Clinical research study
CARMELA: Assessment of Cardiovascular Risk in Seven Latin American Cities

https://doi.org/10.1016/j.amjmed.2007.08.038Get rights and content

Abstract

Objective

This cross-sectional, population-based observational study using stratified multistage sampling assessed the prevalence of cardiovascular risk factors and carotid plaques and measured carotid intima-media thickness in individuals living in major cities in 7 Latin American countries.

Patients and Methods

The study comprised individuals (n = 11,550) aged 25 to 64 years, living in Barquisimeto, Bogota, Buenos Aires, Lima, Mexico City, Quito, and Santiago. Data on anthropometric parameters, blood pressure, fasting glucose, total and high-density lipoprotein cholesterol, triglycerides, carotid intima-media thickness, carotid plaque, and smoking status were collected through household interviews and clinical, biochemical, and sonographic measurements.

Results

The overall prevalence rates (ranges across cities) were as follows: hypertension (≥140/90 mm Hg or pharmacologic treatment), 18% (9%-29%); hypercholesterolemia (total cholesterol ≥240 mg/dL), 14% (6%-20%); diabetes (glycemia ≥126 mg/dL or self-reported diabetes), 7% (4%-9%); metabolic syndrome, 20% (14%-27%); obesity (body mass index ≥30 kg/m2), 23% (18%-27%); smoking, 30% (22%-45%); and plaque, 8% (5%-14%). The mean intima-media thickness was 0.65 mm (0.60-0.74 mm).

Conclusion

The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes was similar to that in the developed countries. Tobacco use in women living in Santiago and Buenos Aires was among the world’s highest. Intima-media thickness and carotid plaque prevalences varied widely.

Section snippets

Patients and Methods

This study was conducted in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice, and local bioethics regulations and laws. All subjects provided written informed consent.

Demographics

Table 1 shows the basic demographics of the 11,550 CARMELA participants. As expected per the study design, the mean age of participants was at the mid-range of study enrollment. Approximately 13% reported family members with cardiovascular disease, and 2% reported prior myocardial infarction or stroke.

Risk Factor Prevalence

The estimated prevalences of risk factors are presented in Table 2. Hypertension prevalences clustered into 2 groups: Barquisimeto, Buenos Aires, and Santiago had the highest prevalence (25%, 29%,

Discussion

Cardiovascular risk was distributed heterogeneously across Latin America, with different risk factors concentrated in different cities. Hypertension prevalences were in 2 clusters: Buenos Aires, Barquisimeto, and Santiago had prevalences approximately 25%, comparable to worldwide (26%) and US (29%) prevalences,11, 12 whereas the other 4 cities had lower prevalences. The prevalence of hypercholesterolemia in Quito, Buenos Aires, Mexico City, and Santiago (15%-20%) was similar to that among US

Conclusions

On the basis of the Framingham risk scores, 1 in 7 persons in the CARMELA cities is at significant risk for a cardiovascular event. Although the appropriateness of using the Framingham algorithm for non-US populations has not been demonstrated,29 this algorithm may provide an initial heuristic for exploring risk patterns until a Latin American risk scoring system is developed and validated.

The CARMELA study is a large cross-sectional, observational study with the added value of being conducted

Acknowledgments

The authors thank Dr Gianni Tognoni for input and critical revision of this article; Dr Marta Torres for rigorous efforts in compiling data provided by the clinical analysis laboratories of each city; Héctor Rosso, database designer and administrator, for help with information technology; Aurélia Puech-Bournonville for coordination of the central reading of the echosonographic intima-media thickness measurements; Drs Eric Vicaut and Julien Labreuche for statistical analyses of data on carotid

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    The CARMELA Study was funded through an unrestricted research grant from Pfizer, Inc.

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