Cardiovascular Disease Risk Profile and Risk Prediction Among Unskilled Workers of a Tertiary Care Teaching Hospital

Background: The prevalence of CVD risk factors in India is steadily increasing moreover CVD in Indians has been shown to occur prematurely. The study was designed to estimate the 10-year cardiovascular risk using region specific WHO/ISH risk prediction chart among unskilled workers of a tertiary care teaching hospital and to determine factors associated with risk. Material and methods: This was a hospital based cross sectional study conducted among 250 workers selected by simple random sampling. Using structured questionnaire, life style related risk factors name-ly, average daily consumption of fruits and vegetables, physical activity, perceived stress, tobacco and al-cohol use was collected. BMI and BP were measured using standard protocol and classified following standard guidelines. Bio-chemical parameters were also measured. Results: Among 250 workers, 37.2% and 10% consumed daily minimal recommended level of vegeta-bles and fruits respectively, 21.1% was current tobacco user, 17.2% was alcohol drinkers, 50.4% were obese, 18.8% had high blood pressure and 6% had elevated cholesterol. Among the workers 46.7 % had <10% risk, 5.3% had 10% to <20% risk and, 3.3% had 20% to <30% risk to develop CVD within future 10 years of lifetime. Drivers and current alcoholics were associated with being in the high-risk group. Conclusion: Employer initiated regular work place health screening and services need to be aimed at the unskilled workers, especially for CVD targeting drivers and alcoholics.

Glaucoma primario de ángulo abierto y factores de riesgo aterosclerótico: hallazgos por eco-Doppler orbitario / Primary open angle glaucoma and atherosclerotic risk factors: orbital echo-Doppler findings

Objetivo: Determinar los hallazgos por eco-Doppler orbitario en pacientes con glaucoma primario de ángulo abierto según factores de riesgo aterosclerótico. Métodos: Se realizó un estudio observacional descriptivo y transversal en 300 órbitas de 150 pacientes con diagnóstico de glaucoma primario de ángulo abierto. A todos los casos se les realizó tonometría de contorno dinámico y tomografía de coherencia óptica. Se identificaron mediante interrogatorio y por el laboratorio clínico los factores de riesgo aterosclerótico: hipertensión arterial, tabaquismo, diabetes mellitus tipo 2, dislipidemia, obesidad y consumo excesivo de alcohol. Se les realizó ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales se procedió a evaluar mediante eco-Doppler las arterias oftálmica, central de la retina y ciliares posteriores temporales. Resultados: La edad media de los sujetos estudiados fue de 62,3 años. El 55,3 por ciento correspondió al sexo femenino y el 47,3 por ciento al color blanco de la piel. El número de factores de riesgo mostró una correlación lineal moderada, positiva y significativa con el índice de resistencia, mientras que con las velocidades dicha correlación resultó ser negativa. Todos los factores de riesgo expresaron efectos dañinos sobre la hemodinámica del flujo ocular, la presión intraocular y el grosor de las capas de fibras neurorretinianas temporales. Tras ajustar para la edad, esta negativa influencia continuó siendo relevante en la mayoría de los casos. Conclusiones: Los aspectos vasculares del glaucoma deben integrarse a la práctica clínica de esta afección, lo que ayudará a que el enfoque sea más completo, y redundará en un mejor pronóstico de la enfermedad(AU)

Objective: Determine the orbital echo-Doppler findings in patients with primary open angle glaucoma according to atherosclerotic risk factors. Methods: A cross-sectional observational descriptive study was conducted of 300 orbits of 150 patients diagnosed with primary open angle glaucoma. All the cases underwent dynamic contour tonometry and optical coherence tomography. Interrogation and clinical laboratory testing led to identification of the following atherosclerotic risk factors: arterial hypertension, smoking, diabetes mellitus type 2, dyslipidemia, obesity and excessive alcohol consumption. Orbital and carotid Doppler ultrasounds were performed, and only if they were normal they would be followed by echo-Doppler evaluation of the ophthalmic, central retinal and posterior temporal ciliary arteries. Results: Mean age of the study subjects was 62.3 years. 55.3 percent were female and 47.3 percent had white skin. The number of risk factors showed a moderate, positive and significant linear correlation with the resistive index, and a negative correlation with the velocities. All the risk factors expressed harmful effects on ocular flow hemodynamics, intraocular pressure and the thickness of temporal neuroretinal fibers. After adjusting for age, this negative influence continued to be relevant in most cases. Conclusions: The vascular aspects of glaucoma should be incorporated into the clinical management of this condition. This will make the approach more thorough and help achieve a better diagnosis(AU)

El glaucoma y las enfermedades sistémicas con compromiso vascular / Glaucoma and systemic diseases of vascular involvement

La presión intraocular es considerada el único factor causal potencialmente modificable con el propósito de prevenir la ceguera por glaucoma. Esta es una enfermedad multifactorial y, aunque es el factor de riesgo más importante en su desarrollo, la reducción de sus valores no garantiza el cese de la progresión del daño glaucomatoso. El glaucoma primario de ángulo abierto y el glaucoma de presión normal comparten factores de riesgo similares en la patogénesis y se pueden clasificar en categorías mecánicas y vasculares. La evidencia científica actual ha logrado demostrar que existe una importante asociación entre las enfermedades sistémicas con compromiso vascular, como la migraña, la apnea obstructiva del sueño, la hipotensión arterial de diferentes causas, la hipertensión arterial, la enfermedad cerebrovascular, la cardiopatía isquémica y la diabetes mellitus con los hallazgos a nivel ocular en pacientes con neuropatía óptica glaucomatosa. Esta correlación orienta a considerar estas enfermedades en conjunto para que cada profesional dedicado a la salud visual considere siempre imprescindible la evaluación de los aspectos que vinculan estas enfermedades para actuar en consecuencia. Se realiza una búsqueda sobre el glaucoma y las enfermedades sistémicas con compromiso vascular(AU)

