The Influence of Diabetes, Hypertension, and Hyperlipidemia on the Onset of Age-Related Macular Degeneration in North China: The Kailuan Eye Study / 生物医学与环境科学（英文）

Objective@#To analyze the prevalence of dry and wet age-related macular degeneration (AMD) in patients with diabetes, hypertension and hyperlipidemia, and to analyze the risk factors for AMD.@*Methods@#A population-based cross-sectional epidemiologic study was conducted involving 14,440 individuals. We assessed the prevalence of dry and wet AMD in diabetic and non-diabetic subjects and analyzed the risk factors for AMD.@*Results@#The prevalence of wet AMD in diabetic and non-diabetic patients was 0.3% and 0.5%, respectively, and the prevalence of dry AMD was 17% and 16.4%, respectively. The prevalence of wet AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 0.5%, 0.3%, 0.2%, and 0.7%, respectively. The prevalence of dry AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 16.6%, 16.2%, 15.2%, and 17.2%, respectively. Age, sex, body mass index, and use of hypoglycemic drugs or lowering blood pressure drugs were corrected in the risk factor analysis of AMD. Diabetes, diabetes/hypertension, diabetes/hyperlipidemia, and diabetes/hypertension/hyperlipidemia were analyzed. None of the factors analyzed in the current study increased the risk for the onset of AMD.@*Conclusion@#There was no significant difference in the prevalence of wet and dry AMD among diabetic and non-diabetic subjects. Similarly, there was no significant difference in the prevalence of wet and dry AMD among subjects with hypertension and hyperlipidemia. Diabetes co-existing with hypertension and hyperlipidemia were not shown to be risk factors for the onset of dry AMD.

Ocorrência de dislipidemias e fatores associados em adultos: um estudo de prevalência / Incidencia de dislipidemias y factores asociados en adultos: un estudio de prevalencia / Occurrence of dyslipidemia and associated factors in adults: a prevalence study

RESUMO Objetivo: estimar a prevalência de dislipidemias e os fatores associados em adultos de Rio Branco, Acre. Métodos: estudo de delineamento seccional, populacional, que avaliou adultos (18 a 59 anos) residentes nas zonas urbana e rural de Rio Branco em 2014. As dislipidemias foram definidas conforme os critérios da Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Ateroscle rose. Empregou-se regressão logística para estimar as odds ratio (OR) e intervalos de confiança de 95% (IC95%). Resultados: a prevalência de dislipidemia, HDL-c baixo, hipertrigliceridemia isolada, hipercolesterolemia isolada e hiperlipidemia mista foi de 56,1%, 37,4%, 23,6%, 9,8% e 3,5%, respectivamente. No modelo final multivariado, apenas a obesidade (OR = 1,86; IC95%: 1,12;3,10) manteve associação estatisticamente significativa com a dislipidemia. Entre os subtipos de dislipidemias, associaram-se à hipertrigliceridemia isolada as variáveis: faixa etária de 40 a 49 anos (OR = 2,17; IC95%: 1,53;4,80); hipercolesterolemia isolada (OR = 2,52; IC95%: 1,23;5,15); HDL-c baixo (OR = 2,53; IC95%: 1,65;3,86); obesidade (OR = 2,10; IC95%: 1,25;3,53); e diabetes mellitus (OR = 5,41; IC95%: 1,46;20,4). Conclusão: a prevalência de alterações lipídicas foi elevada entre adultos. Estratégias de intervenções para diagnóstico, tratamento e intensificação de medidas preventivas e orientações de estilo de vida saudáveis são importantes nessa população.

RESUMEN Objetivo: estimar la prevalencia de dislipidemias y los factores asociados en adultos de Rio Branco, Acre-Brasil. Métodos: estudio de investigación seccional, poblacional, que evaluó adultos (18 a 59 años) residentes en las zonas urbana y rural de Rio Branco en 2014. Las dislipidemias fueron definidas conforme a los criterios de la Actualización de la Directriz Brasileña de Dislipidemias y Prevención de la Aterosclerosis. Se empleó regresión logística para estimar las odds ratio (OR) e intervalos de confianza del 95% (IC95%). Resultados: la prevalencia de dislipidemia, HDL-c bajo, hipertrigliceridemia aislada, hipercolesterolemia aislada e hiperlipidemia mixta fue de 56,1%, 37,4%, 23,6%, 9,8% y 3,5%, respectivamente. En el modelo final multivariado, solo la obesidad (OR = 1,86; IC95%: 1,12;3,10) mantuvo una asociación estadísticamente significativa con la dislipidemia. Entre los subtipos de dislipidemias, se asociaron a la hipertrigliceridemia aislada las variables: franja etaria de 40 a 49 años (OR = 2,17; IC95%: 1,53;4,80); hipercolesterolemia aislada (OR = 2,52; IC95%: 1,23;5,15); HDL-c bajo (OR = 2,53; IC95%: 1,65;3,86); obesidad (OR = 2,10; IC95%: 1,25;3,53); y diabetes mellitus (OR = 5,41; IC95%: 1,46;20,4). Conclusión: la prevalencia de cambios lipídicos fue elevada entre adultos. Estrategias de intervenciones para el diagnóstico, tratamiento e intensificación de medidas preventivas y orientaciones de estilo de vida saludables son importantes en esa población.

