Regression models with undiagnosed CKD defined using the CKD-EPI equation in CRONICAS dataset (se... more Regression models with undiagnosed CKD defined using the CKD-EPI equation in CRONICAS dataset (sensitivity analysis, N = 2368). (DOCX 17 kb)
Flow-chart of participants included from the CRONICAS Cohort Study in the development of the risk... more Flow-chart of participants included from the CRONICAS Cohort Study in the development of the risk score. (DOCX 18Â kb)
OBJECTIVE We aimed to establish optimal definitions for abdominal obesity and metabolic syndrome ... more OBJECTIVE We aimed to establish optimal definitions for abdominal obesity and metabolic syndrome (MetS) among Andean adults. RESEARCH DESIGN AND METHODS Among 1,448 Andean adults, we assessed the relationship between waist circumference and subclinical vascular disease assessed by carotid intima-media thickness (cIMT) and manifest cardiovascular disease (M-CVD). RESULTS Optimal waist circumference cutoffs to classify individuals with abnormal cIMT or M-CVD were >97 and >87 cm in men and women, respectively. With these cutoffs, there was substantial disagreement between the original American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and the recently updated MetS definition, particularly among men (κ = 0.85). Subjects with MetS identified by the updated definition but not meeting the original AHA/NHLBI MetS criteria demonstrated significantly increased cIMT (P < 0.001) compared with subjects who did not meet the MetS criteria by either definition....
Chronic Kidney Disease (CKD) represents a great burden for the patient and the health system, par... more Chronic Kidney Disease (CKD) represents a great burden for the patient and the health system, particularly if diagnosed at late stages. Consequently, tools to identify patients at high risk of having CKD are needed, particularly in limited-resources settings where laboratory facilities are scarce. This study aimed to develop a risk score for prevalent undiagnosed CKD using data from four settings in Peru: a complete risk score including all associated risk factors and another excluding laboratory-based variables. Cross-sectional study. We used two population-based studies: one for developing and internal validation (CRONICAS), and another (PREVENCION) for external validation. Risk factors included clinical- and laboratory-based variables, among others: sex, age, hypertension and obesity; and lipid profile, anemia and glucose metabolism. The outcome was undiagnosed CKD: eGFR < 60 ml/min/1.73m2. We tested the performance of the risk scores using the area under the receiver operatin...
<jats:p> <jats:bold>Background:</jats:bold> Asymmetric dimethylarginine (ADMA) ... more <jats:p> <jats:bold>Background:</jats:bold> Asymmetric dimethylarginine (ADMA) and NG-monomethyl-L-arginine (NMMA), endogenous nitric oxide-synthase inhibitors (End-NOSI), have been associated with cardiovascular risk factors (CVRF) and atherosclerosis. In addition, acute administration of NOSI cause hypertension through hemodynamic effects, but whether circulating End-NOSI are associated with these abnormalities is unknown. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> We studied 922 adults in a population-based study (PREVENCION study). We examined the correlation between End-NOSI/L-arginine and CVRF, as well as the relationship between these biomarkers and arterial hemodynamics, carotid-femoral pulse wave velocity (cf-PWV) and carotid intima-media thickness (c-IMT). We used general linear modeling for statistical analyses. Estimates (β) are standardized. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> In multivariate analyses, LDL-cholesterol and C-reactive protein (CRP) were independent predictors of ADMA, whereas LDL-cholesterol and gender independently predicted NMMA. Age, gender, HDL-cholesterol and CRP were independent predictors of L-arginine. ADMA (β=0.09;p=0.008) and NMMA (β=0.11; p=0.001), but not L-arginine, were strong predictors of c-IMT, even after adjustment for CVRF, CRP and renal function. In contrast, ADMA and NMMA were not predictors of cf-PWV, blood pressure or hemodynamic abnormalities. Higher L-arginine independently predicted higher central (aortic) pulse pressure (β=0.09; p=0.002), incident wave amplitude (β=0.11; p&lt;0.001) and late systolic augmented pressure from wave reflections (β=0.07; p=0.003), but not systemic vascular resistance or cardiac output. </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> ADMA and NMMA are differentially associated with CVRF, but both End-NOSI are independently predictors of carotid atherosclerosis. In contrast, they are not associated with large artery stiffness, hypertension or hemodynamic abnormalities. Our findings are consistent with a role for End-NOSI in atherosclerosis, but not in large artery stiffnening, hypertension or long-term hemodynamic regulation. L-arginine is independently associated with abnormal pulsatile hemodynamics, which may reflect abnormal L-arginine transport, leading to decreased intracellular bioavailability for NO synthesis. </jats:p> <jats:p />
