RESUMO
Background Blood pressure is determined by the interactions between the heart and arterial properties, and subjects with identical blood pressure may have substantially different hemodynamic determinants. Whether arterial hemodynamic indices quantified by impedance cardiography ( ICG ), a simple operator-independent office procedure, independently predict all-cause mortality in adults from the general population, and specifically among those who do not meet criteria for American College of Cardiology/American Heart Association stage 2 hypertension, is currently unknown. Methods and Results We studied 1639 adults aged 18 to 80 years from the general population. We used ICG to measure hemodynamic parameters and metrics of cardiac function. We assessed the relationship between hemodynamic parameters measured at baseline and all-cause mortality over a mean follow-up of 10.9 years. Several ICG parameters predicted death. The strongest predictors were total arterial compliance index (standardized hazard ratio=0.38; 95% confidence interval=0.31-0.46; P<0.0001) and indices of cardiac contractility: velocity index (standardized hazard ratio=0.45; 95% confidence interval=0.37-0.55; P<0.0001) and acceleration index (standardized hazard ratio=0.44; 95% confidence interval=0.35-0.55; P<0.0001). These remained independently predictive of death after adjustment for multiple confounders, as well as systolic and diastolic blood pressure. Among subjects without stage 2 hypertension (n=1563), indices of cardiac contractility were independently predictive of death and identified a subpopulation (25% of non-stage-2 hypertensives) that demonstrated a high 10-year mortality risk, equivalent to that of stage 2 hypertensives. Conclusions Hemodynamic patterns identified by ICG independently predict mortality in the general population. The predictive value of ICG applies even in the absence of American College of Cardiology/American Heart Association stage 2 hypertension and identifies higher-risk individuals who are in earlier stages of the hypertension continuum.
Assuntos
Cardiografia de Impedância/métodos , Hemodinâmica/fisiologia , Hipertensão/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Arterial wave reflections are important determinants of central pressure pulsatility and left ventricular afterload. The augmentation index (AIx) is the most widely used surrogate of arterial wave reflections. Despite multiple cross-sectional studies assessing the correlates of AIx, little prospective data exist regarding changes in AIx over time. We aimed to assess the predictors of changes in AIx over time in adults from the general population. METHODS: We performed radial arterial tonometry assessments a median of 3.18 ± 0.4 years apart on 143 nondiabetic adult participants in the population-based PREVENCION study. Central AIx was obtained using the generalized transfer function of the Sphygmocor device. RESULTS: Predictors of the change in AIx over time were investigated. Among men (n = 67), the change in AIx was predicted by abdominal obesity (standardized ß for waist circumference = 0.34; P = 0.002), impaired fasting glucose (standardized ß = 0.24; P = 0.009), and the change in heart rate (standardized ß = -0.78; P < 0.001). Among women (n = 76), the change in AIx was predicted by non-high-density lipoprotein cholesterol (standardized ß = 0.33; P = 0.001), C-reactive protein levels (standardized ß = 0.24; P = 0.02), change in mean arterial pressure (standardized ß = 0.33; P = 0.001), and change in heart rate (standardized ß = -0.52; P < 0.001). CONCLUSIONS: Metabolic and inflammatory factors predicted changes in AIx over time, with important sex differences. Metabolic factors, such as abdominal obesity and impaired fasting glucose, predicted changes in AIx in men, whereas C-reactive protein and non-high-density lipoprotein cholesterol levels predicted changes in women. Our findings highlight the impact of sex on arterial properties and may guide the design of interventions to favorably impact changes in late systolic pressure augmentation.
Assuntos
Aorta/fisiopatologia , Pressão Arterial , Hipertensão/fisiopatologia , Adulto , Biomarcadores/sangue , Glicemia/análise , Proteína C-Reativa/análise , Colesterol/sangue , Feminino , Frequência Cardíaca , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Manometria , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/epidemiologia , Peru/epidemiologia , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Circunferência da Cintura , Adulto JovemRESUMO
Chronic diseases are the leading cause of morbidity and mortality worldwide. These conditions require considerable time investment and resources from the health system in Peru, as well as from patients and their families. Paradoxically, the developed medical strategies for managing these conditions generate a constant and increasing burden for the patient and their environment, which affects quality of life and therapeutic results. In this article, the role of shared decision making and minimal disruptive medicine will be described as strategies to address these problems.
