Abstract Objective: Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. Methods: The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. Results: Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. Conclusion: The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.

Resumen Objetivo: El valor de la circunferencia abdominal (CA) refleja la adiposidad abdominal, pero la cantidad de grasa abdominal asociada a factores de riesgo cardiometabólicos varía según la etnia. La determinación de anomalías metabólicas no se ha adaptado a la CA en Venezuela. 1) Detrerminar el valor de corte óptimo de CA asociados a ≥ 2 alteraciones cardiometabólicas. 2) Incorporando este nuevo límite de CA, determinar la prevalencia de obesidad abdominal y factores de riesgo cardiometabólicos relacionados en Venezuela. Métodos: Fue un estudio poblacional, transversal, de muestreo aleatorio de 2014 a 2017. Para evaluar el valor de CA para identificar alteraciones cardiometabólicas, se realizaron curvas características operativa del receptor y se calculó área bajo la curva (ABC), sensibilidad, especificidad y razón de similitud. Resultados: se evaluaron 3387 adultos con una edad promedio de 41.2 ± 15.8 años. Utilizando la mejor relación entre sensibilidad y especificidad, se determinó que los valores de corte de 90 cm en hombres (sensibilidad = 72.4% y especificidad = 66.1%) y 86 cm en mujeres (sensibilidad = 76.2% y especificidad = 61.4%) fueron óptimos para la agregación de ≥ 2 alteraciones cardiometabólicas. El ABC fue de 0,75 en hombres y de 0,73 en mujeres usando estos nuevos puntos de corte. La prevalencia de obesidad abdominal y síndrome metabólico fue 59.6% (95IC; 57.5 - 61.7) y 47.6% (95CI; 45.2 - 50.0), respectivamente. La presencia de factores de riesgo cardiometabólicos se asoció con ser hombre, mayor edad, adiposidad y vivir en regiones del norte o del oeste. Conclusión: Los valores óptimos de CA asociados con alteraciones cardiometabólicas fueron 90 cm en hombres y 86 cm en mujeres. Más de la mitad de la población venezolana tenía obesidad abdominal al incorporar este nuevo corte de CA.

A prevalência do diabetes está aumentando em nível global, sobretudo nos países de renda baixa e média, o que exige melhor detecção e manejo da doença. O modelo de doenças crônicas e a medicina de estilo de vida fornecem estruturas para a ação nesse sentido. Os agentes comunitários de saúde (ACS) podem contribuir de maneira significativa para a assistência às doenças crônicas, desde que sejam capacitados e integrados aos sistemas de saúde, que dispõem de recursos limitados. Embora a maioria dos ACS no mundo esteja desempenhando tarefas relacionadas à saúde materno-infantil e doenças infecciosas, estão crescendo outros programas que envolvem a prevenção e manejo das doenças não transmissíveis. O artigo discute as vantagens, desafios e questões relacionados aos possíveis papéis definidos para os ACS na prevenção e manejo do diabetes. Esses papéis incluem testes simples de triagem, implementação de intervenções comportamentais e de estilo de vida e recomendação de alternativas à biomedicina para os pacientes. Especificamente, os ACS podem auxiliar na vigilância epidemiológica do diabetes, realizando triagem baseada em pontuação de risco ou testagem de glicemia capilar, e podem facilitar o auto-manejo do diabetes através de intervenções baseadas no algoritmo nutricional transcultural do diabetes. Além disso, embora o papel não tenha sido definido formalmente, os ACS podem alavancar seu conhecimento íntimo das práticas locais para apoiar decisões pelos pacientes em contextos com sistemas de saúde pluralistas. Devem ser consideradas as diferenças etnoculturais nas funções dos ACS e nas adaptações transculturais de seus papéis durante a assistência ao diabetes. Em resumo, os ACS podem melhorar a assistência ao diabetes através da triagem e da implementação oportuna de intervenções de estilo de vida, principalmente nos países de renda baixa e média.

Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.

La prevalencia de diabetes está aumentando en todo el mundo, especialmente en los países de bajos y medios ingresos (LMIC por sus siglas en inglés), imponiendo la necesidad de una detección y gestión mejoradas. Un modelo de enfermedad crónica y la medicina del estilo de vida proporcionan estructuras para la acción. Los trabajadores comunitarios de salud (CHWs por sus siglas en inglés) pueden contribuir significativamente al cuidado de la enfermedad crónica, si son entrenados e integrados en sistemas con pocos recursos de salud. A pesar de que la mayoría de los actuales CHWs en todo el mundo están desarrollando tareas relacionadas con enfermedades infecciosas en la salud maternal/infantil, otros programas que implican a los CHWs para la prevención y gestión de enfermedades no comunicables están aumentando. En este artículo, discutimos las ventajas, desafíos, y preguntas respecto a los posibles roles asignados a los CHWs, en la prevención y gestión de la diabetes. Estos roles incluyen realizar simples pruebas de detección, implementando intervenciones de estilo de vida/comportamentales, y conectando pacientes con alternativas a la biomedicina. Específicamente, los CHWs pueden ayudar en la vigilancia epidemiológica de la diabetes, llevando a cabo pruebas de detección basadas en marcadores de riesgo o pruebas de glucosa capilares, y pueden facilitar el autocontrol de la diabetes proporcionando intervenciones descritas en el algoritmo transcultural de nutrición en diabetes. Asimismo, mientras este rol no se les haya asignado formalmente, los CHWs pueden potenciar su conocimiento profundo de prácticas locales para proporcionar apoyo en la toma de decisiones a pacientes en entornos con sistemas de salud plurales. Las diferencias etnoculturales en las funciones de los CHW y las adaptaciones transculturales de sus papeles en el cuidado de la diabetes deberían también ser consideradas. En resumen, los CHWs pueden mejorar el cuidado de la diabetes detectando e implementando oportunamente las intervenciones de estilo de vida, especialmente en LMIC.

A prevalência do diabetes está aumentando em nível global, sobretudo nos países de renda baixa e média, o que exige melhor detecção e manejo da doença. O modelo de doenças crônicas e a medicina de estilo de vida fornecem estruturas para a ação nesse sentido. Os agentes comunitários de saúde (ACS) podem contribuir de maneira significativa para a assistência às doenças crônicas, desde que sejam capacitados e integrados aos sistemas de saúde, que dispõem de recursos limitados. Embora a maioria dos ACS no mundo esteja desempenhando tarefas relacionadas à saúde materno-infantil e doenças infecciosas, estão crescendo outros programas que envolvem a prevenção e manejo das doenças não transmissíveis. O artigo discute as vantagens, desafios e questões relacionados aos possíveis papéis definidos para os ACS na prevenção e manejo do diabetes. Esses papéis incluem testes simples de triagem, implementação de intervenções comportamentais e de estilo de vida e recomendação de alternativas à biomedicina para os pacientes. Especificamente, os ACS podem auxiliar na vigilância epidemiológica do diabetes, realizando triagem baseada em pontuação de risco ou testagem de glicemia capilar, e podem facilitar o auto-manejo do diabetes através de intervenções baseadas no algoritmo nutricional transcultural do diabetes. Além disso, embora o papel não tenha sido definido formalmente, os ACS podem alavancar seu conhecimento íntimo das práticas locais para apoiar decisões pelos pacientes em contextos com sistemas de saúde pluralistas. Devem ser consideradas as diferenças etnoculturais nas funções dos ACS e nas adaptações transculturais de seus papéis durante a assistência ao diabetes. Em resumo, os ACS podem melhorar a assistência ao diabetes através da triagem e da implementação oportuna de intervenções de estilo de vida, principalmente nos países de renda baixa e média.

Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.