Título: Diseño y plan operativo del estudio prevención: un estudio poblacional sobre la prevalenc... more Título: Diseño y plan operativo del estudio prevención: un estudio poblacional sobre la prevalencia de enfermedades cardiovasculares en el Perú/Design and operative plan of the study prevention: a population study on the prevalence of cardiovascular diseases in Peru
is undergoing the epidemiologic transition that occurred earlier in developed countries, and is l... more is undergoing the epidemiologic transition that occurred earlier in developed countries, and is likely to face a gigantic epidemic of heart disease in the next few years unless urgent action is taken. The first essential component of any effective cardiovascular disease (CVD) control program is to establish reliable estimates of cardiovascular disease-related morbidity and mortality. However, such data from population-based studies in Latin America are still lacking. In this paper, we present the design and operation of PREVENCION (Estudio Peruano de Prevalencia de Enfermedades Cardiovasculares, for Peruvian Study of the Prevalence of Cardiovascular diseases). PREVENCION is an ongoing population-based study on a representative sample of the civilian non-institutionalized population of the second largest city in Peru. Its population is comparable to the rest of the Peruvian urban population and closely resembles other Latin American populations in countries such as Bolivia and Ecuador. Our study will contribute to the enormous task of understanding and preventing CVD in Latin America.
Journal of the American Society of Hypertension, 2007
Cardiovascular disease is emerging as a leading cause of morbidity and mortality in Latin America... more Cardiovascular disease is emerging as a leading cause of morbidity and mortality in Latin America. Population-based data regarding the prevalence of hypertension and hypertension subtypes in Andean Hispanic populations are scarce. The authors performed a population-based study that included 1878 Peruvian Andean adults to determine: (1) the prevalence, awareness, and control of hypertension and (2) the relative frequency of hypertension subtypes (systolic vs. diastolic). The prevalence of hypertension was 15.7% (95% confidence interval [CI], 14.0%-17.4%), did not differ by gender, and increased steeply with age, particularly in women. Awareness, treatment, and control rates were 47.9%, 39.5%, and 14%, respectively. Diastolic blood pressure increased until age 50 years and reached a plateau thereafter, whereas mean arterial pressure continued to increase with age even after age 50 years. Furthermore, in sharp contrast with the United States population, the predominant type of hypertension was systodiastolic (41.7%; 95% CI, 35.1%-48.5%). Isolated systolic hypertension accounted for only 29.3% of cases (95% CI, 23.9%-35.4%) and was responsible for a minority of cases in all age groups before age 70 years. Hypertension subtypes in this Andean population seem to differ significantly from those present in the United States population, with a much larger proportion of systodiastolic and diastolic hypertension even with advanced age. These differences result from interactions between hemodynamic and structural factors, and further studies aimed at characterizing their genetic and environmental determinants and implications in end-organ damage and prognosis in this population may contribute to understanding the pathophysiology of hypertension.
The aim of our study was to explore the clinicopathological and prognostic significance of extrac... more The aim of our study was to explore the clinicopathological and prognostic significance of extracellular matrix metalloproteinase inducer (EMMPRIN) expression in oral squamous cell carcinomas (OSCC), and its relation with the proliferative tumor status of OSCC. We examined EMMPRIN and Ki-67 proteins expression by immunohistochemistry in 74 cases with OSCC. Statistical analysis was conducted to examine their clinicopathological and prognostic significance in OSCC. EMMPRIN membrane expression was observed in all cases, with both membrane and cytoplasmic tumor expression in 61 cases (82.4%). EMMPRIN overexpression was observed in 56 cases (75.7%). Moderately or poorly differentiated tumors showed EMMPRIN overexpression more frequently than well-differentiated tumors (P = 0.002). Overexpression of EMMPRIN was correlated with high Ki-67 expression (P = 0.004). In the multivariate analysis, EMMPRIN overexpression reveals an adverse independent prognostic value for cancer-specific survival...
