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Women with hypothyroidism are at higher risk of cardiovascular diseases and the consequent mortality. It is not known whether cut-off values of coronary risk factors in women with hypothyroidism are the same as healthy women. This may help to initiate interventions as early to prevent cardiovascular mortality. Therefore, this study was conducted to determine the cut-off values of coronary risk factors in women with hypothyroidism. One hundred women patients with hypothyroidism were compared with 100 healthy controls. Significantly higher mean body mass index (BMI), waist circumference (WC), triglycerides and low-density lipoprotein cholesterol (LDL-C) were observed in women with hypothyroidism than without it. All variables showed an area under curve (AUC) value of >0.6 in receiver operator characteristic curve (ROC) analysis, and similar to healthy women., (© 2024 Biomedical Informatics.)

Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”. Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p Conclusion: Individuals with atypical metabolic phenotypes are common in Maracaibo city. Related factors may include insulin resistance, basal glucose, and triglycerides levels. Lastly, obese subjects show a higher coronary event risk even those with normal metabolic status.

Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”. Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p

BACKGROUND The biochemical mechanism underlying the nutraceutical effects of honey is poorly understood, thus making its functions more a matter of speculations. In this study, we investigated the effects of honey on the atherogenic and coronary risk indices in Wistar rats. METHODS An experimental design comprising two groups of rats fed with normal rat chow but with the experimental group receiving 10% honey in water and the control group water alone, for five weeks. Blood samples were collected weekly from each group, and the level of superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH) and total protein were determined. The lipids profile (total cholesterol, total triglycerides, LDL and HDL) were also determined, and the atherogenic and coronary indices were estimated. Data were analyzed, and p

In modern society, chronic obstructive pulmonary disease has been isolated relatively recently in an independent nosological unit and, along with cardiovascular diseases, constitutes the leading group of socially significant chronic diseases, being one of the most important medical and social problems of pulmonology.The aim of the study was to determine the possibility of predicting and early diagnosis of coronary heart disease in patients with chronic obstructive pulmonary disease living in the North on the basis of evaluation of morphofunctional parameters of the cardiovascular system.Materials and methods. During the prospective five-year follow- up, an in-depth instrumental examination of 182 patients with chronic obstructive pulmonary disease was conducted to identify the five-year dynamics of the morphofunctional parameters of the cardiorespiratory system at various levels of coronary risk taking into account gender differences. In 66 patients (mean age 64.0 ± 1.1 years) (comparison group), nonfatal coronary events were recorded during follow-up.The conclusion. 1. In the North, cardiac remodeling in patients with chronic obstructive pulmonary disease includes changes in the right divisions due to persistent obstructive disorders and a decrease in pulmonary volume, as well as an increase in left chambers, a decrease in myocardial contractility, and progressive left ventricular hypertrophy. 2. In the course of prophylaxis in case of outpatient examination of patients with chronic obstructive pulmonary disease, it is necessary to determine the criteria for predicting high and very high coronary risk according to the formula d = 0.000108 (Systematic Corоnary Risk Evaluation × “Northern Experience” × frequency of exacerbations of chronic obstructive pulmonary disease × terminal diastolic size of the left ventricle (mm) × systolic blood pressure in the pulmonary artery (mm)) for women and d = 0.000078 (Systematic Coronary Risk Evaluation × frequency of exacerbations of chronic obstructive pulmonary disease × diastolic left ventricular size (mm) × reserve expiratory volume (%)) for men. A high and very high risk can be determined at d≥ 27.5 for women; at d≥ 16.2 for men.

