Rody G. Sy, M.D.
Sex: Male
Education:
Doctor of Medicine, University of the Philippines, 1974
General Internship, UP-PGH Medical Center, 1974-1975
Residency in Internal Medicine, UP-PGH Medical Center, 1976-1979
Fellowship in Cardiology, Georgetown University Hospital, 1979-1982
Fellow and Diplomate, Philippine College of Physicians, 1983
Fellow and Diplomate, Philippine College of Cardiology, 1983
Fellow, American College of Cardiology, 1993
Fellow, Philippine Society of Cardiac Catherization and Intervention, 1995
Fellow, Asean College of Cardiology, 2008
Field of Specialization
Cardiogenomics
Cardiology
Epidemiology
Researches:
Article title: Gaps in beliefs and practice in dyslipidaemia management in Japan, Germany, Colombia and the Philippines: insights from a web-based physician survey
Authors: Philip J. Barter, Shizuya Yamashita, Ulrich Laufs, Alvaro J. Ruiz, et al.
Publication title: Lipids in Health and Disease 19(1), June 2020
Abstract:
Background: Implementing evidence-based management of dyslipidaemia is a challenge worldwide. Objectives: To understand physician beliefs and behaviour and identify uncertainties in dyslipidaemia management across four world regions. Methods: Web-based survey of 1758 physicians in Japan, Germany, Colombia and the Philippines who were selected randomly from existing databases. Key inclusion criteria were 1) for cardiologists and diabetes/endocrinology specialists: ≥50 dyslipidaemia patients examined in the last month; 2) for specialists in neurology/neurosurgery/stroke medicine: ≥50 dyslipidaemia patients and ≥ 20 patients with a history of ischaemic stroke examined in the last month; and 3) for specialists in nephrology and general medicine: based at centres with ≥20 beds and ≥ 50 dyslipidaemia patients examined in the last month. The self-report survey covered dyslipidaemia management, target low-density lipoprotein cholesterol (LDL-C) levels in different patient groups, and statin safety. All physicians gave voluntary consent and all data were anonymised. Analysis was solely descriptive. Results: The survey highlighted key areas of uncertainty in dyslipidaemia management in the four countries. These related to LDL-C targets in different patient groups, the safety of low LDL-C levels, the safety of statins, especially for effects on cognitive, renal and hepatic function and for haemorrhagic stroke risk, and lipid management strategies in patients with chronic kidney disease, including those with concomitant hypertriglyceridaemia. Conclusions: This survey of physicians in Japan, Germany, Colombia and the Philippines has identified key gaps in knowledge about dyslipidaemia management. These relate to the safety of low LDL-C levels, the safety of statins, and lipid management of chronic kidney disease. The findings from this survey highlight the need for further education to improve the implementation of guideline recommendations for dyslipidaemia management.
Article title: BAG6 Variant rs805303 is Nominally Associated with ACEi-induced Cough Among Filipinos
Authors: Paul Ferdinand M. Reganit, Rody G. Sy, Jezreel L. Taquiso, Charlene F. Agustin
Publication title: Philippine Journal of Science, 149(1), March 2020
Abstract:
Cough is a common side effect of angiotensin converting enzyme inhibitor (ACEi) therapy. The incidence of ACEi-induced cough has been shown to correlate with genetic variation among different populations. This study aimed to determine the association of candidate genetic polymorphisms with ACEi-induced cough among Filipinos. Two hundred twenty (220) participants on ACEi therapy pressure-lowering in an unmatched case-control study (82 cases with ACEi-induced cough and 138 controls). Genomic DNA samples were extracted and genotyped for selected genetic variants. The association of genetic variants and clinical factors with ACEi-induced cough was determined using regression analyses. Univariate logistic regression showed that the BAG6 variant rs805303 is nominally associated with ACEi-induced cough among Filipinos, at a per-comparison error rate (PCER) of 0.05 (OR 2.10, p = 0.016). The association of the variant with ACEi cough was statistically significant after multiple regression analysis (adjusted OR 2.09, p = 0.022) while adjusting for confounding clinical factors (sex, alcohol intake, and diastolic blood pressure). Further studies are needed to validate these findings.
Article title: Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors among Community Health Workers in Selected Villages in the Philippines
Authors: Olivia Sison, Nina Castillo-Carandang, Mary Ann Jucutan Ladia, Rody G. Sy, et al.
Publication title: Journal of ASEAN Federation of Endocrine Societies 34(2), November 2019
Abstract:
Objective. This study aimed to estimate the prevalence of cardiovascular risk factors and metabolic syndrome among community health workers (CHWs) in selected villages in the Philippines. It also determined the association of urbanization and socio-demographic characteristics with hypertension, diabetes mellitus and metabolic syndrome among CHWs.
Methodology. A cross-sectional study was conducted among CHWs who were actively rendering service from selected communities at the time of the study. Standardized interviews were conducted and clinical measurements were collected.
Results. Of the total of 457 CHWs who participated, 96% were females with a median age of 50 years. The prevalence of hypertension in this population was 32.4%. Hypertension was found to be associated with older age [adjusted odds
ratio (aOR) 5.3, 95% CI: 3.2 to 8.8, p<0.001], obesity (aOR 2.4, 95% CI: 1.4 to 4.0, p=0.002) and alcohol consumption (aOR 1.7, 95% CI: 1.0 to 3.0, p<0.040). The prevalence of diabetes mellitus (DM) was 13.6%. It was found to be more prevalent among CHWs who were at least 50 years old (aOR 2.7, 95% CI: 1.4 to 5.1, p=0.002), and those who spent at least 5 hours a day in sedentary activities (aOR 3.8, 95% CI: 1.1 to 12.7, p<0.033). Borderline to high total cholesterol, low density lipoprotein cholesterol (LDL-c) and triglycerides (TG) were seen in 41%, 37% and 20%, respectively. Sixty percent had low high density lipoprotein cholesterol (LDL-c). The overall prevalence of metabolic syndrome was 52.3%.
Conclusion. Metabolic syndrome is prevalent among CHW participants, with obesity, hypertension and low LDL-c as the most common components present. The prevalence of cardiovascular risk factors in this population was not found to be signicantly dierent between rural and urban areas after adjusting for other factors.
Article title: Effect of alirocumab on cardiovascular outcomes after acute coronary syndromes according to age: An ODYSSEY OUTCOMES trial analysis
Authors: Peter R. Sinnaeve, Gregory G. Schwartz, Daniel M. Wojdyla, Marco Alings, et al.
