Resultados Chilenos del registro internacional de factores de riesgo y tratamiento de angina inestable e infarto al miocardio sin supradesnivel del segmento ST: ACCORD (ACute CORonary syndrome Descriptive study) / Chilean results of the international registry of risk factors and treatment of unstable angina and non ST elevation myocardial infarction: ACCORD (ACute CORonary syndrome Descriptive study)

Background: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however cu-rrent practices are unknown in Chile. Aitn: To evalúate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: Oneyear prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5 percent at the end ofthe follow-up. Mean age was 61.6 years, and 30.6 percent were female. Most of the patients had at least one risk factor (98 percent): hypertension (84 percent), previous myocardial infarction (33 percent), dyslipidemia (54 percent), diabetes (33 percent), current smoking (30 percent). Main procedures duringthe hospitalization were coronary angiogram (67 percent), angioplasty (33 percent; 88 percent with stent) and coronary bypass surgery (7 percent). Duringprocedures, 31 percent of patients received clopidogrel, and 4.2 percent glycoprotein Ilb/IIIa antagonists. Medical management was selected for 60 percent of patients. In comparison to men, women received less interventional procedures despite havingmore risk factors. Treatments prescribed at discharge were aspirin (97 percent), clopidogrel (49 percent), beta blockers (78 percent), diuretics (21 percent), lipid lowering agents (78 percent), oral hypoglycemic agents (13 percent) and insulin (9 percent). At the end ofthe 1-year follow-up, treatments were aspirin (84 percent), beta blockers (72 percent), diuretics (19 percent), and dual antiplatelet therapy with clopidogrel (16 percent). Conclusions: A high prevalence of múltiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50 percent at discharge and decreases during the one year-follow-up.

Razón cintura-estatura: un mejor predictor antropométrico de riesgo cardiovascular y mortalidad en adultos chilenos: nomograma diagnóstico utilizado en el Proyecto San Francisco / Waist to height ratio: a better predictor of cardiovascular risk factors and mortality in Chilean adults: diagnostic nomograms from the San Francisco project

Antecedentes: Medidas antropométricas de adiposidad como índice de masa corporal (IMC), circunferencia de cintura (CC), razón cintura-cadera (RCC) y razón cintura-estatura (RCE) son conocidas por estar asociadas a factores de riesgo metabólico. Sin embargo, es controversial cual de ellas es mejor para predecir riesgo cardiovascular y mortalidad. Método: En este estudio de cohorte prospectivo con una muestra ponderada de 6714 hombres y 6340 mujeres, examinamos la relación entre índices antropométricos de adiposidad, factores de riesgo cardiovascular y mortalidad. Calculamos el área bajo la curva ROC (Receiving Operating Characteristic) evaluando el desempeño de cada índice para detectar hipertensión, diabetes o dislipidemia. El riesgo relativo de mortalidad con intervalos de confianza al95 por ciento (IC95 por ciento) fue calculado utilizando regresión logística controlando por edad y factores de riesgo. Resultados: En hombres, las áreas bajo la curva ROC para detectar uno o más factores de riesgo fueron: IMC 0.75 (0.74-0.77), CC 0.85 (0.84-0.86), RCC 0.80 (0.79-0.81) y RCE 0.90 (0.89-0.91). En mujeres esas áreas fueron 0,72 (0,71-0,74), 0,77 (0,76-0,79), 0,65 (0,63-0,66) y 0,81 (0,80-0,82) respectivamente. Durante 8 años de seguimiento (670 muertes, 362 hombres), el riesgo multivariado de mortalidad para IMC, CC, RCC y RCE fue en hombres 0,81 (0,58-1,10), 1,27 (0,93-1,74), 0,89 (0,66-1,21) y 2,37 (1,61-3,49) respectivamente. En mujeres, el riesgo para IMC, CC, RCC, RCE fue 0,95 (0,70-1,27), 1,35 (1,00-1,85), 1,54 (1,17-2,16), y 1,56 (1,13-2,26) respectivamente. Conclusiones: El ajuste de la CC por la estatura permite predecir con mayor precisión factores de riesgo cardiovascular y mortalidad. Se propone un nomograma para adultos chilenos.

