Giovanna Valentino

Comparison of Lipoprotein-Associated Phospholipase A2 and High Sensitive C-Reactive Protein as Determinants of Metabolic Syndrome in Subjects without Coronary Heart Disease: In Search of the Best Predictor

High sensitivity C-reactive protein (hsCRP) is a marker of metabolic syndrome (MS) and cardiovascular (CV) disease. Lipoprotein-associated phospholipase A2 (Lp-PLA2) also predicts CV disease. There are no reports comparing these markers as predictors of MS. Methods. Cross-sectional study comparing Lp-PLA2 and hsCRP as predictors of MS in asymptomatic subjects was carried out; 152 subjects without known atherosclerosis participated. Data were collected on demographics, cardiovascular risk factors, anthropometric and biochemical measurements, and hsCRP and Lp-PLA2 activity levels. A logistic regression analysis was performed with each biomarker and receiver operating characteristic (ROC) curves were constructed for MS. Results. Mean age was 46 ± 11 years, and 38% of the subjects had MS. Mean Lp-PLA2 activity was 185 ± 48 nmol/mL/min, and mean hsCRP was 2.1 ± 2.2 mg/L. Subjects with MS had significantly higher levels of Lp-PLA2 (P = 0.03) and hsCRP (P < 0.0001) than those without MS. ROC curves showed that both markers predicted MS. Conclusion. Lp-PLA2 and hsCRP are elevated in subjects with MS. Both biomarkers were independent and significant predictors for MS, emphasizing the role of inflammation in MS. Further research is necessary to determine if inflammation predicts a higher risk for CV events in MS subjects.

Impacto de un programa de rehabilitación cardiovascular fase II sobre la calidad de vida de los pacientes

Antecedentes: La rehabilitación cardiovascular (RCV) ha demostrado mejorar la capacidad física (CF) y la calidad de vida. La relación de estos aspectos ha sido escasamente reportada en Chile. Objetivos: 1) Determinar el impacto de la RCV fase II sobre la calidad de vida, medida por la encuesta SF36 y, 2) determinar qué factores, relacionados con el paciente, pueden incidir en esta relación. Método: Estudio prospectivo en sujetos que completaron 36 sesiones de un programa de RCV y Prevención Secundaria (PREV2). Se registraron al ingreso y final de la RCV: antecedentes médicos, factores de riesgo cardiovascular (CV), parámetros antropométricos, previsión de salud, CF (determinada por los metros caminados en test de marcha de 6 minutos-TM6) y puntaje en la encuesta SF36. Resultados: 277 sujetos (78% hombres, edad 59 años). Hubo una mejoría significativa en: a) los metros caminados (diferencia final/inicial= 56 metros, p<0.0001), b) puntaje de salud física (68 vs 79; p<0.0001), c) salud emocional (68 vs 78, p<0.0001) del SF36. Los hombres caminaron más metros promedio (p<0.0001). Hubo una asociación significativa entre los deltas del TM6 final-inicial y SF36 final-inicial, sólo para salud física (p<0.01). Por un aumento de 10 metros caminados en el TM6 final se incrementa el puntaje de la SF36 para salud física (Hombres: 0.38/ Mujeres: 1.52). La mejoría en la salud emocional sólo se asoció significativamente con los cambios en la salud física (p<0.0001). Conclusión: Los pacientes que asisten a un programa de RCV mejoran significativamente su capacidad aeróbica, y su percepción de salud física y emocional. María José Bustamante1, Mónica Acevedo1, Giovanna Valentino1, 2, Cinthia Casasbellas1, María José Saavedra1, Marcela Adasme1, Lorena Orellana1, Ismael Vergara1, Ramón Corbalán1, Carlos Navarrete3.

Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago

Background: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. Aim: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. Material and methods: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. Results: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p<0.01) and diabetes (p<0. 01) and tended to be older (p=0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p=0. 09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p =0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. Conclusions: The new ACC / AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Does Good Aerobic Capacity Attenuate the Effects of Aging on Cardiovascular Risk Factors? Results from a Cross-Sectional Study in a Latino Population

Background. High aerobic capacity is associated with low cardiovascular (CV) risk. The aim of this study was to determine the CV RF burden in subjects with aerobic capacity ≥10 METs and compare it with those having <10 METs. Methods. Cross-sectional study in 2646 subjects (mean age 48 ± 12 years). Demographics, medical history, physical activity, cardiovascular RFs, fasting lipids and blood glucose levels, blood pressure, and anthropometric measurements were collected. Aerobic capacity was determined by exercise stress test. The ACC/AHA 2013 pooled cohort equation was used to calculate CV risk. Logistic models were built to determine the probability of having ≥2 RFs versus 0‐1 RF, by age and sex, according to aerobic capacity. Results. 15% of subjects had aerobic capacity < 10 METs. The ACC/AHA scores were 15% in men and 6% in women with <10 METs and 5% and 2%, respectively, in those with ≥10 METs. The probability of having ≥2 RFs increased with age in both groups; however, it was significantly higher in subjects with <10 METs (odds ratio [OR]: 2.54; 95% CI: 1.92–3.35). Conclusions. Aerobic capacity ≥ 10 METs is associated with a better CV RF profile and lower CV risk score in all age groups, regardless of gender.