Publication title: European Heart Journal 41(24), November 2019
Abstract:
Aims: Lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk irrespective of age, but the evidence is less strong for older patients. Methods and results: This prespecified analysis from ODYSSEY OUTCOMES compared the effect of alirocumab vs. placebo in 18 924 patients with recent acute coronary syndrome (ACS) according to age. We examined the effect of assigned treatment on occurrence of the primary study outcome, a composite of coronary heart disease death, myocardial infarction, ischaemic stroke, or unstable angina requiring hospitalization [major adverse cardiovascular event (MACE)] and all-cause death. Relative risk reductions were consistent for patients ≥65 vs. <65 years for MACE [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.68-0.91 vs. 0.89, 0.80-1.00; Pinteraction = 0.19] and all-cause death [HR 0.77, 0.62-0.95 vs. 0.94, 0.77-1.15; Pinteraction = 0.46], and consistent for MACE when dichotomizing at age 75 years (HR 0.85, 0.64-1.13 in ≥75 vs. 0.85, 0.78-0.93 in <75, Pinteraction = 0.19). When considering age as a continuous variable in regression models, advancing age increased risk of MACE, as well as the absolute reduction in MACE with alirocumab, with numbers-needed-to-treat for MACE at 3 years of 43 (25-186) at age 45 years, 26 (15-97) at age 75 years, and 12 (6-81) for those at age 85 years. Although adverse events were more frequent in older patients, there were no differences between alirocumab and placebo. Conclusion: In patients with recent ACS, alirocumab improves outcomes irrespective of age. Increasing absolute benefit but not harm with advancing age suggests that LDL-C lowering is an important preventive intervention for older patients after ACS.
Article title: Recalibration of biochemistry measurements in a multinational cohort study: LIFE course study in CARdiovascular disease Epidemiology (LIFECARE)
Authors: Ei Ei Nang, Sheryl Hx Ng, Mahham Shafiq, Chuen Seng Tan, et al.
Publication title: (Preprint) - Undergoing Peer Review
Abstract:
Background
Various cardiovascular biomarkers are used to assess and compare the risk of cardiovascular diseases across populations. However, artefactual variations due to the use of different laboratories may make these comparisons invalid. This work describes the inter-laboratory variations in a multi-country cohort, LIFECARE, and the use of recalibration to a reference laboratory to minimise this variability.
Methods
LIFECARE is a cohort of 10,479 participants recruited from Indonesia, Malaysia, Philippines and Thailand between 2008 and 2011, with blood samples analysed at country-specific laboratories(n=4). Thailand was the designated reference laboratory. The measurements from each laboratory were compared against the reference laboratory using a common set of samples analysed at all laboratories, using the MethComp package in R. Laboratory values for cohort participants were recalibrated using the equation generated by the package, if large, statistically significant differences were observed during the comparison.
Results
Glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride measurements were reported for all four countries. Cholesterol and HDL from all laboratories required recalibration while glucose did not. Recalibration altered the proportions of the population at risk substantially, with prevalence of high cholesterol changing from 56.3% to 75.0% in Malaysia, 52.1% to 37.5% in Indonesia and 31.3% to 22.7% in Philippines. Prevalence of low HDL was similarly altered.
Conclusion
There was significant variation in serum lipid levels measured by different laboratories, leading to variations in estimates of population at risk. Recalibration to a reference laboratory can overcome this variability and facilitate meaningful comparisons of laboratory data across countries.
Article title: Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes: a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial
Authors: G.G. Schwartz, P.G. Steg, M. Szarek, D.L. Bhatt, et al.
Publication title: The Lancet Diabetes & Endocrinology 7(8), July 2019
Abstract:
Background: After acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1·4-1·8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary syndrome and diabetes. However, the efficacy and safety of further reduction in LDL cholesterol with an inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) after acute coronary syndrome is unknown. We aimed to explore this issue in a prespecified analysis of the ODYSSEY OUTCOMES trial of the PCSK9 inhibitor alirocumab, assessing its effects on cardiovascular outcomes by baseline glycaemic status, while also assessing its effects on glycaemic measures including risk of new-onset diabetes. Methods: ODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled trial, done at 1315 sites in 57 countries, that compared alirocumab with placebo in patients who had been admitted to hospital with an acute coronary syndrome (myocardial infarction or unstable angina) 1-12 months before randomisation and who had raised concentrations of atherogenic lipoproteins despite use of high-intensity statins. Patients were randomly assigned (1:1) to receive alirocumab or placebo every 2 weeks; randomisation was stratified by country and was done centrally with an interactive voice-response or web-response system. Alirocumab was titrated to target LDL cholesterol concentrations of 0·65-1·30 mmol/L. In this prespecified analysis, we investigated the effect of alirocumab on cardiovascular events by glycaemic status at baseline (diabetes, prediabetes, or normoglycaemia)-defined on the basis of patient history, review of medical records, or baseline HbA1c or fasting serum glucose-and risk of new-onset diabetes among those without diabetes at baseline. The primary endpoint was a composite of death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischaemic stroke, or unstable angina requiring hospital admission. ODYSSEY OUTCOMES is registered with ClinicalTrials.gov, number NCT01663402. Findings: At study baseline, 5444 patients (28·8%) had diabetes, 8246 (43·6%) had prediabetes, and 5234 (27·7%) had normoglycaemia. There were no significant differences across glycaemic categories in median LDL cholesterol at baseline (2·20-2·28 mmol/L), after 4 months' treatment with alirocumab (0·80 mmol/L), or after 4 months' treatment with placebo (2·25-2·28 mmol/L). In the placebo group, the incidence of the primary endpoint over a median of 2·8 years was greater in patients with diabetes (16·4%) than in those with prediabetes (9·2%) or normoglycaemia (8·5%); hazard ratio (HR) for diabetes versus normoglycaemia 2·09 (95% CI 1·78-2·46, p<0·0001) and for diabetes versus prediabetes 1·90 (1·65-2·17, p<0·0001). Alirocumab resulted in similar relative reductions in the incidence of the primary endpoint in each glycaemic category, but a greater absolute reduction in the incidence of the primary endpoint in patients with diabetes (2·3%, 95% CI 0·4 to 4·2) than in those with prediabetes (1·2%, 0·0 to 2·4) or normoglycaemia (1·2%, -0·3 to 2·7; absolute risk reduction pinteraction=0·0019). Among patients without diabetes at baseline, 676 (10·1%) developed diabetes in the placebo group, compared with 648 (9·6%) in the alirocumab group; alirocumab did not increase the risk of new-onset diabetes (HR 1·00, 95% CI 0·89-1·11). HRs were 0·97 (95% CI 0·87-1·09) for patients with prediabetes and 1·30 (95% CI 0·93-1·81) for those with normoglycaemia (pinteraction=0·11). Interpretation: After a recent acute coronary syndrome, alirocumab treatment targeting an LDL cholesterol concentration of 0·65-1·30 mmol/L produced about twice the absolute reduction in cardiovascular events among patients with diabetes as in those without diabetes. Alirocumab treatment did not increase the risk of new-onset diabetes. Funding: Sanofi and Regeneron Pharmaceuticals.
