Conciencia de enfermedad cardiovascular y conocimiento sobre factores de riesgo y prevención cardiovascular: resultados chilenos de encuesta SIAC cono sur / Awareness of risk factors and prevention of cardiovascular disease in chile: SIAC cono sur survey

Resumen La conciencia de la enfermedad cardiovascular (ECV) en mujeres es crucial para prevenir futuros eventos cardiovasculares. En Chile, la percepción sobre ECV es baja. Objetivo: Actualizar el grado de conocimiento de las chilenas sobre ECV. Método: Estudio de corte transversal realizado a través de encuesta online a mujeres entre 20 y 70 años de edad, residentes en Chile durante marzo 2020. La invitación se efectuó a través de redes sociales. La muestra fue no probabilística, ponderándose por edad, nivel socioeconómico y región de residencia (Región Metropolitana, Coquimbo, Valparaíso, Bío-Bío). Resultados: Se obtuvieron 1227 cuestionarios validados. La muestra ponderada correspondió a 900 mujeres. La percepción de ECV como principal causa de muerte fue de 8%, menor que las correspondientes a cáncer de mama (44%) y muerte violenta / homicidio (20%). Como principal problema de salud, la opción más percibida fue cáncer general (39%), seguido de diabetes (18%). Sólo 6 % refirió la ECV como el principal problema. Los principales accesos a la información sobre ECV fueron la internet y las redes sociales (64%, mayor en <30 años), y en el consultorio (32%). La opresión o dolor en el pecho fueron los síntomas más reconocidos asociados al infarto, siendo más seleccionado por mujeres con nivel educacional alto (p< 0.05). Conclusión: Persiste una baja percepción del riesgo de la ECV como principal causa de muerte y problema de salud en mujeres chilenas, aunque tienen acceso a la información y reconocen síntomas de infarto. Es necesario adaptar las estrategias comunicacionales para incrementar la percepción de riesgo CV.

Abstract Awareness of cardiovascular disease (CVD) in women is crucial to prevent cardiovascular events. According to prior information the perception and knowledge about CVD in Chile is extremely low. The aim of this study was to update the information about awareness of CVD in Chilean women. Method: Cross-sectional study carried out through an online survey. Data was obtained from women between 20 and 70 years old during March 2020. Social networks were used to recruit participants. The sample was non-probabilistic, weighted by age, socio-economic level and region of residence (Metropolitan Region, Coquimbo, Valparaíso, Bío-Bío). Results: 1227 validated surveys were obtained. The weighted sample corresponded to 900 women. CVD was perceived as the main cause of death in 8% of women, compared to higher degrees of perception for breast cancer (44%) and violent death/homicide (20%). CVD was perceived as the main health problem by only 6% of women, compared to cancer (39%) and diabetes (18%). The primary source of information about CVD were the internet and social networks (64%,higher in women <30 years old), and the doctor's office (32%). Chest tightness or pain as symptoms associated with a heart attack were significantly more recognized by respondents with a high educational level (p<0.05). Conclusion: An extremely low awareness about CVD as the main cause of death and health problem is persistent in Chilean women, notwithstanding that they have access to information and recognize symptoms of a heart attack. It is necessary to modify our communication strategies to increase the perception of CV risk in Chilean women.

Recomendaciones en la prevención secundaria de cardiopatía isquémica en la mujer / Secondary prevention of ischemic heart disease in women

Resumen: La enfermedad cardiovascular en la mujer es la principal causa de muerte en Chile. La mujer con cardiopatía isquémica coronaria representa un riesgo de mortalidad dos veces mayor que el del hombre. Desgraciadamente, las mujeres han sido subrepresentadas en la mayoría de los estudios clínicos randomizados en prevención secundaria, y más aún, son pocos los que presentan análisis específicos de género en cuanto a la terapia y los puntos finales duros. Así, la evidencia que existe ha sido dirigida especialmente a hombres. Para reducir esta brecha, presentamos una revisión de la información en las distintas terapias en prevención secundaria de cardiopatía isquémica, destacando los resultados de trabajos en que se hizo análisis género-específico.