Assuntos
Doença Crônica/terapia , Tomada de Decisões , Gerenciamento Clínico , Humanos , PeruRESUMO
Las enfermedades crónicas son la causa más importante de morbilidad y mortalidad a nivel mundial. Estas condiciones requieren considerable inversión de tiempo y recursos por parte del sistema de salud en el Perú, así como de los pacientes y sus familiares. Paradójicamente, las estrategias médicas desarrolladas para el manejo de estas condiciones generan una carga constante y creciente para el paciente y su entorno, que repercute en la calidad de vida del paciente y en los resultados terapéuticos. En este artículo describimos el rol de la toma de decisiones compartidas y de la medicina mínimamente impertinente como estrategias para abordar estos problemas.
Chronic diseases are the leading cause of morbidity and mortality worldwide. These conditions require considerable time investment and resources from the health system in Peru, as well as from patients and their families. Paradoxically, the developed medical strategies for managing these conditions generate a constant and increasing burden for the patient and their environment, which affects quality of life and therapeutic results. In this article, the role of shared decision making and minimal disruptive medicine will be described as strategies to address these problems.
Assuntos
Humanos , Masculino , Feminino , Assistência Centrada no Paciente , Doença Crônica , Tomada de Decisões , PeruRESUMO
OBJECTIVE: We aimed to establish optimal definitions for abdominal obesity and metabolic syndrome (MetS) among Andean adults. RESEARCH DESIGN AND METHODS: Among 1,448 Andean adults, we assessed the relationship between waist circumference and subclinical vascular disease assessed by carotid intima-media thickness (cIMT) and manifest cardiovascular disease (M-CVD). RESULTS: Optimal waist circumference cutoffs to classify individuals with abnormal cIMT or M-CVD were >97 and >87 cm in men and women, respectively. With these cutoffs, there was substantial disagreement between the original American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and the recently updated MetS definition, particularly among men (kappa = 0.85). Subjects with MetS identified by the updated definition but not meeting the original AHA/NHLBI MetS criteria demonstrated significantly increased cIMT (P < 0.001) compared with subjects who did not meet the MetS criteria by either definition. CONCLUSIONS: Our findings support the use of ethnic-specific waist circumference cutoffs and the updated MetS definition in Andean adults.
Assuntos
Síndrome Metabólica/diagnóstico , Obesidade Abdominal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hispânico ou Latino , Humanos , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Obesidade Abdominal/etnologia , Circunferência da Cintura , Adulto JovemRESUMO
Antecedentes Las enfermedades cardiovasculares están convirtiéndose en importante causa de mortalidad en Latinoamérica. En Perú son necesarios estimados confiables de prevalencia, tipo y distribución de factores de riesgo cardiovascular, en especial de hipertensión y de prehipertensión arterial, para diseñar adecuados programas de prevención. Objetivo Determinar la prevalencia y las características epidemiológicas, así como las alteraciones hemodinámicas y metabólicas asociadas a la hipertensión y a la prehipertensión arterial en Arequipa Metropolitana. Material y Métodos El Estudio PREVENCION (Prevalencia de Enfermedades Cardiovasculares y Factores de Riesgo Coronario en Arequipa) es un estudio poblacional realizado en esta ciudad que incluyó una muestra representativa de la población adulta de 1878 personas. Se efectuaron determinaciones de presión arterial así como estudios hemodinámicos, tales como velocidad de la onda de pulso arterial aórtico (VOPAA), doppler arterial, tonometría arterial, amplificación de la onda del pulso, determinación del índice de resistencia vascular sistémica (IRVS) y medición del índice de aceleración de la contracción cardiaca (IACC). En cada paciente además se determinó la glicemia en ayunas, el perfil lipídico y microalbuminuria. Resultados La prevalencia de hipertensión arterial fue de 15.7 por ciento (IC al 95 por ciento =14.0û17.4 por ciento) la que se incrementó progresivamente con la edad, especialmente en mujeres (p para la interacción menor que 0.0001). La prevalencia fue mayor en varones antes de los 50 y en mujeres después de los 50 años. La prevalencia de prehipertensión fue de 30.3 por ciento (IC al 95 por ciento =27.8-32.9 por ciento). El tipo predominante de hipertensión fue la sistodiastólica (41.7 por ciento de casos; IC al 95 por ciento =35.1-48.5 por ciento). La hipertensión sistólica aislada representó sólo el 29.3 por ciento (IC al 95 por ciento =23.9-35.4 por ciento) y correspondió a la minoría de casos...