La prevalencia de diabetes está aumentando en todo el mundo, especialmente en los países de bajos y medios ingresos (LMIC por sus siglas en inglés), imponiendo la necesidad de una detección y gestión mejoradas. Un modelo de enfermedad crónica y la medicina del estilo de vida proporcionan estructuras para la acción. Los trabajadores comunitarios de salud (CHWs por sus siglas en inglés) pueden contribuir significativamente al cuidado de la enfermedad crónica, si son entrenados e integrados en sistemas con pocos recursos de salud. A pesar de que la mayoría de los actuales CHWs en todo el mundo están desarrollando tareas relacionadas con enfermedades infecciosas en la salud maternal/infantil, otros programas que implican a los CHWs para la prevención y gestión de enfermedades no comunicables están aumentando. En este artículo, discutimos las ventajas, desafíos, y preguntas respecto a los posibles roles asignados a los CHWs, en la prevención y gestión de la diabetes. Estos roles incluyen realizar simples pruebas de detección, implementando intervenciones de estilo de vida/comportamentales, y conectando pacientes con alternativas a la biomedicina. Específicamente, los CHWs pueden ayudar en la vigilancia epidemiológica de la diabetes, llevando a cabo pruebas de detección basadas en marcadores de riesgo o pruebas de glucosa capilares, y pueden facilitar el autocontrol de la diabetes proporcionando intervenciones descritas en el algoritmo transcultural de nutrición en diabetes. Asimismo, mientras este rol no se les haya asignado formalmente, los CHWs pueden potenciar su conocimiento profundo de prácticas locales para proporcionar apoyo en la toma de decisiones a pacientes en entornos con sistemas de salud plurales. Las diferencias etnoculturales en las funciones de los CHW y las adaptaciones transculturales de sus papeles en el cuidado de la diabetes deberían también ser consideradas. En resumen, los CHWs pueden mejorar el cuidado de la diabetes detectando e implementando oportunamente las intervenciones de estilo de vida, especialmente en LMIC.

Abstract Background: No previous study has evaluated the prevalence of metabolic syndrome (MS) in more than one region in Venezuela. Objective: To determine the prevalence of MS in three Venezuelan regions. Methods: From 2006 to 2010, a total of 1,320 subjects aged ≥ 20 years were selected by multistage stratified random sampling from the regions of Lara State (western region), Mérida State (the Andean region), and Capital District (Capital Region). Anthropometric measurements, blood pressure, and biochemical analysis were obtained from each participant. MS was defined according to the harmonized Joint Interim Statement (2009) definition. Results: Mean age was 44.8 ± 0.39 years and 68.5% of the participants were female. The overall prevalence of MS was 35.7% (95% confidence interval 32.2 - 39.2%), while the prevalence was 42.5% (95% CI 38.8 - 46.1%) among men and 32.6% (95% CI 29.1 - 36.0%) among women (p < 0.001). In women, the prevalence of MS increased at almost every decade of life, while in men, the prevalence was similar from the age of 30 years onwards. The most prevalent abnormalities were low HDL-c levels (58.6%, 95% CI 54.9 - 62.1%), abdominal obesity (52.0%, 95% CI 48.4 - 55.7%), and elevated triglycerides levels (39.7%, 95% CI 36.1 - 43.2%). The prevalence of MS increased with increasing body mass index categories. Conclusion: In Venezuela, MS is a highly prevalent condition, which increases the risk of type 2 diabetes and cardiovascular disease in a large number of subjects. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