Abstract: Cardiovascular disease is the main cause of death in Chilean women. Ischemic heart disease mortality rate in women is two times that of in men. Unfortunately, there have been less enrollment of women in clinical cardiovascular trials and a lack of gender-specific analysis of clinical trial data. Therefore, the evidence for secondary preventive recommendations have been focused on men. To bridge this gap, in this review we address the data for secondary preventive therapies for ischemic heart disease in women assessing the available gender-specific data.

Ejercicio: una herramienta clave en la prevención cardiovascular: Consenso de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular y de la Sociedad Chilena de Kinesiología en Cardiología y Cirugía Cardiovascular / Excercise, a key intervention in Cardiovascular Prevention: Consensus of the Chilean Society of Cardiology and Cardiovascular Surgery and the Chilean Society of Kinesiology in Cardiology and Cardiovascular Surgery

This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.

Conocimiento sobre enfermedad coronaria en familiares de pacientes con evento cardiovascular / Knowledge about coronary disease in relatives of patients with cardiovascular event

Objetivo: describir los conocimientos que refieren los familiares de sujetos con enfermedad cardiovascular, previo a la asistencia a un taller educativo. Materiales y métodos: estudio descriptivo en 103 familiares de pacientes con enfermedad cardiovascular, que participaron en talleres educativos relacionados con enfermedad coronaria entre marzo y agosto de 2013. Los talleres eran los siguientes: 1. La enfermedad coronaria; 2. Ejercicio en enfermedad cardiovascular; 3. Adherencia a medicamentos y 4. Factores psicosociales y enfermedad cardiovascular. Se compararon diferencias entre proporción de sujetos con conocimiento informal y formal en cada taller. Resultados:103 familiares participaron en los talleres (80% mujeres; edad promedio 49± 1.55años). El 39% refiere no tener ningún conocimiento respecto al tema a tratar. El 28% sí tiene conocimientos sobre el tema y la obtiene de fuentes informales como internet, diarios o revistas. Existió una proporción significativamente mayor de sujetos con conocimiento informal sobre ejercicio y adherencia a medicamentos. Conclusiones: estos resultados muestran que: hay poco conocimiento formal de enfermedad cardiovascular y del manejo de sus factores de riesgo, y alto nivel de apoyo del sexo femenino. La necesidad de educar, reforzar y aclarar el conocimiento para mejorar la adherencia al tratamiento y la prevención de nuevos eventos cardiovasculares, es un trabajo importante de enfermería, que debe desarrollarse prestando especial atención al entorno familiar del paciente..(AU)

Objective: to describe the knowledge referred by relatives of subjects with cardiovascular disease prior to attending an educational workshop. Materials and methods:descriptive study in 103 relatives of patients with cardiovascular disease, who participated in educational workshops related to coronary disease between March and August 2013. The workshops were the following: 1. Coronary disease; 2. Exercise in cardiovascular disease; 3. Adherence to medications and 4. Psychosocial factors and cardiovascular disease. Differences were compared between proportion of subjects with informal and formal knowledge in each workshop. Results: 103 relatives participated in the workshop (80% women, average age 49 ± 1.55 years). 39% report having no knowledge about the subject to be treated. 28% do have knowledge about the subject and get it from informal sources such as the internet, newspapers or magazines. There was a significantly higher proportion of subjects with informal knowledge about exercise and medication adherence. Conclusions: these results show that: there is little formal knowledge of cardiovascular disease and the management of its risk factors, and high level of support of the female sex. The need to educate, reinforce and clarify knowledge to improve adherence to treatment and the prevention of new cardiovascular events, is an important work of nursing, which should be developed paying special attention to the patient's family environment..(AU)

La ingesta de "once", en reemplazo de la cena, se asocia al riesgo de presentar síndrome metabólico / Five o'clock tea and the risk of metabolic syndrome

