Myriam Oróstegui

Major Cardiovascular Risk Factors in Latin America: A Comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO)

Background Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. Methods and Findings Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998–2007, n = 31,009) from eight LAC countries and from a national survey of the United States (US) population (1999–2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region’s average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). Conclusions Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.

Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease

Background:Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned.Objective:To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations.Methods:We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk ⩾20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points.Results:WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m2). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively.Conclusion:WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

Prevalence and impact of cardiovascular risk factors in Bucaramanga, Colombia: results from the Countrywide Integrated Noncommunicable Disease Intervention Programme (CINDI/CARMEN) baseline survey

Background Although cardiovascular diseases are the main cause of death in the region, there are few data on the prevalence of cardiovascular risk factors in Latin American. We studied the distribution and impact of cardiovascular risk factors in Bucaramanga, Colombia. Methods We conducted a cross-sectional study in a random sample of 2989 subjects 15–64 years old. Population attributable risks were estimated from Framingham risk scores. Results Smoking prevalence was 16.2% (men 26.3%; women 10.5%). Hypertension prevalence was 9.9% in women and 8.8% in men, but reached 50% in those 60–64 years old. After adjustment for body mass index, men were more likely to be hypertensive, but only if under 40 years old. Obesity was more frequent in women (15.7%) than in men (8.7%), even after age-adjustment. About 46% of the participants were overweight or obese. Women also had higher prevalence of high total cholesterol (19.7 versus 15.7%) and high low-density lipoprotein-cholesterol (23.9 versus 19.5%), but lower prevalence of low high-density lipoprotein (HDL)-cholesterol (22.2 versus 37.6%). Only low-HDL prevalence was significantly different after body mass index and age-adjustment. The prevalence of diabetes was similar in men and women (4%), but age and body mass index-adjusted impaired fasting glucose prevalence was 60% higher in women. Population attributable risks were larger and similar for high total cholesterol, hypertension, and large waist-to-hip ratio (19%). Conclusions Women had higher prevalence of all risk factors with the exception of smoking and low-HDL. Reduction in cholesterol levels, blood pressure and obesity is a priority to control the ongoing epidemic of cardiovascular diseases in this population.

The Latin American Consortium of Studies in Obesity (LASO).

Current, high‐quality data are needed to evaluate the health impact of the epidemic of obesity in Latin America. The Latin American Consortium of Studies of Obesity (LASO) has been established, with the objectives of (i) Accurately estimating the prevalence of obesity and its distribution by sociodemographic characteristics; (ii) Identifying ethnic, socioeconomic and behavioural determinants of obesity; (iii) Estimating the association between various anthropometric indicators or obesity and major cardiovascular risk factors and (iv) Quantifying the validity of standard definitions of the various indexes of obesity in Latin American population. To achieve these objectives, LASO makes use of individual data from existing studies. To date, the LASO consortium includes data from 11 studies from eight countries (Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Peru, Puerto Rico and Venezuela), including a total of 32 462 subjects. This article describes the overall organization of LASO, the individual studies involved and the overall strategy for data analysis. LASO will foster the development of collaborative obesity research among Latin American investigators. More important, results from LASO will be instrumental to inform health policies aiming to curtail the epidemic of obesity in the region.

Population-Based Case-Control Study of Renin-Angiotensin System Genes Polymorphisms and Hypertension among Hispanics

The effect of polymorphisms of the RAS genes on the incidence of hypertension seems to be population-dependent. We studied the effects of the angiotensinogen T174M and M235T, angiotensin converting enzyme insertion/deletion (ACE I/D), and angiotensin II receptor 1 (AT1R) A1166C gene polymorphisms on the risk of hypertension among Hispanics. We selected all cases (n=256) and 257 age and sex group-matched controls from a random sample of free living Colombians (n=2,989). Logistic regression was used to estimate the independent effect of each polymorphism. All polymorphisms were in Hardy-Weinberg equilibrium in controls, with the exception of M235T, which showed a small excess of heterozygotes (p=0.005; disequilibrium coefficient, D=−0.0264). After adjustment for age, sex, body mass index, race, physical activity, family history of hypertension and cardiovascular disease, and other polymorphisms, subjects with the ACE DD genotype were 1.56 times (95% confidence interval [CI]: 1.05, 2.33) more likely to be hypertensive than carriers of the I allele (p=0.03). Also, adjusted systolic and diastolic blood pressure were 4.58 (95% CI: −0.39, 9.56) and 3.32 (95% CI: 0.78, 5.86) mmHg higher in DD homozygous individuals than in carriers of the I allele, respectively. Approximately 15% of the cases of hypertension in this population could be attributed to carriage of the DD genotype. None of the other polymorphisms was associated with either hypertension or blood pressure level. In conclusion, the ACE DD genotype appears to be an independent risk factor for development of hypertension and may explain a significant fraction of incident cases among Hispanics.