Waist to Stature (height) Ratio and Clustering of Metabolic Syndrome Components in Chilean Children and Adolescents

Obesity in children and adolescents is associated with increased risk of presenting metabolic syndrome (MS) and cardiovascular risk in the long term. Waist to stature (height) ratio (WSR) is a good marker of MS in adults and children and may become a simple parameter to predict the clustering of MS components in subjects at risk. Aims: To determine whether higher values of WSR are associated with the progressive aggregation of MS components among Chilean school-aged children. Methods and results: Cross-sectional study in 618 children from urban Santiago. Weight, height, waist circumference, systolic and diastolic blood pressure, and fasting lipid profile and glycemia were determined. Diagnosis of MS was based on the presence of 3 or more out of 5 components of MS defined by Cook et al. (increased waist circumference and blood pressure, hypertriglyceridemia, low HDL cholesterol and hyperglycemia). ROC curves and proportional odds were used to analyze the relationships between WSR and MS and its components. Mean age of the children was 11± 2 years old, 52% female. MS prevalence was 15%. Mean WSR was 0.53 ± 0.1. The best WSR cutoff to diagnose MS was 0.55 (72% sensitivity and 70% specificity). Using a proportional odds model, for each 0.01 increment in WSR, the OR of increasing one or more component of the MS was 1.27 (IC 95%: 1.22-1.32).

DOES A GOOD FUNCTIONAL CAPACITY (≥10 METS) ATENUATE THE EFFECTS OF AGING ON CARDIOVASCULAR RISK FACTORS? RESULTS FROM THE CARDIOVASCULAR RISK PROFILE FROM SUBJECTS OF ALL AGES ACCORDING TO FUNCTIONAL CAPACITY

Aerobic capacity >10 METS is associated with a low cardiovascular (CV) risk, but most studies have been done in sedentary populations. There is scarce evidence of the risk factor profile (RF) in subjects with good functional capacity (METS) by age. We aim to determine the CV RF profile in subjects

Body fat and its relationship with clustering of cardiovascular risk factors.

BACKGROUND Body mass index (BMI) and waist circumference (WC) are the most commonly measured anthropometric parameters given their association with cardiovascular risk factors (RFs). The relationship between percentage body fat (%BF) and cardiovascular risk has not been extensively studied. AIMS This study evaluated %BF and its relationship with cardiometabolic RFs in healthy subjects and compared these findings with the relationship between BMI/ WC and cardiovascular RFs. METHODS This was a cross-sectional study of 99 males and 83 females (mean age 38 ± 10 years) evaluated in a preventive cardiology program. All subjects completed a survey about RFs and lifestyle habits. Anthropometric parameters, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting lipid profile, and blood glucose were collected. Body fat was determined using four skinfold measurements. Fat mass index (FMI) was also calculated. RESULTS Percentage body fat was significantly and directly associated with total cholesterol (R(2)=0.11), triglycerides (R(2)=0.14), low-density lipoprotein cholesterol (R(2)=0.16), non-high-density lipoprotein cholesterol (R(2)=0.24), fasting blood glucose (R(2)=0.16), SBP (R(2)=0.22), and DBP (R(2)=0.13) (p<0.001 for all) and inversely related to high-density lipoprotein cholesterol (R(2)=0.32; p<0.001). When the models of %BF, FMI, WC, and BMI were compared, all of them were significantly related to the same cardiometabolic RFs and the clustering of them. CONCLUSION Percentage body fat and FMI were significantly associated with biochemical variables and to the clustering of RFs. However, these associations were similar but not better than WC and BMI.

Impaired Fasting Glucose in Nondiabetic Range: Is It a Marker of Cardiovascular Risk Factor Clustering?

Background. Impaired fasting glucose (IFG) through the nondiabetic range (100–125 mg/dL) is not considered in the cardiovascular (CV) risk profile. Aim. To compare the clustering of CV risk factors (RFs) in nondiabetic subjects with normal fasting glucose (NFG) and IFG. Material and Methods. Cross-sectional study in 3739 nondiabetic subjects. Demographics, medical history, and CV risk factors were collected and lipid profile, fasting glucose levels (FBG), C-reactive protein (hsCRP), blood pressure (BP), anthropometric measurements, and aerobic capacity were determined. Results. 559 (15%) subjects had IFG: they had a higher mean age, BMI, waist circumference, non-HDL cholesterol, BP, and hsCRP (p < 0.0001) and lower HDL (p < 0.001) and aerobic capacity (p < 0.001). They also had a higher prevalence of hypertension (34% versus 25%; p < 0.001), dyslipidemia (79% versus 74%; p < 0.001), and obesity (29% versus 16%; p < 0.001) and a higher Framingham risk score (8% versus 6%; p < 0.001). The probability of presenting 3 or more CV RFs adjusted by age and gender was significantly higher in the top quintile of fasting glucose (≥98 mg/dL; OR = 2.02; 1.62–2.51). Conclusions. IFG in the nondiabetic range is associated with increased cardiovascular RF clustering.

Dieta DASH y menopausia: Más allá de los beneficios en hipertensión arterial

Resumen: La disminucion en la produccion de estro-genos durante la menopausia favorece una disminucion en la funcion endotelial y en la mineralizacion osea, ade-mas de cambios en la distribucion de la grasa corporal. Estos cambios favorecen un aumento en la prevalencia de hipertension arterial en mujeres mayores de 50 anos, junto con un aumento en otros factores de riesgo cardio-vascular y una disminucion de la densidad osea (DO). La terapia de reemplazo hormonal utilizada en estas mu-jeres para mitigar los cambios descritos, se ha asociado a un mayor riesgo de desarrollar nefrolitiasis. La dieta DASH ha demostrado ser efectiva en reducir la presion arterial y en este trabajo se discuten otros beneficios de esta dieta asociados a otros factores de riesgo, a la DO y en la mantencion de la homeostasis urinaria. Por este motivo, se discute si la dieta DASH seria efectivamente beneficiosa en este grupo de mujeres independiente de sus efectos en la presion arterial. Dieta DASH y menopausia: Mas alla de los beneficios en hipertension arterial