Article title: The Klotho Variant rs36217263 Is Associated With Poor Response to Cardioselective Beta-Blocker Therapy Among Filipinos
Authors: Rody G. Sy, Jose B. Nevado, Elmer Balasico Llanes, Jose Donato A. Magno
Publication title: Clinical Pharmacology & Therapeutics 107(1), July 2019
Abstract:
A common drug used for hypertension among Filipinos are beta‐blockers. Variable responses to beta‐blockers are observed, and genetic predisposition is suggested. This study investigated the association of genetic variants with poor response to beta‐blockers among Filipinos. A total of 76 Filipino adult hypertensive participants on beta‐blockers were enrolled in an unmatched case‐control study. Genotyping was done using DNA from blood samples. Candidate variants were correlated with clinical data using chi‐square and logistic regression analysis. The deletion of at least one copy of allele A of rs36217263 near Klotho showed statistically significant association with poor response to beta‐blockers [dominant; odds ratio (OR)=3.89, p=0.017)], adjusted for diabetes and dyslipidemia. This association is observed among participants using cardioselective beta‐blockers (crude OR=5.60, p=0.008), but not carvedilol (crude OR=2.56, p=0.67). The genetic variant rs36217263 is associated with poor response to cardioselective beta‐blockers, which may become a potential marker to aid in the management of hypertension
Full text available upon request to the author
Article title: Rising rural body-mass index is the main driver of the global obesity epidemic in adults
Authors: BCD Risk Factor Collaboration (NCD-RisC)
Publication title: Nature 569(7755), May 2019
Abstract:
Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
Article title: Cohort Profile: LIFE course study in CARdiovascular disease Epidemiology (LIFECARE)
Authors: Mahham Sahfiq, Alan Yean Yip Fong, Ei Ei Nang, Rody G. Sy, et al.
Publication title: International Journal of Epidemiology, 2018
Abstract: No available
Article title: Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants
Authors: Bin Zhou, James Bentham, Mariachiara Di Cesare, Rody G. SY, et al.
Publication title: International Journal of Epidemiology 47(3), 2018
Abstract:
Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.
Full text available upon request to the author
Article title: The association of the dietary approach to stop hypertension (DASH) diet with blood pressure, glucose and lipid profiles in the Malaysian and Philippines populations
Authors: Xunting Tiong, A. Nursara Shahirah, V.C. Pun, Rody G. Sy, et al.
Publication title: Nutrition, metabolism and cardiovascular diseases: NMCD 28(8), 2018
Abstract:
Background and aim: Despite a growing body of evidence from Western populations on the health benefits of Dietary Approaches to Stop Hypertension (DASH) diets, their applicability in South East Asian settings is not clear. We examined cross-sectional associations between DASH diet and cardio-metabolic risk factors among 1837 Malaysian and 2898 Philippines participants in a multi-national cohort. Methods and results: Blood pressures, fasting lipid profile and fasting glucose were measured, and DASH score was computed based on a 22-item food frequency questionnaire. Older individuals, women, those not consuming alcohol and those undertaking regular physical activity were more likely to have higher DASH scores. In the Malaysian cohort, while total DASH score was not significantly associated with cardio-metabolic risk factors after adjusting for confounders, significant associations were observed for intake of green vegetable [0.011, standard error (SE): 0.004], and red and processed meat (-0.009, SE: 0.004) with total cholesterol. In the Philippines cohort, a 5-unit increase in total DASH score was significantly and inversely associated with systolic blood pressure (-1.41, SE: 0.40), diastolic blood pressure (-1.09, SE: 0.28), total cholesterol (-0.015, SE: 0.005), low-density lipoprotein cholesterol (-0.025, SE: 0.008), and triglyceride (-0.034, SE: 0.012) after adjusting for socio-demographic and lifestyle groups. Intake of milk and dairy products, red and processed meat, and sugared drinks were found to significantly associated with most risk factors. Conclusions: Differential associations of DASH diet and dietary components with cardio-metabolic risk factors by country suggest the need for country-specific tailoring of dietary interventions to improve cardio-metabolic risk profiles.
Full text available upon request to the author
Article title: Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort
Authors: Giselle G. Gervacio, Jaime Manalo Aherrera, Rody G. Sy, Lauro Lim Abrahan IV, et al.
Publication title: Heart Asia 10(2), May 2018
Abstract:
Background Brugada syndrome is the mechanism for sudden unexplained death. The Brugada ECG pattern is found in 2% of Filipinos. There is a knowledge gap on the clinical outcome of these individuals. The clinical profile and 5-year cardiac event rate of individuals with the Brugada ECG pattern were determined in this cohort. Methods This is a sub-study of LIFECARE (Life Course Study in Cardiovascular Disease Epidemiology), a community based cohort enrolling healthy individuals 20 to 50 years old conducted in 2009–2010. ECGs of all enrollees were screened independently by three cardiologists. The prevalence of the coved Brugada ECG pattern was ascertained, and the 5-year cardiac event rate was determined among those individuals with this pattern. The participants were contacted to determine the occurrence of cardiac events, which included syncope, presyncope, seizures, cardiac arrest and unexplained vehicular accidents. Results A total of 3072 ECGs were reviewed, and 14 subjects (0.4%) with the coved Brugada ECG pattern were identified. Four had a cardiac event on follow-up at 5 years, but all remained alive. Most of these 14 coved Brugada individuals were healthy and asymptomatic at baseline. Conclusion Cardiac events occurred commonly among initially asymptomatic Filipinos with the coved Brugada ECG pattern. Such patients need to be followed up closely.
Article title: Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants
Authors: Bin Zhou, James Bentham, Mariachiara Di Cesare, Rody G. Sy, et al.
Publication title: International Journal of Epidemiology 47(3), March 2018
Abstract:
Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.
Article title: Establishing validity of EQ-5D-3L (Tagalog) to measure health-related quality of life states among adult Filipinos (20-50 years old)
Authors: Nina Castillo-Carandang, Olivia Sison, Rody G. Sy, et al.
Publication title: Acta Medica Philippina 52(5):397-403, January 2018
Abstract:
To establish the validity of EQ-5D-3L in Tagalog language in assessing health-related quality of life states among adult Filipinos 20-50 years old. Methods. A face-to-face cross-sectional community survey of apparently healthy adult Filipinos (20-50 years old) in Metro Manila and in 4 nearby provinces (Bulacan, Batangas, Quezon, Rizal) was conducted. Trained interviewers administered the Tagalog language versions of EuroQoL 5-Dimension 3 Levels (EQ-5D-3L), Short-Form 36 version 2 (SF-26v2®), and a socio-economic questionnaire. All questionnaires were pre-tested for cultural appropriateness. Concurrent validity (against the SF-36v2®) and known group validity of the EQ-5D-3L were evaluated. Results. Complete data from 3,056 participants were analyzed. Almost half of the participants reported perfect health on EQ-5D-3L and had higher scores on all SF-36v2® domains compared to those who reported some problems on EQ-5D-3L. Compared to participants who reported some problems on EQ-5D-3L mobility (or anxiety/depression), participants who reported no problem on EQ-5D-3L mobility (or anxiety/depression) reported lower SF-36v2® Physical Functioning (or Mental Health) scores (differences of 7.1 and 10 points, respectively) that were minimally important (i.e. exceeds 5 points). Participants with poorer self-reported health had considerably lower EQ-5D index scores and EQ-5D VAS scores (p < 0.05) irrespective of their socio-demographic characteristics. Conclusion. EQ-5D-3L (Tagalog) demonstrated construct and known groups validity among adult Filipinos (20-50 years old)
Full text available upon request to the author
Article title: Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults
Authors: Majid Ezzati, James Bentham, Mariachiara Di Cesare, Rody G. Sy, et al.