Intraocular pressure is considered to be the only potentially modifiable causative factor to prevent glaucoma blindness. However, glaucoma is a multifactorial disease, and true as it is that its main risk factor is intraocular pressure, its reduction does not ensure cessation of the progress of glaucomatous damage. Primary open angle glaucoma and normal pressure glaucoma share similar pathogenetic risk factors, and may be classified as mechanical or vascular. According to current scientific evidence, an important association exists between systemic diseases with vascular involvement, such as migraine, obstructive sleep apnea, arterial hypotension of various causes, arterial hypertension, cerebrovascular disease, ischemic heart disease and diabetes mellitus, and ocular findings in patients with glaucomatous optic neuropathy. In view of this correlation, these diseases should be considered jointly, so that visual health professionals always bear in mind the evaluation of their common characteristics and act in consequence. A search was carried out on glaucoma and systemic diseases with vascular compromise(AU)

Valores de riesgo vascular de indicadores metabólicos en adolescentes y ancianos de La Habana / Vascular Risk Values of Metabolic Indicators in Adolescents and Elderlies from Havana

Introducción: Durante el ciclo de vida de los individuos son imprescindibles intervenciones para detectar y reducir el riesgo y las complicaciones de las enfermedades crónicas. Objetivo: Determinar la prevalencia de valores de riesgo vascular de los principales indicadores del metabolismo glucídico y lipídico en adolescentes y ancianos de La Habana. Métodos: Se realizó un estudio transversal en una muestra conformada por adolescentes (469 de 12-16 años) aparentemente sanos y ancianos (395 de 65-100 años) sin diagnóstico de enfermedades asociadas a la alteración marcada del estado nutricional y metabólico. Ambas poblaciones fueron evaluadas para glucosa, triglicéridos, colesterol total, colesterol de lipoproteinas de alta densidad y colesterol de lipoproteínas de baja densidad, séricos, mediante métodos enzimáticos convencionales. Se usaron rangos de riesgo referentes. Los resultados se analizaron mediante estadística descriptiva. Resultados: En los adolescentes evaluados, los triglicéridos (35,6 por ciento) y el colesterol total (23,9 por ciento) mostraron las mayores frecuencias de valores de riesgo. En las hembras ambos marcadores se mantuvieron como los más elevados en ese orden, mientras que, en los varones, la glucosa (25,5 por ciento) secundó a los triglicéridos como indicadores más alterados. En ancianos, al colesterol de lipoproteínas de baja densidad (58,2 por ciento) y al colesterol total (48,6 por ciento) correspondieron las mayores frecuencias de cifras de riesgo, patrón que se repitió en cada sexo. Los valores promedio de los indicadores fueron marcadamente superiores en ancianos que, en adolescentes, excepto para glucosa y colesterol de lipoproteínas de alta densidad. Conclusiones: Los resultados obtenidos muestran una elevada prevalencia de valores de riesgo vascular de varios indicadores metabólicos evaluados en adolescentes y ancianos, lo que sugiere la necesidad de monitorear los indicadores analizados e implementar intervenciones modificadoras de sus valores hacia la reducción del riesgo asociado, desde etapas tempranas, como las previas a la adolescencia(AU)

Introduction: During the life cycle of individuals, interventions are essential to detect and reduce the risk and complications of chronic diseases. Objective: To determine the prevalence of vascular risk values of the main indicators of carbohydrate and lipid metabolism in adolescents and elderlies in Havana. Methods: A cross-sectional study was carried out with a sample made up of apparently healthy adolescents (469; aged 12-16 years) and elderlies (395 aged 65-100 years) without a diagnosis of diseases associated with marked alteration of nutritional and metabolic status. Both populations were evaluated regarding serum glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol using conventional enzymatic methods. Reference risk ranges were used. The results were analyzed using descriptive statistics. Results: In the evaluated adolescents, triglycerides (35.6 percent) and total cholesterol (23.9 percent) showed the highest frequencies of risk values. In females, both markers remained the highest in that aspect; while in males, glucose (25.5 percent) accounted second after triglycerides as the most altered indicators. In the elderlies, low-density lipoprotein cholesterol (58.2 percent) and total cholesterol (48.6 percent) corresponded to the highest frequencies of risk values, a pattern that was repeated in each sex. The average values of the indicators were markedly higher in the elderlies than in adolescents, except for glucose and high-density lipoprotein cholesterol. Conclusions: The results obtained show high prevalence of vascular risk values of several metabolic indicators evaluated in adolescents and elderlies, which suggests the need to monitor the analyzed indicators and implement interventions to modify such values, in view of reducing the associated risk, from stages early, such as the pre-adolescence stage(AU)

A study of prevalence of migraine in stroke patients and its association with ischemic versus hemorrhagic stroke: a cross sectional study

Background: Migraine is characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction. Up to one third of patients also have neurological aura symptoms. It has been suggested that migraine can be a risk factor for stroke. Migraine affects three times the number of women than men. The incidence of stroke in men is two times that of women. It is shown in several studies that women aged 35 to 45 years old are at increased risk of ischemic stroke who had migraine with or without aura.Methods: The present cross sectional study was conducted in 350 consecutive patients of stroke who were attended OPD and admitted in wards of the Department of Medicine, M.G.M. Medical College and MY Hospital, Indore, MP, India, during period from December 2017 to December 2018.Results: The highest percentage of respondents i.e. 68% belonged to male group followed by 32% of respondents who were females. The highest percentage of respondents i.e. 66.6% had ischemic stroke while, 33.4% had hemorrhagic stroke. The highest percentage of respondents i.e. 90.9% had no Migraine while, 9.1% had Migraine. The highest percentage of respondents i.e. 31.2% had weekly reoccurrence, followed by forth nightly (25%) and lowest was 3.1% of daily recurrence. The association of type of stroke with sex group of patient’s history of headache which found to be significant (p ?0.05). The association of type of stroke with sex group of patient’s history of various cerebro-vascular risk factors which found to be significant (p<0.05). Patients having hemorrhagic and ischemic stroke also had HTN in 47% and 12.4% patients respectively.Conclusions: In this study it is concluded that migraine can be established as a risk factor for ischemic stroke. Early diagnosis and treatment with available medication can be helpful in prevention or decreasing risk for developing stroke.