Accuracy of the Omron HEM-705 CP for blood pressure measurement in large epidemiologic studies

BACKGROUND Accurate measurement of blood pressure is of utmost importance in hypertension research. In the context of epidemiologic and clinical studies, oscillometric devices offer important advantages to overcome some of the limitations of the auscultatory method. Even though their accuracy has been evaluated in multiple studies in the clinical setting, there is little evidence of their performance in large epidemiologic studies. OBJECTIVE We evaluated the accuracy of the Omron HEM-705-CP, an automatic device for blood pressure (BP) measurement, as compared to the standard auscultatory method with a mercury sphygmomanometer in a large cohort study. METHODS We made three auscultatory measurements, followed by two measurements with the Omron device in 1,084 subjects. Bias was estimated as the average of the two Omron minus the average of the last two auscultatory measurements, with its corresponding 95% limits of agreement (LA). RESULTS The Omron overestimated systolic blood pressure (SBP) by 1.8 mmHg (LA:-10.1, 13.7) and underestimated diastolic blood pressure (DBP) by 1.6 mmHg (LA:-12.3, 9.2). Bias was significantly larger in men. Bias in SBP increased with age and decreased with BP level, while bias in DBP decreased with age and increased with BP level. The sensitivity and specificity of the Omron to detect hypertension were 88.2% and 98.6%, respectively. Minimum bias in the estimates of the effects of several factors resulted from the use of Omron measurements. CONCLUSION Our results showed that the Omron HEM-705-CP could be used for measuring BP in large epidemiology studies without compromising study validity or precision.FUNDAMENTO: La medida precisa de la presion arterial (PA) es de gran importancia en la investigacion de la hipertension. En el contexto de estudios clinicos y epidemiologicos, dispositivos oscilometricos frecuentemente ofrecen importantes ventajas para superar algunas de las limitaciones del metodo auscultatorio. Aunque su precision haya sido evaluada en estudios multiples en el ambiente clinico, hay poca evidencia de su desempeno en grandes estudios epidemiologicos. OBJETIVO: Evaluamos la precision del Omron HEM-705-CP, un dispositivo automatico para medida de PA, cuando fue comparado con el metodo estandar auscultatorio con esfigmomanometro de mercurio, en un gran estudio de cohorte. METODOS: Tres medidas auscultatorias fueron obtenidas, seguidas por dos mediciones con el dispositivo Omron en 1.084 individuos. El sesgo fue estimado como la media de dos medidas por el dispositivo Omron menos la media de las dos ultimas medidas auscultatorias, con sus correspondientes limites de concordancia (LC) de 95%. RESULTADOS: El dispositivo Omron superestimo la presion arterial sistolica (PAS) por 1,8 mmHg (LC:-10,1, 13,7) y subestimo la presion arterial diastolica (PAD) por 1,6 mmHg (LC:-12,3, 9,2). El sesgo fue significantemente mayor en hombres. El sesgo en la PAS aumento con la edad y disminuyo con el nivel de la PA, mientras que el sesgo en la PAD disminuyo con la edad y aumento con el nivel de la PA. La sensibilidad y la especificidad del dispositivo Omron para detectar hipertension fueron 88,2% y 98,6%, respectivamente. El uso de las medidas del dispositivo Omron resulto en sesgo minimo en los estimados de los efectos de varios factores. CONCLUSION: Nuestros resultados demostraron que el dispositivo Omron HEM-705-CP puede ser utilizado para medir la PA en grandes estudios epidemiologicos sin comprometer la validez del estudio o su precision. (Arq Bras Cardiol 2011;96(5):393-398)

Precisão do aparelho Omron HEM-705 CP na medida de pressão arterial em grandes estudos epidemiológicos