Publication title: The Lancet 390, December 2017
Abstract:
Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.
Article title: Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease
Authors: Emil Hagstrom, Frederika Norlund, Amanda Stebbins, Rody G. Sy, et al.
Publication title: Journal of Internal Medicine 283(1), September 2017
Abstract:
Objectives: Assess the risk of ischemic events associated with psychosocial stress in patients with stable coronary heart disease (CHD). Methods: Psychosocial stress was assessed by a questionnaire in 14,577 patients (median age 65.0, IQR 59, 71; 81.6% males) with stable CHD on optimal secondary preventive therapy in the prospective randomised STABILITY clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors, and outcomes. Results: After 3.7 years of follow-up, depressive symptoms, loss of interest, and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of CV death (1.21, 1.09-1.34; 1.15, 1.05-1.27; and 1.19, 1.08-1.30, respectively) and the primary composite endpoint of CV death, non-fatal MI, or non-fatal stroke (1.21, 1.13-1.30; 1.19, 1.11-1.27; and 1.17, 1.10-1.24, respectively). Living alone was related to higher risk of CV death (1.68, 1.38-2.05) and the primary composite endpoint (1.28, 1.11-1.48), whereas being married as compared with being widowed, was associated with lower risk of CV death (0.64, 0.49-0.82) and the primary composite endpoint (0.81, 0.67-0.97). Conclusions: Psychosocial stress, such as depressive symptoms, loss of interest, living alone, and financial stress, was associated with increased CV mortality in patients with stable CHD despite optimal medical secondary prevention treatment. Secondary prevention of CHD should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.
Full text available upon request to the author
Article title: World Heart Federation Cholesterol Roadmap
Authors: Adrianna Murphy, Jose Rocha Faria-Neto, Khalid Al-Rasadi, Rody G. Sy, et al.
Publication title: Global Heart 12(3), July 2017
Abstract:
The World Heart Federation has undertaken an initiative to develop a series of Roadmaps. Objectives: The aim of these is to promote development of national policies and health systems approaches and identify potential roadblocks on the road to effective prevention, detection and management of cardiovascular disease (CVD) in low-and middle-income countries (LMIC), and strategies for overcoming these. This Roadmap focuses on elevated blood cholesterol, a leading risk factor for myocardial infarction, stroke, and peripheral arterial disease. Methods: Through a review of published guidelines and research papers, and consultation with a committee composed of experts in clinical management of cholesterol and health systems research in LMIC, this Roadmap identifies (1) key interventions for primordial, primary and secondary prevention of CVD through detection, treatment, and management of elevated cholesterol and familial hypercholesterolemia (FH); (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMIC; and (4) potential strategies for overcoming these. Results: Despite strong evidence of the importance of cholesterol levels in primary or secondary prevention of CVD, and the effectiveness of statin therapy for cholesterol lowering and reduction of CVD risk, gaps exist in the detection, treatment, and management of high cholesterol globally. Some potential roadblocks include poor access to laboratory facilities or trained professionals for cholesterol management, low awareness of FH among the general population and health professionals, unaffordability of statins for patient households, and low awareness of the importance of persistent adherence to lipid-lowering medication. Potential solutions include point-of-care testing, provision of free or subsidized lipid-lowering medication, and treatment adherence support using text message reminders. Conclusions: Known effective strategies for detection, treatment, and management of elevated cholesterol and FH exist, but there are barriers to their implementation in many low-resource settings. Priorities for health system intervention should be identified at the national level, and the feasibility and effectiveness of proposed solutions should be assessed in specific contexts. Many solutions proposed in this Roadmap may apply to other cardiovascular conditions and present opportunities for integration of CVD care in LMIC.
Full text available upon request to the author
Article title: Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19.1 million participants
Authors: Bin Zhou, James Bentham, Mariachiara Di Cesare, Rody G. Sy, et al.
Publication title: The Lancet 389(10064), January 2017
Abstract:
Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings: We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7-128·3) in men and 122·3 mm Hg (121·0-123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9-79·5) for men and 76·7 mm Hg (75·9-77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4-27·1) in men and 20·1% (17·8-22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe. Funding: Wellcome Trust.
Article title: PS 02-19 Apolipoprotein levels in patients with Acute Coronary Syndrome: a pioneer study
Authors: Elleen Cunanan, Mariel Barcelon-Cruz, Felix Eduardo Punzalan, Rody G. Sy, et al.
Publication title: Journal of Hypertension 34(Supplement I): e109-e110, September 2016
Abstract:
Department of Medicine, Philippine General Hospital, Philippines Abstract Objective: To determine the baseline apolipoprotein level among patients with Acute Coronary Syndrome. Design and Method: This is a Cross-sectional study involving 58 patients admitted at the Philippine General Hospital with Acute Coronary Syndrome (ACS) from October 2015 to January 2016. We measured concentrations of apolipoprotein B, apolipoprotein A-1, lipoprotein a, total cholesterol, triglyceride, LDL, HDL and calculated TC/HDL, TG/HDL and apoB:apoA-1 ratio within 24 hours upon admission. Results: 48% percent was diagnosed with NSTE-ACS, 32.8% had STEMI and 19% had Unstable Angina. The mean age was 60.28 +10.363 and majority were males (67.2%). Majority have high levels of apolipoprotein B (> 90 mg/dl) at 63.8% followed by elevated levels of non-HDL (> 130 mg/dl) in 56.9%, elevated LDL levels (> 100 mg/dl) in 41.4% and elevated levels of lipoprotein (a) (> 35 mg/dl) in 37.9%. Elevated levels of total cholesterol (> 200 mg/dL) and triglyceride (> 150 mg/dl) were found in only 20.7% and 29% respectively. Low levels of HDL (< 40 mg/dl) and apolipoprotein A-1 (< 120 mg/dl) were found in 73% and 63.8% respectively. There was no significant difference between all lipid profile parameters and ACS classification. The apolipoprotein A-1 levels were significantly low in alcoholic patients and apolipoprotein B: apolipoprotein A-1 ratio were significantly elevated in diabetics. Conclusions: Elevated levels of apolipoprotein B, LDL, non-HDL and apoB:apoA1 ratio and low levels of apolipoprotein A-1 were highly prevalent in patients with ACS. Apolipoprotein B:Apolipoprotein A-1 ratio might be of greater value in assessing cardiovascular risk and treatment of patients especially in the diabetic population. Image Tools Image Tools
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Article title: A century of trends in adult human height
Authors: James Bentham, Mariachiara Di Cesare, Gretchen A. Stevens, Rody G. Sy, et al.