Résumé: La vie d'une femme passe par trois phases hormonales, durant lesquelles les hormones sexuelles sont supposées déterminer de façon critique son risque cardiovasculaire (RCV) : la contraception, la grossesse et la ménopause. Afin d'évaluer au mieux ce risque, il faut donc tenir compte de la phase où la femme se trouve, en association avec les autres facteurs de risque cardiovasculaires (FRCV). Le risque artériel de la contraception œstroprogestative dépend de l'œstrogène et de son dosage. Le principal FRCV est le tabac, surtout après 35 ans, âge auquel la contraception œstroprogestative est alors déconseillée, au profit d'une contraception progestative. Les lésions coronaires de la femme sous contraception œstroprogestative sont dominées par les dissections spontanées et les embolies coronaires. L'infarctus du myocarde chez la femme enceinte survient surtout en période de péri-partum essentiellement en lien avec des dissections coronaires spontanées. La procréation médicalement assistée majore le risque gestationnel, surtout après stimulation ovarienne, mais ne semble pas affecter le pronostic cardiovasculaire des mères. Le traitement hormonal de la ménopause n'augmente pas le risque coronaire dans les dix premières années suivant la ménopause et pourrait même avoir un effet protecteur, en favorisant le maintien de l'intégrité artérielle. La voie transdermique doit être privilégiée pour son effet métabolique moindre. Cependant, le traitement hormonal de la ménopause reste contre-indiqué en cas de maladies coronaires avérées et en présence de FRCV non contrôlés. A woman's life goes through three hormonal phases, during which the sex hormones are believed to critically determine her cardiovascular risk: contraception, pregnancy and menopause. In order to best assess this risk, it is therefore necessary to take into account the phase in which the woman finds herself, in association with the other cardiovascular risk factors. The arterial risk of estrogen-progestin contraception depends on estrogen and its dosage. The main cardiovascular risk factor is tobacco, especially after the age of 35, at which time estrogen-progestin contraception is not recommended, in favour of progestin-only contraception. Coronary lesions in women on contraception estrogen-progestin are dominated by spontaneous dissections and coronary embolisms. Myocardial infarction in pregnant women occurs mainly in the peripartum period and is primarily related to spontaneous coronary dissections. Medical procreation increases the risk during pregnancy, especially after ovarian stimulation, but does not appear to affect the mothers' cardiovascular prognosis. The hormonal treatment of menopause does not increase the risk of coronary heart disease in the first ten years after menopause and could even have a protective effect, helping to maintain the integrity of the arterial. The transdermal route should be preferred for its lesser metabolic effect. However, hormonal treatment of menopause remains contraindicated in the case of diseases such as proven coronary arteries and in the presence of uncontrolled cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

South Asian risk for atherosclerotic cardiovascular disease (ASCVD) has received special emphasis in the 2018 US AHA/ACC/Multisociety Cholesterol Guidelines. The term "South Asian" refers specifically to the countries of India, Pakistan, Nepal, Bhutan, Bangladesh, Sri Lanka, and Maldives and to the worldwide diaspora of families from these countries. With this definition, approximately 25% of the world's population is South Asian, but about 50% of ASCVD occurs in this group. In this JCL Roundtable, we discuss the roles of visceral adiposity, diabetes, and features of the metabolic syndrome; lipoprotein(a); and diet and lifestyle, including the transition of both diet and lifestyle over the past 40 to 50 years. Genetic and/or hidden risk is an area of ongoing research. Individual patient assessment and intervention should recognize the earlier onset of ASCVD and the value of screening for traditional risk factors as well as waist circumference, coronary artery calcium scoring, and lipoprotein(a) assay. Culturally acceptable dietary strategies are available, although not widely implemented or evaluated as yet. In very-high-risk cases of secondary prevention, one should consider combining medications to drive low-density lipoprotein cholesterol much lower than 70 mg/dL. Our discussion concludes by insisting that the signal of alarm must be accompanied by decisive action. [ABSTRACT FROM AUTHOR]

Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”. Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p Conclusion: Individuals with atypical metabolic phenotypes are common in Maracaibo city. Related factors may include insulin resistance, basal glucose, and triglycerides levels. Lastly, obese subjects show a higher coronary event risk even those with normal metabolic status.

Kawasaki disease (KD) is a childhood vasculitis syndrome and the coronary arteries are the main target of the vascular damage. The outcome is formation of coronary lesions (CL) that develop in 20%–25% of untreated children. KD is the leading cause of myocardial infarction in infancy. Its consequences among young people are acute coronary syndrome and susceptibility to early atherosclerosis, if the disease were to remain unrecognized. We investigated the cardiac manifestations during the acute phase of the disease, the values of the fever, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and the therapeutic factors that created increased coronary risk in our cohort of patients. The study is retrospective (1993–2014). In the cohort (n = 107), 30.8% had coronary lesions, including 19.6% coronary aneurysms and 11.2% significant dilatations. We found association between myocarditis, papillary and left ventricular dysfunction in the acute phase of KD and the risk of coronary aneurysms (p