Background: Seventy four percent of Chileans replaced the traditional dinner for the consumption of "five o'clock tea" (5CT), a mealtime that includes bread and is simliar to western breakfast. The latter favors the intake of unhealthy foods. Aim: To study whether the consumption of "5CT", instead of dinner, could be a risk factor for the development of metabolic syndrome (MetSyn). Material and Methods: Anthropometric parameters, mean blood pressure, lipid profile, thyroid stimulating hormone and fasting glucose were measured in 489 subjects aged 39 ± 12 years (33% women) who attended a primary cardiovascular prevention (CV) program. A 24-hour recall and usual meal times were registered during a dietary interview. To determine the association between the consumption of "5CT" or dinner and the probability of presenting two or more components of MetSyn, we built an odds proportional model adjusted by age and sex. In addition, severity for MetSyn was calculated. Results: Nineteen percent of participants had MetSyn and 39%, two or more MetSyn components. Those who consumed "5CT" instead of dinner, had 54% more probability of having 2 or more MetSyn components (Odds ratio = 1.54, confidence intervals 1.032.32, p = 0.04). Participants who included processed carbohydrates in their last meal had a higher probability of having components of MetSyn. This probability decreased among participants who ate dinner with a low proportion of refined carbohydrates. Conclusions: Subjects who eat "5CT", instead of dinner as the last meal, have a higher cardiometabolic risk and MetSyn severity.

Cintura e índice de masa corporal: los mejores predictores antropométricos en la reducción y progresión de la agregación de factores de riesgo cardiometabólicos / Waist and body mass index: The best anthropometric predictors in the reduction and progression of the aggregation of cardiometabolic risk factor

El objetivo de este estudio fue determinar el impacto de la variación de distintas mediciones antropométricas en la evolución del síndrome metabólico (SM). El estudio fue prospectivo en 178 sujetos que asistieron a un programa de salud cardiovascular entre el año 2013 y 2016. Se recolectaron datos demográficos, historia médica, factores de riesgo cardiovascular, y se midió perfil lipídico, glicemia de ayuno, presión arterial y medidas antropométricas (IMC, perímetro de cintura y cadera y % de grasa corporal). Se consideró la agregación de 2 o más componentes de síndrome metabólico (SM), excluyendo cintura y se determinó la probabilidad de reversión del SM, considerándose como la reducción desde 2 o más componentes a 1 o ninguno. El tiempo de seguimiento promedio fue de 2 años. La edad promedio fue de 40 años y 37% eran mujeres. Según los modelos de odds proporcionales, ajustados por edad, sexo y tiempo de seguimiento, aquellos sujetos con 2 o más componentes de SM triplicaron su probabilidad de revertir el SM por cada reducción de 1 Kg/m2 de IMC por año (OR IMC = 3,03; 1,74-5,28; p<0,001). En el caso de cintura, esta probabilidad aumentó en 52% por la reducción de 1 cm por año (ORcintura =1,52; 1,28-1,81; p<0,001). Finalmente una reducción de 0,01 en el índice cintura/cadera aumentó en 26% la probabilidad de revertir el SM (ORcintura/cadera =1,26; 1,06-1,491; p<0,01); sin embargo, el % de grasa corporal no tuvo un efecto significativo Los cambios en IMC y circunferencia de cintura serían los parámetros antropométricos más confiables para monitorear la evolución del SM(AU)