Publication title: eLife Sciences 5, July 2016
Abstract:
Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
Full text available upon request to the author
Article title: Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants
Authors: Bin Zhou, Yuan Lu, Kaveh Hajifathalian, Rody G. Sy, et al.
Publication title: The Lancet 387(10027), April 2016
Abstract:
One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings: We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Funding: Wellcome Trust.
Article title: Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19·2 million participants
Authors: Mariachiara Di Cesare, James Bentham, Gretchen A. Stevens, Rody G. Sy, et al.
Publication title: The Lancet 387(10026), April 2016
Abstract:
Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia. Funding Wellcome Trust, Grand Challenges Canada
Article title: Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants
Authors: Goodarz Danael, Saman Fahimi, Yuan Lu, Rody G. Sy, et al.
Publication title: The Lancet Diabetes & Endocrinology 3(8), June 2015
Abstract:
Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. Funding: Wellcome Trust, US National Institutes of Health.
Article title: Association of ECG Abnormalities with Metabolic Syndrome and Socio-demographic Factors in the Philippine LIFECARE Cohort
Authors: Alric V. Mondragon, EJB Llanes, Olivia Sison, Rody G. Sy, et al.
Publication title: Journal of Atherosclerosis and Thrombosis 21, August 2014
Abstract:
With the increasing incidence of cardiovascular diseases and metabolic syndrome, studies have now focused into the relationship between ECG abnormalities and metabolic syndrome and its components. 1-3 ! ! Resting electrocardiography (ECG) has proven to be a valuable diagnostic and prognostic test for cardiovascular diseases. 4 Several studies have found ischemic ECG abnormalities to be associated with increased cardiovascular and coronary death risk even for asymptomatic, apparently healthy individuals. 5-8 ! ! One study has looked into the prevalence of ECG abnormalities in the Philippines. This study by Tirona and colleagues focused on the prevalence of left ventricular hypertrophy (LVH), atrial fibrillation (AF), and Q wave myocardial infarction (MI) in the Filipino population. 9 On the other hand, several studies done internationally, have recognized the value of looking into other abnormalities in the ECG, like QT prolongation, ST segment depression, T-wave inversion, and other nonspecific ST-T wave changes. 8,10-12 ! ! To our knowledge, there are no studies that have correlated these ECG abnormalities to metabolic syndrome among the Filipino population. Our study aims to determine the prevalence of various ECG abnormalities among apparently healthy adult Filipinos in the Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) Study and correlate it to metabolic syndrome, its components, and sociodemographic factors. ! The study participants were drawn from the LIFE course study in CARdiovascular disease Epidemiology (LIFECARE) cohort recruited from both rural and urban areas in Metro Manila and four nearby provinces. The cohort study included apparently healthy participants aged 20-50 years old. Data on the socio-demographic profile, medical history and physical examination of the participants were gathered. Blood tests were taken after a 10-12 hour fast. Analysis of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), and high density lipoprotein cholesterol (HDL).! ! Resting ECG! A resting 12-lead standard supine ECG was performed using the Norav machines, model 1200M. All ECGs were manually read by one of three cardiologists using standard diagnostic criteria. Presence of various abnormalities was noted and any number of diagnoses could be recorded. ECG abnormalities noted were also grouped into: Rhythm abnormalities, Conduction abnormalities, Morphological abnormalities, Axis abnormalities, ST wave changes, and Myocardial Injury.! ! Statistical Analysis! Univariate analysis using Chi-square test was done. A 95% confidence interval performed.
Article title: Who we are: Demographic and stress profile of the Philippine LIFECARE cohort
Authors: Olivia Sison, Queenie G. Ngalob, Felix Eduardo Punzalan, Rody G. Sy, et al.
Publication title: Acta Medica Philippina 48(0001-6071, April 2014
Abstract:
To describe the demographic and stress profile of the participants in the LIFECARE cohort. Methods. The Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) is a community-based prospective cohort of apparently healthy individuals aged 20 to 50 years old with no preexisting cardiovascular disease. The second phase out of four phases of study involves collection of baseline socio-demographic, anthropometric, biochemical and cardiovascular parameters and stress profiles. It was conducted via face-to-face interview using a survey questionnaire. Results and Conclusion. A total of 3072 participants from Metro Manila and 4 provinces in Luzon were recruited. The female to male ratio was 1.3:1. Majority of the participants were aged 30 years old and above. Most were married, employed and literate. Majority attained at least high school level of education. Loss of job was the most common stressor experienced in the past year. Majority of the cohort reported occasional experience of general stress and moderate level of financial stress. Occurence of general stress within the past year was higher among females (p < 0.001), younger age-group (p=0.006), and among those who reached college level of education (p<0.001). Furthermore, level of current financial stress was high to severe among older age-group (p=0.004), and among widow/widower/separated (p<0.0001). While the relationship between psychosocial stress and physical illness had not been established in this study, there is a need to investigate demographics and psychosocial stress, and their implications in increasing adverse health outcomes in general, and cardiovascular risk in particular.
Article title: “You Are What You Eat:” Self-Reported Preferences for Food Taste and Cooking Methods of Adult Filipinos (20-50 years old)
Authors: Nina Castillo-Carandang, Olivia Sison, Felicidad V. Velandria, Rody G. Sy, et al.
Publication title: Acta Medica Philippina 48(2), April 2014
Abstract:
To describe the self-reported preferences for food taste and cooking methods of adult Filipinos (20-50 years old). Methods. This is a cross-sectional community survey of 3,072 adults from Metro Manila, Bulacan, Batangas, Quezon, Rizal. Results and Conclusion. There were differences in preferred tates of males (food that tated "just right", spicy) vs. females (salty); younger adults (sweet, salty, spicy) vs. those with less schooling who liked food which tasted "just right." Smokers preferred spicy taste vs. non-smokers who liked sweet-tasting food. Adults who reported having had alcohol intake preferred spicy food. Those who reported feeling stressed liked savoury taste (sweet, salty) while those who were not stressed liked food which tasted "just right." Cooking with oil was the usual and the most preferred cooking method. Younger adults and smokers liked to use oil in cooking. Food which tasted "just right"/moderate was most preferred by adult Filipinos with hpertension or MeTS. Diabetics did not prefer sweet tasting food. More diabetics (p=0.05) and those with MeTS (p=0.003) usually use other cooking methods instead of frying. Eliciting self-reported taste preferences as well as the usual and preferred cooking methods is important for nutritional management and relevant lifestyle advice which healthcare providers should incorporate in their management of patients, specially those with hypertension, diabetes, and metabolic syndrome.