Abstract Introduction This review discusses new guidelines that were released in 2016 and 2017 for assessing risk of coronary disease (ASCVD) and treatments and that appear to have replaced the 2013 guidelines which superseded the National Cholesterol Education Program Adult Treatment Panel Guidelines (ATP). To put the new guidelines in prospective, I briefly review the history of prior guidelines. The newest guidelines seem to support the idea that elevated LDL cholesterol (C) is a cause of ASCVD. The Review also discusses issues related to these guidelines, especially measurement of LDLC, the importance of nonHDLC and puzzling results that do not seem to support the cause and effect idea. Methods Literature review and critical discussion. Conclusions The 2016 guidelines appear to eliminate most of the flaws in the prior 2013 guidelines that replaced the ATP. They do not seem to rely on randomized control studies alone but the totality of all of the evidence. The new guidelines still fail to identify some persons with characteristics of metabolic syndrome that may be of increased risk for ASCVD although they address some of the problems in treating this group. The guidelines identify LDL cholesterol and nonHDL cholesterol target concentrations that are important for laboratory professionals since they should be defined on reports and are important for consultation. Highlights • Critical review of new cholesterol treatment guidelines • They define target cholesterol concentrations • They improve prior guidelines, lacking only criteria for metabolic syndrome • Discussion of methods for measuring LDL and nonHDL cholesterol • Discussion of studies that do not fit lower LDLC is better. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is a metabolic disorder related to atherosclerosis. Its measurement is of great importance not only as a marker of diabetes but also for cardiovascular disease. The aim of this research study was to evaluate the relationship between various IR indices and coronary risk in an adult population from Maracaibo city, Venezuela. Methods: The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multi-stage sampling. In this sub study, 1272 individuals of both genders were selected with the measurement of basal insulin and coronary risk according to the Framingham-Wilson formula calibrated for our population. The insulin resistance indices evaluated were HOMA2-IR, triglycerides and glucose index (TyG) and triglycerides/HDL ratio (TG/HDL). The predictive capacity and association between each index and the coronary risk event in 10 years were determined. Results: Of the evaluated population, 55.2% were female, 34.8% had a coronary risk ≥5% in 10 years, with the TG/HDL and TyG indices showing the highest AUC 0.712 (0.681-0.743) and 0.707 (0.675-0.739), respectively; compared to HOMA2-IR. Both were also the indices most associated with increased coronary risk, especially TG/HDL ≥3 with a higher association [OR = 2.83 (1.74-4.61); p Conclusions: TyG (≥4.5) and TG/HDL (≥3) indices showed a great predictive capacity of higher coronary risk, with being TG/HDL more associated even after adjusting for abdominal obesity and hs-CRP. Therefore, these represent useful tools for determining IR.

Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”. Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional study with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 5.2% (n=64) corresponded to unhealthy lean subjects, and 17.4% (n=217) to healthy obese subjects. Metabolically unhealthy normal-weight (MUNW) phenotype was found in males in 53.3% in contrast to 51.3% of metabolically unhealthy obese (MUO) phenotype found in females. An association between metabolically unhealthy phenotypes and a higher risk of a coronary event was found, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p Conclusion: Individuals with atypical metabolic phenotypes exist in Maracaibo city. Related factors may include insulin resistance, basal glucose levels, and triglycerides levels. Lastly, cardiovascular risk exhibited by healthy obese individuals should be classified in categories of major coronary risk related to lean subjects.

Background: Insulin resistance (IR) is a metabolic disorder related to atherosclerosis. Its measurement is of great importance not only as a marker of diabetes but also for cardiovascular disease. The aim of this research study was to evaluate the relationship between various IR indices and coronary risk in an adult population from Maracaibo city, Venezuela. Methods: The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multi-stage sampling. In this sub study, 1272 individuals of both genders were selected with the measurement of basal insulin and coronary risk according to the Framingham-Wilson formula calibrated for our population. The insulin resistance indices evaluated were HOMA2-IR, triglycerides and glucose index (TyG) and triglycerides/HDL ratio (TG/HDL). The predictive capacity and association between each index and the coronary risk event in 10 years were determined. Results: Of the evaluated population, 55.2% were female, 34.8% had a coronary risk ≥5% in 10 years, with the TG/HDL and TyG indices showing the highest AUC 0.712 (0.681-0.743) and 0.707 (0.675-0.739), respectively; compared to HOMA2-IR. Both were also the indices most associated with increased coronary risk, especially TG/HDL ≥3 with a higher association [OR = 2.83 (1.74-4.61); p Conclusions: TyG (≥4.5) and TG/HDL (≥3) indices showed a great predictive capacity of higher coronary risk, with being TG/HDL more associated even after adjusting for abdominal obesity and hs-CRP. Therefore, these represent useful tools for determining IR.

Use of acetylsalicylic acid (ASA) in cardiology practice is presented. ASA modes of action and the main indications are discussed. ASA use for primary cardiovascular diseases prevention and its possible side effects are considered especially. Peculiarities of ASA use in specific clinical situations, and some pleiotropic effects are also presented.

A patient's coronary artery calcium score (CACS) is a strong independent predictor of cardiovascular risk. Used in conjunction with traditional measures of risk, the CACS helps the clinician discuss cardiovascular (CV) risk and recommend therapies with the patient. We present several cases in which measurement of the CACS and traditional risk factors were used to help guide the clinician-patient conversation and guide therapies. [ABSTRACT FROM AUTHOR]

