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Del Brutto OH, Mera RM, Rumbea DA, Recalde BY, Sedler MJ. Detrimental effect of high social risk on the cardiovascular health status of community-dwelling older adults living in rural settings. A population-based, longitudinal prospective study. Int J Cardiol 2023; 375:124-130. [PMID: 36581111 DOI: 10.1016/j.ijcard.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Information of the effect of social risk on the cardiovascular health (CVH) status among individuals living in rural settings is limited. We aim to assess this effect in participants of the Three Villages Study cohort. METHODS Following a longitudinal prospective design, older adults living in rural Ecuador received baseline social risk determinations by means of social determinants of health components included in the Gijon's Social-Familial Evaluation Scale (SFES) together with clinical interviews and procedures to determine CVH status included in the Life's Simple 7 construct. Those who also received CVH assessment at the end of the study were included. Random-effects generalized least square and mixed logistic regression models were fitted to assess the longitudinal effect of social risk on CVH metrics, after adjusting for relevant covariates. RESULTS The study included 443 community dwellers (mean age: 67 ± 7 years). The Gijon's SFES mean score was 9.8 ± 2.7 points. The mean number of ideal CVH metrics at baseline was 3.1 ± 1.3, which decreased to 2.6 ± 1.2 (β: -0.467; 95% C.I.: -0.588 to -0.346), after a mean of 7.31 ± 3.26 years of follow-up. The total Gijon's SFES score was higher among individuals with a worsening CVH status compared to those who did not (10.4 ± 2.6 versus 9.3 ± 2.6; p < 0.001). The ideal CVH status declined 1.23 (95% C.I.: 1.13-1.34) times per point of change in the total Gijon's SFES score. CONCLUSION Study results indicate a deleterious effect of high social risk on CVH status at follow-up in this underserved population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
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Paixão TM, Teixeira LR, de Andrade CAF, Sepulvida D, Martinez-Silveira M, Nunes C, Siqueira CEG. Systematic Review and Meta-Analysis of Metabolic Syndrome and Its Components in Latino Immigrants to the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1307. [PMID: 36674066 PMCID: PMC9858988 DOI: 10.3390/ijerph20021307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The Metabolic Syndrome (MetS) is an increasingly prevalent condition globally. Latino populations in the USA have shown an alarming increase in factors associated with MetS in recent years. The objective of the present systematic review was to determine the prevalence of MetS and its risk factors in immigrant Latinos in the USA and perform a meta-analysis of those prevalence. The review included cross-sectional, cohort, or case−control studies involving adult immigrant Latinos in the USA, published during the period 1980−2020 in any language. Studies involving individuals who were pregnant, aged <18 years, immigrant non-Latinos, published outside the 1980−2020 period, or with other design types were excluded. The Pubmed, Web of Science, Embase, Lilacs, Scielo, and Google Scholar databases were searched. The risk of bias was assessed using the checklists of the Joanna Briggs Institute. The review included 60 studies, and the meta-analysis encompassed 52 studies. The pooled prevalence found for hypertension, diabetes, general obesity, and abdominal obesity were 28% (95% Confidence Interval (CI): 23−33%), 17% (95% CI: 14−20%), 37% (95% CI: 33−40%), and 54% (95% CI: 48−59%), respectively. The quality of the evidence of the primary studies was classified as low or very low. Few studies including immigrants from South America were identified. Further studies of those immigrants are needed due to the cultural, dietary, and language disparities among Latin American countries. The research protocol was registered with the Open Science Framework (OSF).
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Affiliation(s)
- Talita Monsores Paixão
- Center of Studies of Worker Health and Human Ecology, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil
| | - Liliane Reis Teixeira
- Center of Studies of Worker Health and Human Ecology, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil
| | | | | | - Camila Nunes
- Fluminense Federal Institute of Education Science and Technology, Campos dos Goytacazes 28030-130, Brazil
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Del Brutto VJ, Mera R, Recalde BY, Rumbea DA, Costa AF, Del Brutto OH. Total cerebral small vessel disease score and all-cause mortality in older adults of Amerindian ancestry: The Atahualpa Project. Eur Stroke J 2022; 6:412-419. [PMID: 35342801 DOI: 10.1177/23969873211060803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Cerebral small vessel disease (SVD) predicts all-cause mortality in Eastern Asian and Caucasian populations. However, little is known about SVD impact in individuals of different races/ethnic groups. In this study, we sought to estimate the mortality risk according to the total SVD (tSVD) score in older adults of Amerindian ancestry. Methods Participants aged ≥60 years from the prospective population-based Atahualpa Project cohort underwent brain MRI between June 2012 and June 2017. The tSVD score was calculated based on the presence of moderate-to-severe white matter hyperintensities, enlarged perivascular spaces, one or more lacune, and one or more cerebral microbleed. We ascertained all-cause mortality during post-MRI follow-up. Poisson regression and Cox-proportional hazards models adjusted for demographics and cardiovascular risk were obtained to estimate mortality risk according to the tSVD score. Results Analysis included 375 participants with available brain MRI and clinical data (mean age 69.0 ± 8.3 years, 56.3% women). The tSVD score was 0 point in 216 individuals (57.6%), 1 point in 71 (18.9%), 2 points in 53 (14.1%), and 3-4 points in 35 (9.3%). Increasing tSVD score was associated with advancing age, hypertension, low level of education, and physical inactivity. Using tSVD score of 0 as reference, a multivariate Poisson regression model showed an increased mortality for individuals with a tSVD score 3-4 points (IRR: 2.27; 95% CI: 1.20-4.28). Likewise, in the Cox-proportional model adjusted for demographics and cardiovascular risk, participants with a tSVD score 3-4 maintained a greater than two-fold mortality risk when compared to those with tSVD score of 0 points (HR: 2.32; 95% CI: 1.23-4.39). Conclusions High-burden SVD as determined by the tSVD score predicts mortality in community-dwelling older adults of Amerindian ancestry. Incidental diagnosis of covert SVD should prompt aggressive control of cardiovascular health.