Article title: Where We Are: Socio-Ecological and Health Profile of the Philippine Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) Study Sites
Authors: Elmer Balasico Llanes, Paulette D. Nacpil-Dominguez, Rody G. Sy, et al.
Publication title: Acta Medica Philippine 48(2), April 2014
Abstract:
This study aims to describe the socio-ecological and health profile of the Philippine LIFECARE study sites, its health care services and leading causes of mortality and morbidity. Methods. This is a prospective cohort study that recruited participants aged 20-50 years from Metro Manila and four provinces (Bulacan, Batangas, Quezon, Rizal). Study sites were characterized according to their geographical area, terrain and environmental profile, and available health care system. Results. 3,072 subjects were included, with male-to-female ratio of 1:1.3 and majority aged 30-50 years. Metro Manila was the most congested site. Two-thirds of the 62 villages (barangays) were rural, outside the town proper, and in lowlands. One-fourth were along coastal area. Almost all were accessible by public transportation. Majority have reduced forest cover, but were relatively safe from environmental hazards. Rural health units, hospitals, and professional health care workers were concentrated in Metro Manila. Leading cause of morbidity was respiratory tract infection, while cardiovascular diseases caused most of mortalities. Conclusion. Study sites were mainly rural, outside the town proper and in lowlands, with available public transportation. There is an unequal distribution of health resources. Cardiovascular diseases is still the leading cause of mortality. The disparities in geographical access to health care play an important role in shaping human health.
Article title: Prevalence of Cardiovascular Risk Factors in relation to Socio-demographic Profile of the Life Course Study in Cardiovascular Disease Epidemiology Study (LIFECARE) Philippine Cohort
Authors: Felix Eduardo Punzalan, Rody G. Sy, Olivia Sison, Nina Castillo-Carandang, et al.
Publication title: Acta Medica Philippina 48(2), April 2014
Abstract:
To describe the distribution of the clinical cardiovascular risk profile of the LIFECARE Philippine cohort in relation to its socio-demographic factors. Methods. We recruited a total of 3,072 apparently healthy participants from Manila and nearby provinces of Rizal, Batangas, Bulancan and Quezon. Face-to-face interview was done to obtain socio-demographic data. Baseline clinical parameters and biochemical tests were obtained. Prevalence of cardiovascular risk factors was determined by sex, place of residence, level of education and employment. Results. Overall prevalence of diabetes mellitus was at 5%, similar between sexes, area class, educational attainment and employment status. More smokers were male, employed or with an elementary level of education. Prevalence of hypertension was at 14.5% and was seen more in males, urban dwellers, employed or with an elementary level of education. Dyslipdemia was seen more in males, living in the rural areas, employed or with a college level of education. Lastly, obese participants were seen more in females, living in urban areas, employed with a college level of eduction. Conclusion. Older, male and employed participants who are living in the urban areas have more cardiovascular risk factors.
Article title: Official document of the International Society of Atherosclerosis: general recommendations for treatment of dyslipidemia. Executive summary
Authors: Scott M. Grundy, Hidenori Arai, Philip Barter, Thomas P. Bersot, Rody G. Sy, et al.
Publication title: Clinica e Investigacion en Arteriosclerosis 26(1), February 2014
Abstract:
No abstract available
Full text available upon request to the author
Article title: An International Atherosclerosis Society Position Paper: global recommendations for the management of dyslipidemia–full report
Authors: Scott M. Grundy, Hidenori Arai, Philip Barter, Rody G. Sy, et al.
Publication title: Atherosclerosis 232(2), February 2014
Abstract:
An international panel of the International Atherosclerosis Society has developed a new set of recommendations for the management of dyslipidemia. The panel identifies non high-density lipoprotein cholesterol as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins are derived for the two forms of prevention. For primary prevention, the recommendations emphasize lifestyle therapies to reduce atherogenic lipoproteins; drug therapy is reserved for subjects at greater risk. Risk assessment is based on estimation of lifetime risk according to differences in baseline population risk in different nations or regions. Secondary prevention emphasizes use of cholesterol-lowering drugs to attain optimal levels of atherogenic lipoproteins. Published by Elsevier Inc. on behalf of National Lipid Association.
Full text available upon request to the author
Article title: Residual macrovascular risk in 2013: What have we learned?
Authors: Jean-Charles Fruchart, Jean Davignon, Michel P. Hermans, Rody G. Sy, et al.
Publication title: Cardiovascular Diabetology 13(1), January 2014
Abstract:
Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptoralpha agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
Full text available upon request to the author
Article title: Socio-Demographic Factors and the Prevalence of Metabolic Syndrome Among Filipinos from the LIFECARE Cohort
Authors: Rody G. Sy, Elmer Balasico Llanes, Paul Ferdinand M. Reganit, Nina Castillo-Carandang, et al.
Publication title: Journal of Atherosclerosis and Thrombosis 21(Suppl 1), January 2014
Abstract:
Metabolic syndrome(MetS) is an aggregation of multiple metabolic risk factors shown to lead to the development of cardiovascular disease. The International Diabetes Federation(IDF) and the modified National Cholesterol Education Program Adult Treatment Panel Ⅲ(mNCEP) criteria are used in identifying MetS. This report will determine the prevalence of MetS and its component risk factors of the Philippine cohort of the LIFE course study in CARdiovascular disease Epidemiology(LIFECARE). Methods: Our study recruited 3,072 participants aged 20-50 years old from Metro Manila and four nearby provinces. Baseline anthropometric and clinical parameters were measured. Prevalence of MetS and its component factors were determined. Associations with socio-demographic factors were determined. Results: The prevalence of MetS was 19.7% and 25.6% by IDF and mNCEP, respectively(kappa 0.83). Both were associated with increasing age, urban residence, and employed status. It was higher in females by IDF and in males by mNCEP. IDF missed 40% of males and 10% of females identified with MetS by mNCEP. More males were identified by the mNCEP as MetS despite relatively normal waist circumference. Conclusion: MetS is common in the Philippines among older, educated, and urban residents. The mNCEP criteria identified more MetS than the IDF criteria.
Full text available upon request to the author
Article title: A Community-Based Validation Study of the Short-Form 36 Version 2 Philippines (Tagalog) in Two Cities in the Philippines
Authors: Nina Castillo-Carandang, Olivia Sison, Mary Lenore Grefal, Rody G. Sy, et al.