Background: Several obesity anthropometric measures like body-mass-index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are known to be associated with metabolic risk factors. However, it remains controversial which of these markers is better to predict cardiovascular risk factors and mortality. Methods: In this prospective observational study with a weighted random sample of 6714 men and 6340 women (San Francisco de Mostazal, Chile), we examined the relation between obesity anthropometric measures, cardiovascular risk factors and all-cause mortality. We calculated area under curve ROC (Receiving Operating Characteristic) to evaluate performance of anthropometric measures for detecting one or more cardiovascular risk factors. Multivariate risks for mortality were calculated with logistic regression models controlling for age and cardiovascular risk factors. Results: In men, areas under curve ROC for detecting one or more risk factors at the baseline were: BMI 0.85 (0.74-0.77), WC 0.85 (0.84-0.86), WHR 0.80 (0.79-0.81) and WHtR 0.90 (0.89-0.91). In women, these areas were respectively 0,72 (0,71-0,74), 0,77 (0,76-0,79), 0,65 (0,63-0,66) and 0,81 (0,80-0,82). During 8 years of follow-up (670 deaths, 362 men), multivariate risks with 95 percent confidence intervals (95%CI) for BMI, WC, WHR, and WHtR were respectively in men 0,80 (0,58-1,10), 1,27 (0,93-1,74), 0,89 (0,66-1,21) and 2,37 (1,61-3,49). In women, multivariate risks for BMI, WC, WHR and WHtR were respectively 0,95 (0,70-1,27), 1,35 (1,00-1,85), 1,54 (1,17-2,16), and 1,56 (1,13-2,26). Conclusions: In this prospective cohort study, adjusting WC for body height was the best way for predicting cardiovascular risk factors and all-cause mortality in Chilean adults.

Desigualdad educacional y socioeconómica como determinante de mortalidad en Chile: análisis de sobrevida en la cohorte del proyecto San Francisco / Socioeconomic and educational inequities as independent predictors for mortality in a developing country: A cohort study in San Francisco, Chile

Background: The socioeconomic position (SEP) and educational level of individuals have an inverse correlation with mortality in developed societies. Aim To assess in a society undergoing a socioeconomic transition, the mortality risk associated to a low SEP (combination of education and income, scale 0-25 points, reference > 10 points) and low education (education years, reference > 8 years), adjusting for other known risk factors. Material and methods: In this prospective cohort study, a random sample of 920 subjects, living in San Francisco de Mostazal, Chile, aged more than 20years (395 males) was examined for the first time in 1997-1999 and re-examined in 2005-2006. All had information about economic household income and level of education. A Cox regression model was used to evaluate the association between mortality and socioeconomic measures. Results: The crude mortality hazard ratio (HR) was 3.34 (95 percent confidence interval (CI) 2.88-3.87) and 6.05 (95 percent CI 5.04-7.26) for low SEP and low educational level, respectively. After adjusting for age, gender, hypertension, diabetes, dyslipidemia, abdominal obesity, smoking, alcohol intake and family history of cardiovascular disease, the figures were 1.23 (95 percent CI 1.04-1.43) and 1.54 (95 percent CI 1.23-1.85) for low SEP and low educational level, respectively. Conclusions: In a society in socioeconomic transition, low SEP and especially low educational level are risk factors for mortality even after adjusting for known mortality risk factors.

Razón cintura-estatura como un predictor de mortalidad en población chilena: un estudio de 8 años de seguimiento en la cohorte del proyecto San Francisco / Wais-to-height ratio to predict mortality in chilean adults: an 8 year follow-up studies

Antecedentes: Medidas antropométricas de obesidad como el índice de masa corporal (IMC), circunferencia de cintura (CC), razón cintura-cadera (RCC) y razón cintura-estatura (RCE) son conocidas por estar asociadas a factores de riesgo metabólico. Sin embargo, es controversial cuál de ellas es mejor para predecir mortalidad. Método: En este estudio prospectivo observacional, reclutamos 920 adultos sanos (>20 años, 395 hombres, San Francisco de Mostazal, Chile) y examinamos la relación entre medidas antropométricas de obesidad y mortalidad general utilizando puntos de corte población-específicos (IMC≥28 kg/m2 ambos sexos; CC≥92cm hombres, ≥88cm mujeres; RCC≥0,94 hombres, ≥0,84 mujeres y RCE≥0,55 ambos sexos). El riesgo relativo (RR) fue calculado utilizando regresión logística controlando por factores de riesgo cardiovascular convencionales. Además, calculamos el área bajo la curva ROC (Receiving Operating Characteristic) para evaluar el desempeño de cada medida antropométrica para predecir mortalidad. Resultados: Durante 8 años de seguimiento ocurrieron 47 muertes. En hombres, el RR con intervalos de confianza al 95 por ciento (IC95 por ciento) para IMC, CC, RCC y RCE fue 1.21 (0.93-1.58), 2.52 (1.86-3.40), 1.11 (0.86-3.20) y 3.38 (2.31-4.96) respectivamente. En mujeres, el RR fue 0.78 (0.60-1.01), 1.44 (1.07-1.93), 1.54 (1.13-2.10), y 1.56 (1.13-2.26) respectivamente. En hombres, las áreas bajo la curva ROC (IC95 por ciento) fueron: IMC 0.66 (0.65-0.68), CC 0.72 (0.71-0.74), RCC 0.72 (0.71-0.74) y RCE 0.77 (0.75-0.78). En mujeres, estas áreas fueron: 0.59 (0.57-0.61), 0.65 (0.63-0.67), 0.58 (0.56-0.60) y 0.70 (0.68-0.71) respectivamente.

