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      Prevalencia e interrelación de enfermedades crónicas no transmisibles y factores de riesgo cardiovascular en México: Resultados finales de la Encuesta Nacional de Salud (ENSA) 2000 Translated title: Prevalence and interrelations of noncommunicable chronic diseases and cardiovascular risk factors in Mexico: Final outcomes from the National Health Survey 2000

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          Abstract

          Propósito: Determinar la prevalencia e interrelación de enfermedades crónicas no transmisibles (ECNT), obesidad, tabaquismo y proteinuria en la población adulta (entre 20 y 69 años) de la república mexicana, así como su estratificación de acuerdo a grupos de edad, género y área geográfica. Método: En el año 2000 se realizó una encuesta nacional probabilística en 45,300 personas. El tamaño de la muestra fue calculado para abordar ENCT con una prevalencia mínima estimada de 6%. La encuesta corresponde al tipo III del método paso a paso descrito por la OMS. Los datos fueron ponderados para la distribución de población y género, de acuerdo con la encuesta nacional de población y vivienda 2000 (INEGI). Resultados: Un total de 38,377 (98.8%) sujetos fueron incluidos para el análisis. El 69.4% fueron mujeres. La edad promedio para el género masculino fue de 39.4 ± 12.9 y para el femenino de 38.6 ± 13.0 transmisibles con la encuesta nacional de salud. La prevalencia nacional promedio para hipertensión fue del 30.05%, para diabetes del 10.7%, para obesidad del 24.4%, para glucosa capilar anormal del 12.7% y para proteinuria del 9.2%. Las prevalencias de hipertensión y diabetes fueron directamente relacionadas con la edad, índice de masa corporal y perímetro de la cintura. La distribución piramidal de la población mexicana determinó que la proporción mayoritaria en las prevalencias de las ECNT se ubicaran antes de los 54 años de forma significativa (> 75%). Conclusión: ENSA 2000 demuestra el incremento notable en la prevalencia de ECNT en México y alerta sobre la necesidad urgente de estrategias nacionales que permitan contener este importante problema de salud pública. Las estrategias deben ser orientadas al abordaje conjunto de las ECNT ya que su interrelación clínica y fisiopatológica queda demostrada en ENSA 2000.

          Translated abstract

          Purpose: To determine the prevalence and interrelation of noncommunicable chronic diseases (NCCD), obesity, smoking, and proteinuria in the adult population (between 20 and 69 years of age) of Mexico, and their stratification according to age, gender, and geographical area. Method: During the year 2000, a probabilistic national survey was performed in 45,300 persons. The sample size was calculated to approach NCCD with a minimal estimated prevalence of 6%. The survey corresponds to type III of the step-by-step method described by WHO. Data were weighted for the distribution of the population and gender, according to the national survey of population and housing (National Institute of Statistics and Geography, INEGI). Results: A total of 38,377 (98.8%) of individuals were included in the analysis; 69.4% were women. Average age for men was 39.4 ± 12.9 and for women 38.6 ± 13.0. National average prevalence for hypertension was 30.05%, for diabetes of 10.7%, for obesity of 24.4%, for abnormal capillary glucose of 12.7%, and for proteinuria of 9.2%. Prevalence for hypertension and diabetes were directly related with age, body mass index, and waist perimeter. The pyramidal distribution of the Mexican population determined that the greatest proportion of prevalence of NCCD was given by those under 54 years of age with a statistical significance (>75%). Conclusion: ENSA 2000 demonstrates the marked increase in NCCD prevalence in the Mexican population and alerts on the urgent need of national strategies to restrain this important public health problem. Strategies must be oriented towards an integrated approach of the NCCD, since their clinical and physiopathological interrelation is clearly demonstrated through ENSA 2000. (Arch Cardiol Mex 2003; 73:62-77)

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          Effects of current smoking and smoking discontinuation on renal function and proteinuria in the general population.

          Smoking may adversely affect the progression of renal diseases. However, it is unknown whether smoking affects renal function in subjects without nephropathy. In 1998, 28,409 volunteers from the general population were examined at the Institut Régional pour la Santé (IRSA). Renal function was estimated with creatinine clearance using the Cockcroft formula. Dipstick proteinuria was assessed on an overnight urine sample by a trained technician. Adjusted creatinine clearance was higher in current smokers than in former smokers and never smokers (100.6 +/- 13.6 vs. 98.8 +/- 13.9 mL/min/1.73 m2, P < 0.0001, and vs. 98.5 +/- 14.0 mL/min/1. 73 m2, P < 0.0001, respectively). This difference was predominant in men and weak in women, and was associated with the number of cigarettes smoked daily. The slope of the projected age-related decline in the creatinine clearance accelerated with age, but it was similar in current smokers, former smokers, and never smokers. Creatinine clearance was associated with a relative risk of proteinuria [for each mL/min/1.73 m2, the relative risk was 1.007 (95% CI, 1.000 to 1.015), P = 0.056, for 1+ or higher proteinuria; and 1.018 (1.004 to 1.030), P = 0.0078, for 2+ or higher proteinuria]. Current and former smokers had a marked risk of 2 or higher proteinuria [adjusted RR (95% CI), 3.26 (1.66 to 6.80), P = 0. 0009, and 2.69 (1.24 to 5.99), respectively, P = 0.013, vs. never smoking], which was independent of the daily or cumulative cigarette consumption. In the general population, smokers do not exhibit lower creatinine clearance than never smokers. In fact, creatinine clearance is slightly higher in current smokers at least in men, even when normotensive and hypertensive subjects are analyzed separately, but the difference is small, especially in women. This effect seems reversible upon smoking discontinuation. Chronic smoking results in a marked risk of irreversible proteinuria that may occur despite moderate smoking.
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            CARDIO-VASCULAR DISEASES

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              The risk of hypertension in men: direct and indirect effects of chronic smoking.

              To assess the risk of hypertension associated with smoking status. A population-based cross-sectional study in 12 417 men screened for a routine medical and biological check-up provided by their medical insurance at the 'Institut inter-Régional pour la Santé' (IRSA, Regional Institute for Health), a group of 10 medical centres in Western and Central France. The prevalence and the relative risk of hypertension associated with smoking status. Overall, the prevalence of hypertension was higher in former smokers than in never smokers (13.5 versus 8.8%, P < 0.001). The risk of hypertension was higher [odds ratio (OR) 1.31 (1.13-1.52), P < 0.001] in former smokers than in never smokers, independently of age and alcohol intake. Both current and former smokers were at risk for systolic hypertension, especially those subjects aged 60 years and above. The risk of hypertension was associated with the number of cigarettes smoked [OR per 10 cigarettes smoked daily: 1.13 (1.05-1.21), P < 0.001] and the duration of smoking cessation [OR 0.99 (0.98-1.00), P = 0.01]. When body mass index was entered into the model, the risk of hypertension in former smokers was no longer significant; however, current smokers remained at risk for systolic hypertension. Former smokers are at risk for hypertension, probably because of the higher prevalence of overweight and obese subjects in this group. Current smokers are also at risk for systolic hypertension, especially in those subjects aged 60 years or older. However, this risk is independent of body mass index.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
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                Journal
                acm
                Archivos de cardiología de México
                Arch. Cardiol. Méx.
                Elsevier
                1405-9940
                March 2003
                : 73
                : 1
                : 62-77
                Affiliations
                [1 ] Secretaria de Salud México
                Article
                S1405-99402003000100009
                Product
                Product Information: website
                Categories
                Cardiac & Cardiovascular Systems

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