Publication title: PLoS ONE 8(12), December 2013
Abstract:
To evaluate the validity and reliability of the Philippines (Tagalog) Short Form 36 Health Survey version 2 (SF-36v2(®)) standard questionnaire among Filipinos residing in two cities. The official Philippines (Tagalog) SF-36v2 standard (4-week recall) version was pretested on 30 participants followed by formal and informal cognitive debriefing. To obtain the feedback on translation by bilingual respondents, each SF-36v2 question was stated first in English followed by Tagalog. No revisions to the original questionnaire were needed except that participants thought it was appropriate to incorporate "po" in the instructions to make it more polite. Face-to-face interviews of 562 participants aged 20-50 years living in two barangays (villages) in the highly urbanized city of Makati City (Metro Manila) and in urban and rural barangays in Tanauan City (province of Batangas) were subsequently conducted. Content validity, item level validity, reliability and factor structure of the SF-36v2 (Tagalog) were examined. Content validity of the SF-36v2 was assessed to be adequate for assessing health status among Filipinos. Item means of Philippines (Tagalog) SF-36v2 were similar with comparable scales in the US English, Singapore (English and Chinese) and Thai SF-36 version 1. Item-scale correlation exceeded 0.4 for all items except the bathing item in PF (correlation: 0.31). In exploratory factor analysis, the US two-component model was supported. However, in confirmatory factor analysis, the Japanese three-component model fit the Tagalog data better than the US two-component model. The Philippines (Tagalog) SF-36v2 is a valid and reliable instrument for measuring health status among residents of Makati City (Metro Manila) and Tanauan City (Province of Batangas).
Article title: IAS Panel for Global Recommendations for the Management of Dyslipidemia
Authors: Scott M. Grundy, Hidenori Arai, Philip Barter, Rody G. Sy, et al.
Publication title: Journal of Clinical Lipidology, January 2013
Abstract:
An international panel of the International Atherosclerosis Society has developed a new set of recommendations for management of dyslipidemia. The panel identifies non-high density lipoprotein cholesterol (non-HDL-C) as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins are derived for the two forms of prevention. For primary prevention, the recommendations emphasize lifestyle therapies to reduce atherogenic lipoproteins; drug therapy is reserved for higher risk subjects. Risk assessment is based on estimation of lifetime risk according to differences in baseline population risk in different nations or regions. Secondary prevention emphasizes use of cholesterol-lowering drugs to attain optimal levels of atherogenic lipoproteins.
Full text available upon request to the author
Article title: Prevalence of Atherosclerosis-Related Risk Factors and Diseases in the Philippines
Authors: Rody G. Sy, Dante Morales, Antonio Dans, Elizabeth Paz Pacheco, et al.
Publication title: Journal of Epidemiology 22(5), July 2012
Abstract:
We conducted a survey in 2008 to measure the prevalence of lifestyle-related diseases and risk factors in Philippine adults. Methods Stratified multistage sampling was used to cover the entire Philippine population of adults aged 20 years or older. Using health questionnaires, anthropometric measurements, and blood examinations, the prevalences of atherosclerosis-related risk factors and diseases were determined. Survey results were compared with those obtained in 2003. Results Out of 7700 eligible subjects, 64% to 93.7% responded to different survey items. Age-adjusted hypertension prevalence was 24.6% at a single visit and 20.6% when corrected for true prevalence. The prevalence of diabetes was 3.9% on the basis of fasting blood glucose (FBG), 5.2% by FBG and history, and 6.0% when 2-hour post-load plasma glucose level was determined. The prevalence of dyslipidemia was 72.0% and the prevalence of smoking was 31%. The prevalence of obesity was 4.9% by body mass index (BMI), and 10.2% and 65.6% by waist-hip ratio (WHR) in men and women, respectively. The prevalences of coronary, cerebrovascular, and peripheral arterial diseases were 1.1%, 0.9%, and 1.0%, respectively. Conclusions The prevalences of risk factors for atherosclerosis were higher in 2008 than in 2003, although the increase in diabetes was not significant and smoking decreased. These findings indicate a need for active collaborative intervention by all government agencies and medical societies in the Philippines.
Article title: The incidence of type 2 diabetes mellitus in the Philippines: A 9-year cohort study
Authors: Maria Luz B. Soria, Rody G. Sy, Bernard S. Vega, Tommy Ty-Willing
Publication title: Diabetes Research and Clinical Practice 86(2), September 2009
Abstract:
Currently, there are no available data on the incidence of type 2 diabetes mellitus (T2DM) in the Philippines. A cohort derived from a national study population (FNRI-NNS, 1998) was revisited after 9 years to yield valuable data on glucose homeostasis among Filipinos. Six out of 13 national regions were included in the cohort. There were 1749 out of 2122 respondents (82.4%). 1386 (95.9%) consented to a fasting blood glucose (FBG) test, and 1275 (88.2%) completed the 2h post-glucose (2HPG) load determination using whole blood capillary samples. We observed a significant increase of mean FBGs (91.5mg/dL to 103.3mg/dL) from 1998 to 2007. The 9-year incidence of T2DM was 16.3%. The prevalence of T2DM was 28.0%. The prevalence of pre-diabetes, i.e., combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) was 31.3%; IFG was 17.5% and IGT was 23.9%. The study shows the alarming growth of diabetes, IFG, and IGT in our country that warrants early aggressive intervention for prevention and management. We encourage the use of 2h post-glucose load aside from FBG in screening for true diabetics, IFGs, and IGTs.
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Article title: An update on cardiovascular disease epidemiology in South East Asia. Rationale and design of the LIFE course study in CARdiovascular disease Epidemiology (LIFECARE)
Authors: E-Shyong Tai, Richie Poulton, Julian Thumboo, Rody G. Sy, et al.
Publication title: CVD Prevention and Control 4(2), June 2009
Abstract:
The burden of cardiovascular disease (CVD) is likely to increase dramatically in Asia over the next several decades. In this paper, we review the existing data on CVD epidemiology in Asia, with a focus on the INTERHEART study and the Asia Pacific Cohort Studies Collaboration. Existing data suggests that much of CVD may be preventable through reduction in the levels of well-established CVD risk factors and that these findings are likely to be relevant to Asian populations. However, these studies have several important limitations. These include a lack of longitudinal studies with collection of repeated measures of CVD risk factors and the environmental factors that may result in the age-related increase in the levels of these risk factors. As such, the natural history of the development of CVD risk factors such as obesity, diabetes, hypertension and dyslipidemia in Asia, and their relationship in terms of duration and timing of exposure to various environmental influences is currently unknown. In addition, there is a paucity of data related to psychosocial factors that may be involved in the pathogenesis of CVD, either directly or through effects on other CVD risk factors. Finally, little data is available with regards to the impact of CVD and its attendant risk factors on health related quality of life and health care utilization. This information is crucial for the design and evaluation of evidence based programs for primary prevention. We have designed a LIFE Course Study in CARdiovascular disease Epidemiology (LIFECARE) involving 12,000 individuals in four South East Asian countries to address these data needs.
Article title: The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patient
Authors: Rody G. Sy, Jean-Charles Fruchart, Frank M. Sacks, Michel P. Hermans, et al.