Resumen Introducción: Ningún estudio ha reportado la prevalencia de factores de riesgo cardiometabólico en varias regiones de Venezuela. Objetivo: Determinar la prevalencia de factores de riesgo cardiometabólico en 3 poblaciones de Venezuela. Materiales y Métodos: El estudio VEMSOLS es un estudio sub-nacional, transversal, poblacional, de muestreo aleatorio bi-etápico, evaluando 751 sujetos de 20 o más años de edad de 3 municipios de Venezuela. Mediciones antropométricas y bioquímicas fueron obtenidas. Analysis of Variance se utilizó para variables continuas y Chi-cuadrado para proporciones, significancia fue p<0,05. Resultados: 69% fueron mujeres y 81,4% del área urbana. Colesterol HDL bajo fue la alteración más prevalente (63,8% [Intervalo de Confianza –IC- 95%: 60,1-67,4]), siendo más común en mujeres que en hombres (74,1% [69,9 -77,9] y 40,4% [33,7-43,4], respectivamente, p< 0,05); seguidos por obesidad abdominal (47,4% [43,8 -51,1]) e hipertrigliceridemia (45,2% [41,5 – 49,0]). Un tercio (30,0% [26,7-33,4]) tenía hipertensión, 11,8% (9,5 -14,5) diabetes, 23,1% (20,2 – 26,3) obesidad y 20,1% (17,2-23,4) colesterol LDL elevado. El síndrome metabólico estuvo presente en 29,9% (26,5-33,5) de la muestra. La población rural de los Andes (Páramo) presentó una baja prevalencia de obesidad y colesterol HDL bajo comparado con las muestras urbanas (p < 0,05). La población de Lara, quien tenía el índice de masa corporal más elevado de las 3 municipalidades, mostró una alta prevalencia de obesidad abdominal, dislipidemia aterogénica y colesterol LDL elevado en comparación con las otras dos poblaciones (p< 0.05). Conclusión: Se observó una elevada prevalencia de anormalidades cardiometabólicas en 3 poblaciones de Venezuela con una menor prevalencia de alteraciones en el área rural. MÉD.UIS. 2018;31(1):15-22.

Abstract Introduction: No previous studies had reported the prevalence of cardiometabolic diseases various regions of Venezuela. Objective: To determine the prevalence of cardiometabolic risk factors in 3 populations of Venezuela. Methods: The VEMSOLS study is a sub-national, cross-sectional, population based, with bi-stage random sampling study, evaluating 751 subjects aged 20 or older from 3 selected municipalities of Venezuela. Anthropometric and biochemical measurements were obtained. ANOVA was used to continous variables and Chi-square to proportions, a p<0.05 was significant. Results: 69% were females and 81.4% from urban areas. Low HDL-c was the most prevalent disorder (63.8% [–CI- 95% 60.1-67.4]), being more common in women than in men (74.1% [69.9 -77.9] and 40.4% [33.7-43.4], respectively, p < 0.05); followed by abdominal obesity (47.4% [43.8 -51.1]) and hypertriglyceridemia (45.2% [41.5 - 49.0]). One third (30.0% [26.7-33.4]) had hypertension, 11.8% (9.5 -14.5) diabetes, 23.1% (20.2-26.3) obesity, and 20.1% (17.2-23.4) elevated LDL-cholesterol. Metabolic syndrome was present in 29.9% (26.5-33.5) of the sample. Rural population from the Andeans mountains (Páramo) presented a lower prevalence of obesity and low HDL-c (p < 0.05) comparing with urban samples. Lara’s population, which had the highest Body Mass Index of the 3 municipalities, had a higher prevalence of abdominal obesity, atherogenic dyslipidemia and elevated LDL-c than the other two populations (p < 0.05). Conclusion: A high prevalence of cardiometabolic abnormalities in 3 populations of Venezuela was observed with a lower prevalence of alterations in the rural area. MÉD.UIS. 2018;31(1):15-22.