Background Cardiovascular disease has emerged as a leading cause of death in Latin America. Reliable estimates of the prevalence, patterns and population distribution of cardiovascular risk factors, especially of hypertension and prehypertension in Peru, are needed in order to design appropriate prevention programs. Objective We aimed to determine the prevalence, epidemiological characteristics, and hemodynamic and metabolic changes associated with hypertension and prehypertension in Arequipa city. Methods PREVENCION Study (for Prevalencia de Enfermedades Cardiovasculares y Factores de Riesgo Coronario en Arequipa) is a population based-study undertaken in this city in a representative sample of adult people, which enrolled 1878 subjects. Arterial pressure and hemodynamic studies such as aortic pulse wave velocity (APWV), arterial Doppler, arterial tonometry, pulse wave amplification, systemic vascular resistance index (SVRI) and cardiac contraction acceleration index (CCAI) were measured. We also determined fasting glucose, cholesterol and triglycerides and microalbuminuria in each subject. Results The prevalence of hypertension was 15.7 per cent (95 per cent CI: 14.0 û 17.4 per cent), and increased steeply with age. However, this increase was steeper in females (p for interaction less than 0.0001). Hypertension was more prevalent among males aged less than 50 and females aged more equal than 50 years. The prevalence of prehypertension was 30.3 per cent (95 per cent CI=27.8- 32.9 per cent). The predominant type of hypertension was by far systodiastolic (41.7 per cent; 95 per cent CI=35.1-48.5). Isolated systolic hypertension accounted for only 29.3 per cent of cases (95 per cent CI=23.9-35.4 per cent) and was responsible for a minority of cases...
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares , Hipertensão/epidemiologia , Hipertensão/metabolismo , Fatores de Risco , Peru , PrevalênciaRESUMO
Antecedentes: El sobrepeso y la obesidad aumentan el riesgo de padecer enfermedades cardiovasculares y otras patologías que alteran significativamente la calidad y expectativa de vida. Estudios en otras poblaciones de América Latina y el Perú muestran que la prevalencia de obesidad viene aumentando en las últimas décadas. Métodos: PREVENCION es un estudio poblacional realizado en la ciudad de Arequipa entre los años 2004-2006, en el que se obtuvo una muestra probabilística, multietápica y estratificada de adultos no institucionalizados de entre 20-80 años de edad constituida por 1878 individuos (867 varones y 1011 mujeres) pertenecientes a 626 familias. Evaluamos la prevalencia de sobrepeso y obesidad de acuerdo al índice de masa corporal (IMC) y la prevalencia de obesidad abdominal considerando el perímetro de cintura (PC). Resultados: El valor promedio del IMC en la población fue 26.2 kg/m2 (IC al 95 por ciento = 25.9û26.5 kg/m2). Las prevalencias estandarizadas por edad de obesidad (IMC≥30) y sobrepeso (IMC = 25.0û29.9) fueron 17.6 por ciento (IC al 95 por ciento=15.7û19.6 por ciento) y 41.8 por ciento (IC al 95 por ciento=39.3û44.4 por ciento), respectivamente. La prevalencia de obesidad fue más alta en mujeres (20.5 por ciento; IC al 95 por ciento=17.9-23.2 por ciento) que en hombres (14.7 por ciento; IC al 95 por ciento=12.3-17.5 por ciento; p=0.001). Sin embargo, la prevalencia de sobrepeso fue mayor en hombres (47.8 por ciento; IC al 95 por ciento=44.1-51.5 por ciento) que en mujeres (35.9 por ciento; IC al 95 por ciento=32.7-39.1 por ciento ; p<0.001), de modo que el 37.4 por ciento de hombres y el 43.7 por ciento de mujeres presentaron un IMC<25.0. La prevalencia de obesidad abdominal según los criterios del ATP III fue de 15.2 por ciento (IC al 95 por ciento=12.8-18.1 por ciento) en hombres y 39.7 por ciento (IC al95 por ciento=36.3-43.2 por ciento) en mujeres (p<0.0001). A su vez, las prevalencias de obesidad abdominal en hombres y mujeres...