Data regarding the prevalence of metabolic syndrome (MTS) in Andean populations are limited. We e... more Data regarding the prevalence of metabolic syndrome (MTS) in Andean populations are limited. We evaluated the prevalence of MTS according to American Heart Association/National Heart, Lung and Blood Institute criteria among 1878 subjects in the PREVENCION study in Peru. In women, the most common component was low HDL cholesterol (60.9%) followed by abdominal obesity (36.9%). In men, the most common component was elevated triglycerides (52.0%) followed by low HDL cholesterol (32.5%), whereas the prevalence of abdominal obesity was 14%. Abnormal fasting glucose was the least common component in men (5.4%) and women (5.0%). The prevalence of MTS was significantly higher in women compared to men (23.2% versus 14.3%) and increased steeply with age, particularly in women (p < 0.0001). Using body mass index (BMI ! 30 kg/m 2) instead of waist circumference as a component of the MTS lead to equivalent prevalence estimates of MTS in men but significantly underestimated the prevalence in women. The MTS is highly prevalent among Peruvian Andeans, particularly in older women. The pattern of MTS components in this Andean population is characterized by a high prevalence of dyslipidemia and a relatively low prevalence of elevated fasting glucose. Further studies are required to characterize genetic and environmental determinants of these patterns.
Resumo: Antecedentes Las enfermedades cardiovasculares están convirtiéndose en importante causa d... more Resumo: Antecedentes Las enfermedades cardiovasculares están convirtiéndose en importante causa de mortalidad en Latinoamérica. En Perú son necesarios estimados confiables de prevalencia, tipo y distribución de factores de riesgo cardiovascular, en ...
Regression models with undiagnosed CKD defined using the CKD-EPI equation in CRONICAS dataset (se... more Regression models with undiagnosed CKD defined using the CKD-EPI equation in CRONICAS dataset (sensitivity analysis, N = 2368). (DOCX 17 kb)
Flow-chart of participants included from the CRONICAS Cohort Study in the development of the risk... more Flow-chart of participants included from the CRONICAS Cohort Study in the development of the risk score. (DOCX 18Â kb)
OBJECTIVE We aimed to establish optimal definitions for abdominal obesity and metabolic syndrome ... more OBJECTIVE We aimed to establish optimal definitions for abdominal obesity and metabolic syndrome (MetS) among Andean adults. RESEARCH DESIGN AND METHODS Among 1,448 Andean adults, we assessed the relationship between waist circumference and subclinical vascular disease assessed by carotid intima-media thickness (cIMT) and manifest cardiovascular disease (M-CVD). RESULTS Optimal waist circumference cutoffs to classify individuals with abnormal cIMT or M-CVD were >97 and >87 cm in men and women, respectively. With these cutoffs, there was substantial disagreement between the original American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and the recently updated MetS definition, particularly among men (κ = 0.85). Subjects with MetS identified by the updated definition but not meeting the original AHA/NHLBI MetS criteria demonstrated significantly increased cIMT (P < 0.001) compared with subjects who did not meet the MetS criteria by either definition....
Chronic Kidney Disease (CKD) represents a great burden for the patient and the health system, par... more Chronic Kidney Disease (CKD) represents a great burden for the patient and the health system, particularly if diagnosed at late stages. Consequently, tools to identify patients at high risk of having CKD are needed, particularly in limited-resources settings where laboratory facilities are scarce. This study aimed to develop a risk score for prevalent undiagnosed CKD using data from four settings in Peru: a complete risk score including all associated risk factors and another excluding laboratory-based variables. Cross-sectional study. We used two population-based studies: one for developing and internal validation (CRONICAS), and another (PREVENCION) for external validation. Risk factors included clinical- and laboratory-based variables, among others: sex, age, hypertension and obesity; and lipid profile, anemia and glucose metabolism. The outcome was undiagnosed CKD: eGFR < 60 ml/min/1.73m2. We tested the performance of the risk scores using the area under the receiver operatin...