ABSTRACT Objective: to estimate the prevalence of dyslipidemia and associated factors in adults in Rio Branco, Acre. Methods: a cross-sectional, population-based study that assessed adults (age 18 to 59 years) living in urban and rural areas of Rio Branco in 2014. Dyslipidemias were defined according to the criteria of the Brazilian Guidelines Update on Dyslipidemias and Prevention of Atherosclerosis. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). Results: the prevalence of dyslipidemia, low HDL-c, isolated hypertriglyceridemia, isolated hypercholesterolemia and mixed hyperlipidemia was 56.1%, 37.4%, 23.6%, 9.8% and 3.5%, respectively. In the final multivariate model, only obesity (OR = 1.86; CI95%: 1.12; 3.10) maintained a statistically significant association with dyslipidemia. Among the dyslipidemia subtypes, the following variables were associated with isolated hypertriglyceridemia: age group 40 to 49 years (OR = 2.17; CI95%: 1.53; 4.80); isolated hypercholesterolemia (OR = 2.52; CI95%: 1.23; 5.15); low HDL-c (OR = 2.53; CI95%: 1.65; 3.86); obesity (OR = 2.10; CI95%: 1.25;3.53); and diabetes mellitus (OR = 5.41; CI95%: 1.46; 20.4). Conclusion: the prevalence of lipid alterations was high among adults. Intervention strategies for diagnosis, treatment and intensification of preventive measures and healthy lifestyle guidelines are important in this population.

Comparación de puntajes de riesgo para predecir aterosclerosis subclínica / Comparison of risk scores to predict subclinical atherosclerosis

La aterosclerosis subclínica es un potente predictor de eventos cardiovasculares, aunque se desconoce cuál de los puntajes de riesgo es más eficaz para predecir su presencia en una población latinoamericana. El objetivo fué comparar la performance de los puntajes de riesgo: Framingham, Regicor y Atherosclerotic Cardiovascular Disease Risk Estimator para predecir la existencia de aterosclerosis subclínica en pacientes asintomáticos sin enfermedad cardiovascular conocida; así como determinar la prevalencia y distribución en los distintos lechos vasculares. Desde 2014 a 2017 se evaluaron pacientes de 35 a 75 años asintomáticos y sin enfermedad cardiovascular conocida, a quienes se les realizó una eco Doppler carotídea y femoral, y score de calcio. Se definió como aterosclerosis subclínica a la presencia de placas en las arterias carótidas y/o femorales o a la presencia de calcio en las coronarias (score de Agatston > 0). Se estudiaron así 212 pacientes, edad media 53 ± 7 años, de los cuales el 60% (128) eran varones. La prevalencia de aterosclerosis subclínica fue 62% (131 casos). De esos 131 con placa en alguno de los territorios, el Atherosclerotic Cardiovascular Disease Risk Estimator fue el que identificó el mayor número de casos con riesgo cardiovascular elevado (39%), Framingham detectó 20%, y Regicor 0% (p < 0.01). La reclasificación neta fue del 41%, 50% y 60% respectivamente (< 0.01). La prevalencia de aterosclerosis subclínica en sujetos asintomáticos sin antecedentes de enfermedad cardiovascular fue 62%. El calculador Atherosclerotic Cardiovascular Disease Risk Estimator fue el más efectivo para predecir aterosclerosis subclínica en esta población.

Subclinical atherosclerosis is a powerful predictor of cardiovascular events, although it is unknown which of the risk scores is more useful to predict its presence in a Latin American population. The objective was to compare the performance of the risk scores: Framingham, Regicor and Atherosclerotic Cardiovascular Disease Risk Estimator to predict the presence of subclinical atherosclerosis in asymptomatic persons without known cardiovascular disease; as well as determining its prevalence and distribution in the different vascular beds. From 2014 to 2017, patients from 35 to 75 years, asymptomatic and without known cardiovascular disease who underwent a carotid and femoral Doppler echo and calcium score were evaluated. Subclinical atherosclerosis was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score > 0). A total of 212 patients were included. The mean age was 53 ± 7 years, of which 60% (128) were male. The prevalence of subclinical atherosclerosis was 62% (131 cases). Of these 131 subjects with a plaque in any of the territories, the Atherosclerotic Cardiovascular Disease Risk Estimator was the one that identified the highest number of cases with high cardiovascular risk (39%), Framingham detected 20%, and Regicor 0% (p < 0.01). The net reclassification was 41%, 50% and 60% respectively (< 0.01). The prevalence of subclinical atherosclerosis in asymptomatic persons without a history of cardiovascular disease was 62%. The Atherosclerotic Cardiovascular Disease Risk Estimator was the most effective predictor of subclinical atherosclerosis in this population.

Evolución del riesgo cardiovascular y sus factores en Temuco entre 1989 y 2011-12 / Cardiovascular risk factors among males in 1989 and 2011-12 in a southern Chilean city

Background: A successful cardiovascular prevention program should induce a reduction of risk factors along time. Aim: To assess changes in cardiovascular risk factors among males aged between 35 and 65 years living in Southern Chile. Material and Methods: The results of two cross sectional household surveys, with a probability sampling stratified by socioeconomic status, were analyzed. Two hundred males were evaluated in 1989 and 800 in 2011-12, paired by age for selection. Results: In the second survey, a mean weight increase of 4.5 kg was recorded. Body mass index increased from 27.1 to 28.6 kg/m² (p < 0.01), especially in men younger than 45 years old. No changes in smoking prevalence were observed. The prevalence of hypertension and hypertensive patients in treatment increased from 32.7 to 38.1% and from 17 to 33%, respectively. The number of treated hypertensive patients with a well-controlled blood pressure did not change significantly. In 1989 and 2011-12, mean total cholesterol values were 192 and 201 mg/dl respectively (p < 0.01). The figures for mean non-HDL cholesterol were 152 and 160 mg/dl (p = 0.03). The frequency of people with total cholesterol over 240 mg/dl or using statins increased from 15 to 25% (p < 0.01). The estimated 10 years risk of myocardial infarction and coronary death using Framingham tables was 9,0 in both periods (p = 0.95). Conclusions: In a 22 years period an increase in the prevalence of obesity and elevated total cholesterol was observed. There was a higher proportion of individuals treated for hypertension and dyslipidemia, but without reduction in the estimated cardiovascular risk.