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Robertino Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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Del Brutto OH, Mera RM, Recalde BY, Rumbea DA, Sedler MJ. Life's simple 7 and all-cause mortality. A population-based prospective cohort study in middle-aged and older adults of Amerindian ancestry living in rural Ecuador. Prev Med Rep 2022; 25:101668. [PMID: 34976705 PMCID: PMC8683764 DOI: 10.1016/j.pmedr.2021.101668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/11/2023] Open
Abstract
Life's Simple 7 is an initiative of the American Heart Association developed for stratifying risk factors associated with adverse vascular outcomes and premature mortality. While this scale has been widely used, there is limited information on its applicability to individuals living in remote communities where risk factors and lifestyles differ from those found in urban settings. This longitudinal prospective study aimed to assess, according to the Life's Simple 7 scale, all-cause mortality in community-dwelling middle-age and older adults of Amerindian ancestry living in rural Ecuador. A total of 933 Atahualpa residents aged ≥ 40 years who received baseline interviews and procedures for measurement of cardiovascular health (CVH) metrics were enrolled and followed-up for a median of 8 years (interquartile range: 4-9 years). Using a Poisson regression model (adjusted for age at baseline, gender and the level of education), the predicted incidence rate of mortality was 4.22 per 100 person-years (95% C.I.: 2.48-5.97) for individuals with 0-1 CVH metrics in the ideal range, which decreased to 1.23 (95% C.I.: 0.24-2.21) for those with five ideal metrics. In an adjusted Cox-proportional hazard model that included all the CVH metrics, having three or more metrics in the ideal range significantly reduced the mortality hazard ratio when compared with individuals having 0-2 ideal metrics. Study results emphasize the usefulness of the Life's Simple 7 scale to estimate mortality risk in Amerindians living in remote communities. Control of CVH metrics should prove cost-effective for reducing premature deaths in underserved populations.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
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Janković J, Mandić-Rajčević S, Davidović M, Janković S. Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis. PLoS One 2021; 16:e0255959. [PMID: 34379696 PMCID: PMC8357101 DOI: 10.1371/journal.pone.0255959] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH. METHODS A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I2 statistics. RESULTS This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics. CONCLUSIONS To the best of our knowledge, this is the first systematic review on the relationship between participants' socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.
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Affiliation(s)
- Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maša Davidović
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Social Determinants of Health and Risk of SARS-CoV-2 Infection in Community-Dwelling Older Adults Living in a Rural Latin American Setting. J Community Health 2021; 46:292-297. [PMID: 32671516 PMCID: PMC7363014 DOI: 10.1007/s10900-020-00887-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
High social risk, as measured by the social determinants of health (SDH), may increase the risk of SARS-CoV-2 infection. However, this association has not been studied in rural communities. Using the Atahualpa Project cohort, we aimed to assess the association between SDH and SARS-CoV-2 seropositivity in community-dwelling older adults living in rural Ecuador. SARS-CoV-2 antibodies were determined in 319 individuals aged ≥ 60 years that completed a validated field instrument to assess their social risk before the introduction of this novel pandemic. Multivariate models were fitted to assess the independent association between SDH-and each of their components-and SARS-CoV-2 seropositivity, after adjusting for relevant covariates. According to the Gijon scale, 102 (32%) individuals had a high social risk (≥ 10 points). A total of 141 (44%) individuals were seropositive to SARS-CoV-2. A fully-adjusted logistic regression model showed an independent) association between social risk and SARS-CoV-2 positivity (OR 1.15; 95% CI 1.04-1.27; p = 0.008). For every unit of the total SDH score, the odds of SARS-CoV-2 seropositivity increased 15% (95% CI 3.7-27%). In addition, multivariate models showed that the individual component of SDH more strongly associated with SARS-CoV-2 seropositivity was housing, which suggested that lack of basic home facilities may increase the risk of SARS-CoV-2 infection. Knowledge on the association between high social risk and SARS-CoV-2 infection is indispensable for the development of cost-effective preventive strategies for controlling modifiable factors that are in the path of SARS-CoV-2 infection among older adults living in underserved communities.