BACKGROUND Accurate measurement of blood pressure is of utmost importance in hypertension research. In the context of epidemiologic and clinical studies, oscillometric devices offer important advantages to overcome some of the limitations of the auscultatory method. Even though their accuracy has been evaluated in multiple studies in the clinical setting, there is little evidence of their performance in large epidemiologic studies. OBJECTIVE We evaluated the accuracy of the Omron HEM-705-CP, an automatic device for blood pressure (BP) measurement, as compared to the standard auscultatory method with a mercury sphygmomanometer in a large cohort study. METHODS We made three auscultatory measurements, followed by two measurements with the Omron device in 1,084 subjects. Bias was estimated as the average of the two Omron minus the average of the last two auscultatory measurements, with its corresponding 95% limits of agreement (LA). RESULTS The Omron overestimated systolic blood pressure (SBP) by 1.8 mmHg (LA:-10.1, 13.7) and underestimated diastolic blood pressure (DBP) by 1.6 mmHg (LA:-12.3, 9.2). Bias was significantly larger in men. Bias in SBP increased with age and decreased with BP level, while bias in DBP decreased with age and increased with BP level. The sensitivity and specificity of the Omron to detect hypertension were 88.2% and 98.6%, respectively. Minimum bias in the estimates of the effects of several factors resulted from the use of Omron measurements. CONCLUSION Our results showed that the Omron HEM-705-CP could be used for measuring BP in large epidemiology studies without compromising study validity or precision.FUNDAMENTO: La medida precisa de la presion arterial (PA) es de gran importancia en la investigacion de la hipertension. En el contexto de estudios clinicos y epidemiologicos, dispositivos oscilometricos frecuentemente ofrecen importantes ventajas para superar algunas de las limitaciones del metodo auscultatorio. Aunque su precision haya sido evaluada en estudios multiples en el ambiente clinico, hay poca evidencia de su desempeno en grandes estudios epidemiologicos. OBJETIVO: Evaluamos la precision del Omron HEM-705-CP, un dispositivo automatico para medida de PA, cuando fue comparado con el metodo estandar auscultatorio con esfigmomanometro de mercurio, en un gran estudio de cohorte. METODOS: Tres medidas auscultatorias fueron obtenidas, seguidas por dos mediciones con el dispositivo Omron en 1.084 individuos. El sesgo fue estimado como la media de dos medidas por el dispositivo Omron menos la media de las dos ultimas medidas auscultatorias, con sus correspondientes limites de concordancia (LC) de 95%. RESULTADOS: El dispositivo Omron superestimo la presion arterial sistolica (PAS) por 1,8 mmHg (LC:-10,1, 13,7) y subestimo la presion arterial diastolica (PAD) por 1,6 mmHg (LC:-12,3, 9,2). El sesgo fue significantemente mayor en hombres. El sesgo en la PAS aumento con la edad y disminuyo con el nivel de la PA, mientras que el sesgo en la PAD disminuyo con la edad y aumento con el nivel de la PA. La sensibilidad y la especificidad del dispositivo Omron para detectar hipertension fueron 88,2% y 98,6%, respectivamente. El uso de las medidas del dispositivo Omron resulto en sesgo minimo en los estimados de los efectos de varios factores. CONCLUSION: Nuestros resultados demostraron que el dispositivo Omron HEM-705-CP puede ser utilizado para medir la PA en grandes estudios epidemiologicos sin comprometer la validez del estudio o su precision. (Arq Bras Cardiol 2011;96(5):393-398)

Dental care associated with an outbreak of HIV infection among dialysis patients

An outbreak of 14 cases of human immunodeficiency virus (HIV) infection was discovered by chance in May 1993 among hemodialysis patients at a university hospital in Bucaramanga, Colombia. The outbreak occurred in 1992. Stored sera were used to establish the probable period of infection (PPI) for 10 of the 14 cases. A nested case-control study was carried out to evaluate possible transmission mechanisms. The health care experience of each HIV-positive patient during that patients PPI was compared to the experience of time-matched controls. Only invasive dental procedures were significantly associated with the risk of infection. Patients upon whom invasive dental procedures were performed during their PPIs had an average risk of HIV infection 8.15 times greater than comparable controls (P = 0.006), and seven out of nine cases of HIV infection with known PPIs in 1992 had an invasive dental procedure performed one to six months before seroconversion. None of the dental care personnel were found to be infected. Based on the available evidence, it seems most likely that the infection was transmitted from patient to patient by contaminated dental instruments.