Encare clínico de las dislipemias / Clinical care of dyslipidemias / Encargo clínico de dislipidemias

Resumen: El manejo de los pacientes con dislipemias en la práctica clínica diaria implica el conocimiento de la evidencia científica relevante, la experiencia clínica, el sentido común, así como el respeto a la voluntad del paciente. La evidencia demuestra que el tratamiento hipolipemiante con estatinas reduce la morbimortalidad cardiovascular en un amplio grupo de pacientes, con un porcentaje de efectos colaterales bajo. Un punto crítico en el tratamiento es la decisión de iniciar o no dichos fármacos. Hay pacientes que tienen indicación formal de estatinas sin necesidad de hacer una evaluación del riesgo vascular. Tal es el caso de los que están en prevención secundaria, pacientes con colesterol unido a las lipoproteínas de baja densidad (C-LDL) muy alto (>190 mg/dl) y diabéticos entre 40 y 75 años. En los demás individuos la indicación de estatinas pasa en primer lugar por una evaluación formal del riesgo cardiovascular. Con este fin, las guías estadounidenses sugieren el uso de las Pooled Cohort Equations, en tanto que las guías europeas utilizan el Heartscore. Ambos scores estratifican a los pacientes en cuatro grupos según la intensidad del riesgo. El beneficio absoluto en la reducción del riesgo de eventos es tanto mayor cuanto más elevado sea el riesgo basal del paciente. Es por ello que se recomienda que tanto la intensidad del tratamiento, como el nivel de descenso objetivo de C-LDL, sean tanto mayores cuanto mayor sea el riesgo del paciente. Las recomendaciones de ambas guías no son coincidentes en algunos casos. Por lo tanto, además del riesgo cardiovascular se debe considerar el riesgo de efectos adversos potenciales y la voluntad del paciente en una discusión franca con su médico. El ezetimibe primero y los inhibidores PCSK9 después (limitados en estos momentos por costos y disponibilidad) aparecen como los grandes aliados de las estatinas, cuando no se toleran las dosis adecuadas o no se llega al C-LDL objetivo. A los efectos del abordaje del tema hemos optado por analizar cinco historias clínicas representativas de los principales escenarios clínicos que obligan al médico a tomar decisiones terapéuticas específicas.

Summary: In daily clinical practice the management of patients with dyslipidemias implies knowledge of relevant clinical scientific evidence, common sense, as respect of patient preferences. There is strong evidence that treatment of dyslipidemias mainly with statins reduces morbidity and mortality in a wide group of patients with few side effects. A critical step in management of this individuals is to make the decision of whether statin treatment is indicated or not. There are patients that have a clear indication of statin use without any further cardiovascular risk calculation. Such is the case in secondary prevention, patients with extremely high low density lipoprotein cholesterol levels (>190 mg/dl) and diabetics between 40 and 75 years-old. In all other patients, statin indication should start with a formal cardiovascular risk evaluation. American guidelines suggest using the Pooled Cohort Risk Equations and European guidelines prefer Heartscore. Both scoring systems stratify risk in four categories according to risk intensity. The absolute cardiovascular risk reduction obtained with treatment increases in parallel with the basal cardiovascular risk. This explains the recommendation that both treatment intensity and magnitude of low density lipoprotein cholesterol lowering should increase as the risk of the patient increases. Recommendations provided by American and European guidelines do not always coincide. Thus, besides basal cardiovascular risk estimation, potential adverse drug effects and patient preferences should always be considered in the context of a clinician-patient frank discussion. Ezetimibe first and PCSK9 inhibitors eventually (currently limited by costs and availability) appear as the great allies of statins, when adequate doses are not tolerated or the target is not reached. We will tackle the subject through five cases that illustrate the main clinical situations in which physicians have to adopt specific therapeutic decisions.

Resumo: O manejo de pacientes com dislipidemias na prática clínica diária envolve conhecimento de provas científicas relevantes, experiência clínica, senso comum, bem como a respeito da vontade do paciente. A evidência mostra que o tratamento hipolipemiente com estatina reduz a morbimortalidade cardiovascular em um grande grupo de pacientes com uma baixa taxa de efeitos colaterais. Um ponto crítico no tratamento desses pacientes é a decisão de iniciar ou não estas drogas. Há pacientes que têm indicação formal de estatinas sem necessidade de fazer uma avaliação de risco vascular. Tal é o caso dos pacientes que estão na prevenção secundária, pacientes com colesterol da lipoproteína de baixa densidade muito alta (>190 mg/dl) e diabéticos entre 40 e 75 anos. Em outros indivíduos a indicação de uma estatinas passa primeiro através de uma avaliação formal de risco cardiovascular. Para este fim diretrizes Americanas sugerem o uso do Pooled Cohort Equations, enquanto as directrizes europeias usam o Heartscore. Ambos scores estratificam pacientes em quatro grupos de acordo com a intensidade do risco. O benefício absoluto na redução do risco de eventos é maior quanto mais elevado seja o risco base do paciente. Por isso, recomenda-se que tanto a intensidade do tratamento e do nível de descida desejada da lipoproteína de baixa densidade, são muito maior quanto maior for o risco do paciente. As recomendações de ambas as guias em alguns casos não são coincidentes. Portanto, além do risco cardiovascular deve ser considerado o risco de efeitos adversos potenciais e a vontade do paciente em uma discussão franca entre médico e paciente. Ezetimiba primeiro e os inibidores PCSK9 depois (limitado atualmente pela disponibilidade e custo) aparecem como os grandes aliados das estatinas, quando não são toleradas doses adequadas ou não se chega ao objetivo. Para efeitos da abordagem do assunto que escolhemos para analisar cinco histórias clínicas de pacientes representativos dos principais cenários clínicos que exige do médico a tomar decisões terapêuticas específicas.