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Hajri T, Caceres L, Angamarca-Armijos V. The burden of hypertension in Ecuador: a systematic review and meta-analysis. J Hum Hypertens 2021; 35:389-397. [PMID: 33420379 DOI: 10.1038/s41371-020-00471-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
Hypertension is a major risk factor of cardiovascular diseases, which occurrence has increased consistently worldwide. With this in mind, this review was designed to evaluate the prevalence of hypertension in Ecuador. We systematically searched publications in Medline, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database, and Ibero-America electronic databases for articles published through September 2019 and reporting the prevalence of hypertension in Ecuador. Selected data were subjected to meta-analysis, and pooled prevalence and their 95% (95% CI) were calculated. Seventeen articles have been selected according to the inclusion/exclusion criteria of the study. The overall estimate of the pooled prevalence of hypertension was 35.8% (CI: 31.3-38.4). Most importantly, the prevalence of hypertension increased markedly with age and obesity. Pooled estimates for the four age subdivisions (<30 years), (≥30 and ≤50 years), (>50 and ≤60 years) and (>60 years) were 9.4% (CI: 7.3-11.5), 22.0% (CI: 19.0-25.0), 26.1% (22.2-30.0) and 48.7% (CI: 45.4-52.0), respectively. Moreover, the pooled estimate of subjects with BMI ≥ 30 kg/m2 (57.7%, CIs: 45.6-69.8) was markedly higher than those with BMI < 30 kg/m2 (30.4%, CI: 23.3-38.4). Although limited, available data reported higher rates of hypertension in Afro-Ecuadorians than other ethnicities. This study underlines a high prevalence of hypertension in adults nationwide, but mostly in elderly and obese individuals. The magnitude of this burden emphasizes the need for robust and targeted interventions to control hypertension, and ultimately reverse the trend of cardiovascular diseases.
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Affiliation(s)
- Tahar Hajri
- Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Luis Caceres
- Hackensack University Medical Center, Hackensack, NJ, USA
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Del Brutto OH, Mera RM, Peralta LD, Hill JP, Generale LM, Torpey AP, Sedler MJ. Cardiovascular Health Status Among Community-Dwelling Ecuadorian Natives Living in Neighboring Rural Communities: The Three Villages Study. J Community Health 2019; 45:154-160. [PMID: 31446542 DOI: 10.1007/s10900-019-00728-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Knowledge of cardiovascular health (CVH) status in rural communities is essential to implement cost-effective strategies aimed to address the growing burden of cardiovascular diseases in these settings. Here, we report on the CVH status and health metrics of 1508 community-dwellers aged ≥ 40 years in three neighboring rural villages of Coastal Ecuador (Atahualpa, El Tambo, and Prosperidad). According to the American Heart Association, a poor CVH status is designated when at least one cardiovascular health metric is in the poor range. About 70% of individuals in the villages studied had a poor CVH status, with no overall differences across villages. However, the relative prevalence of poor health metrics varied. Using Atahualpa as the referent village, a multinomial logistic regression model showed that El Tambo residents were more often smokers and had a worse diet, while Prosperidad residents had more high blood pressure but better fasting glucose levels. Probabilities of having poor health metrics were lower in Atahualpa than in El Tambo (p < 0.001), but not better than in Prosperidad (p = 0.097). Predictive estimates of having poor health metrics were significantly higher in El Tambo than in Atahualpa or in Prosperidad. This comparative study demonstrates that the CVH status of rural populations of coastal Ecuador is basically similar. However, individual health metrics in the poor range were found to vary across villages. While the three villages are generally comparable, interventions should be tailored according to local priorities. The same may occur in other rural communities, but more studies are needed to confirm our findings.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador. .,Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador. .,Air Center 3542, PO Box 522970, 33152-2970, Miami, FL, USA.
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
| | | | - John P Hill
- School of Medicine, Stony Brook University, New York, NY, USA
| | | | - Andrew P Torpey
- School of Medicine, Stony Brook University, New York, NY, USA
| | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY, USA
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Janković J, Davidović M, Bjegović-Mikanović V, Janković S. Status of cardiovascular health in the Republic of Serbia: Results from the National Health Survey. PLoS One 2019; 14:e0214505. [PMID: 30917180 PMCID: PMC6436747 DOI: 10.1371/journal.pone.0214505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) remain the most significant cause of death in low- and middle-income countries where the burden of CVD continues to rise due to the increasing incidence of CVD. The aim of this study was to assess the prevalence of ideal cardiovascular health (CVH) across sex and age groups and to analyze associations between demographic and socio-economic variables and ideal CVH metrics in the adult population of the Republic of Serbia. METHODS Information on demographic (age, sex, marital status, and type of settlement) and socio-economic characteristics (education, and wealth index), and the 7 ideal CVH metrics (smoking, physical activity, healthy diet, BMI, blood pressure, cholesterol, and glucose) was obtained for 13100 respondents aged 20 years and above, from the 2013 National Health Survey in the Republic of Serbia. According to the American Heart Association, the ideal CVH was defined as the simultaneous presence of 7 ideal CVH metrics. RESULTS Out of all ideal CVH metrics, the most prevalent components were ideal glucose (92.2%), ideal cholesterol (86.4%) and ideal smoking (63%), while the least prevalent ideal CVH component was ideal healthy diet (2.4%). Only 0.1% had all 7 CVH components at the ideal level. According to the multivariable logistic regression analysis the higher number of ideal CVH metrics was observed in women (OR = 4.46), younger people (OR = 7.12), people living without partner (OR = 1.70), more educated (OR = 2.51 for middle educated and OR = 3.57 for high educated), as well as among the rich (OR = 1.43). CONCLUSION Our findings of existing age-specific, sex and socio-economic differences in the prevalence and number of ideal CVH metrics should serve for the development of appropriate CVD prevention policies tailored to fit specific needs of both sexes, all age groups and people with different socioeconomic status.