Aim: Sleep disordered breathing and its most frequent presentations, cardiovascular complications of OSAS, are important, frequent and not well known causes of mortality and morbidity. When considering physiological hemodynamic processes during sleep, togetherness of HT and OSAS become an important clinical picture. To investigate the frequency of hypertension in 'Obstructive Sleep Apnea Syndrome' (OSAS) patients applied to sleep laboratory. Study Design: Retrospective clinical study. Material and Methods: The test protocol consisted of the PSG recording and diagnosis. Sleep stages and respiratory events observed during sleep were evaluated according to "American Academy of Sleep Medicine" (AASM). The blood pressure measured manually by a sphygmomanometer and the measurements occur 3 times on the left arm. Data analysis was performed using IBM SPSS 23.0 statistical software package. Data were analyzed using descriptive statistical methods (frequency, percentage, mean, standard deviation, median, min-max). Results: Blood pressure measurements of 336 patients were evaluated. 98 (48 male, 50 female) of 336 OSAS patients were diagnosed as hypertension (29%). Hypertensive male patients had 3.3 times increased risk to be diagnosed as severe OSAS than female patients (OR=3,30; 95% CI=1,436-7,585). Together with this, hypertension frequency was found as 29% in patients with sleep disordered breathing. Conclusion: Finally; although hypertension and OSAS seem to be distinct clinical pictures, co-existence of these two disorders has been increased. Frequency of hypertension increases with increasing severity of OSAS. Hypertensive patients have increased risk for developing OSAS. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is a childhood vasculitis syndrome and the coronary arteries are the main target of the vascular damage. The outcome is formation of coronary lesions (CL) that develop in 20%–25% of untreated children. KD is the leading cause of myocardial infarction in infancy. Its consequences among young people are acute coronary syndrome and susceptibility to early atherosclerosis, if the disease were to remain unrecognized. We investigated the cardiac manifestations during the acute phase of the disease, the values of the fever, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and the therapeutic factors that created increased coronary risk in our cohort of patients. The study is retrospective (1993–2014). In the cohort (n= 107), 30.8% had coronary lesions, including 19.6% coronary aneurysms and 11.2% significant dilatations. We found association between myocarditis, papillary and left ventricular dysfunction in the acute phase of KD and the risk of coronary aneurysms (p< 0.001). The expressively elevated CRP levels and the persistent fever during the early subacute phase correlated significantly with coronary risk (p< 0.002). The treatment with intravenous immunoglobulin (IVIG) reduced the risk of coronary aneurysms 4.8 times (p< 0.002). A follow-up was performed in 53 children with coronary lesions during the first year of the disease. A longitudinal follow-up was performed in 38 patients. Their results indicate that cardiac monitoring is obligatory for all patients who have experienced KD. [ABSTRACT FROM AUTHOR]

