El diabético inmigrante: factores de riesgo cardiovascular y su control. Aportaciones del estudio IDIME

The Upcoming Epidemic of Heart Failure in South Asia

Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.

Type 2 diabetes prevalence among Andean immigrants and natives in a Southern European City

AIMS

Inequalities in diabetes prevalence among immigrants from Andean countries remain unknown. Andean populations are one of the largest groups of immigrants in Madrid city. We examined the association between country of birth and type 2 diabetes mellitus (T2DM) prevalence in Andean immigrant population relative to Spanish-natives; and whether this association varied by age, sex and length of residence.

METHODS

We analyzed 1,258,931 electronic medical records from Spanish native and Andean immigrant adults aged 40-75 years of Madrid city. We used logistic regression and test interaction terms to address our aims.

RESULTS

Andean immigrants showed 1.13 (95% CI 1.10-1.17) greater adjusted odds for T2DM than Spanish natives. This association was positive in Ecuadorians and Bolivians but protective in Peruvians and Colombians. There was heterogeneity of this association according to age and sex. Relative to Spanish natives, odds of T2DM in Andeans of all ages and women were higher but lower in men.

CONCLUSION

Andean adults showed greater odds of T2DM compared with Spanish native adults in Madrid, with variation observed by age and sex. These findings emphasize the need for studying immigrant populations in a disaggregated manner to implement specific clinical and preventive approaches.

Ethnic differences in body composition, sociodemographic characteristics and lifestyle in people with type 2 diabetes mellitus living in Italy

This study aimed to compare immigrants and Italian natives with type 2 diabetes mellitus (DM2) in terms of anthropometric parameters and lifestyle-related characteristics and to investigate the relationship between ethnicity and glycemic control in men and women with DM2 living in Italy. The sample included 100 immigrants (55 Albanians and 45 Africans) and 100 Italians, followed by the Public Health Clinics of Rimini. The association of ethnicity with sex, socioeconomic status, anthropometric and hematological characteristics, and lifestyle were examined. In addition, differences among groups in glycemic control were evaluated. Among males, African participants presented significantly lower values than other groups in adiposity parameters and triglycerides. The highest percentage of obesity and of normal weight was found in Italians and in Africans, respectively. Among females, there were scanty differences, but Italians presented higher WHR values than the other groups. No statistical differences appeared in hematological parameters among groups. There were no significant differences in glycemic control among groups and sexes. Also considering the differences between subjects with optimal (L) or nonoptimal (H) glycemic control, the differences in lifestyle, anthropometric, and hematological variables remained scarce. Among all groups, significantly higher values of glucose were detected in H than in L. A similar condition appeared for triglycerides in males. Immigrant and native Italian diabetics did not present any difference in their clinical characteristics, but Italians generally presented worst lifestyle habits. The percentage of subjects with poor metabolic control of diabetes was not low, but similar in immigrants and natives.

Epidemiology, risk factors, and opportunities for prevention of cardiovascular disease in individuals of South Asian ethnicity living in Europe

South Asian (SA) individuals represent a large, growing population in a number of European countries. These individuals, particularly first-generation SA immigrants, are at higher risk of developing type 2 diabetes, atherogenic dyslipidaemia, and coronary heart disease than most other racial/ethnic groups living in Europe. SAs also have an increased risk of stroke compared to European-born individuals. Despite a large body of conclusive evidence, SA-specific cardiovascular health promotion and preventive interventions are currently scarce in most European countries, as well as at the European Union level. In this narrative review, we aim to increase awareness among clinicians and healthcare authorities of the public health importance of cardiovascular disease among SAs living in Europe, as well as the need for tailored interventions targeting this group - particularly, in countries where SA immigration is a recent phenomenon. To this purpose, we review key studies on the epidemiology and risk factors of cardiovascular disease in SAs living in the United Kingdom, Italy, Spain, Denmark, Norway, Sweden, and other European countries. Building on these, we discuss potential opportunities for multi-level, targeted, tailored cardiovascular prevention strategies. Because lifestyle interventions often face important cultural barriers in SAs, particularly for first-generation immigrants; we also discuss features that may help maximise the effectiveness of those interventions. Finally, we evaluate knowledge gaps, currently available risk stratification tools such as QRISK-3, and future directions in this important field.

Comparison of different vascular risk engines in the identification of type 2 diabetes patients with high cardiovascular risk

Background

Some authors consider that secondary prevention should be conducted for all DM2 patients, while others suggest that the drug preventive treatment should start or be increased depending on each patient’s individual CVR, estimated using cardiovascular or coronary risk functions to identify the patients with a higher CVR. The principal objective of this study was to assess three different cardiovascular risk prediction models in type 2 diabetes patients.

Methods

Multicentre, cross-sectional descriptive study of 3,041 patients with type 2 diabetes and no history of cardiovascular disease. The demographic, clinical, analytical, and cardiovascular risk factor variables associated with type 2 diabetes were analysed. The risk function and probability that a cardiovascular disease could occur were estimated using three risk engines: REGICOR, UKPDS and ADVANCE. A patient was considered to have a high cardiovascular risk when REGICOR ≥ 10 % or UKPDS ≥ 15 % in 10 years or when ADVANCE ≥ 8 % in 4 years.

Results

The ADVANCE and UKPDS risk engines identified a higher number of diabetic patients with a high cardiovascular risk (24.2 % and 22.7 %, respectively) compared to the REGICOR risk engine (10.2 %). The correlation using the REGICOR risk engine was low compared to UKPDS and ADVANCE (r = 0.288 and r = 0.153, respectively; p < 0.0001). The agreement values in the allocation of a particular patient to the high risk group was low between the REGICOR engine and the UKPDS and ADVANCE engines (k = 0.205 and k = 0.123, respectively; p < 0.0001) and acceptable between the ADVANCE and UKPDS risk engines (k = 0.608).

Conclusions

There are discrepancies between the general population and the type 2 diabetic patient-specific risk engines. The results of this study indicate the need for a prospective study which validates specific equations for diabetic patients in the Spanish population, as well as research on new models for cardiovascular risk prediction in these patients.

Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review

Background

Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry.

Methods

We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process.

Results

Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed.

Conclusions

Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1799-x) contains supplementary material, which is available to authorized users.