Resumo Fundamento: A prevalência de dislipidemia em várias regiões da Venezuela é desconhecida. A Síndrome Metabólica venezuelana, Obesidade e Estilo de Vida Estudo (VEMSOLS) foram realizados para avaliar os fatores de risco cardiometabólico na Venezuela. Objetivo: Determinar a prevalência de dislipidemia em cinco populações de três regiões da Venezuela. Métodos: Durante os anos de 2006 a 2010, 1320 indivíduos com 20 anos ou mais foram selecionados por amostragem aleatória estratificada de vários estágios de todas as famílias em cinco municípios a partir de 3 regiões da Venezuela: Estado Lara (região Oeste), Estado de Mérida (região andina) e Capital Distrito (região Capital). medidas antropométricas e análise bioquímica foram obtidas de cada participante. Dislipidemia foi definida de acordo com as definições NCEP / ATPIII. Resultados: A idade média foi de 44,8 ± 0,39 anos, e 68,5% eram do sexo feminino. A prevalência de lípidos anormalidades relacionadas à síndrome metabólica (HDL-c baixo [58,6%; IC95% 54,9-62,1] e triglicerídeos elevados [39,7%; 36,1-43,2]) foram as alterações lipídicas mais prevalente, seguida pela dislipidemia aterogênica ( 25,9%; 22,7-29,1), LDL-C elevado (23,3%; 20,2-26,4), hipercolesterolêmica (22,2%; 19,2-25,2), e misturar dislipidemia (8,9%; 6,8-11,0). Dislipidemia foi mais prevalente com o aumento do índice de massa corporal. Conclusão: As dislipidemias são fatores de risco cardiometabólico prevalentes na Venezuela. Entre elas, uma maior prevalência de baixo HDL é uma condição também consistentemente relatada na América Latina.

Abstract Background: The prevalence of dyslipidemia in multiple regions of Venezuela is unknown. The Venezuelan Metabolic Syndrome, Obesity and Lifestyle Study (VEMSOLS) was undertaken to evaluate cardiometabolic risk factors in Venezuela. Objective: To determine the prevalence of dyslipidemia in five populations from three regions of Venezuela. Methods: During the years 2006 to 2010, 1320 subjects aged 20 years or older were selected by multistage stratified random sampling from all households in five municipalities from 3 regions of Venezuela: Lara State (Western region), Merida State (Andean region), and Capital District (Capital region). Anthropometric measurements and biochemical analysis were obtained from each participant. Dyslipidemia was defined according to the NCEP/ATPIII definitions. Results: Mean age was 44.8 ± 0.39 years and 68.5% were females. The prevalence of lipids abnormalities related to the metabolic syndrome (low HDL-c [58.6%; 95% CI 54.9 - 62.1] and elevated triglycerides [39.7%; 36.1 - 43.2]) were the most prevalent lipid alterations, followed by atherogenic dyslipidemia (25.9%; 22.7 - 29.1), elevated LDL-c (23.3%; 20.2 - 26.4), hypercholesterolemia (22.2%; 19.2 - 25.2), and mix dyslipidemia (8.9%; 6.8 - 11.0). Dyslipidemia was more prevalent with increasing body mass index. Conclusion: Dyslipidemias are prevalent cardiometabolic risk factors in Venezuela. Among these, a higher prevalence of low HDL is a condition also consistently reported in Latin America.

La relación entre el uso de tabaco no inhalado (TBNI) y la diabetes mellitus tipo 2 (DM2) ha sido únicamente reportada en hombres de Suecia, con resultados contradictorios. En Venezuela, el chimó es la preparación más común de TBNI. La relación entre el chimó y la DM2 en Venezuela es desconocida. El objetivo de este estudio fue evaluar la relación entre el uso de chimó y la DM2 en una población con elevada prevalencia de uso de TBNI en la región de los Andes de Venezuela. Se diseñó un estudio observacional, transversal, tipo correlacional. Durante 2013-2014, 759 sujetos de 20 o más años fueron evaluados de forma consecutiva en un centro médico. La edad promedio fue 53,1 años, 58% fueron mujeres y 24,1% reportó uso de TBNI. El uso de TBNI fue más frecuente en hombres que en mujeres (32,9% vs. 17,7%; p < 0,001). Los consumidores de TBNI mostraron menor índice de masa corporal (IMC), grasa corporal y colesterol total, pero mayor frecuencia de DM2 que los no consumidores de TBNI. El análisis de regresión logística ajustado por edad, historia familiar de DM2 e hipertrigliceridemia, demostró que el uso de TBNI se asoció con un incremento de 77% de probabilidad de presentar DM2 (OR 1,77; 95% CI 1,15 - 2,72). En conclusión, el chimó, una forma de TBNI frecuentemente usada en la región de los Andes de Venezuela, está asociada con una mayor frecuencia de DM2 y con una menor masa grasa. Se discuten las implicaciones de este hallazgo.