Avaliação dos níveis lipídicos na população adulta do estudo ESATU: associação com a obesidade / Evaluation of lipid profile in adult population of ESATU study: association with obesity

Introdução: Atualmente, a doença aterosclerótica detém uma posição indiscutível de principal causa de mortalidade nos países desenvolvidos. Mesmo sendo de caráter multifatorial, é determinante a relação direta das dislipidemias e riscos de eventos cardiovasculares e obesidade. O objetivo do estudo foi determinar os níveis séricos do perfil lipídico e prevalência de dislipidemia na população adulta de um município no Sul do Brasil e sua associação com a obesidade. Métodos: Estudo transversal de base populacional com adultos residentes em Tubarão, Santa Catarina, entre novembro de 2011 e junho de 2012. Os participantes foram submetidos à entrevista, coleta de sangue para realização de exames laboratoriais, aferição da pressão arterial e antropometria. Resultados: Foram estudados 369 adultos, com média de idade de 40,6±12,2 anos, 64,0% mulheres. Entre os fatores comportamentais 31,4% eram fumantes/ ex-fumantes, 8,4% eram alcoolistas, 61,0% eram sedentários e 62,1% não apresentavam um padrão alimentar considerado saudável. Quanto às condições clínicas, foi verifi cado que 6,0% eram diabéticos, 36,9% apresentavam hipertensão arterial sistêmica, 27,1% eram obesos e 65% dislipidêmicos. Houve associação positiva entre dislipidemia e idade mais avançada, ter companheiro fixo, baixa escolaridade, tabagismo, obesidade e hipertensão arterial sistêmica. Conclusão: A prevalência de dislipidemia foi de 65%, e obesidade e tabagismo foram fatores associados de forma independente ao desfecho. Os resultados indicam a necessidade de intervenções que promovam um estilo de vida saudável, com ênfase na adoção de hábitos alimentares adequados e exercício físico (AU)

Introduction: At present atherosclerosis holds an undisputed position as the leading cause of death in developed countries. Despite its multifactorial nature, the direct relationship of dyslipidemia and risk of cardiovascular events and obesity is determinant. The aim of the study was to determine serum lipid profiles and prevalence of dyslipidemia in the adult population of a city in south Brazil and their association with obesity. Methods: Cross-sectional population-based study with adults living in Tubarão, Santa Catarina, between November 2011 and June 2012. Participants underwent an interview, blood collection for laboratory tests, blood pressure measurement and anthropometry. Results: We studied 369 adults with a mean age of 40.6 ± 12.2 years, 64.0% women. Among behavioral factors, 31.4 % were smokers/ex-smokers, 8.4% were alcoholics, 61.0 % were sedentary, and 62.1 % did not have an eating pattern considered healthy. Regarding clinical conditions, we found that 6.0% were diabetic , 36.9% had high blood pressure, 27.1% were obese and 65% had dyslipidemia. There was a positive correlation of dyslipidemia with older age, having a steady partner, low education, smoking, obesity and hypertension. Conclusion: The prevalence of dyslipidemia was 65%, and obesity and smoking were independently associated factors with the outcome. The results indicate the need for interventions that promote a healthy lifestyle, with an emphasis on adopting proper eating habits and exercise (AU)

Dyslipidemia in young adults aged [20-40] years attending Baghdad teaching hospital and Al-Mansour primary health care center in Baghdad city

Hyperlipidemia is a condition characterized by high quantities of lipids in the blood stream. Lipids include cholesterol, triglycerides and phospholipids. Fats and cholesterol are generally processed in the liver and carried on proteins in the blood, forming lipoproteins. Its complications include pancreatitis, atherosclerosis, coronary artery diseases and stroke. Is to estimate the prevalence of hyperlipidemia in the Iraqi young adults aged 20-40 years and to shed a light on any significant association between some socio-demographic and life style variables with hyperlipidemia. A cross-sectional study was conducted from the first of December 2011 to the first of June 2012. The prevalence rate of any lipid abnormality [at least one abnormality] was 75%.The prevalence rates of elevated serum total cholesterol, low serum high density lipoprotein cholesterol, elevated serum triglyceride and elevated serum low density lipoprotein cholesterol were [32.5%, 38.5%, 29.5%, 30%], respectively. The prevalence rate of elevated TC/HDL ratio was 61%. There is a high prevalence of lipid abnormality in young adults of whom males had higher prevalence than females but the difference was not significant. The significant associated risk factors with hyperlipidemia were age, BMI, newly diagnosed or uncontrolled diabetic and hypertensive patients, cholesterol/fat rich diet and type of cooking oil

