.98 higher odds of dyslipidemia among youth (95% CI, 1.37–2.87). Neither hypertension nor diabetes was associated with higher odds of high blood pressure or hyperglycemia (prediabetes or diabetes) in youth. Findings were consistent by sex and in younger (age <12 years) versus older (≥12 years) youth. Hispanic/Latino youth share patterns of obesity and CVD risk factors with their parents, which portends high risk for adult CVD

Association of Social Adversity with Comorbid Diabetes and Depression Symptoms in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: A Syndemic Framework

Low household income is associated with comorbidity of diabetes and high depression symptoms in U.S. Latinos. Adverse childhood experiences, discrimination, and neighborhood problems are associated with comorbidity compared to having neither condition