Résumé Au cours de sa vie, la femme passe par trois phases hormonales durant lesquelles les hormones sexuelles joueront un rôle fondamental dans son risque cardiovasculaire et coronarien. Afin d’évaluer au mieux ce risque, il faut donc tenir compte de cette phase en association à ses facteurs de risque cardiovasculaires et ce aux trois étapes clefs : la contraception, la grossesse, la ménopause. Le risque artériel de la contraception estroprogestative dépend de l’estrogène et de son dosage. Le principal facteur de risque cardiovasculaire augmentant le risque d’infarctus du myocarde est le tabac surtout après 35 ans, âge auquel la contraception estroprogestative est alors contre-indiquée au profit de progestatif. Les lésions coronaires de la femme sous contraception estroprogestative sont dominées par les dissections spontanées et les emboles coronaires. L’infarctus chez la femme enceinte survient surtout en période de péri- et post-partum sur des lésions principalement de dissections spontanées. Concernant la procréation médicalement assistée, elle majore le risque gestationnel surtout après stimulation ovarienne mais n’affecte pas le devenir cardiovasculaire des mères. Le traitement hormonal de la ménopause n’augmente pas le risque coronarien dans les 10 premières années suivant la ménopause et pourrait même avoir un effet protecteur en favorisant le maintien de l’intégrité artérielle. La voie transdermique doit être privilégiée pour son effet métabolique. Le traitement hormonal de la ménopause reste contre-indiqué en cas de maladies coronaires avérés et devant des facteurs de risque cardiovasculaires non contrôlés. During their lives, women go through three different phases during which sex hormones play a fundamental role in contributing to specific cardiovascular and coronary risks. To evaluate this risk, we must take into account these various phases with their associated cardiovascular risk factors, and this during three key steps: contraception, pregnancy and menopause. Arterial risk linked to estrogen combined with progestin contraception, depends on the dosage of estrogen. The main cardiovascular risk factor responsible for increasing the risk of myocardial infarction is tobacco, especially after 35 years of age, contraindicating estrogen combined with progestin contraception at the benefit of progestin. Spontaneous dissections and coronary emboli are the most common coronary lesions linked with oestroprogestative contraception. Acute myocardial infarction during pregnancy occurs mostly in the peripartum or postpartum period; and is often caused by spontaneous coronary dissection lesions. Fertility treatment is not associated with an increased risk of developing cardiovascular disease later in life. Hormone therapy during menopause does not increase coronary risk in the first 10 years after menopause and may even have a protective effect, by sustaining arterial integrity. The transdermal route is to be preferred for its metabolic effect. Hormonal treatment during menopause is nonetheless contraindicated in the case of proven coronary disease and uncontrolled cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Introducción: la capacidad predictiva del riesgo coronario es superior a la que se establece por la consideración aislada de los factores de riesgo cardiovasculares. Objetivo: determinar la magnitud del riesgo coronario y las prioridades de prevención cardiovascular en pacientes pertenecientes al consultorio médico de la familia No.5, del policlínico "Ana Betancourt", en el municipio Playa. Métodos: investigación descriptiva, de corte transversal realizada entre 2009-2010. El universo de estudio estuvo constituido por las 856 personas mayores de 20 años perteneciente a dicho consultorio. Después de aplicados los criterios de selección, la muestra quedó conformada por 242 pacientes. Se utilizaron los criterios de las Tablas de Predicción del Riesgo Coronario de Framingham, que permiten estimar dicho riesgo a diez años, en las personas con factores de riesgo cardiovascular que aún no han tenido enfermedad coronaria establecida y que requieren intervenciones de cambio de su estilo de vida. Resultados: predominaron los pacientes en la categoría de riesgo coronario moderado, 97 (40,1 %), seguido por los de alto riesgo, 82 (33, 8 %) y finalmente, los de bajo riesgo, 63 (26 %). Ninguno de los pacientes estudiados estaba exento de riesgo coronario. Conclusiones: es muy probable, que más de la mitad de la muestra sufra un episodio coronario, mortal o no, durante los próximos diez años. Es urgente aplicar una estrategia de intervención comunitaria, basada en la modificación de los factores de riesgo asociados al estilo de vida, que permita disminuir la actual expresión del riesgo coronario en la población estudiada.Introduction: the predictive capacity of the coronary risk is greater than the prediction set by the individual consideration of the cardiovascular risk factors. Objective: to determine the coronary risk and the cardiovascular prevention priorities in patients from the family doctor's office no.5 in "Ana Betancourt" polyclinics located in Playa municipality. Methods: a cross-sectional descriptive study was conducted in the 2009-2010 period. The universe of study was made up of 856 people aged over 20 years in this doctor's office. After applying the criteria of selection, 242 patients formed the final sample. The criteria of Framingham's coronary risk prediction tables, which allow estimating the risk covering 10 years in those people who present cardiovascular risk factors but not coronary disease and require health interventions to change their lifestyles, were applied. Results: the patients included in the moderate coronary risk category (97 for 40.1 %), followed by high risk patients (82 for 33.8 %) and finally, the low risk (63 for 26 %) predominated. None of the patients were exempted from the coronary risk. Conclusions: it is more likely that over half of the sample would have some coronary event, either deadly or not, in the forthcoming ten years. Therefore, it is urgent to apply a community-based intervention strategy, based on the change of lifestyle-associated risk factors, capable of reducing the current manifestation of the coronary risk in the studied population.

The incidence of diabetes, atherosclerosis and sudden cardiac death is high among obese individuals, with significant metabolic and cardiovascular adverse effects being observed when obesity is centered in the abdominal region. The objective of this study was to determine which of the anthropometric indicators of abdominal obesity commonly used show the highest predictive power to discriminate a high coronary risk (HCR) and to propose cut-off values for their use in clinical practice and in population studies on Brazilian adults. The studies publi-shed by the research group on non-transmissible chronic diseases of the Public Health Institute (PHI), Federal University of Bahia (UFBA), that compare different anthropometric indicators as predictors of HCR were analyzed. The evidence provided by the studies analyzed suggests the use of the conicity index for the evaluation of abdominal obesity in clinical practice, with cut-off values of 1.25 for men and of 1.18 and 1.22 for women ≤ 49 years and > 50 years, respectively. The waist-height ratio should be used in population studies, with the recommendation that waist should not exceed half the height of a particular subject.