The objective of this study was to determine the impact of variation of different anthropometric parameters at follow-up in the evolution of the metabolic syndrome (MetS). Prospective study in 178 subjects who attended a cardiovascular health program between 2013 and 2016. Demographical data, medical history and cardiovascular (CV) risk factors (RFs) were collected. In addition, fasting lipid profile, blood glucose, blood pressure and anthropometrical parameters (BMI, WC, hip, and fat percentage) were measured. To determine the evolution of MetS, the clustering of 2 or more of the MetS components were considered, excluding WC. Odds proportional models adjusted by age, sex and time of follow-up were built to determine the probability of reverting the MetS. MetS reversion was considered as the reduction to 1 or 0 components in subjects with 2 or more. Mean follow-up time was 2 years. Mean age was 40 years old and 37% were women. According to the odds proportional models, subjects tripled their chance of reverting MetS for each 1 kg/m2 of BMI reduction (ORBMI=3.03; 1.74-5.28; p<0.001). For WC, the chance of reverting MetS increased 52% for each reduction of 1 cm of waist (ORwaist =1.52; 1.28-1.81; p<0.001). A reduction of 0.01 in the waist to hip ratio increased in 26% the chance of reverting MetS (ORwaist/hip=1.26; 1.06-1.491; p<0.01); however, fat percentage did not have a significant effect on the evolution of the MetS. BMI and WC are the most reliable anthropometrical parameters for monitoring the evolution of MetS aggregation in the out-patient clinical setting(AU)

Dislipidemia aterogénica en Latino América: prevalencia, causas y tratamiento / Atherogenic dislipidemia in Latin America: prevalence, causes and treatment

En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad escasamente atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA), se organizó un grupo de expertos que se ha denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para generar un documento con análisis de su prevalencia y ofrecer recomendaciones prácticas. Se utilizó la metodología Delphi modificada, con revisión comprensiva de la literatura con énfasis en aquellas publicaciones con implicaciones para LA. Subsecuentemente, se desarrollaron preguntas claves para ser discutidas. En LA no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. Múltiples causas se han reconocidos, como alta ingesta de alimentos de mayor densidad calórica, contenido de colesterol, grasas trans, sedentarismo y cambios epigenéticos. La DA bien puede ser tratada con los cambios terapéuticos del estilo de vida (CTEV) con incremento en la actividad física, ejercicio regular y dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA.

In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document for analyzing its prevalence and to offer practical recommendations. Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. In LA there is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2%, more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increased in physical activities, regular exercise and a diet with a low proportion of carbohydrates y rich in poliunsatured fatty acid, such as omega-3 fatty acid as primary intervention. If needed, this strategie must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3.fatty acid. Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are its cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated. It is important and neccesary to design a global study of risk factors in LA to know the true prevalence of AD.

Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago / Evaluation the American College of Cardiology and American Heart Association Predictive score for cardiovascular diseases

Background: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. Aim: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. Material and Methods: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3,284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the Death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. Results: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p < 0.01) and diabetes (p < 0. 01) and tended to be older (p = 0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p = 0.09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p = 0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. Conclusions: The new ACC/AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Dislipidemia aterogénica en latino américa: prevalencia, causas y tratamiento / Atherogenic dyslipidemia in Latin America: prevalence, causes and treatment

En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad no muy atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA). Métodos: organizamos un grupo de expertos denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para así generar un documento con análisis de su prevalencia y recomendaciones terapéuticas prácticas. Se utilizó la metodología Delphi modificada, con una revisión integral de la literatura y énfasis en las publicaciones con implicaciones para LA. Subsecuentemente, desarrollamos preguntas claves para ser discutidas. Resultados: En Latinoamérica (LA) no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. La DA bien puede ser tratada con los cambios del estilo de vida (CTEV) como ncremento en laactividad física, dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Conclusiones: Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA(AU)

