Chagas Cardiomyopathy in the Context of the Chronic Disease Transition

Latin America is undergoing a transition from disease patterns characteristic of developing countries with high rates of infectious disease and premature deaths to a pattern more like industrialized countries, in which chronic conditions such as obesity, hypertension and diabetes are more common. Many rural residents with Chagas disease have now migrated to cities, taken on new habits and may suffer from both types of disease. We studied heart disease among 394 adults seen by cardiologists in a public hospital in the city of Santa Cruz, Bolivia; 64% were infected with T. cruzi, the parasite that causes Chagas disease. Both T. cruzi infected and uninfected patients had a high rate of hypertension (64%) and overweight (67%), with no difference by infection status. Nearly 60% of symptomatic congestive heart failure was due to Chagas disease; mortality was also higher for infected than uninfected patients. Males and older patients had more severe Chagas heart disease. Chagas heart disease remains an important cause of congestive heart failure in this hospital population, but often occurs in patients who also have obesity, hypertension and/or other cardiac risk factors

EKG and echocardiogram findings among patients with and without <i>Trypanosoma cruzi</i> infection.

a<p>Unadjusted results based on exact Pearson chi-square tests.</p>b<p>Adjusted results based on logistic regression, adjusted for sex and age as a quadratic function. See text for explanation of age adjustment.</p>c<p>EKG analyses include a total of 237 seropositive and 137 seronegative participants. 14 seropositive and 5 seronegative participants were excluded from the EKG analyses because they had implanted pacemakers.</p>d<p>Denominator for ‘any ventricular arrhythmia’ includes 14 seropositive and 5 seronegative participants with pacemakers excluded from the other EKG analyses.</p>e<p>Echochardiogram analyses include 229 seropositive and 127 seronegative participants.</p>f<p>Defined as end diastolic diameter >57 mm.</p>g<p>Defined as left atrial end diastolic diameter >40 mm not explained by diastolic dysfunction or left ventricular hypertrophy.</p>h<p>Data missing for one participant.</p

Characteristics of seropositive and seronegative study participants.

<p>^<b>a</b>Unadjusted results based on exact Pearson chi-square tests.</p><p>^<b>b</b>Adjusted results based on logistic regression, adjusted for gender and age as a quadratic function. Note that gender is adjusted for age as a quadratic function only. See text for explanation of age adjustment.</p><p>^<b>c</b>Data missing for 18 seropositive and 8 seronegative patients.</p><p>^<b>d</b>Data missing for 38 seropositive and 21 seronegative patients.</p><p>^<b>e</b>Data missing for 29 seropositive and 8 seronegative patients.</p><p>^<b>f</b>Data missing for 22 seropositive and 29 seronegative patients.</p

Multivariable model of characteristics associated with positive results on conventional <i>Trypanosoma cruzi</i> PCR among seropositive patients.

<p>Data missing for 96 patients.</p

Multivariable logistic regression model of factors associated with risk of <i>Trypanosoma cruzi</i> infection.

<p>Data missing for 7 patients.</p><p>^<b>a</b>Results for each risk factor are adjusted for other variables listed and for age as a quadratic function; see text for explanation.</p><p>^<b>b</b>Significant interaction between years of residence in an endemic area and housing. Risk associated with housing conditions evaluated holding years in endemic area fixed at the mean (45.2 years).</p