Abstract

BACKGROUND:

There is growing evidence that hypertensive disorders of pregnancy are associated with increased long term cardiovascular mortality in the mother. However, hypertension in pregnancy, until recently, has been largely ignored as a risk factor for future cardiovascular disease and mortality, as the link between the two is not fully understood.

OBJECTIVE:

To determine the association between women with hypertension in pregnancy and long term cardiovascular disease mortality.

STUDY DESIGN:

All women who delivered at a metropolitan hospital between the period 01/01/1980 to 31/12/1989 were identified utilising the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification.

RESULTS:

The total number of deliveries in the given time period was 31 656 with 4387 (14%) of the women identified as having had hypertension in their pregnancy. Utilising information from the New South Wales Births, Deaths and Marriages Registry and the Australian Bureau of Statistics Death Registry a total of 651 deaths were identified from this cohort (n=31 656). There were 521 deaths amongst the women who remained normotensive in their pregnancy and 129 deaths for women who had hypertension in their pregnancy. Overall, the women with hypertensive disorders of pregnancy were at greater risk of death than the women who remained normotensive in their pregnancy (OR 1.56 CI 95% 1.28-1.89 p<0.001).

CONCLUSION:

Women with a history of hypertension in their pregnancy are at an increased risk of future cardiovascular mortality. This identifies a group of women who may benefit from early screening and intervention strategies to help reduce their risk of future cardiovascular disease.

Copyright ? 2015 Elsevier Inc. All rights reserved.
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Objective To compare hypertensive patients with and without chronic kidney disease and identify factors associated with their clinical condition and antihypertensive treatment. Method This was a cross-sectional study conducted with patients hospitalized in a general medical ward at a university hospital in the city of S?o Paulo, Brazil. Data were collected from medical records. Significance was set at p<0.05. Results Of the 386 patients studied, 59.3% presented hypertension and, of these, 37.5% presented chronic kidney disease. The data showed an independent association between chronic kidney disease and prior history of diabetes (OR 1.86; CI 1.02-3.41), congestive heart failure (OR 3.42; CI 1.36-9.03) and living with a partner (OR 1.99; CI 1.09-3.69). Regarding antihypertensive treatment, there was a difference (p<0.05) between hypertensive patients with and without chronic kidney disease in terms of administering healthcare treatment (93.2% versus 77.7%); ongoing use of antihypertensive drugs, (79.1% versus 66.4%); higher number of antihypertensive drugs; the use of beta-adrenergic blockers (34.9%versus 19.6%), calcium channel blockers (29.1%versus 11.2%), loop diuretics (30.2%versus 10.5%) and vasodilators (9.3%versus 2.1%). Conclusion The hypertensive patients with chronic kidney disease presented a more compromised clinical profile; however, the attitudes of these patients toward antihypertensive treatment were more positive than those without chronic kidney disease.

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Abstract

IMPORTANCE:

The association between obesity and diabetic retinopathy (DR) is equivocal, possibly owing to the strong interrelation between generalized and abdominal obesity leading to a mutually confounding effect. To our knowledge, no study in Asia has investigated the independent associations of these 2 parameters with DR to date.

OBJECTIVE:

To investigate the associations of generalized (defined by body mass index [BMI], calculated as weight in kilograms divided by height in meters squared) and abdominal obesity (assessed by waist to hip ratio [WHR]) with DR in a clinical sample of Asian patients with type 2 diabetes mellitus.

DESIGN, SETTING, AND PARTICIPANTS:

This cross-sectional clinic-based study was conducted at the Singapore National Eye Centre, a tertiary eye care institution in Singapore, from December 2010 to September 2013. We recruited 498 patients with diabetes. After exclusion of participants with ungradable retinal images and type 1 diabetes, 420 patients (mean [SD] age, 57.8 [7.5] years; 32.1% women) were included in the analyses.

EXPOSURES:

Body mass index and WHR as waist/hip circumference (in centimeters).

MAIN OUTCOMES AND MEASURES:

The presence and severity of DR were graded from retinal images using the modified Airlie House Classification into none (n?=?189), mild-moderate (Early Treatment Diabetic Retinopathy Study scale score, 20-41; n?=?125), and severe DR (Early Treatment Diabetic Retinopathy Study scale score ≥53; n?=?118). The associations of BMI and WHR with DR were assessed using multinomial logistic regression models adjusting for age, sex, traditional risk factors, and mutually for BMI and WHR.