Efectividad y durabilidad de la endarterectomía carotidea a largo plazo / Effectiveness and durability of long-term carotid endarterectomy

Introducción: Los accidentes cerebrovasculares constituyen un problema de salud mundial con tendencia creciente; en la actualidad es la tercera causa de muerte. Objetivo: Describir la efectividad y durabilidad de la endarterectomía carotidea a largo plazo en la enfermedad carotidea extracraneal. Métodos: Se realizó un estudio descriptivo, ambispectivo en 44 pacientes sometidos a un total de 52 endarterectomías carotideas realizadas en el servicio de Angiología y Cirugía Vascular del Hospital Docente Clínico Quirúrgico Hermanos Ameijeiras. A todos se les realizó un seguimiento clínico con ultrasonografía doppler. El período de tiempo analizado fue de ocho años. Se tuvo en cuenta las variables: sexo, edad, factores de riesgo asociados, categoría clínica, localización topográfica de las lesiones, complicaciones tardías, tiempo de permeabilidad y resultados posquirúrgicos. Resultados: Predominó el sexo masculino (68,2 por ciento). Las lesiones carotideas asintomáticas y sintomáticas representaron el 50 por ciento respectivamente. El hábito de fumar y la dislipidemia fueron los factores de riesgo más frecuentes. Hubo predominio de las complicaciones tardías (55,8 por ciento) con relevancia de la restenosis carotidea (n= 21). El tiempo promedio de permeabilidad primaria del sector revascularizado fue de cinco años. El 86,5 por ciento de los pacientes seguidos a largo plazo mostraron resultados posquirúrgicos satisfactorios al no presentar eventos neurológicos isquémicos o lesiones carotideas con repercusión hemodinámica. Conclusiones: La endarterectomía carotidea es un procedimiento seguro con baja morbilidad y mortalidad perioperatorias que garantiza una reducción significativa en las tasas de enfermedad cerebrovascular isquémica en el seguimiento a largo plazo con baja incidencia de complicaciones vasculares y neurológicas tardías(AU)

Introduction: Cardiovascular events constitute a global health problem with a growing tendency. Nowadays, they represent the third cause of death. Objective: To describe the effectiveness and durability of long-term carotid endarterectomy in the extracranial carotid disease. Methods: A descriptive, ambispective study was conducted in 44 patients subjected to 52 carotid endarterectomies that were performed in the service of Angiology and Vascular Surgery of Hermanos Ameijeiras Teaching-Clinical- Surgical Hospital. A clinical follow-up was performed with Doppler ultrasonography to all the patients. The period analyzed was eight years. The variables considered were: sex, age, associated risk factors, clinical category, topographical localization of the lesions, late complications, time of permeability and postsurgical results. Results: Male sex predominated (68,2 percent). Asymptomatic and symptomatic carotid lesions represented 50 percent respectively. The smoking habit and dyslipidemia were the most common risk factors. There was predominance of late complications (55,8 percent) being notable the carotid restenosis (n = 21). The average time of primary permeability of the revascularized sector was five years. 86,5 percent of the patients followed in the long term showed satisfactory postsurgical results by not presenting ischemic neurological events or carotid lesions with hemodynamic impact. Conclusions: Carotid endarterectomy is a safe procedure with low morbidity and peri-operative mortality that ensures a significant reduction in ischemic cerebrovascular disease´s rates in long-term follow-up with low incidence of late vascular and neurological complications(AU)

Analysis of the vascular risk factors for the elderly with mild cognitive impairment in community / 中华行为医学与脑科学杂志

Objective@#To explore the effects of vascular risk factors on cognitive function among the elderly in community.@*Methods@#A cross-sectional study was conducted in 1 269 elderly people (aged 65 and over) who were randomly selected from three communities.Through face-to-face interview, cognitive function was assessed by mini-mental state examination(MMSE), and blood samples were collected for laboratory examination.Logistic regression analysis was used to analyze the vascular risk factors affecting cognitive function.@*Results@#Age ((73.1±6.6), (71.3±4.9), t=4.603, P<0.05), education level (χ2=12.727, P<0.05), hypertension (χ2=9.106, P<0.05) and LDL-C (χ2=5.157, P<0.05) were significantly different in the elderly with or without mild cognitive impairment(MCI). After controlling age, gender and education, the logistic regression analysis showed that hypertension(β=0.378, P=0.006, OR(95%CI)=1.44(1.10-1.91)), systolic blood pressure ≥140 mmHg(β=0.350, P=0.011, OR(95%CI)=1.42(1.08-1.86), 1 mmHg=0.133 kPa), and high LDL-C(β=0.355, P=0.014, OR(95%CI)=1.43(1.08-1.89)) were the risk factors of MCI in the elderly in the community.Hypertension alone or high LDL-C (β=0.365, P=0.029, OR(95%CI)=1.44(1.04-2.00)) alone was risk factor for mild cognitive impairment in the elderly in the community.The risk of mild cognitive impairment in the elderly with hypertension and high LDL-C was 2.00 times higher than that in the healthy elderly (β=0.696, P<0.05, OR(95%CI)=2.00(1.36-2.97)).@*Conclusion@#Mild cognitive impairment in the elderly is closely related to hypertension and elevated LDL-C levels.Multiple vascular risk factors can further increase the risk of cognitive impairment.