<jats:p> <jats:bold>Background:</jats:bold> Asymmetric dimethylarginine (ADMA) ... more <jats:p> <jats:bold>Background:</jats:bold> Asymmetric dimethylarginine (ADMA) and NG-monomethyl-L-arginine (NMMA), endogenous nitric oxide-synthase inhibitors (End-NOSI), have been associated with cardiovascular risk factors (CVRF) and atherosclerosis. In addition, acute administration of NOSI cause hypertension through hemodynamic effects, but whether circulating End-NOSI are associated with these abnormalities is unknown. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> We studied 922 adults in a population-based study (PREVENCION study). We examined the correlation between End-NOSI/L-arginine and CVRF, as well as the relationship between these biomarkers and arterial hemodynamics, carotid-femoral pulse wave velocity (cf-PWV) and carotid intima-media thickness (c-IMT). We used general linear modeling for statistical analyses. Estimates (β) are standardized. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> In multivariate analyses, LDL-cholesterol and C-reactive protein (CRP) were independent predictors of ADMA, whereas LDL-cholesterol and gender independently predicted NMMA. Age, gender, HDL-cholesterol and CRP were independent predictors of L-arginine. ADMA (β=0.09;p=0.008) and NMMA (β=0.11; p=0.001), but not L-arginine, were strong predictors of c-IMT, even after adjustment for CVRF, CRP and renal function. In contrast, ADMA and NMMA were not predictors of cf-PWV, blood pressure or hemodynamic abnormalities. Higher L-arginine independently predicted higher central (aortic) pulse pressure (β=0.09; p=0.002), incident wave amplitude (β=0.11; p&lt;0.001) and late systolic augmented pressure from wave reflections (β=0.07; p=0.003), but not systemic vascular resistance or cardiac output. </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> ADMA and NMMA are differentially associated with CVRF, but both End-NOSI are independently predictors of carotid atherosclerosis. In contrast, they are not associated with large artery stiffness, hypertension or hemodynamic abnormalities. Our findings are consistent with a role for End-NOSI in atherosclerosis, but not in large artery stiffnening, hypertension or long-term hemodynamic regulation. L-arginine is independently associated with abnormal pulsatile hemodynamics, which may reflect abnormal L-arginine transport, leading to decreased intracellular bioavailability for NO synthesis. </jats:p> <jats:p />
Título: Diseño y plan operativo del estudio prevención: un estudio poblacional sobre la prevalenc... more Título: Diseño y plan operativo del estudio prevención: un estudio poblacional sobre la prevalencia de enfermedades cardiovasculares en el Perú/Design and operative plan of the study prevention: a population study on the prevalence of cardiovascular diseases in Peru
is undergoing the epidemiologic transition that occurred earlier in developed countries, and is l... more is undergoing the epidemiologic transition that occurred earlier in developed countries, and is likely to face a gigantic epidemic of heart disease in the next few years unless urgent action is taken. The first essential component of any effective cardiovascular disease (CVD) control program is to establish reliable estimates of cardiovascular disease-related morbidity and mortality. However, such data from population-based studies in Latin America are still lacking. In this paper, we present the design and operation of PREVENCION (Estudio Peruano de Prevalencia de Enfermedades Cardiovasculares, for Peruvian Study of the Prevalence of Cardiovascular diseases). PREVENCION is an ongoing population-based study on a representative sample of the civilian non-institutionalized population of the second largest city in Peru. Its population is comparable to the rest of the Peruvian urban population and closely resembles other Latin American populations in countries such as Bolivia and Ecuador. Our study will contribute to the enormous task of understanding and preventing CVD in Latin America.