Background: The association between shift work and coronary high risk status (CHRS) is still unclear. The present work was designed to study the influence of shift work in a gas field petroleum company in Dakahlia on CHRS; as well as, to investigate its possible mechanisms. Methods: A cross-sectional approach was used and a systematic random technique was applied to select 200 shift workers and 200 non-shift workers. Both study groups were subjected to interview questionnaire about personal, social, smoking, occupational and medical histories. Clinical examination, including general and cardiovascular examinations, was done. Height, weight and waist circumference were measured and body mass index (BMI Kg/m2 ) was calculated. Laboratory investigations included measurements of fasting blood glucose, lipid profile and uric acid; as well as, electrocardiographic examination (ECG). Coexistence of more than 2 conventional risk factors or diabetes mellitus (DM) or new and old coronary artery disease (CAD) defined CHRS. Vanillyl mandelic acid (VMA) was measured in 24 hours urine samples as a stress indicator for a randomly selected sub-sample from those with CHRS (25 shift and 25 non-shift workers). The R-R deep breathing variability test on the resting ECG as a measure for autonomic function was done for the same group. Results: The study revealed that 42.5% of shift workers were complaining of deterioration in performance and concentration during work. In addition, 35.5% of shift workers had the desire to change shift work. Among shift workers, 36% were smokers in comparison to 26.5% of non-shift workers with a statistically significant difference (p = 0.04). Rates of hypertension, hypercholesterolemia, high LDLcholesterol, low HDL-cholesterol, hypertriglyceridemia, obesity and DM showed a statistically significant increase among shift workers than non-shift workers (p < 0.05). The overall rate of CHRS was significantly higher among shift workers (p = 0.001). Multiple logistic regression analysis of coronary high risk status as the dependant variable revealed that shift work kept a significant effect on CHRS even after adjustment for other confounders (p= 0.002). Mean level of urinary VMA was significantly higher for shift workers than non-shift workers (p= 0.0001); meanwhile, significantly lower R-R variability indices were recorded among shift workers than non-shift workers (p < 0.05). Conclusion and Recommendations: The present study revealed that shift work has a significant impact on CHRS that might be related to sympathetic over-activity. It is recommended to screen for coronary risk factors in pre-placement and periodic medical examinations of shift workers with implementation of special preventive programs. Urinary VMA and R-R variability testing in ECG could be used as stress indicators among CHRS shift workers. Cases of CAD should be excluded from shift work.

Se realizó un estudio descriptivo, transversal y retrospectivo de 33 pacientes con diagnóstico de infarto agudo del miocardio, ingresados en la unidad de cuidados intensivos del Hospital "Emilio Bárcenas Pier" del municipio de II Frente de la provincia de Santiago de Cuba, durante el año comprendido de enero a diciembre del 2007. En la casuística se halló un predominio de esa cardiopatía en los ancianos con alto riesgo coronario y del dolor precordial como manifestación clínica. Solo fallecieron 3 de los integrantes de la serie, pero ninguno de los tratados con medicación trombolítica.A descriptive, cross-sectional and retrospective study of 33 patients with acute heart attack diagnosis, admitted in the intensive care unit of the "Emilio Bárcenas Pier" Hospital in the municipality of II Frente, Santiago de Cuba province was carried out during the year 2007, from January to December. In the case material a predominant heart condition was found in elderly with high coronary risk and precordial pain sensation as a clinical feature. From the case material only three of the integrants died, but none of them treated with thrombolytic drugs.

La epidemia por el virus de inmunodeficiencia adquirida (VIH) constituye un problema de la salud pública a nivel mundial. La morbilidad y mortalidad asociada al síndrome de inmunodeficiencia adquirida (sida) ha variado de forma significativa con el empleo de la terapia antirretroviral. Sin embargo, se ha visto afectada por los cambios que ocasiona en el metabolismo lipoproteico. Estos se caracterizan por la elevación de los niveles de lipoproteína de muy baja densidad y triglicéridos, el incremento del colesterol total, lipoproteína de baja densidad, y la disminución de los niveles de lipoproteína de alta densidad. La infección por VIH, asociada a otros factores inflamatorios, es un modelo de progresión de la aterosclerosis. El perfil lipídico proaterogénico en personas con VIH/sida constituye un alto riesgo para el desarrollo de enfermedad coronaria. En este trabajo se revisó la contribución tanto de la infección por VIH como del efecto de la terapia antirretroviral en el metabolismo lipídico y su procedimiento terapéutico.The HIV epidemic is a public health problem at worldwide. The morbidity and mortality associated with AIDS have change in a significant way with the use of anti-retroviral therapy. However, it has been affected by the changes provoked in the lipoprotein metabolism, which are characterized by a rise of the very low-density lipoprotein (VLDL) levels and triglycerides, an increase of total cholesterol, low-density lipoprotein (LDL). HIV-infection associated with other inflammatory factors, is a progression model of atherosclerosis. The proatherogenic lipid profile in HIV/AIDS persons is a high risk for the development of the coronary disease. In present paper we analyzed the contribution of both the HIV-infection and the antiretroviral therapy effect on the lipid metabolism and its therapeutical procedure.