In the current clinical guidelines, atherogenic Med Interna (Caracas) 2017; 33 (3): 121 - 139 Dislipidemia Aterogénica en Latino América: Prevalencia, causas y tratamiento Carlos I. Ponte-N, Jesús E. Isea-Pérez, Alberto J. Lorenzatti, Patricio López-Jaramillo, Fernando Stuardo Wyss-Q, Xavier Pintó, Fernando Lanas, Josefina Medina, Livia T. Machado-H, Mónica Acevedo, Paola Varleta Alfonso Bryce, Carlos Carrera, Carlos Ernesto Peñaherrera, José Ramón Gómez-M, Alfredo Lozada, Alonso Merchan-V, Daniel Piskorz, Enrique Morales, María Paniagua, Félix Medina-Palomino, Raúl Alejandro Villar-M, Leonardo Cobos, Enrique Gómez-Álvares, Rodrigo Alonso, Juan Colan, Julio Chirinos, Jofre Lara, Vladimir Ullauri, Ildefonso Arocha Documento de la posición de expertos de la Academia Latino Americana para el estudio de los Lípidos (ALALIP) y avalado por la Sociedad Interamericana de Cardiología (SIAC), Sociedad Sur Americana de Cardiología (SSC), el Colegio Panamericano de Endotelio (CPAE) y la Sociedad Internacional de Aterosclerosis (IAS). Publicado en conjunto con las Revistas de la Sociedad Venezolana de Medicina Interna y de la Sociedad Venezolana de ndocrinología y Metabolismo. dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document to analize it´s prevalence and to offer practical recommendations. Methodology: Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. Results: In LA There is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2% more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increase in physical activities, regular exercise and a diet with a low proportion of carbohydrates and rich in poliunsatured fatty acid, such as omega-3 fatty acids as primary intervention. If needed, this strategy must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3. fatty acid. conclusions: Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are the cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated It is important and necesary to design a global study of risk factors in LA to know the true prevalence of AD(AU)

Impacto de un programa de rehabilitación cardiovascular fase II sobre la calidad de vida de los pacientes / Quality of life: impact of a phase II cardiovascular rehabilitation program

Antecedentes: La rehabilitación cardiovascular (RCV) ha demostrado mejorar la capacidad física (CF) y la calidad de vida. La relación de estos aspectos ha sido escasamente reportada en Chile. Objetivos: 1) Determinar el impacto de la RCV fase II sobre la calidad de vida, medida por la encuesta SF36 y, 2) determinar qué factores, relacionados con el paciente, pueden incidir en esta relación. Método: Estudio prospectivo en sujetos que completaron 36 sesiones de un programa de RCV y Prevención Secundaria (PREV2). Se registraron al ingreso y final de la RCV: antecedentes médicos, factores de riesgo cardiovascular (CV), parámetros antropométricos, previsión de salud, CF (determinada por los metros caminados en test de marcha de 6 minutos-TM6) y puntaje en la encuesta SF36. Resultados: 277 sujetos (78% hombres, edad 59 años). Hubo una mejoría significativa en: a) los metros caminados (diferencia final/inicial= 56 metros, p<0.0001), b) puntaje de salud física (68 vs 79; p<0.0001), c) salud emocional (68 vs 78, p<0.0001) del SF36. Los hombres caminaron más metros promedio (p<0.0001). Hubo una asociación significativa entre los deltas del TM6 final-inicial y SF36 final-inicial, sólo para salud física (p<0.01). Por un aumento de 10 metros caminados en el TM6 final se incrementa el puntaje de la SF36 para salud física (Hombres: 0.38/ Mujeres: 1.52). La mejoría en la salud emocional sólo se asoció significativamente con los cambios en la salud física (p<0.0001). Conclusion: Los pacientes que asisten a un programa de RCV mejoran significativamente su capacidad aeróbica, y su percepción de salud física y emocional.

Background: Cardiovascular rehabilitation (CVR) has been shown to improve functional capacity (FC) and quality of life. The relation between these aspects has been scarcely reported in Chile. Objectives: 1) To determine the impact of the CVR phase II program on quality of life as measured by the SF36 survey and 2) to determine which patient related factors can influence this relationship. Method: Prospective study in subjects who completed 36 sessions of an RCV and Secondary Prevention program (PREV2). Medical records, cardiovascular risk factors (CV), anthropometric parameters, health forecast, functional capacity (FC) (determined by meters walked on 6-minute Walking test-TM6) and SF36 scores were recorded at the beginning and end of the CVR. Results: Data on 277 subjects (78% men, age 59 years) was analyzed. There was a significant improvement in: a) walking meters (final / initial difference = 56 meters, p <0.0001), b) physical health score (68 vs 79, p <0.0001), c) emotional health (68 vs 78, p <0.0001) of the SF36. The men walked more meters (p <0.0001). There was a significant association between delta TM6 final-initial and SF36 final-initial only for physical health (p <0.01). For an increase of 10 meters walked in the final TM6, SF36 score for physical health increased 0.38 points in men ad 1.52 in women. Improvement in emotional health was significantly associated only with changes in physical health (p <0.0001). Conclusion: Patients attending a phase II cardiovascular rehabilitation program significantly improve their aerobic capacity, and their perception of physical and emotional health.

