Obesidad y factores de riesgo de enfermedad coronaria en Chile

Abstract

Objective: To assess the effect of obesity in cardiovascular risk and in cardiovascular risk factors in Chile, the tendency in time and the association with adiponectin and their genetic determinants Methods: Three studies were performed: 1) An analysis of the anthropometric variables used to assess obesity and their association with cardiovascular risk factors and cardiovascular risk. The relationship between anthropometric measurements of obesity: BMI, waist circumference and waist to height ratio, with hypertension, dyslipidemia and diabetes prevalence, and estimated 10 years risk of coronary artery disease was assessed using the Chilean National Health Survey 2009-2010. Optimal cutoff points to assess obesity were defined with ROC curves and Net Reclassification Improvement was used to assess if they provide advantage over those cut points internationally recommended. 2) A study of the changes in obesity in urban males in the Chilean city of in the last 22 years, and the observed changes in risk factors and coronary artery risk. Two hundred males, included in the first study were compared with 800 males randomly selected and paired by age. Ten years coronary risk was estimated with Framingham equation. Mean values of body weight, height, blood pressure, blood lipids and cardiovascular risk were compared using t test for independent samples. Risk factor prevalence was compared using X2 test. The statistical package used was Stata 11.0 3) A cross sectional study to assess the clinical and genetic factors associated with adiponectin plasmatic levels, a fundamental cytokine involved in the mechanism of cardiovascular risk factor due to obesity. Fifty four men and 54 women, ramdonly selected from the “Prospective Urban and Rural Epidemiology” (PURE) paired by age and the presence of central obesity were included. The relationship between adiponectin plasma levels and physical activity, fasting glucose and insulin, insulin resistance, reactive C protein, and adiponectin gene polymorphism 276 A>C, T45G y -11377C>G y -11391G3A was assessed using univariate analysis and logistic regression. Results: 1) Waist to height ratio and waist circumference, compared with BMI, has a higher association with car diovascular risk factors and the estimated cardiovascular risk and improves assignment to risk category. 2) Between 1989 and 2011 an increment in obesity prevalence in men in Temuco from 24% to 31.1% was observed, associated with an increase in hypertension and dyslipidemia prevalence that explained the absence of cardiovascular risk reduction in spite of a better diagnosed and control of hypertension and the use of medication for dyslipidemia. 3) Adiponectin plasmatic levels were inversely associated with obesity anthropometric measurements, physical activity level and GG genotype of adiponectin gen rs1501299. Conclusions: Waist to height ratio and waist circumference are the obesity anthropometric measure with higher association with risk factors and cardiovascular risk in Chilean population. The increased obesity prevalence, and its consequences has avoid a reduction in cardiovascular risk in our population. Plasmatic adiponectin levels are mainly related with obesity, with a minor influence of genetic factors

Date of Award	5 Sept 2016
Original language	Spanish
Supervisor	Maria Teresa Puig Reixach (Director)