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Affiliation(s)
- Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre—School of Public Health and Management, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maša Davidović
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre—School of Public Health and Management, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Bjegović-Mikanović
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre—School of Public Health and Management, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Peng Y, Cao S, Yao Z, Wang Z. Prevalence of the cardiovascular health status in adults: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2018; 28:1197-1207. [PMID: 30360955 DOI: 10.1016/j.numecd.2018.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/20/2018] [Accepted: 08/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The American Heart Association has outlined seven cardiovascular health (CVH) metrics, including smoking, body mass index, physical activity, dietary pattern, total cholesterol, and fasting plasma glucose, to define and monitor CVH status. Our study was to evaluate the global CVH in adults. METHODS AND RESULTS We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and reference lists of relevant articles for studies published between 1 January 2010 and 30 June 2018. Included studies should report the proportions of ideal status for the seven CVH metrics and/or provide the prevalence of overall poor (having 0-2 ideal metrics) or ideal (having 5-7 ideal metrics) CVH status in adults. 88 articles were identified: 75 for the prevalence of ideal CVH metrics, 58 for the proportion of overall poor CVH status, and 55 for the proportion of overall ideal CVH status. Smoking had the highest prevalence of ideal status (69.1%) while dietary pattern has the lowest (12.1%). 32.2% and 19.6% of participants had overall poor and ideal CVH, respectively. Females and young adults had better CVH status when compared to males and older adults. There existed regional variations in ideal CVH metrics and overall CVH status. The overall CVH status had improved over study time. CONCLUSION The prevalence of ideal status was low for some metrics, such as dietary pattern, and the overall CVH status was still unsatisfactory. We should continue to measure the CVH status and carry out lifestyle interventions to improve the CVH status in the whole population.
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Affiliation(s)
- Y Peng
- Centre for Chronic Disease, School of Clinical Medicine, The University of Queensland, Herston, Australia.
| | - S Cao
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Australia
| | - Z Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Z Wang
- Centre for Chronic Disease, School of Clinical Medicine, The University of Queensland, Herston, Australia
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Del Brutto OH, Mera RM, Castillo PR, Del Brutto VJ. Key findings from the Atahualpa Project: what should we learn? Expert Rev Neurother 2017; 18:5-8. [DOI: 10.1080/14737175.2018.1400382] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Guayaquil, Ecuador
| | | | - Pablo R. Castillo
- Sleep Disorders center, Mayo Clinic College of Medicine, Jacksonville, FL, USA
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Del Brutto OH, Mera RM, Ha JE, Del Brutto VJ, Castillo PR, Zambrano M, Gillman J. Oily fish consumption is inversely correlated with cerebral microbleeds in community-dwelling older adults: results from the Atahualpa Project. Aging Clin Exp Res 2016; 28:737-43. [PMID: 26497828 DOI: 10.1007/s40520-015-0473-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oily fish is a major dietary source of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). These nutrients improve endothelial dysfunction, reduce β-amyloid induced damage of neurovascular units, and might prevent the occurrence of cerebral microbleeds. However, this relationship has not been investigated so far. AIM To evaluate the association between oily fish intake and cerebral microbleeds in a population of frequent fish consumers living in coastal Ecuador. METHODS Cerebral microbleeds were identified by gradient-echo MRI and oily fish consumption was calculated in community-dwellers aged ≥60 years enrolled in the Atahualpa Project. The association between cerebral microbleeds and fish servings was examined in regression models adjusted for relevant confounders. A predictive model was constructed using quintiles of fish servings to take into account the non-linearity in the relationship. RESULTS Out of 311 eligible individuals, 293 (94 %) were enrolled. Cerebral microbleeds were recognized in 37 (13 %) individuals. Mean fish consumption was 8.8 ± 5.4 servings per week (ω-3 PUFAs estimates: 10.2 ± 7.1 g). Multivariate analysis showed an inverse relationship between cerebral microbleeds and fish consumption (p < 0.001). Predictive margins of CMB were higher for individuals in the lowest (≤4.3) than for those in the highest (≥13.1) quintile of fish servings (17.4 vs 2.3 %, p < 0.001). CONCLUSIONS This study shows a lower cerebral microbleed presence among older adults eating large amounts of oily fish (13 servings per week, equivalent to about 15 g of ω-3 PUFAs). These high requirements can be more readily accomplished in other populations by taking fish oil preparations. Longitudinal studies are warranted to assess whether these interventions reduce incident cerebral microbleeds in high-risk individuals.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
- , Air Center 3542, PO Box 522970, Miami, FL, 33152-2970, USA.