Adherencia farmacológica y prevención secundaria cardiovascular: una de las principales barreras en el tratamiento de la enfermedad ateroesclerótica: posición del Departamento de Prevención Cardiovascular de SOCHICAR en el uso de la polipíldora en prevención secundaria / Adherence to pharmacologic treatment in secondary prevention of cardiovascular disease

This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.

Prevalencia y determinantes de adherencia a terapia antihipertensiva en pacientes de la Región Metropolitana / Assessment of adherence to antihypertensive therapy

Background: Lack of adherence with medications is the main cause of antihypertensive treatment failure. Aim: To assess adherence to antihypertensive drugs and its determinants. Material and Methods: The Morinsky-Green questionnaire to determine treatment adherence was applied to 310 hypertensive patients from primary care centers, aged 60 ± 10 years (65% females) in treatment for 4 ± 1 months. Socio-demographic features, use of medications and quality of life using EQ5D questionnaire were also assessed. Results: Twenty percent of patients were diabetic and 19% were smokers. Fifty four percent were adherent to therapy. A higher age and being unemployed were associated with a higher compliance. The main reasons to justify the lack of adherence were forgetting to take the pills in 67% and adverse effects in 10%. Only diastolic pressure was lower in adherent patients, compared with their non-adherent counterparts (78 ± 12 and 81 ± 17 mmHg, respectively p < 0.01). Conclusions: Only half of hypertensive patients comply with their antihypertensive therapy.

Dieta DASH y menopausia: más allá de los beneficios en hipertensión arterial / DASH diet and menopause: beyond the benefits on control of blood pressure

La disminución en la producción de estrógenos durante la menopausia favorece una disminución en la función endotelial y en la mineralización ósea, además de cambios en la distribución de la grasa corporal. Estos cambios favorecen un aumento en la prevalencia de hipertensión arterial en mujeres mayores de 50 años, junto con un aumento en otros factores de riesgo cardiovascular y una disminución de la densidad ósea (DO). La terapia de reemplazo hormonal utilizada en estas mujeres para mitigar los cambios descritos, se ha asociado a un mayor riesgo de desarrollar nefrolitiasis. La dieta DASH ha demostrado ser efectiva en reducir la presión arterial y en este trabajo se discuten otros beneficios de esta dieta asociados a otros factores de riesgo, a la DO y en la mantención de la homeostasis urinaria. Por este motivo, se discute si la dieta DASH sería efectivamente beneficiosa en este grupo de mujeres independiente de sus efectos en la presión arterial.

Decreased production of estrogens after menopause produces endothelial dysfunction and a decrease in bone mineralization, as well as changes in body fat distribution. These changes favor an increase in the prevalence of hypertension in women older than 50 years old, along with an increase in other cardiovascular risk factors and decreased bone density. Hormone replacement therapy mitigates the changes described above, but it has been associated with a higher risk of nephrolithiasis. DASH diet has been shown to be effective in reducing blood pressure along with other benefits such as increasing bone density and maintaining urinary homeostasis. Here, we discuss whether DASH diet would actually benefit menopausal women independently of its effects on blood pressure.