The relationship between smokeless tobacco (ST) use and type-2 diabetes (T2D) has only been reported in Swedish men, though with contradictory results. In Venezuela, chimó is the most common ST preparation. The relationship between chimó and T2D in Venezuela is unknown. The objective of the study was to evaluate the relationship between chimó use and T2D in a population with high prevalence of ST use in the Andes region of Venezuela. An observational, cross-sectional, correlational study was designed. During 2013-2014, 759 consecutive subjects aged 20 years or older were evaluated in a medical center. Anthropometric measurements and responses to a standard questionnaire were obtained. Blood glucose and lipid concentrations were measured. The mean age was 53.1 years, 58% were female, and 24.1% reported ST use. ST use was more frequent in men than women (32.9% vs. 17.7%; p < 0.001). ST users showed lower body mass index (BMI), body fat and total cholesterol, but a higher frequency of T2D, than non-ST users. Logistic regression analysis, adjusted by age, family history of T2D, and hypertriglyceridemia, demonstrated that ST use was associated with an increased odd for T2D by 77% (OR 1.77; 95% CI 1.15 - 2.72) among ST-users. In conclusion, chimó, a ST form frequently used in the Andes region of Venezuela, is associated with a higher frequency of T2D and lower fat mass. Implications of these findings are discussed.

Resumo Fundamentos: O uso do tabaco e a hipertensão arterial sistêmica (HAS) são as principais causas preveníveis de morte a nível global. O tabaco é apresentado nas formas com ou sem fumaça (TSF). O uso do TSF tem sido relacionado à doença cardiovascular, diabetes tipo 2 (DM2) e câncer. Na Venezuela, o chimó é a preparação de TSF mais comum e a sua relação com a HAS é desconhecida. Objetivo: Avaliar a relação entre o uso de chimó e HAS em uma população com alta prevalência de uso de TSF na Venezuela. Métodos: Entre 2013-2014, um total de 1.938 indivíduos com 20 anos ou mais foram avaliados consecutivamente em um centro médico. Foram obtidas medidas antropométricas e de pressão arterial (PA), além de respostas a um questionário padrão. Resultados: Os participantes tinham uma média de idade de 49,2 anos, 59,5% eram do sexo feminino, 38,9% apresentavam HAS, 23,2% relataram uso de TSF e 11,6% relataram ter DM2. Um terço dos indivíduos com DM2 eram usuários de TSF, e este grupo mostrou valores mais baixos de frequência cardíaca, PA sistólica, índice de massa corporal (IMC) e frequência de HAS quando comparado a sujeitos com DM2 não usuários de TSF (p < 0,05). Em indivíduos com DM2 com 50 anos ou mais, o uso de TSF foi associado a uma frequência 69% mais baixa de HAS quando comparados a indivíduos que não usavam TSF. Em regressão logística ajustada pela frequência cardíaca, idade, ocorrência de DM2, sobrepeso/obesidade e história familiar de HAS, o uso de TSF esteve associado a uma frequência 30% mais baixa de HAS (razão de chances 0,70; intervalo de confiança de 95% 0,55 - 0,90). Conclusão: O chimó, um TSF frequentemente utilizado na região dos Andes na Venezuela, está associado a valores mais baixos de PA, frequência cardíaca, IMC e frequência mais baixa de HAS em indivíduos com DM2 com mais de 50 anos. Esta associação contraintuitiva negativa entre o chimó e alguns fatores de risco cardiometabólicos realça o caráter complexo destas relações e a necessidade de estudos adicionais.