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Obesidade , Sobrepeso , PrevalênciaRESUMO
OBJECTIVES: To estimate the prevalence of lifestyle-related cardiovascular risk factors in the adult population of Arequipa, the second largest city in Peru. METHODS: The prevalence and patterns of smoking, alcohol drinking, lack of physical activity, high-fat diet, and low fruit and vegetable intake were evaluated among 1 878 subjects (867 men and 1 011 women) in a population-based study. RESULTS: The age-standardized prevalence of current smoking, former smoking, and never smoking were 21.6 percent, 14.3 percent, and 64.1 percent, respectively. The prevalence of current smoking was significantly higher in men than women (31.1 percent vs. 12.1 percent; P < 0.01). The prevalence of current alcohol use was 37.7 percent and significantly higher in men than women (55.5 percent vs. 19.7 percent; P < 0.01). Similarly, the prevalence of binge drinking was 21.2 percent, and the percentage of men who binge drink (36.1 percent) was significantly higher than for women (6.4 percent; P < 0.01). The vast majority of alcohol drinkers reported a pattern of alcohol consumption mainly on weekends and holidays rather than regular drinking with meals during the week. The proportion of insufficiently active people was 57.6 percent and was significantly higher in women than men (63.3 percent vs. 51.9 percent; P < 0.01). Overall, 42.0 percent of adults reported consuming high-fat diets, 34.5 percent reported low fruit intake, and 33.3 percent reported low vegetable intake. CONCLUSIONS: The high prevalence of lifestyle-related cardiovascular risk factors found in this Andean population is of concern. Preventive programs are urgently needed to deal with this growing problem.
OBJETIVOS: Estimar la prevalencia de factores de riesgo cardiovascular relacionados con el estilo de vida de adultos de Arequipa, la segunda mayor ciudad de Perú. MÉTODOS: Se realizó un estudio de base poblacional para evaluar la prevalencia y los patrones de consumo de tabaco y bebidas alcohólicas, la falta de actividad física, la dieta rica en grasas y el bajo consumo de frutas y vegetales en 1 878 personas (867 hombres y 1 011 mujeres). RESULTADOS: Las prevalencias estandarizadas por la edad de los fumadores actuales, pasados y de los que nunca fumaron fueron 21,6 por ciento, 14,3 por ciento y 64,1 por ciento, respectivamente. La prevalencia de tabaquismo fue significativamente mayor en los hombres que en las mujeres (31,1 por ciento frente a 12,1 por ciento; P < 0,01). La prevalencia del consumo de bebidas alcohólicas fue de 37,7 por ciento, significativamente mayor en los hombres que en las mujeres (55,5 por ciento frente a 19,7 por ciento; P < 0,01). La prevalencia del consumo excesivo de alcohol fue de 21,1 por ciento, mayor en los hombres que en las mujeres (36,1 por ciento frente a 6,4 por ciento; P < 0,01). La gran mayoría de los bebedores presentó un patrón de consumo concentrado fundamentalmente en los fines de semana y los días feriados, más que el consumo habitual con las comidas en los días laborables. La proporción de personas con insuficiente actividad fue de 57,6 por ciento, significativamente mayor en las mujeres que en los hombres (63,3 por ciento frente a 51,9 por ciento; P < 0,01). En general, 42,0 por ciento de los adultos informaron consumir dietas ricas en grasas, 34,5 por ciento dijo tener un bajo consumo de frutas y 33,3 por ciento un bajo consumo de vegetales. CONCLUSIONES: La alta prevalencia de factores de riesgo cardiovascular relacionados con el estilo de vida encontrada en esta población de los Andes es preocupante. Se deben implementar urgentemente programas preventivos para resolver este creciente problema.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estilo de Vida , Atividade Motora , Peru , Prevalência , Fatores de Risco , Fumar/epidemiologiaRESUMO