Background: Several obesity anthropometric measures like body-mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are known to be associated with metabolic risk factors. However, it remains controversial which of these markers is better to predict mortality. Methods: In this prospective observational study, we enrolled 920 healthy adults (> years, 395 men, 98.7 percent Chilean-Hispanics living in San Francisco de Mostazal, Chile). We examined the relation between obesity anthropometric measures and all-cause mortality using population-specific cutoffs (BMI ≥28 kg/m2 both genders; WC ≥92 cm men, ≥88 cm women; WHR ≥0,94 men, 0,84 women and WHtR ≥0,55 both genders). Multivariate risks were calculated with logistic regression models controlling for cardiovascular and metabolic risk factors. In addition we calculated area under ROC curve (Receiving Operating Characteristic) to evaluate performance of every anthropometric measure to predict mortality. Results: Forty seven deaths occurred during 8 years of follow-up. In men, multivariate risks with 95 percent CI) for BMI, WC, WHR, and WHtR were respectively 1.21 (0.93-1.58), 2.52 (1.86-3.40), 1.11 (0.86-3.20) and 3.38 (2.31-4.96). In women, multivariate risk were respectively 0.78 (0.60-1.01). 1.44 (1.07-1.93), 1.54 (1.13-2.10), and 1.56 (1.13-2.26). In men, areas under curve ROC (95 percent CI) were BMI 0.66 (0.65-0.68), WC 0.72 (0.71-0.74), WHR 0.72 (0.71-0.74) and WHtR 0.77 (0.75-0.78). In women these areas were respectively 0.59 (0.57-0.61), 0.65 (0.63-0.67), 0.58 (0.56-0.60) and 0.70 (0.68-0.71). Conclusions: In this Chilean-Hispanic cohort WHtR is the most accurate predictor of all-cause mortality in comparison with other anthropometric measures of adiposity.

Mediciones antropométricas y riesgo de sufrir un evento cardiovascular no fatal en población chilena: resultados del proyecto San Francisco / Anthropometric indexes and risk of non-fatal cardiovascular events in a Chilean population: the San Francisco Project

Antecedentes: Varios índices antropométricos (IA) de obesidad han mostrado ser predictores de morbilidad cardiovascular en estudios epidemiológicos internacionales. Objetivo: Evaluar el impacto del índice de masa corporal (IMC), circunferencia de abdomen (CA), razón cintura/cadera (RCC), razón cintura/estatura (RCE) e índice pulso-masa (IPM) sobre el riesgo de sufrir un evento cardiovascular (ECV) en una cohorte de población chilena. Diseño: Estudio longitudinal de 920 personas (edad 39,5 +/- 16,3 años, 382 hombres) que participan en el proyecto San Francisco (PSF). Método: La población fue examinada entre 1997 y 1999 consignándose nivel socioeconómico (NSE), hipertensión arterial (HTA), diabetes, colesterol total, triglicéridos, tabaquismo, IMC > 30 kg/m2, CA > 102 cm en hombres y > 85 cm en mujeres, RCC > 1,00 en hombres y > 0,85 en mujeres, IPM > 1,00 y RCE > 0,53. Análisis de riesgo (RR) con intervalos de confianza al 95 por ciento (IC95 por ciento) y regresión logística mediante procedimiento stepwise. Resultados: Luego de 5,3 +/- 0,3 años de seguimiento se registraron 26 ECV resultando predictores: diabetes RR=4,48 (IC95 por ciento 1,87-10,7); HTA RR=5,16 (IC84 por ciento 2,27-11,71); bajo NSE RR=1,81 (IC95 por ciento 1,38-2,37); IMC RR=2,43 (IC95 por ciento 1,10- 5,37); CA RR=3,10 (IC95 por ciento 1,39-6,91) y RCE RR=6,58 (IC95 por ciento 1,96-22,1). En el análisis multivariado que incluyo con todos los IA controlados por edad y sexo, sólo la RCE fue predictor independiente con riesgo de 3,14 (p<0,01). En el modelo completo que incluyó todos los factores de riesgo analizados, sólo la edad, HTA, diabetes, RCE y bajo NSE predicen un ECV no fatal. Conclusión: En la cohorte de San Francisco la RCE aparece como un predictor simple e independiente de enfermedad cardiovascular con mejor desempeño que otros IA de obesidad. Sin embargo, puntos de corte específicos para población chilena deberían ser determinados y evaluados.