Cardiovascular disorders risk factors in different industries of Iran

Disorders of cardiovascular system can cause disability or death, screening is necessary specially in workers who maybe had risk factors. Hypertension, hyperlipidemia, obesity, smoking, genetic, exposure to chemicals, fumes, solvents, coldness are non occupational and occupational risk factors. Objective was comparison of cardiovascular disorders risk factors between workers in different industries of Iran. In a cross-sectional study, workers of automobile, food industries and light works had been selected and cardiovascular disorders risk factors had been gathered then data analyzed in SPSS with one-way ANOVA, Chi-2 and multi nominal logistic regression with P < 0.05. 875 workers had been participated in the study, all of the cardiovascular disorders risk factors were in the normal range. Mean of high density lipoprotein [HDL] in food industry workers was 63.83 +/- 17.42 mg/dl and it was protective, but in workers who work in automobile industry was 38.97 +/- 11.08 mg/dl and the lowest, Also hypertension and hypertriglyceridemia were more prominent in this industry and after regression with P < 0.05, the differences were significant. Screening of cardiovascular disorders risk factors were important and helpful in industries specially automobile industry, that might be preventive method for these disorders in the future

Factores de riesgo cardiovascular en una población urbana de Colombia / Cardiovascular risk factors in an urban Colombia population

Objetivo Evaluar la prevalencia de los factores de riesgo cardiovascular en una población urbana entre 25 y 50 años del municipio de Santa Rosa de Osos, Antioquia 2009. Determinar el Porcentaje de Riesgo Atribuible Poblacional para infarto agudo al miocardio de los factores de riesgo coronario. Materiales y Métodos Se realizó un estudio de prevalencia, con muestreo aleatorio bietápico en 357 personas sin enfermedad cardiovascular conocida, se administró una encuesta prediseñada para evaluar la prevalencia de los factores de riesgo cardiovascular; se midieron en sangre colesterol total, lipoproteínas de baja y alta densidad, triglicéridos y glucosa; se tomaron valores de presión arterial, perímetro abdominal, talla y peso. Resultados Los factores de riesgo cardiovascular más importantes fueron baja actividad física (56,6 por ciento), obesidad central (52,7 por ciento), dislipidemias (35,3 por ciento), tabaquismo (19,0 por ciento), síndrome metabólico (19,6 por ciento) y obesidad por Índice de Masa Corporal (17,4 por ciento). Los factores de riesgo con mayor riesgo atribuible poblacional fueron la hipertensión arterial (17,1 por ciento), Índice colesterol total/lipoproteína de alta densidad (16,4 por ciento) y baja actividad física (15,7 por ciento). Conclusión Se encontró una prevalencia alta de los factores de riesgo cardiovascular lo que puede llevar a un incremento de las enfermedades cardiovasculares a mediano y largo plazo.

Objective Evaluating the prevalence of cardiovascular risk factors in an urban population aged 25 to 50 in Santa Rosa de Osos, Antioquia, Colombia, during 2009. Determining the population attributable risk percentage (PARP) for coronary heart disease risk factors. Materials and Methods A prevalence study was conducted; two-stage random sampling was made of 357 people without known cardiovascular disease. A pre-designed survey was administered to assess the prevalence of cardiovascular risk factors; total cholesterol, low and high density lipoproteins, triglycerides and glucose were measured in blood and blood pressure, waist circumference and weight were also measured.Results The most important cardiovascular risk factors were physical inactivity (56.6 percent), central obesity (52.7 percent), dyslipidaemia (35.3 percent), smoking (19 percent), metabolic syndrome (19.6 percent) and obesity according to body mass index (17.4 percent). Risk factors having the highest PARP were hypertension (17.1 percent), total cholesterol/high density lipoprotein index (16.4 percent) and physical inactivity (15.7 percent). Conclusion A high prevalence of cardiovascular risk factors was found; this may lead to increased cardiovascular disease in the medium- and long-term.

Hyperlipidaemia in patients with sleep-related breathing disorders: Prevalence & risk factors.

Background & objectives: several studies have shown a close relationship between obstructive sleep apnoea (OSA) and dyslipidaemia. This study was designed to clarify the relationship of metabolic dysfunctions in sleep related-breathing disorders (SRBD), including OSA and simple snoring. The end point was to determine the prevalence of hyperlipidaemia and hyperuricaemia in SRBD. Factors contributing to hyperlipidaemia and hyperuricaemia in SRBD were also evaluated. Methods: Outpatients >20 yr old with complaint of habitual snoring were prospectively enrolled. All patients underwent an overnight polysomnography (PSG) in a sleep laboratory and blood assay after overnight fasting. The factors of gender, age, body mass index (BMI), apnoea-hypopnoea index (AHI), and desaturation index (DI) were recorded in the PSG report. A logistic regression analysis was conducted to investigate the relationship between metabolic dysfunctions and these factors. Results: Of the 275 patients (88.4% male), 236 (85.8%) were diagnosed with OSA (AHI>5/h). The mean (± SD) of age, BMI, AHI, and DI were 44.2 ± 11.4 yr, 27.4 ± 4.0 kg/m2, 37.9 ± 30.6/h, and 21.2 ± 23.2/h, respectively. The overall prevalence of hypercholesterolaemia, hypertriglyceridaemia, and hyperuricaemia in this study was 61.1, 55.3, and 25.8 per cent, respectively. Logistic regression analysis revealed that DI was a significant independent factors contributing to hypercholesterolaemia [odds ratio (OR)=1.016, P=0.010, 95% confidence interval (CI)=1.004-1.028] and hypertriglyceridaemia (OR=1.021, P=0.002, 95% CI=1.008-1.034). Interpretation & conclusions: The data of the present study support a high prevalence of hyperlipidaemia in SRBD. DI may be a determining factor contributing to hyperlipidaemia in SRDB. Underdiagnosis of hyperlipidaemia in SRBD is a critical problem.

