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Background: Cardiovascular Disease (CVD) epidemiology varies significantly among Low and Middle-Income Countries. Honduras is the Central American country with the highest ischemic heart disease and CVD mortality rates. The objective of this study is to provide an epidemiologic perspective of CVD in Western Honduras by analyzing cardiovascular (CV) risk in a population of Hispanics/mestizos and calculating their predicted CVD mortality using Cardiovascular Risk Assessment Scores (CVRAS) such as AHA/ACC Pooled-Cohort Equations (PCEs), Framingham Risk Score (FRS) and Multi-Ethnic Study on Atherosclerosis (MESA) Risk Score. Methods: Data was derived from Torres et al study, which was a cross-sectional, primary-prevention study, including 382 subjects between 45-75 years, in Copán, Honduras, between November 2016 and January 2017. Results: Out of 379 subjects meeting inclusion criteria, 38% (143 of 379) were male and 62% (237 of 379) were female. Age was 57 ± 8.2 for men and 58 ± 7.7 for women. Prevalence of hypertension was 49.7% (71 of 143) in men and 47.7% (113 of 237) in women; 91.3% (168 of 184) were being treated. DM was present in 19% (27 of 143) of men and 22.1% (52 of 237) of women; 96.2% (75 of 79) were being treated. Obesity was 24.5% (35 of 143) in men and 24.1% (57 of 237) in women. Total cholesterol was ≥ 200 mg/dl in 63.1% (239 of 379) of subjects, 21.8% (52 of 239) were taking lipid-lowering medications. For men and women respectively; AHA/ACC-PCEs was ≥7.5% (high-risk) in 62.2% (89 of 143) and 29.8% (71 of 237), FRS was ≥20% in 46.2% (66 of 143) and 15.2% (36 of 237), and MESA Risk Score was ≥7.5% in 70.6% (101 of 143) and 17.7% (42 of 237). Conclusions: After collecting anthropometric and laboratory data, calculation of CVRAS showed significantly elevated rates of high-CV risk patients according to all 3 scores. This is the first study of its type in Honduras. Efforts should be made to aggressively reduce CVD risk factors, and follow this cohort of subjects to better understand CVD morbidity and mortality in Western Honduras.

Introduction: Heart Failure (HF) is categorized according to the AHA/ACC 2013 HF Guidelines based on Left Ventricular Ejection Fraction (LVEF); HF with Reduced Ejection Fraction (HFrEF, EF≤40%), and HF with preserved EF (HFpEF, EF ≥ 50%). There is a group of “borderline” patients with EF 41%-49%, termed Heart Failure with Mid-Range Ejection Fraction (HFmrEF). Given this category is not well understood, we sought to evaluate clinical characteristics and management patterns for patients with HFmrEF. Methods: A systematic review was performed using Ovid MEDLINE, EMBASE, Cochrane CENTRAL and LILACS (1946 – 03/2018). Search terms included HF, mid-range, borderline LVEF with several ranges (40-50 or 40-45 or 45-50). Variables characterizing clinical features and medications were extracted for each HF group and adjusted odds ratios (ORs) were pooled. Results: Of 1,131 abstracts identified, 24 met inclusion criteria (total patients 480,188). Patients with HFmrEF compared to those with HFrEF were more likely to be female (OR 1.42), have hypertension [HTN] (OR 1.34) and diabetes (OR 1.11), higher SBP (OR 1.17), better NYHA-FC (FC I OR 1.73, FC II 1.33), less likely to have coronary artery disease [CAD] (OR 0.74) and more likely to be treated with ACEI, ARB, BB, Digoxin, MRA and statins (Figure 1-2). HFmrEF patients when compared to those with HFpEF were less likely to be female (OR 0.54) or have HTN (OR 0.68), and more likely to have CAD (OR 1.25), and to be treated with HF medications and statins. Conclusions: Patients with HFmrEF have higher SBP and better NYHA-FC (I and II) compared to HFrEF patients and are less likely to be female and more likely to have CAD compared to HFpEF patients. Further research is needed to help guide management in this unique but clinically important population. Figure 1A. Forest plot of adjusted ORs comparing baseline clinical characteristics of HFrEF vs HFmrEF patients Figure 1B. Forest plot of adjusted ORs comparing baseline clinical characteristics of HFmrEF vs HFpEF patients Figure 2A. Forest plot of adjusted ORs comparing medications used in HFrEF vs HFmrEF patients Figure 2B. Forest plot of adjusted ORs comparing medications used in HFmrEF vs HFpEF patients