| | | | - Jung-Eun Ha
- Langone Medical Center, New York University, New York, NY, USA
| | | | - Pablo R Castillo
- Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL, USA
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Del Brutto OH, Mera RM, Zambrano M, Castillo PR. Caffeine intake has no effect on sleep quality in community dwellers living in a rural Ecuadorian village (The Atahualpa Project). ACTA ACUST UNITED AC 2016; 9:35-9. [PMID: 27217907 PMCID: PMC4866974 DOI: 10.1016/j.slsci.2015.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
Abstract
More information is needed to better understand the effect of caffeine on sleep quality at the community level. In a population-based, cross-sectional study design, we aimed to assess the effect of caffeine intake on sleep quality by the use of a multivariate exposure-effect model, adjusted for relevant confounders. All Atahualpa residents aged ≥40 years were identified during a door-to-door survey and interviewed with the Pittsburgh Sleep Quality Index (PSQI) and a structured instrument designed to estimate the daily amount of caffeine intake. An exposure-effect model was built using augmented inverse probability weighting taking into account variables that were associated with exposure (using a probit model) and variables that were associated with outcome (in a linear model). Out of 779 eligible individuals, 716 (92%) were included. Consumption of <100 mg/day of caffeine was recorded in 320 (45%) participants, from 100 to 200 mg/day in 299 (42%), and >200 mg/day in 97 (13%). Mean score in the PSQI was 4.5±2.2 points, with 203 (28%) individuals classified as poor sleepers (≥6 points). The exposure-effect model, adjusted for variables associated with the exposure (symptoms of depression, total cholesterol blood levels and smoking) and the outcome (age, symptoms of depression, physical activity and fasting glucose levels), revealed no effect of caffeine intake in sleep quality (average exposure effect: 0.027, 95% C.I.: -0.284 to 0.338, p=0.866). This population-based study shows that caffeine intake has no effect on sleep quality in community-dwelling adults living in a rural village of Ecuador.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
| | - Robertino M Mera
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Pablo R Castillo
- Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL, United States
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Del Brutto OH, Mera RM, Gillman J, Ha JE, Zambrano M. Calcifications in the carotid siphon correlate with silent cerebral small vessel disease in community-dwelling older adults: A population-based study in rural Ecuador. Geriatr Gerontol Int 2015; 16:1063-7. [PMID: 26337141 DOI: 10.1111/ggi.12599] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
AIM Using a population-based, cross-sectional design, we aimed to assess whether the presence of calcifications in the carotid siphon (as seen on computed tomography) is associated with silent markers of cerebral small vessel disease (on magnetic resonance imaging) in apparently healthy older adults living in Atahualpa, a rural Ecuadorian village. METHODS Stroke-free Atahualpa residents aged ≥60 years identified during a door-to-door survey underwent head computed tomography for assessment of carotid siphon calcifications, and brain magnetic resonance imaging for identification of white matter hyperintensities and silent lacunar infarcts. We evaluated the association between calcifications and markers of small vessel disease using logistic regression models adjusted for demographics and cardiovascular risk factors. RESULTS The mean age of the 236 participants was 71 ± 8 years, and 139 (59%) were women. Computed tomography readings showed high calcium content in the carotid siphon in 64 individuals (27%), and magnetic resonance imaging showed moderate-to-severe white matter hyperintensities in 51 (30%) and lacunar infarcts in 28 (12%). In the univariate analysis, individuals with high calcium content were older and were more likely to have high fasting glucose levels than those with low calcium content. After adjusting for confounding variables, we found an independent association between high calcium content in the carotid siphon and moderate-to-severe white matter hyperintensities (OR 2.3, 95% CI 1.1-4.9, P = 0.035) as well as lacunar infarcts (OR 3.1, 95% CI 1.3-7.6, P = 0.013). CONCLUSIONS The present study shows a direct relationship between calcium content in the carotid siphon and silent small vessel disease in an indigenous Latin American population. Geriatr Gerontol Int 2016; 16: 1063-1067.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.,Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | - Robertino M Mera
- Gastroenterology Department, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer Gillman
- Langone Medical Center, School of Medicine, New York University, New York, New York, USA
| | - Jung-Eun Ha
- Langone Medical Center, School of Medicine, New York University, New York, New York, USA
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Del Brutto OH, Mera RM, Del Brutto VJ, Maestre GE, Gardener H, Zambrano M, Wright CB. Influence of depression, anxiety and stress on cognitive performance in community-dwelling older adults living in rural Ecuador: results of the Atahualpa Project. Geriatr Gerontol Int 2015; 15:508-14. [PMID: 25155360 PMCID: PMC11006020 DOI: 10.1111/ggi.12305] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2014] [Indexed: 12/01/2022]
Abstract
AIM To assess the relationship between cognitive status and self-reported symptoms of depression, anxiety and stress of older adults living in an underserved rural South American population. METHODS Community-dwelling Atahualpa residents aged ≥60 years were identified during a door-to-door census, and evaluated with the Depression Anxiety Stress Scale-21 (DASS-21) and the Montreal Cognitive Assessment (MoCA). We explored whether positivity in each of the DASS-21 axes was related to total and domain-specific MoCA performance after adjustment for age, sex and education. RESULTS A total of 280 persons (59% women; mean age, mean age 70 ± 8 years) were included. Based on established cut-offs for the DASS-21, 12% persons had depression, 15% had anxiety and 5% had stress. Mean total MoCA scores were significantly lower for depressed than for not depressed individuals (15.9 ± 5.5 vs 18.9 ± 4.4, P < 0.0001). Depressed participants had significantly lower total and domain-specific MoCA scores for abstraction, short-term memory and orientation. Anxiety was related to significantly lower total MoCA scores (17 ± 4.7 vs 18.8 ± 4.5, P = 0.02), but not to differences in domain-specific MoCA scores. Stress was not associated with significant differences in MoCA scores. CONCLUSION The present study suggests that depression and anxiety are associated with poorer cognitive performance in elderly residents living in rural areas of developing countries.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil
| | - Robertino M Mera
- Gastroenterology Department, Vanderbilt University, Nashville, Tennessee
| | | | - Gladys E Maestre
- Departments of Psychiatry and Neurology, and Gertrude H. Sergievsky Center, Columbia University, New York, New York
| | - Hannah Gardener
- McKnight Brain Institute and Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Clinton B Wright
- McKnight Brain Institute and Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Del Brutto OH, Gardener H, Del Brutto VJ, Maestre GE, Zambrano M, Montenegro JE, Wright CB. Edentulism associates with worse cognitive performance in community-dwelling elders in rural Ecuador: results of the Atahualpa project. J Community Health 2014; 39:1097-100. [PMID: 24627152 PMCID: PMC11003771 DOI: 10.1007/s10900-014-9857-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies in industrialized nations suggest that severe edentulism correlates with cognitive impairment, but there is little information on this association in underserved populations. We conducted a community-based study to assess whether edentulism associates with cognitive impairment in elders living in rural Ecuador. Atahualpa residents aged ≥60 years were identified during a door-to-door census and evaluated using the Montreal Cognitive Assessment (MoCA). Persons were classified into two groups according to whether they have severe edentulism (<10 remaining teeth) or not. In addition, a questionnaire allowed self-rating of oral health. A total of 274 persons (mean age 69.6 ± 7.7 years; 59% women) were included. Persons with <10 remaining teeth (n = 116) have significantly lower MoCA scores than those with ≥10 teeth (n =158), after adjusting for demographics, cardiovascular risk factors, depression and dementia (β = -1.06, p = 0.03). Self-rated poor oral health was more prevalent among persons with <10 teeth (p < 0.0001), but did not correlate with MoCA scores (good vs. poor, β = -0.89, p = 0.89). Severe edentulism is associated with poor cognitive performance in elders living in rural Ecuador. Public health campaigns directed to improve oral health may facilitate early recognition of persons with cognitive impairment in underserved populations.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador,
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Prevalence, correlates, and prognosis of peripheral artery disease in rural ecuador-rationale, protocol, and phase I results of a population-based survey: an atahualpa project-ancillary study. Int J Vasc Med 2014; 2014:643589. [PMID: 25389500 PMCID: PMC4217317 DOI: 10.1155/2014/643589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Little is known on the prevalence of peripheral artery disease (PAD) in developing countries. Study design. Population-based study in Atahualpa. In Phase I, the Edinburgh claudication questionnaire (ECQ) was used for detection of suspected symptomatic PAD; persons with a negative ECQ but a pulse pressure ≥65 mmHg were suspected of asymptomatic PAD. In Phase II, the ankle-brachial index will be used to test reliability of screening instruments and to determine PAD prevalence. In Phase III, participants will be followed up to estimate the relevance of PAD as a predictor of vascular outcomes. Results. During Phase I, 665 Atahualpa residents aged ≥40 years were enrolled (mean age: 59.5 ± 12.6 years, 58% women). A poor cardiovascular health status was noticed in 464 (70%) persons of which 27 (4%) had a stroke and 14 (2%) had ischemic heart disease. Forty-four subjects (7%) had suspected symptomatic PAD and 170 (26%) had suspected asymptomatic PAD. Individuals with suspected PAD were older, more often women, and had a worse cardiovascular profile than those with nonsuspected PAD. Conclusions. Prevalence of suspected PAD in this underserved population is high. Subsequent phases of this study will determine whether prompt detection of PAD is useful to reduce the incidence of catastrophic vascular diseases in the region.
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Affiliation(s)
- Donald M. Lloyd-Jones
- From the Department of Preventive Medicine and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Janković S, Stojisavljević D, Janković J, Erić M, Marinković J. Status of cardiovascular health in a transition European country: findings from a population-based cross-sectional study. Int J Public Health 2014; 59:769-78. [DOI: 10.1007/s00038-014-0579-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/08/2014] [Accepted: 06/16/2014] [Indexed: 01/01/2023] Open
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Benavente OR, Pearce LA, Bazan C, Roldan AM, Catanese L, Bhat Livezey VM, Vidal-Pergola G, McClure LA, Hart RG. Clinical-MRI correlations in a multiethnic cohort with recent lacunar stroke: the SPS3 trial. Int J Stroke 2014; 9:1057-64. [PMID: 24862645 DOI: 10.1111/ijs.12282] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neuroimaging manifestations of small vessel disease are heterogeneous, and correlation with patient features has not been adequately characterized. AIM Our goal was to correlate magnetic resonance imaging findings with clinical features in a large multiethnic cohort with recent lacunar stroke. METHODS Patient characteristics were correlated with neuroimaging results in the Secondary Prevention of Small Subcortical Stroke study participants. RESULTS Among 3005 patients, mean age was 63 years; 62% were men; and 51%, 30%, and 16% were non-Hispanic White, Hispanic, and Black, respectively. Recent lacunar infarcts were distributed between the subcortical hemisphere (31%), thalamus (26%), brainstem/cerebellum (26%), and basal ganglia/internal capsule (16%). Multiple lacunar infarcts (i.e., acute and remote) were present in 40% and associated with increased age (OR 1·3 per 20 years, 95% CI 1·1, 1·5), male gender (OR 1·5, CI 1·3, 1·7), hypertension (OR 1·5, CI 1·2, 1·8), increased systolic blood pressure (OR 1·2 per 20 mmHg, CI 1·1, 1·3), and prior stroke (OR 3·8, CI 2·9, 5·0). Moderate-severe white matter hyperintensities were present in 50% and associated with increased age (OR 4·3 per 20 years, CI 3·4, 5·4), hypertension (OR 1·8, CI 1·4, 2·3), increased systolic blood pressure (OR 1·3 per 20 mmHg, CI 1·1, 1·5), increased diastolic blood pressure (OR 1·2 per 10 mm, CI 1·0, 1·3), and prior stroke (OR 3·3, CI 2·3, 4·5). Infarct location varied significantly by race-ethnicity (P < 0·001), with Blacks and Hispanics having more infarcts in the brainstem/cerebellum than non-Hispanic Whites, and by gender with women more often having thalamic lacunes than men (P ≤ 0·001). CONCLUSIONS In patients with recent lacunar stroke, infarct location and number have distinctie associations with gender, vascular risk factors, and race-ethnicity, demonstrating the complex pathogenesis of lacunar stroke and cerebral small artery disease.