Journal of the American Society of Hypertension, 2007
Cardiovascular disease is emerging as a leading cause of morbidity and mortality in Latin America... more Cardiovascular disease is emerging as a leading cause of morbidity and mortality in Latin America. Population-based data regarding the prevalence of hypertension and hypertension subtypes in Andean Hispanic populations are scarce. The authors performed a population-based study that included 1878 Peruvian Andean adults to determine: (1) the prevalence, awareness, and control of hypertension and (2) the relative frequency of hypertension subtypes (systolic vs. diastolic). The prevalence of hypertension was 15.7% (95% confidence interval [CI], 14.0%-17.4%), did not differ by gender, and increased steeply with age, particularly in women. Awareness, treatment, and control rates were 47.9%, 39.5%, and 14%, respectively. Diastolic blood pressure increased until age 50 years and reached a plateau thereafter, whereas mean arterial pressure continued to increase with age even after age 50 years. Furthermore, in sharp contrast with the United States population, the predominant type of hypertension was systodiastolic (41.7%; 95% CI, 35.1%-48.5%). Isolated systolic hypertension accounted for only 29.3% of cases (95% CI, 23.9%-35.4%) and was responsible for a minority of cases in all age groups before age 70 years. Hypertension subtypes in this Andean population seem to differ significantly from those present in the United States population, with a much larger proportion of systodiastolic and diastolic hypertension even with advanced age. These differences result from interactions between hemodynamic and structural factors, and further studies aimed at characterizing their genetic and environmental determinants and implications in end-organ damage and prognosis in this population may contribute to understanding the pathophysiology of hypertension.
The aim of our study was to explore the clinicopathological and prognostic significance of extrac... more The aim of our study was to explore the clinicopathological and prognostic significance of extracellular matrix metalloproteinase inducer (EMMPRIN) expression in oral squamous cell carcinomas (OSCC), and its relation with the proliferative tumor status of OSCC. We examined EMMPRIN and Ki-67 proteins expression by immunohistochemistry in 74 cases with OSCC. Statistical analysis was conducted to examine their clinicopathological and prognostic significance in OSCC. EMMPRIN membrane expression was observed in all cases, with both membrane and cytoplasmic tumor expression in 61 cases (82.4%). EMMPRIN overexpression was observed in 56 cases (75.7%). Moderately or poorly differentiated tumors showed EMMPRIN overexpression more frequently than well-differentiated tumors (P = 0.002). Overexpression of EMMPRIN was correlated with high Ki-67 expression (P = 0.004). In the multivariate analysis, EMMPRIN overexpression reveals an adverse independent prognostic value for cancer-specific survival...
Data regarding the prevalence of metabolic syndrome (MTS) in Andean populations are limited. We e... more Data regarding the prevalence of metabolic syndrome (MTS) in Andean populations are limited. We evaluated the prevalence of MTS according to American Heart Association/National Heart, Lung and Blood Institute criteria among 1878 subjects in the PREVENCION study in Peru. In women, the most common component was low HDL cholesterol (60.9%) followed by abdominal obesity (36.9%). In men, the most common component was elevated triglycerides (52.0%) followed by low HDL cholesterol (32.5%), whereas the prevalence of abdominal obesity was 14%. Abnormal fasting glucose was the least common component in men (5.4%) and women (5.0%). The prevalence of MTS was significantly higher in women compared to men (23.2% versus 14.3%) and increased steeply with age, particularly in women (p < 0.0001). Using body mass index (BMI ! 30 kg/m 2) instead of waist circumference as a component of the MTS lead to equivalent prevalence estimates of MTS in men but significantly underestimated the prevalence in women. The MTS is highly prevalent among Peruvian Andeans, particularly in older women. The pattern of MTS components in this Andean population is characterized by a high prevalence of dyslipidemia and a relatively low prevalence of elevated fasting glucose. Further studies are required to characterize genetic and environmental determinants of these patterns.
Resumo: Antecedentes Las enfermedades cardiovasculares están convirtiéndose en importante causa d... more Resumo: Antecedentes Las enfermedades cardiovasculares están convirtiéndose en importante causa de mortalidad en Latinoamérica. En Perú son necesarios estimados confiables de prevalencia, tipo y distribución de factores de riesgo cardiovascular, en ...
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