Analysis of the vascular risk factors for the elderly with mild cognitive impairment in community / 中华行为医学与脑科学杂志

Objective To explore the effects of vascular risk factors on cognitive function among the elderly in community. Methods A cross-sectional study was conducted in 1 269 elderly people ( aged 65 and over) who were randomly selected from three communities. Through face-to-face interview, cognitive function was assessed by mini-mental state examination(MMSE),and blood samples were collected for labo-ratory examination. Logistic regression analysis was used to analyze the vascular risk factors affecting cogni-tive function. Results Age (( 73. 1 ± 6. 6), ( 71. 3 ± 4. 9),t=4. 603,P<0. 05),education level ( χ2=12. 727,P<0. 05),hypertension (χ2=9. 106,P<0. 05) and LDL-C (χ2=5. 157,P<0. 05) were significantly different in the elderly with or without mild cognitive impairment(MCI). After controlling age,gender and ed-ucation,the logistic regression analysis showed that hypertension(β=0. 378,P=0. 006,OR(95%CI)=1. 44 (1. 10-1. 91)),systolic blood pressure ≥140 mmHg( β=0. 350,P=0. 011,OR( 95% CI)= 1. 42( 1. 08-1. 86),1 mmHg=0. 133 kPa),and high LDL-C( β=0. 355,P=0. 014,OR(95%CI)=1. 43( 1. 08-1. 89)) were the risk factors of MCI in the elderly in the community. Hypertension alone or high LDL-C (β=0. 365, P=0. 029,OR(95%CI)=1. 44(1. 04-2. 00)) alone was risk factor for mild cognitive impairment in the eld-erly in the community. The risk of mild cognitive impairment in the elderly with hypertension and high LDL- C was 2. 00 times higher than that in the healthy elderly ( β=0. 696,P<0. 05,OR( 95%CI)= 2. 00( 1. 36-2. 97)). Conclusion Mild cognitive impairment in the elderly is closely related to hypertension and elevat-ed LDL-C levels. Multiple vascular risk factors can further increase the risk of cognitive impairment.

A preliminary report on physical activity patterns among children aged 8–14 years to predict risk of cardiovascular diseases in Malwa region of Punjab

Objective To determine the pattern of physical activity specific to age and gender among young Indian school going girls and boys aged 8-14 years. Design Cross-sectional study. Setting Private and government sponsored schools in Patiala and Mansa District of Punjab, India. Participants: Two hundred thirty four school going girls and boys aged 8–14 years. Methodology A structured questionnaire recorded the various forms of daily physical activity, sedentary activity as well as physical activity level of all the participants. The energy expenditure was also calculated using the standard metabolic equivalent index. Results There is a significant difference between mean weights of participants belonging to different physical activity levels (p < .04). In comparison to boys, the girl participants have significant lower values of physical activity duration as well as total metabolic equivalent expenditure (p < .05). The total duration of moderate/vigorous physical activity declined in both girls and boys as the age increased. Conclusion Physical activity among children in Northern regions of India is on decline as their age increases especially among girls. It is important to determine physical activity duration in early age groups and motivate children for daily physical activity.

A study of non-alcoholic fatty liver disease and its relation to type 2 diabetic patients and cardiovascular risk markers

Background: Non-alcoholic fatty liver disease (NAFLD) is a unique entity characterised by fatty changes with lobular hepatitis in absence of a history of alcoholism. Compelling evidence over the past several years has substantiated a significant link between NAFLD and cardiovascular disease ranging from coronary artery disease to subclinical carotid atherosclerosis. Close follow up, treatment of risk factors for NAFLD, and cardiovascular risk stratification are necessary to predict morbidity and mortality in these patients. The objective of this study is to find out hepatic involvement in type 2 diabetic patients and to correlate the associations between non-alcoholic fatty liver disease and different Cardiovascular risk factors.Methods: This prospective and observational study was conducted in a tertiary care Centre, Kolkata, West Bengal and was conducted among 128 patients having patients having been diagnosed as type 2 diabetic and whose liver USG scan showing fatty changes.Results: In the studied 128 cases, 99 patients had fatty liver and 29 cases without fatty liver diagnosed by abdominal ultrasonography. Most of the Diabetic NAFLD cases were detected in their 5th and 6th decade of life with a male preponderance. Ultrasonography remains a reliable non-invasive method for detection. Ischemic changes in ECG were noted in the study population without statistical significance probably due to low sampling.Conclusions: Left ventricular diastolic dysfunction found to be the prime echocardiographic abnormality in type 2 diabetes mellitus patients.

Riesgo vascular en personas con diabetes mellitus tipo 2 y dislipidemia / Vascular risk in people with type 2 diabetes mellitus and dyslipidemia

Introducción: la dislipidemia constituye un factor de riesgo vascular frecuente en la diabetes tipo 2. Objetivo: identificar la relación entre las alteraciones lipídicas y el riesgo vascular en la diabetes tipo 2. Métodos: estudio transversal y correlacional de 111 personas con diabetes tipo 2 y dislipidemia (41 con primaria y 70 con secundaria), atendidas en el Centro de Atención al Diabético del Instituto Nacional de Endocrinología, durante 2014-2015. Se analizaron las variables: edad, sexo, tabaquismo, índice de masa corporal, circunferencia de cintura, índices cintura-cadera y cintura-talla, presión arterial sistólica y de pulso, colesteroles total, lipoproteínas de baja densidad y las lipoproteínas de alta densidad, triglicéridos, apoproteínas A y B, hemoglobina glucosilada, complejo íntima-media carotídeo y riesgo cardiovascular por tablas de la OMS y Gaziano. Para comparar variables cualitativas (porcentaje), se utilizó prueba de Fisher y para cuantitativas ( ± DE), U de Mann-Whitney. Para todos los análisis, se asumió una p< 0,05. Resultados: la disminución de lipoproteínas de alta densidad-colesterol fue la alteración de fracción lipídica que más se relacionó con alteración de variables clínicas y bioquímicas, para ambas dislipidemias. La dislipidemia primaria se asoció con mayor riesgo cardiovascular según tablas de la OMS (p= 0,015). Conclusiones: la dislipidemia primaria y la disminución de lipoproteínas de alta densidad-colesterol se relacionaron con mayor riesgo vascular(AU)