Abstract Background: Tobacco use and hypertension are leading preventable causes of death globally. Tobacco is presented as smoked or smokeless tobacco (ST). ST use has been related to cardiovascular disease, type 2 diabetes (T2D), and cancer. In Venezuela, chimó is the most common ST preparation, and its relationship with hypertension is unknown. Objective: To evaluate the relationship between chimó use and hypertension in a population with a high prevalence of ST use in Venezuela. Methods: From 2013-2014, a total of 1,938 consecutive subjects aged 20 years or older were evaluated in a medical center. Anthropometrics and blood pressure (BP) measurements, and responses to a standard questionnaire were obtained. Results: The participants had a mean age of 49.2 years, 59.5% were female, 38.9% had hypertension, 23.2% reported ST use, and 11.6% reported having T2D. One-third of the subjects with T2D were ST users, and this group showed lower heart rate, systolic BP, body mass index (BMI), and frequency of hypertension when compared with T2D subjects who were not ST users (p < 0.05). In subjects with T2D who were 50 years or older, ST use was associated with a 69% lower frequency of hypertension when compared with subjects without ST use. On logistic regression adjusted by heart rate, age, occurrence of T2D, overweight/obesity, and family history of hypertension, ST use was associated with a 30% lower frequency of hypertension (odds ratio 0.70; 95% confidence interval 0.55 - 0.90). Conclusion: Chimó, a ST frequently used in the Andes region of Venezuela, is associated with lower BP, heart rate, BMI, and frequency of hypertension in subjects with T2D older than 50 years. This counter-intuitive negative association of chimó with some cardiometabolic risk factors highlights the complex nature of these relationships and the need for further studies.

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.

Se desconoce la prevalencia de hipertensión arterial (HTA) en múltiples regiones de Venezuela. El objetivo fue determinar la prevalencia de HTA en cinco poblaciones de tres regiones. Durante 2006 a 2010, 1392 sujetos de 20 o más años de edad fueron seleccionados mediante un muestreo aleatorio estratificado polietápico, de todas las casas en 5 municipios de: Estado Lara (región Oeste), Estado Mérida (región Andina) y Distrito Capital (región Capital). Se obtuvieron medidas antropométricas, presión arterial y análisis bioquímico. La media de edad fue 45,2 ± 0,4 años, y 68% fueron mujeres. La prevalencia de HTA fue 31,3% (IC 95%: 28,9 - 33,8), mayor en hombres que en mujeres (38,1% [33,5 - 42,8] vs 28,2% [25,4 - 31,2], respectivamente; p <0,001). Los sujetos hipertensos mostraron mayor edad, índice de masa corporal (IMC), glucemia, colesterol total, c-LDL y triglicéridos; y valores más bajos de c-HDL, que los sujetos pre-hipertensos y normotensos (p< 0,05). En las mujeres, la prevalencia de HTA aumentó linealmente en cada década de la vida y en cada categoría de IMC; en los hombres, se incrementó hasta la quinta década, siendo similar en sujetos con sobrepeso y obesidad. El riesgo de HTA se incrementó con la edad, presencia de sobrepeso/obesidad, diabetes, e historia familiar de HTA. Sólo 17,7% de los sujetos hipertensos se encontraban tratados y controlados. En conclusión, un tercio de los sujetos evaluados presentó HTA y alrededor de un quinto está bajo control. En Venezuela, la HTA es un grave problema de salud pública exacerbado por la edad y el sobrepeso.