RESULTS:

Among the total of 420 patients, the median (interquartile range) for BMI and WHR were 25.7 (5.7) and 0.94 (0.08), respectively. In multivariable models, BMI was inversely associated with mild-moderate and severe DR (odds ratio [OR], 0.90 [95% CI, 0.84-0.97] and OR, 0.92 [95% CI, 0.85-0.99] per 1-unit increase, respectively), while WHR was positively associated with mild-moderate and severe DR (OR, 3.49 [95% CI, 1.50-8.10] and OR, 2.68 [95% CI, 1.28-5.62] per 0.1-unit increase, respectively) in women (P for interaction?=?.006). No sex-specific associations were found between BMI and DR (P for interaction >.10).

CONCLUSIONS AND RELEVANCE:

In Asian patients with type 2 diabetes, a higher BMI appeared to confer a protective effect on DR, while higher WHR was associated with the presence and severity of DR in women. Our results may inform future clinical trials to determine whether WHR is a more clinically relevant risk marker than BMI for individuals with type 2 diabetes.

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Abstract

BACKGROUND:

Due to the importance of coronary artery disease (CAD), continuous investigation of the risk factors (RFs) is needed.

OBJECTIVE:

To evaluate the prevalence of RFs for CAD in cities in Rio Grande do Sul State, and compare it with that reported in a similar study conducted in the same cities in 2002.

METHODS:

Cross-sectional study on 1,056 healthy adults, investigating the prevalence and absolute and relative frequencies of the following RFs for CAD: obesity, systemic arterial hypertension (SAH), dyslipidemias, smoking, sedentary lifestyle, diabetes mellitus, and family history, as well as age and sex. Data was collected in 19 cities, host of the Offices of the Regional Coordinators of Health, as in the 2002 study.

RESULTS:

Twenty-six percent of the sample consisted of older adults and 57% were women. The prevalence of sedentary lifestyle was 44%, history family 50%, smoking 23%, overweight/obesity 68%, dyslipidemia (high cholesterol levels) 43%, SAH 40%, and diabetes 11%. When compared to the 2002 study, the prevalence of active smoking and sedentary behavior decreased, whereas the prevalence of hypertension, dyslipidemia and obesity increased. Obesity is the most prevalent RF in women, and SAH the most prevalent in men.

CONCLUSIONS:

The prevalence of RFs for CAD in Rio Grande do Sul State remains high. Hypertension, obesity and dyslipidemia are still prevalent and require major prevention programs. Smoking and physical inactivity have decreased in the state, suggesting the efficacy of related campaigns.

Abstract

STUDY QUESTION:

What is the association between potato consumption before pregnancy and the risk of gestational diabetes mellitus (GDM)?

METHODS:

This prospective cohort study included 15?632 women from the Nurses’ Health Study II (1991-2001). They had no previous GDM or chronic diseases before pregnancy. Consumption of potatoes and other foods was assessed every four years. Incident first time GDM was ascertained from self reports of a physician diagnosis of GDM, which was previously validated by medical records.

STUDY ANSWER AND LIMITATIONS:

Over the 10 year follow-up there were 854 incident cases of GDM among 21?693 singleton pregnancies. After adjustment for age, parity, and dietary and non-dietary factors, women who consumed more potatoes before pregnancy had higher rates of developing GDM. Substitution of two servings a week of total potatoes with other vegetables, legumes, and whole grain foods was significantly associated with a 9-12% lower risk of GDM. Consumption and diabetes were self reported, and severity of diabetes was unknown. More than 90% of women were white. A causal association cannot be assumed.

WHAT THIS PAPER ADDS:

Higher levels of potato consumption before pregnancy are associated with greater risk of GDM, and substitution of potatoes with other vegetables, legumes, or whole grain foods might lower the risk.
FUNDING, COMPETING INTERESTS, DATA SHARING:
Funding was received from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health, and the American Diabetes Association (No 7-12-MN-34). The authors have no competing interests or additional data to share.

Published by the BMJ Publishing Group Limited.
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