Precisión del aparato Omron HEM-705 CP en la medida de presión arterial en grandes estudios epidemiológicos

BACKGROUND Accurate measurement of blood pressure is of utmost importance in hypertension research. In the context of epidemiologic and clinical studies, oscillometric devices offer important advantages to overcome some of the limitations of the auscultatory method. Even though their accuracy has been evaluated in multiple studies in the clinical setting, there is little evidence of their performance in large epidemiologic studies. OBJECTIVE We evaluated the accuracy of the Omron HEM-705-CP, an automatic device for blood pressure (BP) measurement, as compared to the standard auscultatory method with a mercury sphygmomanometer in a large cohort study. METHODS We made three auscultatory measurements, followed by two measurements with the Omron device in 1,084 subjects. Bias was estimated as the average of the two Omron minus the average of the last two auscultatory measurements, with its corresponding 95% limits of agreement (LA). RESULTS The Omron overestimated systolic blood pressure (SBP) by 1.8 mmHg (LA:-10.1, 13.7) and underestimated diastolic blood pressure (DBP) by 1.6 mmHg (LA:-12.3, 9.2). Bias was significantly larger in men. Bias in SBP increased with age and decreased with BP level, while bias in DBP decreased with age and increased with BP level. The sensitivity and specificity of the Omron to detect hypertension were 88.2% and 98.6%, respectively. Minimum bias in the estimates of the effects of several factors resulted from the use of Omron measurements. CONCLUSION Our results showed that the Omron HEM-705-CP could be used for measuring BP in large epidemiology studies without compromising study validity or precision.FUNDAMENTO: La medida precisa de la presion arterial (PA) es de gran importancia en la investigacion de la hipertension. En el contexto de estudios clinicos y epidemiologicos, dispositivos oscilometricos frecuentemente ofrecen importantes ventajas para superar algunas de las limitaciones del metodo auscultatorio. Aunque su precision haya sido evaluada en estudios multiples en el ambiente clinico, hay poca evidencia de su desempeno en grandes estudios epidemiologicos. OBJETIVO: Evaluamos la precision del Omron HEM-705-CP, un dispositivo automatico para medida de PA, cuando fue comparado con el metodo estandar auscultatorio con esfigmomanometro de mercurio, en un gran estudio de cohorte. METODOS: Tres medidas auscultatorias fueron obtenidas, seguidas por dos mediciones con el dispositivo Omron en 1.084 individuos. El sesgo fue estimado como la media de dos medidas por el dispositivo Omron menos la media de las dos ultimas medidas auscultatorias, con sus correspondientes limites de concordancia (LC) de 95%. RESULTADOS: El dispositivo Omron superestimo la presion arterial sistolica (PAS) por 1,8 mmHg (LC:-10,1, 13,7) y subestimo la presion arterial diastolica (PAD) por 1,6 mmHg (LC:-12,3, 9,2). El sesgo fue significantemente mayor en hombres. El sesgo en la PAS aumento con la edad y disminuyo con el nivel de la PA, mientras que el sesgo en la PAD disminuyo con la edad y aumento con el nivel de la PA. La sensibilidad y la especificidad del dispositivo Omron para detectar hipertension fueron 88,2% y 98,6%, respectivamente. El uso de las medidas del dispositivo Omron resulto en sesgo minimo en los estimados de los efectos de varios factores. CONCLUSION: Nuestros resultados demostraron que el dispositivo Omron HEM-705-CP puede ser utilizado para medir la PA en grandes estudios epidemiologicos sin comprometer la validez del estudio o su precision. (Arq Bras Cardiol 2011;96(5):393-398)

Atención dental asociada con un brote de infección por VIH en pacientes en diálisis

En mayo de 1993 se descubrio fortuitamente un brote de 14 casos de infeccion por virus de la inmunodeficiencia humana (VIH) en pacientes sometidos a hemodialisis en un hospital universitario de Bucaramanga, Colombia. El brote tuvo lugar en 1992. Se usaron sueros almacenados para determinar el periodo de infeccion probable (PIP) de 10 de los 14 casos y se llevo a cabo un estudio de casos y controles anidado a fin de evaluar los posibles mecanismos de transmision. La atencion de salud recibida por cada paciente positivo a VIH durante su PIP se comparo con la atencion recibida por controles apareados con los casos en tiempo. Solamente los procedimientos odontologicos invasores mostraron una asociacion significativa con el riesgo de infeccion. Los pacientes sometidos a procedimientos dentales invasores durante su PIP tuvieron un riesgo promedio de infeccion 8,15 veces mayor que los controles de caracteristicas similares (P = 0,006), y de nueve casos de infeccion por VIH con PIP conocidos en 1992, siete habian sido sometidos a un procedimiento dental invasor 1 a 6 meses antes de la seroconversion. No se detecto infeccion en ninguno de los miembros del personal de salud dental. A juzgar por las pruebas disponibles, lo mas probable es que la infeccion haya sido transmitida de un paciente a otro por instrumentos dentales contaminados.