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Affiliation(s)
- Oscar R Benavente
- Department of Medicine, Division of Neurology, Brain Research Center, University of British Columbia, Vancouver, Canada
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Cerebrovascular Correlates of Sleep Disorders—Rational and Protocol of a Door-to-Door Survey in Rural Coastal Ecuador. J Stroke Cerebrovasc Dis 2014; 23:1030-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022] Open
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Del Brutto OH, Mera RM. Indices of abdominal obesity may be better than the BMI to discriminate Latin American natives/mestizos with a poor cardiovascular status. Diabetes Metab Syndr 2014; 8:115-118. [PMID: 24907177 DOI: 10.1016/j.dsx.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS To assess whether the anthropometric index used by the American Heart Association (AHA) to evaluate cardiovascular health (CVH) status, i.e., the body mass index (BMI), could also be of value in ethnic groups phenotypically different than Whites. METHODS CVH status was evaluated in 616 Ecuadorian natives/mestizos aged ≥40 years with the seven metrics proposed by the AHA. Then, the BMI was replaced by the waist-to-hip (WtoHp) and the waist-to-height (WtoHt) ratios to estimate whether these changes modify the CVH status and the presence of ≥5 ideal metrics per person. RESULTS Replacing the BMI for either the WtoHt or the WtoHp ratios reduces the percentage of persons with ≥5 ideal CVH metrics from 13%, to 8% (p<0.004) and to 6.8% (p<0.0003), respectively. The number of persons with a poor CVH status increased when the WtoHt ratio was used instead of the BMI (81.5% versus 69.8%, p<0.0001). CONCLUSIONS These results may explain the paradox "better CVH status/similar stroke prevalence" previously found in Ecuadorian natives/mestizos, and suggest that the WtoHt ratio could be the best anthropometric index to be included in the set of metrics used to evaluate the CVH status in populations that are phenotypically different than Whites.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
| | - Robertino M Mera
- Gastroenterology Department, Vanderbilt University, Nashville, TN, United States
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Association between sleep quality and cardiovascular health: a door-to-door survey in rural Ecuador. Environ Health Prev Med 2014; 19:234-7. [PMID: 24477858 DOI: 10.1007/s12199-014-0379-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Cardiovascular correlates of sleep disorders have not been well investigated in underserved populations. The aim of this door-to-door survey was to evaluate the association between sleep quality and cardiovascular health status in persons aged ≥40 years living in a village that is representative of rural Ecuador. METHODS All stroke-free Atahualpa residents aged ≥40 years were screened with a validated Spanish version of the Pittsburgh Sleep Quality Index and the seven cardiovascular health (CVH) metrics proposed by the American Heart Association to assess the CVH status. RESULTS A total of 635 persons (mean age 59 ± 13 years; 58 % women) were identified. A poor sleep quality was present in 27 % of the subjects (95 % CI 24-31 %) and a poor cardiovascular health in 69 % (95 % CI 63-71 %). In a multivariate logistic regression model, a poor sleep quality was associated with some CVH metrics in the poor range, including smoking status (p = 0.026), physical activity (p = 0.01) and blood glucose levels (p = 0.036). CONCLUSIONS A poor sleep quality may be linked to individual cardiovascular risk factors in this underserved Latin American population. This finding provides useful insights for the implementation of regional prevention priorities.