OBJECTIVES: To estimate the prevalence of lifestyle-related cardiovascular risk factors in the adult population of Arequipa, the second largest city in Peru. METHODS: The prevalence and patterns of smoking, alcohol drinking, lack of physical activity, high-fat diet, and low fruit and vegetable intake were evaluated among 1 878 subjects (867 men and 1 011 women) in a population-based study. RESULTS: The age-standardized prevalence of current smoking, former smoking, and never smoking were 21.6%, 14.3%, and 64.1%, respectively. The prevalence of current smoking was significantly higher in men than women (31.1% vs. 12.1%; P < 0.01). The prevalence of current alcohol use was 37.7% and significantly higher in men than women (55.5% vs. 19.7%; P < 0.01). Similarly, the prevalence of binge drinking was 21.2%, and the percentage of men who binge drink (36.1%) was significantly higher than for women (6.4%; P < 0.01). The vast majority of alcohol drinkers reported a pattern of alcohol consumption mainly on weekends and holidays rather than regular drinking with meals during the week. The proportion of insufficiently active people was 57.6% and was significantly higher in women than men (63.3% vs. 51.9%; P < 0.01). Overall, 42.0% of adults reported consuming high-fat diets, 34.5% reported low fruit intake, and 33.3% reported low vegetable intake. CONCLUSIONS: The high prevalence of lifestyle-related cardiovascular risk factors found in this Andean population is of concern. Preventive programs are urgently needed to deal with this growing problem.
Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estilo de Vida , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Peru , Prevalência , Fatores de Risco , Fumar/epidemiologiaAssuntos
Consumo de Bebidas Alcoólicas , Doenças Cardiovasculares , Dieta , Exercício Físico , Prevalência , Fatores de Risco , Fumar , Peru , Consumo de Bebidas Alcoólicas , Doenças Cardiovasculares , Dieta , Exercício Físico , Prevalência , Fatores de Risco , Tabagismo , Estilo de Vida , Fumar , Doenças Cardiovasculares , Atividade Motora , Prevalência , Fatores de RiscoRESUMO
Data regarding the prevalence of metabolic syndrome (MTS) in Andean populations are limited. We evaluated the prevalence of MTS according to American Heart Association/National Heart, Lung and Blood Institute criteria among 1878 subjects in the PREVENCION study in Peru. In women, the most common component was low HDL cholesterol (60.9%) followed by abdominal obesity (36.9%). In men, the most common component was elevated triglycerides (52.0%) followed by low HDL cholesterol (32.5%), whereas the prevalence of abdominal obesity was 14%. Abnormal fasting glucose was the least common component in men (5.4%) and women (5.0%). The prevalence of MTS was significantly higher in women compared to men (23.2% versus 14.3%) and increased steeply with age, particularly in women (p<0.0001). Using body mass index (BMI>or=30kg/m2) instead of waist circumference as a component of the MTS lead to equivalent prevalence estimates of MTS in men but significantly underestimated the prevalence in women. The MTS is highly prevalent among Peruvian Andeans, particularly in older women. The pattern of MTS components in this Andean population is characterized by a high prevalence of dyslipidemia and a relatively low prevalence of elevated fasting glucose. Further studies are required to characterize genetic and environmental determinants of these patterns.