Introduction: dyslipidemia is a frequent vascular risk factor in type 2 diabetes. Objective: to identify the relation between lipid alterations and vascular risk in type 2 diabetes. Methods: cross-sectional and correlational study of 111 people with type 2 diabetes and dyslipidemia (41 of them with primary and 70 with secondary) attended at the Diabetics Care Center of the National Institute of Endocrinology during 2014-2015. The variables analyzed were: age, sex, smoking habit, body mass index, waist circumference, waist-hip and waist-height indexes, systolic and pulse blood pressure, total cholesterol, low density lipoproteins and high density lipoproteins, triglycerides, apoproteins A and B, glycosylated hemoglobin, carotid intima-media complex; and cardiovascular risk by WHO and Gaziano tables. To compare qualitative variables (percentage), Fisher's test was used, and for quantitative ( ± DE), Mann-Whitney U. For all analyzes, a p< 0.05 was assumed. Results: the decrease of high density-cholesterol´s lipoproteins was the alteration of lipid fraction that was more related to the alteration of clinical and biochemical variables, for both dyslipidemias. Primary dyslipidemia was associated with a higher cardiovascular risk according to WHO tables (p= 0.015). Conclusions: primary dyslipidemia and the decrease of high density-cholesterol´s lipoproteins were associated with a higher vascular risk(AU)

Estado nutricional y factores de riesgo vascular en pacientes ingresados en el Centro de Atención al Diabético de La Habana / Nutritional state and vascular risk factors of patients admitted to the Center of Diabetic Care in Havana

Introducción: la obesidad y la diabetes constituyen una asociación frecuente y letal, que a su vez, también se relacionan con otros factores que incrementan el riesgo cardiovascular. Objetivo: caracterizar el estado nutricional e identificar factores de riesgo vascular en personas con diabetes ingresadas en el Centro de Atención al Diabético de La Habana. Métodos: estudio descriptivo transversal. Se revisaron 1 916 historias clínicas, y las variables estudiadas fueron: tipo de diabetes, índice de masa corporal, circunferencia de la cintura, hipertensión arterial, tabaquismo, hipercolesterolemia, control glucémico y excreción urinaria de albúmina. Resultados: el 88,2 por ciento de los pacientes tenían diabetes tipo 2; de ellos, 74,5 por ciento eran sobrepeso u obesos, 62,5 por ciento tenían circunferencia de cintura incrementada, hipertensión el 67,2 por ciento, descontrol glucémico el 55,2 por ciento, hipercolesterolemia el 50,6 pr ciento, tabaquismo el 44,4 pore ciento y excreción urinaria de albúmina el 27,6 por ciento. El 11,8 por ciento tenía diabetes tipo 1, de ellos 66,4 por ciento eran normopesos; con descontrol glucémico 57,5 por ciento, con sobrepeso u obesidad 33,7 por ciento, con excreción urinaria de albúmina el 31,4 por ciento, con hipercolesterolemia el 29,9 por ciento, con tabaquismo el 28,7 por ciento, con hipertensión el 23,9 por ciento y el 21,2 por ciento tenía incrementada la circunferencia de la cintura. Conclusiones: la mayoría de los pacientes tenían diabetes tipo 2 y sobrepeso, con predominio de la obesidad abdominal. La asociación de varios factores de riesgo fue muy frecuente, independientemente del tipo de diabetes. Se deben diseñar estrategias efectivas para el tratamiento integral de la diabetes y los factores de riesgo asociados(AU)

Introduction: obesity and diabetes is a frequent and lethal association that, in turn, is related to other factors increasing the cardiovascular risks. Objective: to characterize the nutritional state and to identify vascular risk factors in diabetic persons who were admitted to the Center of Diabetic Care in Havana. Methods: cross-sectional and descriptive study that reviewed 1 916 medical histories and the studied variables were type of diabetes, body mass index, waist circumference, blood hypertension, smoking, hypercholesterolemia, glycemic control and urinary excretion of albumin. Results: in the study group, 88.2 percent of patients suffered type 2 diabetes, 74.5 percent of them was overweighed or obese; 62.5 percent had increased waist circumference; 67.2 percent were hypertensive; 55.2 percent had no glycemic control; 50.6 percent had hypercholesterolemia; 44.4 percent were smokers and 27.6 percent had urinary excretion of albumin. Type 1 diabetes was present in 11.8 percent ; 66.4 percent of the latter were normoweighed; 57.5 percent had no glycemic; 33.7 percent were overweighed or obese; 31.4 percent showed urinary excretion of albumin; 29.9 percent hypercholesterolemia; 28.7 percent were smokers and 23.9 percent hypertensive whereas 21.2 percent had increased waist circumference. Conclusions: most of patients had type 2 diabetes and overweight, with abdominal obesity. The association of several risk factors was very common, regardless of the type of diabetes. Effective strategies must be designed to treat diabetes and the associated risk factors in a comprehensive way(AU)

Correlation of different Framinghan vascular risk factors and cognitive impairment / 中华行为医学与脑科学杂志