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Del Brutto OH. Implications and expectancies of the "Atahualpa Project": A population-based survey designed to reduce the burden of stroke and cardiovascular diseases in rural Ecuador. J Neurosci Rural Pract 2013; 4:363-5. [PMID: 24250190 PMCID: PMC3821443 DOI: 10.4103/0976-3147.118776] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Oscar H Del Brutto
- Department of Neurology, School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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Del Brutto OH, Zambrano M, Peñaherrera E, Montalván M, Pow-Chon-Long F, Tettamanti D. Prevalence of the metabolic syndrome and its correlation with the cardiovascular health status in stroke- and ischemic heart disease-free Ecuadorian natives/mestizos aged ≥40 years living in Atahualpa: a population-based study. Diabetes Metab Syndr 2013; 7:218-222. [PMID: 24290088 DOI: 10.1016/j.dsx.2013.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Epidemiologic studies assessing cardiovascular risk factors affecting a given population may prove cost-effective to reduce the burden of cardiovascular diseases in the developing world. We evaluated the prevalence of the metabolic syndrome in Atahualpa, a village representative of rural coastal Ecuador. METHODS Prevalence of the metabolic syndrome and its correlation with the cardiovascular (CVH) status was assessed in a door-to-door survey performed in stroke- and ischemic heart disease-free Ecuadorian native/mestizos aged ≥40 years. RESULTS The metabolic syndrome was diagnosed in 288 (55.7%) out of 517 persons. Worst individual components were: increased waist circumference (75%), increased fasting glucose (68.1%) and high blood pressure (56.5%). Prevalence of individual components of this condition varied according to age, gender, education, and alcohol intake. However, no differences were found in the odds for having the metabolic syndrome when persons were stratified according to these parameters. A poor CVH status was found in 80.2% persons with and in 55.9% without the metabolic syndrome (p<0.0001). CONCLUSIONS Prevalence of the metabolic syndrome in Atahualpa is high. Most persons with the metabolic syndrome also have a poor CVH status. However, sizable subsets only have either the metabolic syndrome or a poor CVH status. Stratification of cardiovascular risk according to whether the person has both, one, or none of these two sets of risk factors would be of value to evaluate if the metabolic syndrome, a poor CVH status or the combination of both, better predict the occurrence of vascular outcomes in the long-term follow-up.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
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Del Brutto OH, Mera RM, Montalván M, Del Brutto VJ, Zambrano M, Santamaría M, Tettamanti D. Cardiovascular health status and metabolic syndrome in Ecuadorian natives/Mestizos aged 40 years or more with and without stroke and ischemic heart disease--an atahualpa project case-control nested study. J Stroke Cerebrovasc Dis 2013; 23:643-8. [PMID: 23834848 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/05/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Knowledge of regional-specific cardiovascular risk factors is mandatory to reduce the growing burden of stroke and ischemic heart disease in Latin American populations. We conducted a population-based case-control study to assess which risk factors are associated with the occurrence of vascular events in natives/mestizos living in rural coastal Ecuador. METHODS We assessed the cardiovascular health (CVH) status and the presence of the metabolic syndrome in all Atahualpa residents aged 40 years or more with stroke and ischemic heart disease and in randomly selected healthy persons to evaluate differences in the prevalence of such risk factors between patients and controls. RESULTS A total of 120 persons (24 with stroke or ischemic heart disease and 96 matched controls) were included. A poor CVH status (according to the American Heart Association) was found in 87.5% case-patients and 81.3% controls (P = .464). The metabolic syndrome was present in the same proportion (58.3%) of case-patients and controls. Likewise, both sets of risk factors (poor CVH status and the metabolic syndrome) were equally prevalent among both groups (58.3% versus 49%, P = .501). CONCLUSIONS This case-control study suggests that none of the measured risk factors is associated with the occurrence of vascular events. It is possible that some yet unmeasured risk factors or an unknown genetic predisposition may account for a sizable proportion of stroke and ischemic heart disease occurring in the native/mestizo population of rural coastal Ecuador.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
| | | | - Martha Montalván
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Victor J Del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | - Mauricio Zambrano
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | | | - Daniel Tettamanti
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador; Research Department, Hospital Luis Vernaza, Guayaquil, Ecuador
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Living alone and cardiovascular health status in residents of a rural village of coastal Ecuador (The Atahualpa Project). Environ Health Prev Med 2013; 18:422-5. [PMID: 23733495 DOI: 10.1007/s12199-013-0344-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Knowledge of region-specific factors affecting the cardiovascular health (CVH) is mandatory to reduce the growing burden of stroke and ischemic heart disease in rural areas of Latin American. We conducted a population-based case-control study to assess the CVH status of Atahualpa residents-a rural village representative of Coastal Ecuador-according to their living arrangements. METHODS All Atahualpa residents aged ≥40 years and free of stroke or ischemic heart disease that lived alone were identified during a door-to-door census, and their CVH status was compared to that of a sample of residents that lived with relatives. Four controls individually matched for age, gender, education, job and alcohol intake, and randomly selected from different households, were selected for each case-person. RESULTS A total of 185 persons (37 who lived alone and 148 matched controls) were included. A poor CVH status was found in 89.2 % case-patients and 72.3 % controls (p = 0.03). We found significantly worse levels of physical activity (p < 0.0001) and non-significant trends for worse healthy diet and glucose levels among case-persons than controls. CONCLUSIONS This study suggests that social isolation is associated with a worse CVH in rural coastal Ecuador. An ongoing community-based intervention may prove effective to improve CVH status in these social isolated persons.
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The "know your numbers" program in Atahualpa--a pilot study aimed to reduce cardiovascular diseases and stroke burden in rural communities of developing countries. Int J Cardiol 2013; 168:3123-4. [PMID: 23647598 DOI: 10.1016/j.ijcard.2013.04.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 11/23/2022]
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