Background: International studies have shown that several obesity related anthropometric indices are associated to increased cardiovascular risk. Aim: To evaluate the risk of non-fatal cardiovascular events associated to body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) , pulse mass index (PMI) and waist-to-height ratio (WHtR) upon cardiovascular risk in a cohort of Chileans subjects. Methods: 920 subjects (age 39.5 +/- 16.3 years, 382 males) from the San Francisco Project were prospectively followed.From 1997 to 1999 we determined the socio-economic status (SES), the presence of hypertension, diabetes, cholesterol, and triglyceride levels, smoking status, obesity (BMI >30 kg/m2 , WC >102 for males and > 85 cm for females, WHR > 1 for males and > 0.85 for females, PMI >1 and WHtR > 0.53). Risk ratios and 95 percent confidence intervals (CI) along with stepwise logistic regression were used to assess statistical significance.Results: 26 cardiovascular events took place within 5.3+/-0.3 years of follow up. Significant predictive values were shown for diabetes (RR=4.8, CI 1.9-10.7), hypertension (RR=5.16, CI 2.27 – 11.7), low SEL(RR=1.81, CI 1.38-2.37), BMI (RR 2.43, CI 1.1-5.37), WC (RR=3.1, CI 1.39-6.91 and WHtR (RR = 6.58, CI 1.96-22.1). Logistic regression analysis indicated that only WHtR remained an independent predictor for cardiovascular events. After a different adjustment model, age, hypertension, diabetes, WHtR and low SES had predictive value for cardiovascular events. Conclusion: WHtR appears to be an independent marker for cardiovascular risk in the San Francisco cohort study. However, specific anthropometric cut-off points for chonic diseases in chilean subjets should be determined and tested.

Capacidad aeróbica, composición corporal y gasto calórico asociado a oxidación de sustratos energéticos durante el ejercicio en mujeres sedentarias con sobrepeso / Changes in body composition associated to oxidation of energetic substrates during exercise in sedentary obese women

Objetivo: Explorar la relación entre el consumo de oxígeno máximo (VO2max), composición corporal y oxidación de ácidos grasos (AG) en mujeres con sobrepeso. Métodos: En una serie consecutiva de 30 mujeres sedentarias se evaluó composición corporal por bio-impedanciometría determinando masa grasa absoluta y porcentual (MG y por ciento MG) masa magra (MM y por ciento MM), circunferencia mayor de abdomen (CMA) e índice de masa corporal (IMC). Todas fueron sometidas a calorimetría indirecta en reposo y ejercicio determinándose el índice metabólico basal (IMB), el VO2max y la oxidación de AG. Se realizó análisis por correlación de Pearson y regresión multivariante, error alfa del 5 por ciento. Resultados: El IMC y el CMA muestran correlaciones directas con el IMB sin ajustar. Cuando éste último es ajustado por unidad de peso corporal se observa una relación inversa, especialmente de la CMA con el IMB (-0,81;p<0.01). Lo mismo ocurre con el VO2max que ajustado por unidad de masa corporal exhibe correlación inversa con el por ciento MG (-0,47;p<0,01), IMC (-0,30;p<0,05) y CMA (-029;p<0,05) manteniendo un correlación directa con el por ciento MM (-0,47;p<0,01) y la oxidación de AG durante el ejercicio (0,30;p<0,05). El IMB está fuertemente determinado por la MM (0,99;p<0,001) y éste último fue el mejor predictor del VO2 max en los modelos multivariantes. Conclusión: Tanto IMB y VO2 max ajustados por unidad de peso sugieren que la obesidad, especialmente abdominal, reduce la capacidad metabólica fuertemente dependiente de una disminución de la MM. Así, ejercicios para aumentar MM provocarían un aumento del IMB mientras ejercicios aeróbicos mejorarían la capacidad oxidativa de AG.