[Frequency of risk factors for atherosclerosis in children with family history of premature myocardial infarction]

Clinical manifestations of coronary artery disease such as myocardial infarction generally have onset from middle age onwards. However, studies indicate that the atherosclerotic process begins to develop during childhood. The purpose of this study was to evaluate the frequency of risk factors for atherosclerosis in children with family history of premature myocardial infarction in Arak city in 2007. This was a cross sectional study in which 209 children and adolescents aged 3-18 years with a family history of early onset myocardial infarction were selected base on convenience sampling. Total cholesterol, low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], triglycerides, blood pressure, weight and height and fasting blood sugar were investigated. Data were analyzed by SPSS. The prevalence of hypercholesterolemia and hypertriglyceridemia were 28.2% and 20.1% respectively. 19.1% of these individuals had HDL-C values lower than 35mg/dL. 19/1% of them had LDL-C levels higher than 129 mg/dL. 4/31% presented hypertension and 28/71% had excessive weight. There was no relationship between hyperlipidemia and fasting blood sugar. However, there was significant association between hyperlipidemia and level of BMI and blood pressure [P<0.05]. More than a quarter of children had at least one risk factor for atherosclerosis. Obesity was identified to be significantly associated with hyperlipidemia. These results emphasis the importance of evaluating children and adolescents with family history of early onset myocardial infarction for atherosclerotic disease

Early-onset type 2 diabetes in a Mexican survey: results from the National Health and Nutrition Survey 2006 / Diabetes tipo 2 de inicio temprano en una encuesta nacional: resultados de la Encuesta Nacional de Salud y Nutrición 2006

OBJECTIVE: To describe the characteristics of patients with type 2 diabetes diagnosed before age 40 (early-onset type 2 diabetes) identified in a nation-wide, population-based study. MATERIALS AND METHODS: The survey was done in Mexico during 2006. Medical history, anthropometric and biochemical measurements were obtained in every subject. RESULTS: Cases diagnosed before (n=181) and after age 40 (n=659) were included. Early-onset type 2 diabetes was present in 13.1 percent of the previously diagnosed, 30.3 percent of the cases identified during the survey and 21.5 percent of the whole population with diabetes. These individuals had a greater prevalence of obesity and hypertriglyceridemia compared to the cases diagnosed after age 40. CONCLUSIONS: Early-onset type 2 diabetes was present in 21.5 percent of patients with type 2 diabetes in Mexico. Close to 70 percent of them were obese or overweight and had the clinical profile of the metabolic syndrome.

OBJETIVO: Describir las características de los pacientes con diabetes diagnosticados antes de los 40 años en una encuesta representativa de la población mexicana. MATERIAL Y MÉTODOS: La encuesta fue realizada en México durante 2006. Se registró la historia médica, mediciones antropométricas y bioquímicas de los participantes. RESULTADOS: Se incluyeron casos diagnosticados antes (n=181) y después (n=659) de los 40 años. La diabetes tipo 2 de inicio temprano está presente en 13.1 por ciento de los casos previamente diagnosticados, 30.3 por ciento de los identificados durante la encuesta y en 21.5 por ciento de la población total con diabetes. En los casos diagnosticados antes de los 40 años hay una prevalencia mayor de obesidad e hipertrigliceridemia que en los diagnosticados después de los 40. CONCLUSIONES: La diabetes de aparición temprana está presente en 21.5 por ciento de los casos con diabetes en México. Setenta por ciento de ellos tenían un peso mayor al saludable y tenían el perfil clínico del síndrome metabólico.

The status of diabetes care in Mexican population: are we making a difference? Results of the National Health and Nutrition Survey 2006 / El cuidado de la diabetes en población mexicana: ¿estamos siguiendo la estrategia correcta? Resultados de la Encuesta Nacional de Salud y Nutrición 2006

OBJECTIVE: Examine clinical indicators to evaluate diabetes care in Mexico. MATERIAL AND METHODS: Diabetics (self reported, with therapy) were examined with standardized questionnaires, anthropometry, glucose, lipids and glycohemoglobin. Data were analyzed statistically. RESULTS: There were 2 644 patients, 677 cases without access to medical care (73 percent women), most lived in rural communities and spoke aboriginal dialect. Prevalence of obesity for private access group was 21.2 percent, for other or non access group was between 31 and 65 percent. The group without or basic education was most common, 76 percent of the cases had HDL <40 mg/dl and 36 percent had hypertriglyceridemia. Only 6.6 percent of patients had HbA1c <7 percent. There was no significant difference between HbA1c values observed in the group with or without access. Most patients were treated with oral agents. A significant group was without therapy. Assessments for complications was infrequent. CONCLUSIONS: Current model for diabetes care in Mexico is inefficacious and a paradigm change is necessary.