OBJETIVO: O estudo teve como objetivo determinar a associação entre os diversos indicadores de obesidade e risco coronariano elevado (RCE) em adultos na cidade de Salvador-BA. MÉTODOS: O desenho foi de corte transversal, com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40.4%) homens. A análise constou da regressão logística, sendo calculadas as Odds Ratio (OR) entre o índice de conicidade (índice C), índice de massa corporal (IMC), razão circunferência cintura-quadril (RCCQ), circunferência de cintura (CC) e RCE. Utilizou-se intervalo de confiança a 95%. RESULTADOS: Após ajustamento por idade, as OR encontradas para homens foram: a) RCCQ: 5.81 (3.00-11.23), b) índice C: 5.52 (2.94-10.36), c) CC: 4.37 (2.31-8.26), d) IMC: 3.04 (1.62-5.73). Para mulheres dos 30 aos 49 anos e 50 aos 74 anos as OR encontradas foram, respectivamente: a) RCCQ: 7.85 (2.15-28.69) e 1.81 (0.98-3.36); b) IMC: 7.28 (1.61-32.97) e 1.09 (0.61-1.96); c) índice C: 6.88 (1.89 -25.11) e 2.89 (1.58-5.27); d) CC: 6.41 (2.09-19.65) e 1.38 (0.77-2.50). CONCLUSÕES: Os resultados demonstram que, entre homens e mulheres de 30-49 anos, todos os indicadores de obesidade apresentam forte associação com RCE, destacando-se entre os homens os indicadores de obesidade central, RCCQ e IC, enquanto que para as mulheres entre 50 e 74 anos o índice C é o melhor indicador.OBJECTIVE: To determine the association between the many anthropometric indicators of obesity and high coronary risk (HCR). METHODS: This is a cross-sectional study. Its population comprised 968 adults, 30-74 years of age, of which 391 (40.4%) were men. Logistic regression analysis was used and the Odds Ratio (OR) was calculated between the conicity index (C index), body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC), and HCR. A 95% confidence interval was utilized. RESULTS: The OR between obesity indicators and HCR, adjusted by age, in men were: a) WHR - 5.81 (3.00-11.23), b) C index - 5.52 (2.94-10.36), c) WC - 4.37 (2.31-8.26), d) BMI - 3.04 (1.62-5.73). In women 30-49 years old and 50-74 years old the OR adjusted by age, respectively, were: a) WHR - 7.85 (2.15-28.69) and 1.81 (0.98-3.36), b) BMI - 7.28 (1.61-32.97) and 1.09 (0.61-1.96), c) C index - 6.88 (1.89 -25.11) and 2.89 (1.58-5.27), d) WC - 6.41 (2.09-19.65) and 1.38 (0.77-2.50). CONCLUSION: Both in men and women, 30-49 years old, all obesity indicators are strongly associated with HCR. However, WHR and C index were found to be the most effective in male individuals, while C index was the best indicator in women from 50 to 74 years of age.

Observational data have given, for years, an inverse association between amount of HDL-C and CHD risk. However, clinical trials with inhibitors of CETP have produced negative results in spite of considerable increases in HDL-C concentration. Human genetic variants associated with HDL-C levels do not support the observational data, and their studies have disentangled the confusion between correlation and causation. Furthermore, they have strongly put SR-BI as the direct and main cholesterol accept or from HDL-C. [ABSTRACT FROM AUTHOR]

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The aim of this study was to determine whether perceived intensity of training moderates the physical activity-health, physical activity-fitness, and fitness-health relationships. The participants (N=237) from eight different companies were assessed for participation in physical activity, cardiovascular fitness and health. Fasting blood samples, resting heart rate and blood pressure, as well as body composition measurements were taken. The YMCA three-stage cycle ergometer test was conducted and the ACSM (2010) metabolic and multi-stage equations were utilised to calculate functional capacity in METs. Physical activity was measured with two questionnaires (Sharkey index and Baecke questionnaire), that allows for comparison of relative intensity of training with absolute physical activity scores. ANCOVA and Stepwise Multiple Regression analyses were used to assess the relationships of perceived intensity of training and functional capacity with various measures of health. Perceived intensity of training had marginally moderating effects on physical activity-health (F=1.135; Eta2=1.7% versus F=0.228; Eta2=0.4%) and the physical activity-fitness (F=8.5; Eta2=8.5% versus F=2.35; Eta2=2.5%) relationships. Cardiovascular fitness (MET) contributed 9.5% (p=0.002) to the variance of a composite health score in comparison to the nonsignificant (p=0.470), 1.2% contribution of intensity of training. [ABSTRACT FROM AUTHOR]

