Objective: The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality. Design: We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings: MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject: Eleven prospective studies with 229 785 participants and average followup period of 13·37 years (range 5·5-19 years). Results: Higher Na intake was significantly associated with higher CVD mortality (relative risk = 1·12; 95 % CI 1·06, 1·19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk = 1·08; 95 % CI 1·01, 1·15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P = 0·016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality. Conclusions: Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

No abstract

Objective Few data are available on population level regarding domain-specific correlates of physical activity (PA) in Latin America. The aim of this study was to examine the relationships among PA patterns and their main sociodemographic determinants and cardiovascular risk factors in the Southern Cone of Latin America. Methods CESCAS I is a population-based prospective cohort study with a 4-stage stratified sampling of a general population of 7,524 adults aged 35–74 years from four mid-sized cities in Argentina, Chile and Uruguay. PA was assessed using the transcultural adaptation of the International Physical Activity Questionnaire long form (IPAQ). The questionnaire asked about frequency (days/week) and duration (minutes/day) of moderate and vigorous intensity activities in three different domains: work, leisure time and active transportation (walking and bicycling). PA levels ≥ 600 metabolic equivalent tasks (MET) minutes/week was considered sufficiently active (SA). Odds ratios for associations of SA status with sociodemographic determinants and cardiovascular risk factors were obtained using multivariable-adjusted logistic regression models. Results Almost sixty five percent (64.8%) of the participants reported ≥ 600 MET minutes/week. The lowest prevalence of sufficiently active individuals was seen in Temuco, Chile (58.0 %), among women (58.7%), older individuals (55.4%), those with higher educational level (61.6%) and homemakers (53.4%). Approximately 22.8% of the population reported no PA. In multivariable analysis, PA levels were lower among women, individuals who were older, obese, university educated, with clerical work, retired/unemployed or homemakers, and those with physical limitations. Conclusions Future interventions to increase PA levels in the Southern Cone of Latin America must take into account disparities by gender and socioeconomic status. The promotion of PA during leisure time in women –unemployed and homemakers– and of active transportation for those performing office or clerical work should be a priority in this population.

ObjectiveTo estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs.MethodsWe estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted.FindingsWe estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually.ConclusionEven under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.