OBJETIVO: Examinar indicadores para evaluar la atención de diabetes en México. MATERIAL Y MÉTODOS: Se examinaron diabéticos (autorreportados, con tratamiento) con cuestionario estandarizado, antropometría, glucosa, lípidos y hemoglobina glucosilada. Los datos se analizaron estadísticamente. RESULTADOS: De 2 644 casos, 677 no tenían acceso a atención médica (73 por ciento mujeres), la mayoría eran de comunidades rurales y hablaban un dialecto indígena. La prevalencia de obesidad en el grupo con acceso privado fue 21,2 por ciento; en personas con otro o sin acceso, fue entre 31 y 65 por ciento. El grupo sin o con educación básica fue el más común. El 76 por ciento de los casos tenían colesterol HDL <40 mg/dl y 36 por ciento tenía hipertrigliceridemia. Sólo 6.6 por ciento tenían la HbA1c <7 por ciento. No hubo diferencias entre valores de HbA1c en el grupo con o sin acceso. La mayoría recibían hipoglucemiantes orales, muchos sin tratamiento. La evaluación de complicaciones fue infrecuente. CONCLUSIONES: El modelo de atención de diabetes en México es ineficaz y es preciso cambiar de paradigma.

Prevention of cardiovascular disease based on lipid lowering treatment: a challenge for the Mexican health system / Prevención de la enfermedad cardiovascular basada en tratamiento hipolipemiante: un reto para el sistema de salud de México

OBJECTIVE: To estimate the percentage of Mexican adults that may require lipid-lowering treatment according to National Cholesterol Education Program-III guidelines, using data from the National Health and Nutrition Survey 2006 (ENSANut 2006). MATERIAL AND METHODS: Information was obtained from 4 040 subjects aged 20 to 69 years, studied after a 9 to 12 hours fast. RESULTS: A cardiovascular risk equivalent was found in 13.8 percent and >2 risk factors were present in 31.5 percent of the population. LDL-C concentrations were above the treatment goal in 70 percent of the high-risk group and in 38.6 percent of subjects with >2 risk factors. Nearly 12 million Mexicans should be taught how to change their lifestyles and close to 8 million individuals require drug therapy to decrease their cardiovascular risk. CONCLUSIONS: Thirty percent of Mexican adults require some form of lipid-lowering treatment (lifestyle modifications in 36.25 percent, drug therapy in 24.19 percent).

OBJETIVO: Calcular el porcentaje de adultos que requiere tratamiento hipolipemiante de acuerdo con las recomendaciones del Programa Nacional de Educación en Colesterol-III, usando los datos de la Encuesta Nacional de Salud y Nutrición 2006. MATERIAL Y MÉTODOS: Se incluyeron 4040 individuos con edad entre 20 y 69 años estudiados bajo un ayuno de 9 a 12 horas. RESULTADOS: Un equivalente de enfermedad cardiovascular fue identificado en 13.8 por ciento de los participantes. El 31.5 por ciento de la población tenía >2 factores de riesgo cardiovascular. La concentración de colesterol LDL estuvo arriba de la meta terapéutica en 70 por ciento de los casos con alto riesgo cardiovascular y en el 38.6 por ciento de los sujetos con >2 factores de riesgo. Cerca de 12 millones de mexicanos deben modificar su estilo de vida para reducir su concentración de colesterol LDL. Casi 8 millones califican para recibir tratamiento farmacológico. CONCLUSIONES: Una tercera parte de los adultos requiere alguna forma de tratamiento hipolipemiante (cambios en el estilo de vida: 36.25 por ciento, medicamentos: 24.19 por ciento).

Frequency of dyslipidemia in Pakistani soldiers in multan garrison

To determine the frequency of dyslipidemia in army soldiers in Multan garrison. Descriptive study. Department of Medicine at Combined Military Hospital Multan from January 1998 to January 2000. One thousand, otherwise healthy male soldiers, from various units in Multan Garrison were included in this study. Their fasting venous blood samples were obtained in sterile disposable syringe for lipid profile test. Those who were smokers or had history of diabetes mellitus, hypothyroidism or family history of early coronary heart disease [CHD] were excluded. Sixty eight [6.8%] soldiers were found to have dyslipidemia. Thirty [3%] had low HDL levels, 26 [2.6%] had increased serum triglyceride levels, 10 [1.0%] soldiers were found having isolated increase in LDL-cholesterol level with normal total serum cholesterol, and 2[0.2%] were having raised total and LDL cholesterol levels. Eighty four percent of studied population was not aware of the fact that dyslipidemia is a risk factor for heart disease. Frequency of dyslipidemia in Pakistani soldiers is moderate and it can be further reduced by increasing the awareness of disease

Las enfermedades crónicas no transmisibles en México: sinopsis epidemiológica y prevención integral / Chronic non-communicable diseases in Mexico: epidemiologic synopsis and integral prevention

El gobierno federal desarrolla acciones para reducir la mortalidad por las "enfermedades crónicas no transmisibles" (ECNT). Una de ellas es la creación de unidades médicas de especialidad (Uneme) diseñadas para el tratamiento especializado de las ECNT (sobrepeso, obesidad, riesgo cardiovascular y diabetes). La intervención se basa en la participación de un grupo multidisciplinario entrenado ex profeso, la educación del paciente sobre su salud, la incorporación de la familia al tratamiento y la resolución de las condiciones que limitan la observancia de las recomendaciones. El tratamiento está indicado con base en protocolos estandarizados. La eficacia de la intervención se evalúa en forma sistemática mediante indicadores cuantitativos predefinidos. Se espera que las Uneme resulten en ahorros para el sistema de salud. En suma, este último desarrolla mejores medidas de control para las ECNT. La evaluación del desempeño de las Uneme generará información para planear acciones preventivas futuras.