Objective To evaluate the relationship between different Framinghan vascular risk factor and cognitive impairment in the middle-aged and elderly.methods 71 participants from Physical Examination Center,Zhongnan Hospital of Wuhan University were consecutively recruited from March 2016 to May 2016.Framingham Cardiovascular Disease Risk Profile (FCVDRP),Framingham Stroke Risk Profile (FSRP) and Framingham Coronary Heart Disease Risk Profile (FCHDRP) were respectively used to evaluate the vascular burden of the participants.Mini-mental state examination (MMSE) and digital sign conversion test (DST) were used to evaluate the cognitive function of the participants.Partial correlation analysis was used to investigate the correlation between FCVDRP,FSRP and FCHDRP scoring methods and cognitive function.Result s(1)After adjusting for education years,with the increase of vascular burden scores,the scores of MMSE (FCVDRP:low-risk group (28.29±1.38),mid-risk group(27.40±1.73),high-risk group (26.72±1.93);FSRP:low-risk group (28.00±1.60),mid-risk group (26.26±2.46),high-risk group (27.2±2.04);FCHDRP:low-risk group (27.74±1.73),mid-risk group (27.46±2.00),high-risk group (27.18±1.59)) and DST (FCVDRP:low-risk group (29.24±5.54),mid-risk group (27.40±1.73),high-risk group (26.72±6.76);FSRP:low-risk group (30.09±5.61),mid-risk group (25.11±7.55),high-risk group (23.53±5.60);FCHDRP:low-risk group (30.37±6.41),mid-risk group (25.46±6.76),high-risk group (26.82±5.99)) were significantly decreased(all P<0.05).(2)The Result s of partial correlations analysis showed that the scores of FSRP were significantly correlated with MMSE (r=-0.249) and DST (r=-0.291)(both P<0.05).Conclusion Aggregation of vascular risks factors may aggravate cognitive impairment in middle-aged and elderly people.Compared to FCVDRP and FCHDRP,FSRP assessment may be more significantly associated with vascular cognitive impairment.

Hypertension is Associated with Depressive Symptoms in Alzheimer's Disease

OBJECTIVE: To explore the effect of vascular risk factors to the depressive symptom in Alzheimer's disease (AD). METHODS: Retrospective chart reviews were performed for the patients, who underwent comprehensive neuropsychiatric assessment in the geriatric psychiatric clinic in the period between May of 2015 and January of 2017. Patients with moderate to severe stage of AD, neurological comorbidities and major psychiatric disorders were excluded to minimize the confounding factors. Sixty five newly diagnosed early AD patients were included and bisected by the cutoff point of 5 in the short version of the Geriatric Depression Scale. Comparisons were done between two groups for vascular risk factors and other relevant clinic-demographic variables. Binary logistic regression analysis was additionally performed to estimate the effect of hypertension to the depressive symptoms. RESULTS: Among the investigated vascular risk factors, hypertension was associated with depressive symptom in the early AD patients. In the logistic regression, odd ratio of hypertension for depression was 4.34 (95% confidence interval 1.47-12.79). CONCLUSION: Depressive symptoms in the AD patients were associated with hypertension. Therefore, managing this vascular factor in the middle age may not only decrease the risk for neurovascular disorders, but also provide additional benefits in curtailing depression in AD.

The effects of the age onset on cognitive function in late life depression / 中国神经精神疾病杂志

Objective To investigate the cognitive characteristics and vascular risk factor between early onset de?pression and late onset depression in late life depression and provide a clue to elucidate the cause of cognitive impairment in late life depression. Method Fifty-six late life depression patients were recruited in our hospital, including 29 early on?set depression patients and 27 late onset depression patients. 25 controls were recruited from Guangzhou community. Cog?nitive evaluation were conducted in all the patients and controls, including MMSE, memory, attention, language, visuospa?tial abilities,executive function and Framingham vascular risk assessment, and analyze the cognitive and vascular risk be?tween the patients. Result There were statistically significant differences in overall cognitive assessment MMSE(24.8 ± 2.9,22.8±3.5,P=0.030), symbol digit modalities test(SDMT)(29.8±10.5, 22.9±11.8, P=0.028), clock drawing test(CDT) (3.6 ± 0.8, 2.9 ± 1.3, P=0.006) and trail making test(TMT) (60.4 ± 20.6, 74.7 ± 28.8, P=0.027) between late onset depression and early onset depression. In addition, the score of vascular risk assessment was significant between late onset depression and early onset depression(14.6±2.7,12.3±2.2,P=0.001). Conclusion Compare with early onset depression, late onset de?pression has much severe cognitive impairments and increased vascular risk factors.

A study of vascular risk factors and distribution characteristics in young acute lacunar infarction with intracranial large artery stenosis / 重庆医学

Objective To explore the independent risk factors and distribution of intracranial arterial stenosis in young pa‐tients with acute lacunar infarction .Methods We retrospectively reviewed the clinical data of 30-45 year‐old young patients with lacunar infarction who were admitted to the Third Affiliated Hospital of Xinxiang Medical University .The patients were divided in‐to two groups according to their skull blood vessel examination :intracranial arterial stenosis group and intracranial arterial stenosis group .Results There were 28 cases of intracranial large artery stenosis and 17 cases without stenosis in 45 young patients ,it was found that the levels of triglyceride ,low density lipoprotein cholesterol and carotid artery plaque in the intracranial arterial stenosis were significantly less than those of the intracranial artery stenosis (P0 .05) .Simple ante‐rior circulation stenosis in 12 cases ,simple posterior circulation stenosis in 8 cases ,only the anterior and posterior circulation in‐tracranial artery stenosis ,vascular risk factors were not statistically significant ( P> 0 .05 ) .Binary Logistic regression analysis showed that LDL cholesterol was an independent risk factor of intracranial arterial stenosis .Conclusion With intracranial artery stenosis in young patients with lacunar cerebral infarction prone to progressive stroke ,young patients with cerebrovascular infarc‐tion should be examined .

Risk Factors for Subjective Memory Impairment in Cognitively Normal Elderly

OBJECTIVES: We examined the risk factors for subjective memory impairment in cognitively normal elderly. METHODS: One hundred fifty five cognitively normal elderly individuals with subjective memory impairment and 126 normal control subjects without subjective memory impairment were selected. All participants underwent clinical evaluation for dementia and clinical psychiatric disorder conformed to the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet and Korean version of Mini-International Neuropsychiatric Interview, respectively. Korean version of Geriatric Depression Scale-Revised was administered to evaluate depression. Subjective memory impairment was defined as 1) subjective memory complaint by the participant and/or the informants and 2) evidence of memory impairment. RESULTS: Depression [odds ratio (OR)=1.07, 95% confidence interval (CI)=1.03-1.10] and female (OR=2.27, 95% CI=1.17-4.39) significantly increased the risk of subjective memory impairment in cognitively normal elderly. CONCLUSION: Depression can be a risk factor of subjective memory impairment in cognitively normal elderly. The clinicians should be vigilant regarding the presence of depression when assessing the subjects with subjective memory complaint.