Niveles de fosfolipasa A2 asociada a lipoproteína en sujetos sin enfermedad coronaria con riesgo cardiovascular variable / Association of lipoprotein-associated phospholipase activity A2 with cardiovascular risk factors

Background:Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory biomarker involved in atherosclerosis and directly associated with cardiovascular events. Aim: To determine Lp-PLA2 levels in asymptomatic subjects with differing cardiovascular risk. Material and Methods: We studied 152 subjects aged 46 ± 11 years (69 women). We recorded traditional cardiovascular risk factors, creatinine, ultrasensitive C-reactive protein, fibrinogen, fasting lipids, blood sugar and activity levels of Lp-PLA2. Cardiovascular risk was classified according to the number of risk factors of each subject (0,1-2 or ≥ 3 risk factors). Besides, we calculated global Framingham risk score. Results: The average Framingham score of participants was 6%. Twenty percent of participants had no risk factors, 46% had 1 or 2 and 34% had ≥ 3. Mean Lp-PLA2 levels were 185 ± 48 nmol/ml/min (201 ± 49 in men and 166 ± 38 in women). Lp-PLA2 correlated significantly (p < 0,05 for all) with non-HDL cholesterol, LDL, HDL, creatinine, waist circumference, body mass index and Framingham risk score. There was no correlation with blood sugar, C-reactive protein, fibrinogen or smoking status. Lp-PLA2 levels were significantly higher according to the number of risk factors: 0 factors: 163 ± 43, 1-2 factors: 185 ± 45 and ≥ 3 factors: 201 ± 47 nmol/ml/min, respectively. Linear regression analysis showed that the best predictor of Lp-PLA2 was non-HDL cholesterol (β= 0,74; p < 0,0001). Conclusions: Lp-PLA2 activity increased along with the number of cardiovascular risk factors and was correlated mainly with non -HDL cholesterol.

Rehabilitación cardiovascular y ejercicio en prevención secundaria / Exercise and cardiac rehabilitation in secondary cardiovascular prevention

Exercise and cardiac rehabilitation are indications with type I A evidence in most secondary cardiovascular prevention guidelines. Rehabilitation programs not only include exercise but also provide integral care and education about cardiovascular risk factors. However there is a paucity of such programs in Chile. Moreover there is a lack of awareness about the benefits of exercise and there is lack of knowledge about the details of exercise prescription in secondary prevention. Therefore, the divulgation of this knowledge is of utmost importance.

¿Sirven los marcadores de riesgo no tradicionales en la diferenciación del riesgo cardiovascular en adultos jóvenes con exceso de peso? / Carotid intima media thickness and C reactive protein among overweight or obese subjects without metabolic syndrome

Background: Recognizing cardiovascular risk in overweight adults is challenging, as they usually have a low Framingham risk score (FRAM). In these subjects, non-traditional biomarkers could improve risk stratification. Aim: To assess carotid intima media thickness (CIMT) and ultrasensitive C-reactive protein (usCRP) among overweight and obese subjects without metabolic syndrome (MetSyn). Subjects and Methods: In 1558 asymptomatic participants (816 women, 45 ± 11 years) we measured body mass index (BMI), waist circumference, blood pressure, lipid profile, blood glucose, FRAM, usCRP and CIMT. For analytical purposes, we divided the subjects in three groups according to BMI and number of ATPIII-MetSyn risk factors (RF): 1) BMI < 25 and < 3RF, 2) BMI ≥ 25 and < 3RF and 3) BMI ≥ 25 and ≥ 3RF. Results: Participants of group 2 (BMI ≥ 25 and < 3RF) had a low FRAM (8%). Compared with participants of group 1, they had a higher CIMT (0.61 ± 0.1 and 0.57 ± 0.09 mm, respectively, p < 0.01) and usCRP (2.1 ± 2.1 and 1.5 ± 1.9 mg/L respectively, p < 0.01). Conclusions: This study shows that although subjects with overweight/obesity without MetSyn have low cardiovascular risk based on FRAM, they have higher CIMT and usCRP than their normal weight counterparts.

Hipertensión arterial en la mujer adulta / Hypertension in women

The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.