The federal government has implemented several strategies to reduce mortality caused by chronic non-communicable diseases (CNTD). One example is the development of medical units specialized in the care of CNTD (i.e. overweight, obesity, cardiovascular risk and diabetes), named UNEMES (from its Spanish initials). These units -consisting of an ad-hoc, trained, multi-disciplinary team- will provide patient education, help in the resolution of obstacles limiting treatment adherence, and involve the family in patient care. Treatment will be provided using standardized protocols. The efficacy of the intervention will be regularly measured using pre-specified outcomes. We expect that these UNEMES will result in significant savings. In summary, our health care system is developing better treatment strategies for CNTD. Evaluating the performance of the UNEMES will generate valuable information for the design of future preventive actions.

Análise do perfil lipídico de mulheres idosas em Curitiba - Paraná / Analysis of the lipid profile of elderly woman in Curitiba - Parana

FUNDAMENTO: A dislipidemia é considerada um dos principais fatores de risco para a doença cardiovascular, que, por sua vez, é mais freqüente em indivíduos de idade avançada. Contudo, evidências sugerem que uma parcela da população idosa desconhece a característica de seu perfil lipídico, assim como muitos não possuem acesso a um tratamento adequado. OBJETIVO: Analisar o perfil lipídico e a freqüência da utilização da terapia hipolipemiante de mulheres idosas em Curitiba - Paraná. MÉTODOS: A amostra foi composta por 312 mulheres (idade média 68,8; desvio padrão 6,0 anos). O perfil lipídico foi determinado por meio das dosagens de colesterol total (CT), colesterol de lipoproteína de alta densidade (HDL-C), colesterol de lipoproteína de baixa densidade (LDL-C) e triglicerídeos (TG). A utilização da terapia hipolipemiante foi verificada por meio de auto-relato, em seguida os grupos foram divididos em dois subgrupos, satisfatório e insatisfatório. RESULTADOS: Foi encontrada uma grande prevalência de indivíduos com valores insatisfatórios nos componentes do perfil lipídico, no grupo que relatou não estar sob terapia hipolipemiante: 74,2 por cento das mulheres portadoras de doenças cardiovasculares (DCV) apresentaram valores superiores à meta lipêmica para o LDL-C (<100,0 mg/dl). Por sua vez, 45,8 por cento a 49,3 por cento dos indivíduos do grupo que relatou utilizar medicamento hipolipemiante apresentaram valores insatisfatórios para CT, TG e LDL-C, e 25,4 por cento obtiveram valores de HDL-C inferiores a 40,0 mg/dl. CONCLUSÃO: Os resultados desta investigação indicam uma alta prevalência de mulheres idosas, independentemente do auto-relato de utilizar terapia hipolipemiante, com o perfil lipídico desfavorável, principalmente em relação à meta lipêmica para o LDL-C nas mulheres idosas portadoras de DCV.

BACKGROUND: Dyslipidemia is considered one of the main risk factors for cardiovascular disease (CVD), which is more frequent in older individuals. However, evidence suggests that a large number of elderly individuals is not aware of their lipid profile status; additionally, many of them do not have access to adequate treatment. OBJECTIVE: To analyze the lipid profile and the frequency of lipid-lowering therapy use in elderly women from the city of Curitiba, state of Parana, Brazil. METHODS: The sample consisted of 312 women (mean age = 68.8; SD = 6.0 years). The lipid profile was determined by plasma levels of total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C) and triglycerides (TG). The number of subjects that reported being on lipid-lowering therapy was self-reported; therefore, the groups were divided into two subgroups, satisfactory and unsatisfactory. RESULTS: A high prevalence of individuals with unsatisfactory levels of lipid profile components was observed in the group that self-reported not being on lipid-lowering therapy; of these, 74.2 percent of women with CVD presented levels above the LDL-C goal. On the other hand, 45.8 to 49.3 percent of the individuals from the group that self-reported being on lipid-lowering therapy had unsatisfactory values of TC, TG and LDL-C, and 25.4 percent had HDL-C levels lower than 40.0 mg/dl. CONCLUSION: The results of this investigation indicate a high prevalence of elderly women, regardless of self-reports of being on lipid-lowering therapy, with an unsatisfactory lipid profile, mainly related to LDL-C goal for those individuals with CVD.

Hiperlipidemias e fatores dietéticos: estudo transversal entre nipo-brasileiros / Hyperlipidemias and dietary patterns: transversal study of japanese brazilians

Este estudo teve como objetivo avaliar a associação entre hiperlipidemia e dieta de nipo-brasileiros de Bauru, município do Estado de São Paulo. Foram obtidos de 1.330 indivíduos dados mediante questionários previamente testados (dados demográficos e dietéticos). Os exames físicos e laboratoriais incluíram a coleta (ou dosagem) antropométrica, de pressão arterial, de glicemia de jejum e de 2 horas, de perfil lipídico e de TSH e T4 livre. Utilizaram-se teste qui-quadrado e medida de odds ratio para avaliar associação entre as variáveis estudadas e presença de hiperlipidemia. Foi encontrado 81,5 por cento de hiperlipidêmicos e acometeu, principalmente, indivíduos tabagistas, com excesso de peso, hipotireoidismo, hipertensão arterial e intolerância a glicose. Observaram-se, mediante análise bruta, relações entre hiperlipidemia e ácido graxo saturado, ácido oléico e fibras de grãos e cereais. Após o ajuste para as variáveis de controle, observaram-se associações entre hiperlipidemia e consumo de lípides (totais, ácido oléico, saturados e trans), fibras e álcool. Conclui-se que mudanças no estilo de vida, particularmente no hábito alimentar, podem levar a uma melhora do quadro hiperlipidêmico e que o consumo de lípides pode ser um dos principais fatores para o aumento da hiperlipidemia. Estudos prospectivos auxiliarão para testar essas hipóteses nos nipo-brasileiros de Bauru.