Calidad de vida relacionada con la salud en usuarios de un programa comunitario de actividad f¡sica / Quality of life related to users of a communitary health program of phycal activity

Introducción:en Colombia existen pocos es- tudios que den cuenta de la percepción de la calidad de vida relacionada con la salud (CVRS) en usuarios de los programas de actividad física (AF). Objetivo: determinar la percepción de CVRS de los usuarios de un programa de AF en un municipio colombiano. Metodología:estudio transversal descriptivo. Participaron 1076 suje- tos, con promedio edad 56,6 años DE 12,8; el 88,3% mujeres. Se evaluaron variables socio- demográficas, factores de riesgo cardiovascular, niveles de AF y la percepción de la CVRS. Se realizó el análisis univariado, bivariado (U de Mann-whitney y Kruskal Wallis) y multivariado exploratorio (regresión lineal). Significancia estadística p<0,05. Resultados: Se incluyeron 1076 participantes, promedio edad 56,6 anos DE 12,8; el 88,3% mujeres. Los puntajes de CVRS variaron entre 65 y 70,2 con valores m s bajos en la dimension “ambiental” y mas alta en la “fisica”. Las variables que se asociaron a deterioro de la percepcion de CVRS fueron: dimension “fisica” (ser hombre, mayor edad, educacion baja, viudo, desempleado, fumar, ser hipertenso y tener diabetes mellitus); dimension psicologica (mayor edad, educacion baja, desempleado, fumador; dimension “social” (educacion baja); dimension “ambiental” (vivir en  area rural, educacion baja, desempleado y obesidad por % de grasa). Conclusion: La percepcion de CVRS se deteriora con variables sociodemograficas como el ser hombre, tener mayor edad, poseer un bajo nivel educativo, estar desempleado y padecer enfermedades como el tabaquismo, la hipertension arterial y la diabetes mellitus, con mayor afectacion en las dimensiones fisica y psicologica.

Introduction: There are in Colombia a few studies that give an account of Health- Related Quality of Life (HRQOL) in the programs of physical activity (PA) users. Objective: To determine the HRQOL perception among users of a PA program within a Colombian town. Methodology: transversal, descriptive study. Socio-demographic variables were evaluated, cardio-vascular risk factors, levels of PA and HRQOL perception. Univariate analysis were done, bivariate (U of Mann – whitney and Kruskal Wallis) and exploratory multivariate (lineal regression). Statistical significance p ˂0,05. Results: 1076 participants were included, average 56,6 years of age SD 12,8; 88.3% were women. The HRQOL scores varied between 65 and 70,2 with lower values among the environment dimension and the highest on the physical. The associated variables to the decline of the HRQOL perception were: physical dimension (to a man, adult, low educational background, widower, unemployed, smoker, hypertensive, and to have diabetes mellitus); psychological dimension (adult, low educational background, unemployed, smoker); social dimension (low educational background); environmental dimension (to live in a rural area, low educational background, unemployed and obesity percentage of fat). Conclusion: The HRQOL perception decayed with socio-demographic variables like to a man, being an adult, to have a low educational background, being an unemployed and to suffer from illnesses like smoking, high blood pressure and diabetes mellitus, affecting the physical and psychological dimensions.

Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil / Sintomas Cognitivos e Psicológicos nas Demências (SCPD) em pacientes com demência vascular isolada ou demência mista em ambulatório especializado no sudeste do Brasil

Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries. OBJECTIVE: We aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic. METHODS: We reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation. RESULTS: Two hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors. CONCLUSION: We found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.

Demência Vascular (DV) e comprometimento cognitivo vascular (CCV) são diagnósticos cada vez mais relatados em todos os continentes. Entretanto, o perfil dos sintomas comportamentais e psicológicos das demências (SCPD) nos pacientes com DV é ainda pouco descrito e caracterizado, nos países em desenvolvimento. OBJETIVO: Determinar a prevalência dos SCPD, o perfil de manifestações neuropsiquiátricas e cognitivas, nos pacientes com DV no ambulatório de Neurologia Cognitiva e Comportamental (ANCC), do Hospital das Clínicas da Universidade de São Paulo em Ribeirão Preto (HCRP-FMUSP). MÉTODOS: Revisamos os prontuários de 253 pacientes diagnosticados com DV ou CCV atendidos entre janeiro de 1996 e dezembro de 2005. Excluímos 19 pacientes que não completaram a investigação diagnóstica, não preencheram os critérios clínicos do DSM-IV, e neuroimagem não disponível para análise. Coletamos dados sócio-demográficos, nível de escolaridade, fatores de risco vascular, e SCPD da consulta de admissão. RESULTADOS: 234 pacientes foram incluídos nesta análise. A idade média global foi de 67,77±10,35; com 38% de mulheres; escolaridade de 2,84±2,96 anos; MEEM inicial 13,22±7,00, e 68% de CDR 2 & 3. 79% de pacientes com SCPD foram divididos nas seguintes categorias: psicose (52,6%), alucinações (23,5%), agitação (22,2%), depressão (17,5%) e apatia (17,5%) foram às manifestações mais prevalentes. Hipertensão Arterial e AVC prévio foram os fatores de risco de maior prevalência. CONCLUSÃO: Verificou-se elevada prevalência de SCPD em DV. O perfil destas alterações neuropsiquiátricas na DV mostrou uma tendência na direção de sintomatologia psicótica, devendo ser objeto de mais pesquisas, pois os padrões em nações desenvolvidas podem ser substancialmente diferentes.