Assuntos
Síndrome Metabólica/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , HDL-Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Indígenas Sul-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , População Branca/estatística & dados numéricosRESUMO
Cardiovascular disease is emerging as a leading cause of morbidity and mortality in Latin America. Population-based data regarding the prevalence of hypertension and hypertension subtypes in Andean Hispanic populations are scarce. The authors performed a population-based study that included 1878 Peruvian Andean adults to determine: (1) the prevalence, awareness, and control of hypertension and (2) the relative frequency of hypertension subtypes (systolic vs. diastolic). The prevalence of hypertension was 15.7% (95% confidence interval [CI], 14.0%-17.4%), did not differ by gender, and increased steeply with age, particularly in women. Awareness, treatment, and control rates were 47.9%, 39.5%, and 14%, respectively. Diastolic blood pressure increased until age 50 years and reached a plateau thereafter, whereas mean arterial pressure continued to increase with age even after age 50 years. Furthermore, in sharp contrast with the United States population, the predominant type of hypertension was systodiastolic (41.7%; 95% CI, 35.1%-48.5%). Isolated systolic hypertension accounted for only 29.3% of cases (95% CI, 23.9%-35.4%) and was responsible for a minority of cases in all age groups before age 70 years. Hypertension subtypes in this Andean population seem to differ significantly from those present in the United States population, with a much larger proportion of systodiastolic and diastolic hypertension even with advanced age. These differences result from interactions between hemodynamic and structural factors, and further studies aimed at characterizing their genetic and environmental determinants and implications in end-organ damage and prognosis in this population may contribute to understanding the pathophysiology of hypertension.
RESUMO
Antecedentes: El sobrepeso y la obesidad aumentan el riesgo de padecer enfermedades cardiovasculares y otras patologías que alteran significativamente la calidad y expectativa de vida. Estudios en otras poblaciones de América Latina y el Perú muestran que la prevalencia de obesidad viene aumentando en las últimas décadas. Métodos: PREVENCION es un estudio poblacional realizado en la ciudad de Arequipa entre los años 2004-2006, en el que se obtuvo una muestra probabilística, multietápica y estratificada de adultos no institucionalizados de entre 20-80 años de edad constituida por 1878 individuos (867 varones y 1011 mujeres) pertenecientes a 626 familias. Evaluamos la prevalencia de sobrepeso y obesidad de acuerdo al índice de masa corporal (IMC) y la prevalencia de obesidad abdominal considerando el perímetro de cintura (PC). Resultados: El valor promedio del IMC en la población fue 26.2 kg/m2 (IC al 95 por ciento = 25.9û26.5 kg/m2). Las prevalencias estandarizadas por edad de obesidad (IMC≥30) y sobrepeso (IMC = 25.0û29.9) fueron 17.6 por ciento (IC al 95 por ciento=15.7û19.6 por ciento) y 41.8 por ciento (IC al 95 por ciento=39.3û44.4 por ciento), respectivamente. La prevalencia de obesidad fue más alta en mujeres (20.5 por ciento; IC al 95 por ciento=17.9-23.2 por ciento) que en hombres (14.7 por ciento; IC al 95 por ciento=12.3-17.5 por ciento; p=0.001). Sin embargo, la prevalencia de sobrepeso fue mayor en hombres (47.8 por ciento; IC al 95 por ciento=44.1-51.5 por ciento) que en mujeres (35.9 por ciento; IC al 95 por ciento=32.7-39.1 por ciento ; p<0.001), de modo que el 37.4 por ciento de hombres y el 43.7 por ciento de mujeres presentaron un IMC<25.0. La prevalencia de obesidad abdominal según los criterios del ATP III fue de 15.2 por ciento (IC al 95 por ciento=12.8-18.1 por ciento) en hombres y 39.7 por ciento (IC al95 por ciento=36.3-43.2 por ciento) en mujeres (p<0.0001). A su vez, las prevalencias de obesidad abdominal en hombres y mujeres...