To identify the cut-off points and furthermore to discriminate, among different obesity anthropometrics indicators, the best performing ones in predicting high coronary risk profile (HCR) among women of two different age groups. This cross-sectional study involved 577 women aged 30–74 year. The analyses used receiver-operatingcharacteristic (ROC) curves to identify and compare the statistical significance between conicity index (C index), body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC), and also to discriminate CHR between women in age groups of 30-49 and 50-74 years. A 95% confidence interval (CI) was used. Areas underROC curve between the several obesity indicators and HCR were statistically significant and did not differ among 30-49 year old women, while among women aged 50-74 years, only areas under ROC curve using C index and WHR with HCR showed statistical significance. Cut-off points were defined for the several obesity indicators as a screening tool among women grouped into 30-49 years and 50-74 years. In women aged 30-49 years, the obesity indicators showed the same discriminating power for HCR. However, in 50-74 year-old women, the indicators were less effective discriminators and just central obesity indicators, C index and WHR, performed well for predicting HCR. RESUMOO principal objetivo do trabalho foi Identificar os pontos de corte de diferentes indicadores antropométricos de obesidade e determinar qual apresenta maior poder para discriminar risco coronariano elevado (RCE) em mulheres de dois diferentes grupos etários. O estudo foi de corte transversal realizado em 577 mulheres, com idade entre 30-74 anos, residentes na cidade de Salvador-Ba. A análise foi feita através das curvas ROC (Receiver Operating Characteristic) para identificar e comparar a significância estatística da área sob a mesma entre o índice de conicidade (índice C), índice de massa corporal (IMC), razão circunferência cintura-quadril (RCCQ) e circunferência de cintura (CC) para discriminar RCE entre mulheres de 30-49 anos e 50-74 anos de idade. Foi utilizado intervalo de confiança a 95%. As áreas sob a curva ROC entre os diversos indicadores de obesidade e RCE são statisticamente significativas e não apresentam diferenças em mulheres de 30-49 anos. Nas mulheres de 50-74 anos, apenas as áreas sob a curva ROC entre índice C e RCCQ com RCE apresentam significado estatístico. Pontos de corte foram definidos para os diversos indicadores de obesidade como instrumento de triagem em mulheres de 30-49 anos e 50-74 anos de idade. Os resultados do estudo demonstram que entre mulheres de 30-49 anos os indicadores de obesidade apresentam igual poder discriminatório para RCE. Em mulheres de 50-74 anos, o poder discriminatório é menor sendo que apenas os indicadores de obesidade centralíndice C e RCCQ podem ser utilizados como discriminadores de RCE.

OBJETIVO: Comparar vários indicadores antropométricos de obesidade e identificar dentre eles qual melhor discrimina o risco coronariano elevado (RCE). MÉTODOS: Estudo de corte transversal, com amostra composta por 968 adultos de 30 a 74 anos de idade, sendo 391 (40,4%) do sexo masculino. Foram construídas diversas curvas Receiver Operating Characteristic (ROC) e comparadas às áreas sob as mesmas entre o índice de conicidade (índice C), índice de massa corporal (IMC), razão circunferência cintura-quadril (RCCQ), circunferência de cintura (CC) e RCE. Verificou-se também a sensibilidade e especificidade para identificar e comparar o melhor ponto de corte entre os diversos indicadores de obesidade para discriminar o RCE. Foi utilizado intervalo de confiança a 95%. RESULTADOS: A maior área sob a curva ROC foi encontrada entre o índice C e RCE, em indivíduos do sexo masculino, 0,80 (0,74-0,85), diferindo significativamente dos demais indicadores de obesidade. Em mulheres, a maior área sob a curva ROC encontrada foi de 0,76 (0,71-0,81), sendo iguais entre índice C, RCCQ e RCE. CONCLUSÃO: Esses resultados demonstram que o índice C e RCCQ são os melhores indicadores de obesidade para discriminar RCE. A CC tem intermediário poder discriminatório e o IMC foi o indicador antropométrico de obesidade menos adequado para discriminar RCE. Estes dados sugerem que os indicadores de obesidade abdominal são melhores para discriminar RCE que os indicadores de obesidade generalizada.OBJECTIVE: To compare some anthropometric indexes of obesity and identify among them which one best discriminates the high coronary risk (HCR). METHODS: A cross-section study, with sample consisting of 968 adults, between 30 and 74 years old, being 391 (40.4%) men. Many Receiver Operating Characteristic (ROC) curves were obtained and compared to areas under them among the conicity index (C index), body mass index (BMI), waist-hip circumference ratio (WHCR), waist circumference (WC) and HCR. The sensitivity and specificity to identify and compare the best cut-off point among the many indexes of obesity to discriminate the HCR were also identified. A confidence interval of 95% was used. RESULTS: The largest area under ROC curve was found between the C index and the HCR, in individuals of male sex, 0.80 (0.74-0.85), significantly differing from the other indexes of obesity. In women, the largest area found under the ROC curve was 0.76 (0.71-0.81), being equal between C, WHCR and HCR indexes. CONCLUSION: Those results show that C and WHCR indexes are the best indexes of obesity to discriminate HCR. WC has intermediate discriminatory power and the BMI was the least suitable anthropometric index of obesity to discriminate HCR. Those data suggest that the indexes of abdominal obesity are better to discriminate HCR than the indexes of general obesity.