The prevalence of hypertension in multiple regions of Venezuela is unknown. The objective of this study was to estimate the prevalence of hypertension in five populations from three regions. During 2006 to 2010, 1392 subjects aged 20 or older were selected by multistage stratified random sampling from all households in five municipalities from: Lara State (Western region), Merida State (Andean region), and Capital District (Capital region). Anthropometric measurements, blood pressure, and biochemical analysis were obtained from each participant. Mean age was 45.2 ± 0.4 years and 68% were females. The overall prevalence of hypertension was 31.3% (CI 95% 28.9 - 33.8), it was higher in men than women (38.1% [33.5 - 42.8] vs. 28.2% [25.4 - 31.2], respectively; p <0.001). The hypertensive participants were older, with higher body mass index (BMI), glucose, total cholesterol, LDL-c, and triglycerides; and lower values of HDL-c, than pre-hypertensive and normotensive participants (p < 0.05). In women, hypertension prevalence increased linearly for every decade of life and by category of BMI; whereas in men it increased until the fifth decade of life, and was similar in patients with overweight and obesity. The risk of hypertension increased with age, the presence of obesity, diabetes, overweight and family history of hypertension. Only 17.7% of the hypertensive subjects were both treated and controlled. In conclusion, about one third of the subjects evaluated had hypertension and about one fifth of them had their hypertension under control. In Venezuela, hypertension is a serious public health problem exacerbated by age and overweight.

Objetivos: Conocer la prevalencia de consumo de tabaco no inhalado (chimó) en el Municipio Miranda del Estado Mérida, Venezuela, así como, su asociación con la ansiedad y el estrés. Métodos: Estudio transversal; tipo encuesta; modo de selección: muestreo aleatorio poliestratificado de las casas del Municipio; criterio de inclusión: sujetos de 10 años o más edad. Se aplicó un formato estándar, así mismo, la escala de ansiedad y depresión de Zigmond y Snaith, escala de estrato social de Graffar - Méndez Castellano y el cuestionario de estrés del estudio INTERHEART. Resultados: Se incluyeron 100 sujetos (50 hombres y 50 mujeres), con una edad promedio de 34,1 años (DE ± 14,4). Predominantemente de raza mixta (96%), en estratos sociales III - IV (96%). La prevalencia de tabaco no inhalado fue del 38% (58% hombres - 18% mujeres; p< 0,0001), la cual se incrementó con la edad (10 - 20 años 13%; 21 - 34 años 40%; 35 - 48 años 44,8%; 49 y más años 55,5%; p= 0,029). El consumo de tabaco se asoció con la presencia de síntomas de ansiedad (p=0,039), depresión (p=0,023) y número de eventos estresantes (p=0,016). Al calcular el OR, el consumo de chimó en el género femenino incremento en 10 veces la posibilidad de presentar síntomas de ansiedad y 15 veces los síntomas de depresión. Conclusión: Se encontró una alta prevalencia de consumo de chimó en el Municipio Miranda del Estado Mérida, Venezuela.

Objectives: To estimate the prevalence of used smokeless tobacco (chimó) in Miranda Township, Mérida State, Venezuela, and his association with anxiety and stress. Methods: A cross-sectional health survey Township representative randomized sample of population was done. There were included all subjects of 10 years or older. Standard questionnaire was applied, and anxiety and depression scale of Zigmond and Snaith, social stratum scales Graffar - Méndez Castellano, stress questionnaire of INTERHEART study. Results: There were included 100 subjects (50 men - 50 women), average of age 34.1 years (ED ± 14.4). Mostly mix race (96%) and social stratum III - IV (96%). Smokeless tobacco prevalence was 38% (men 58% - women 18%, p< 0.0001), increased with age (10 - 20 years old 13%; 21 - 34 years old 40%; 35 - 48 years old 44.8%; 49 years and older 55.5%; p= 0.029). Prevalence smokeless tobacco were associated with anxiety (p=0.039) and depression (p=0.023) symptoms, and number stress events (p=0.016). When calculating the OR, chimó consumption in females increased 10 times the chance of developing symptoms of anxiety and 15 times the symptoms of depression. Conclusion: There are highest prevalence smokeless tobacco (chimó) products in Miranda Township from Mérida State, Venezuela.