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Obesidade , Prevalência , SobrepesoRESUMO
Antecedentes: Para dise±ar programas efectivos de prevención cardiovascular es necesario estimar no solamente la prevalencia y características de los factores de riesgo cardiovascular, sino también los patrones de riesgo global y la distribución poblacional de los sujetos en las diferentes categorías de riesgo absoluto. Población y Métodos: Estudiamos el riesgo cardiovascular global (calculado mediante el puntaje de riesgo de Framingham) en una muestra representativa de la población adulta de Arequipa Metropolitana de 20-80 a±os de edad constituida por 1878 adultos, seleccionados en forma probabilística, multietßpica, estratificada y por conglomerados. Resultados: Se estimó que un 83.9 por ciento de la población adulta (IC al 95 por ciento=82.3-85.5) presenta un riesgo <10 por ciento , un 10.4 por ciento (IC al 95 por ciento =9.2=11.7) presenta un riesgo entre 10 y 20 por ciento y un 5.7 por ciento (IC al 95 por ciento=4.8-6.7) presenta un riesgo >20 por ciento de sufrir un evento coronario en los siguientes 10 a±os. Esto significa que, sólo en la ciudad de Arequipa, existen 60,673 (IC al 95 por ciento=53,723-67,623) adultos en riesgo moderado y 33,143 (IC al 95 por ciento=27,917-38,369) adultos en riesgo alto para un evento coronario. El riesgo global se incrementó marcadamente con la edad (p<0.0001), de modo que el 15.4 por ciento (IC al 95 por ciento=12.3-19.0) de mujeres y el 18.7 por ciento (IC al 95 por ciento =15.1-23.1) de hombres mayores de 50 a±os demuestran se encuentran en la categoría de alto riesgo. A pesar de que sólo una minoría (<3 por ciento) de sujetos menores de 50 a±os presentan alto riesgo cardiovascular, el 27.6 por ciento (IC al 95 por ciento=19.7-37.3) de sujetos de alto riesgo son menores de 50 a±os. Conclusiones: La población adulta de Arequipa demuestra un alto riesgo cardiovascular global, particularmente en adultos mayores de 50 a±os. Aunque la categoría ...
Background: In order to design effective cardiovascular prevention programs, it is necessary not only to accurately estimate the prevalence and characteristics of cardiovascular risk factors, but also the patterns of global subjects in the different categories of absolute risk. Study Population and Methods: We studied the global cardiovacular risk (estimated by the Framingham risk score) in a representative sample of the adult population of Metropolitan Arequipa, consisting of 1878 adults aged 20-80 years. The sampling strategy was probabilistic, multistaged, stratified and clustered. Results: We estimated that 83.9 per cent of the adult population (95 per cent CI=82.3-85.5) demonstrates <10 per cent risk, 10.4 per cent (95 per cent CI=9.2-11.7) demonstrates 10-20 per cent risk and 5.7 per cent (IC al 95 per cent=4.8-6.7) demonstrates >20 per cent risk of experiencing a coronary event in the next 10 years. This means that, in Arequipa city only, there are 60,673 (95 per cent CI= 53,723-67,623) adults in moderate-risk and 33,143 (95 per cent CI=27,917-38,369) adults in high-risk for a coronary event. Global risk increased markedly with increasing age (p<0.0001), such that 15.4 per cent (95 per cent CI=12.3-19.0) of women and 18.7 per cent (95 per cent CI=15.1-23.1) of men older than 50 years of age are in the high-risk category. Depite the fact that only a minority (<3 per cent) of subjects younger than age 50 demonstrate high cardiovascular risk, 27.6 per cent (95 per cent CI=19.7-37.3) of high-risk subjects are younger than 50 years of age. Conclusions: The adult population of Arequipa demonstrates high global cardiovascular risk, particularlyamong subjects older than age 50. Although the high-risk category is unfrequent in young adults, the age distribution of our population determines that approximately 1 in 4 high-risk adults are younger than 50 years of age. This population distribution represents achallenge for the cost-effective ...