This study aimed at evaluating the association between hyperlipidemia and dietary patterns of Japanese Brazilians with and without hypothyroidism from Bauru, city in the State of São Paulo. We evaluated 1,330 individuals by means of demographic and dietary measurement, whom were gotten through standardized questionnaires previously tested. Clinical examination and laboratory data were anthropometry, blood pressure, fasting and 2-h glucose load, lipid profile and TSH and free T4. The chi-square and the odds ratio were used to evaluate associations between hyperlipidemia with studied variables. The prevalence of hyperlipidemia was 81.5 percent and it was associated with smokers, overweight, hypothyroid, hypertensive and glucose intolerants. We observed, in crude analysis, relationships with the presence of hyperlipidemia and fat saturated, oleic acid and dietary fiber from grains and cereals. After adjusting for the control variables, we observed relationships between hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) with habitual intake of total fat, oleic acid, saturated fat, trans fat, dietary fiber and alcohol. As a conclusion, changes in the style of life, particularly in the dietary habits, can improve lipidic profile and that lipids intake can be a risk factor for hyperlipidemia. Prospectives studies will help test the hypothesis in Japanese Brazilians from Bauru.

Hyperlipidemia and glucose intolerance in patients with HIV infection receiving antiretroviral therapy

OBJETIVO: Determinar la prevalencia de los efectos secundarios sobre el metabolismo de los lípidos y la glucosa provocados por la terapia antirretrovírica hiperactiva (TARHA), así como el impacto que el uso de los distintos esquemas de antirretrovíricos tiene sobre los lípidos y la glucosa en un grupo de pacientes de Yucatán, México.MATERIAL Y MÉTODOS: Se realizó un estudio transversal. A cada paciente se le aplicó un cuestionario creado para este estudio y se le determinaron los valores de colesterol total, triglicéridos y glucosa en ayuno. Se determinó la prevalencia de hiperlipidemia y alteraciones de la glucosa y su relación con las variables de la encuesta.RESULTADOS: Se estudiaron 211 pacientes, 36 (17%) mujeres y 175 (83%) hombres; 92 (44%) tuvieron hiperlipidemia. De éstos, 43 (20%) presentaron hipercolesterolemia (HC) y 82 (39%) hipertrigliceridemia (HT). La presencia de HC e HT combinadas se verificó en 30 (14%) pacientes; además, 19 (9%) pacientes exhibieron alteraciones en la glucosa, seis (3%) presentaron diabetes mellitus y 13 (6%), intolerancia a la glucosa. Las variables que se vincularon con la presencia de hiperlipidemia fueron los números de linfocitos CD4 >350 células/µl [RM= 2.79 (1.08-7.27), p= 0.03], el género masculino [RM= 3.6 (1.4-9.12), p= 0.006] y el uso de nucleósidos inhibidores de la transcriptasa inversa (NITI) [RM= 3.1 (1.2-8.1), p= 0.01].CONCLUSIONES: Los pacientes con la infección por el VIH que reciben terapia antirretroviral (TAR) tienen un riesgo aumentado de presentar dislipidemia. A diferencia de lo que informan la mayor parte las publicaciones, las alteraciones de los lípidos se asociaron con más frecuencia al uso de NITI, por lo que se concluye que la patogenia de estas alteraciones no es única y que resulta probable la existencia de un efecto sinérgico entre las distintas familias de fármacos antirretrovíricos y que otros factores del huésped participen en la génesis de estas alteraciones.

Incidencia de las dislipidemias y su relación con la cardiopatía isquémica en la población del Policlínico Héroes del Moncada / Incidence of dyslipidemias and their relation to ischemic heart disease in the population of Héroes del Moncada Polyclinic

Con el objetivo de conocer la incidencia de las dislipidemias y su relación con la cardiopatía isquémica en la población perteneciente al Policlínico ¨Héroes del Moncada¨ de Ciudad de La Habana, se estudiaron 311 pacientes de edades comprendidas entre los 18 y los 91 años, a los que se les aplicó una encuesta confeccionada por el Centro de Investigaciones y Referencias de la Aterosclerosis de La Habana y se les determinaron los niveles sanguíneos de colesterol total (CT), HDL-colesterol, LDL-colesterol, VLDL-colesterol y triglicéridos (TG). Obtuvimos una incidencia de dislipidemias no tratadas de un 47 por ciento. Los triglicéridos, VLDL-colesterol, colesterol total y HDL-colesterol, son las lipoproteínas que presentaron un riesgo significativo para la enfermedad cardiovascular aterosclerótica, con un predominio de hipertrigliceridemia. Entre los restantes factores de riesgo estudiados, la diabetes mellitus junto a las dislipidemias constituyeron los factores que se relacionaron más con la incidencia de cardiopatía isquémica