Publication title: Diabetes & Vascular Disease Research 5(4), December 2008
Abstract:
Despite current standards of care aimed at achieving targets for low-density lipoprotein (LDL) cholesterol, blood pressure and glycaemia, dyslipidaemic patients remain at high residual risk of vascular events. Atherogenic dyslipidaemia, specifically elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, is common in patients with established cardiovascular disease, type 2 diabetes, obesity or metabolic syndrome and is associated with macrovascular and microvascular residual risk. The Residual Risk Reduction Initiative (R3I) was established to address this important issue. This position paper aims to highlight evidence that atherogenic dyslipidaemia contributes to residual macrovascular risk and microvascular complications despite current standards of care for dyslipidaemia and diabetes, and to recommend therapeutic intervention for reducing this, supported by evidence and expert consensus. Lifestyle modification is an important first step. Additionally, pharmacotherapy is often required. Adding niacin, a fibrate or omega-3 fatty acids to statin therapy improves achievement of all lipid risk factors. Outcomes studies are evaluating whether these strategies translate to greater clinical benefit than statin therapy alone. In conclusion, the R3I highlights the need to address with lifestyle and/or pharmacotherapy the high level of residual vascular risk among dyslipidaemic patients who are treated in accordance with current standards of care.
Article title: Metabolic syndrome in the Philippine general population: Prevalence and risk for atherosclerotic cardiovascular disease and diabetes mellitus
Authors: Dante Morales, Felix Eduardo Punzalan, Elizabeth Paz-Pacheco, Rody G. Sy, et al.
Publication title: Diabetes & Vascular Disease Research 5(1), March 2008
Abstract:
The objectives of this study were to determine the prevalence of metabolic syndrome (MS) and its component risk factors among Filipinos using three sets of criteria and to evaluate the association between MS and atherosclerotic cardiovascular disease and diabetes mellitus. The study utilised a multi-staged cluster sampling design. The prevalence of MS was found to be 11.9% by National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP III) criteria, 14.5% by International Diabetes Federation (IDF) criteria and 18.6% by NCEP/ATP III criteria modified by the American Heart Association/National Heart, Lung and Blood Institute (NCEP/ATP III-AHA/NHLBI) criteria. Low levels of high-density lipoprotein cholesterol (HDL-C) occurred in 60.2% of men and 80.9% of women. Abdominal obesity was noted in 17.7% of men and 35.1% of women. Blood pressure (BP) > or = 130/85 mmHg was seen in 33.3%, hypertriglyceridaemia in 20.6% and fasting blood sugar > or = 100 mg/dL (5.55 mmol/L) in 7.1%. Age-adjusted odds ratios showed that MS, by all three definitions, predisposed an individual to diabetes mellitus (DM) and stroke while MS by the IDF definition predisposed an individual to myocardial infarction (MI). Individuals with MS did not have a significant predisposition to angina and peripheral artery disease (PAD). Thus, the metabolic syndrome is common in Filipinos, with low HDL-C as the most prevalent component. The metabolic syndrome predisposes to diabetes mellitus and stroke, with a tendency to MI using the IDF criteria.
Article title: Human Cholestryl Ester Transfer Protein (TaqIB) Polymorphism among Filipinos with Cardiovascular Risk Factors
Authors: Rody G. Sy, Eva Maria C. Cutiongco, Felix Eduardo Punzalan, Ronald S. Santos
Publication title: Journal of Atherosclerosis and Thrombosis 14(3), July 2007
Abstract:
HDL-C has emerged as an important independent predictor of cardiovascular disease. The FNRI-HDL and NNHes Study Group in the Philippines reported that there was a high prevalence of low HDL among Filipinos. Most cases of low HDL-C are associated with secondary causes like Metabolic Syndrome. A primary cause of reduced HDL-C such as increase Cholesteryl Ester Transfer Protein activity has been identified. Objectives: 1. To determine the phenotype and frequency of Cholesteryl Ester Transfer Protein (TaqIB) polymorphism among Filipinos with cardiovascular risk factors. 2. To determine the association of TaqIB polymorphism with HDL-C levels among Filipinos with cardiovascular risk factors. Design: Cross-sectional Study. Setting: University of the Philippines-Philippine General Hospital. Statistical analysis: Descriptive statistics, Chi square test and Fisher's correlation test using Stata version 6. Methods: Fifty patients were included in this pilot study and were examined with respect to genotype, lipid profiles, blood sugar and other cardiovascular risk factors. Polymerase Chain Reaction (PCR), Restriction Fragment Length Polymorphism (RFLP) and Agarose Gel Electrophoresis techniques were used to determine the CETP TaqIB Polymorphism. Results: Out of 50 patients, 66% were females and 34% were males with a mean age of 55 y/o and a BMI of 27 kg/m(2). The following risk factors were identified: hypertension (92%), dyslipidemia (88%), obesity (68%), smoking (50%), diabetes mellitus type 2 (18%) and family history of premature CAD (14%). The genotype frequencies of B1B1; B1B2; B2B2 were 40%; 50% 10% respectively. The B1B1 homozygote was associated with lower HDL-C levels (45.35 +/- 8.82 mg/dL) compared to B1B2 (48.96 +/- 10.10 mg/dL) and B2B2 (48.99 +/- 10.13 mg/dL)). Conclusions: Cholesteryl Ester Transfer Protein (TaqIB) Polymorphisms exist among Filipinos with cardiovascular risk factors. The frequency of TaqIB polymorphism among Filipinos with cardiovascular risk factors were B1B1 (40%), B1B2 (50%) and B2B2 (10%). B1B1 polymorphism is more common than B2B2 and associated with low HDL-C.
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Article title: Low Density Lipoprotein - Receptor (LDL-R) Gene Mutations among Filipinos with Familial Hypercholesterolemia
Authors: Felix Eduardo Punzalan, Rody G. Sy, Ronald S. Santos, Eva Maria Cutiongco, et al.
Publication title: Journal of Atherosclerosis and Thrombosis 12(5), October 2005
Abstract:
Familial Hypercholesterolemia (FH) is an autosomal dominant disease resulting from mutations of the LDL (LDLR) receptor gene leading to a diminished catabolism and elevated level of LDL cholesterol (LDL-C). It is associated with an increased risk for cardiovascular disease (CVD). The MEDPED (Make Early Diagnosis-Prevent Early Death) program, an initiative cited by the WHO Human Genetics Programme in their report on FH, initiated international collaboration to identify and follow-up patients with FH globally. From Asia-Pacific, only 6 countries are participating and no data among Filipinos particularly on genetic profiles is available at present. This study attempts to initiate data collection and participation in the global initiative.Objectives:Primary: 1. To describe the phenotype of Filipino patients with FH. 2. To determine and characterize the LDL-R gene mutations among Filipino patients with clinical features of FH. Secondary: To determine the association of the clinical characteristics of FH with the presence of LDLR gene mutations. Cross- Sectional Study. Multicenter, Outpatient Clinic. 60 unrelated patients, 18 y/o and above from UP-PGH, Manila Doctors Hospital and Cardinal Santos Medical Center. FH was diagnosed according to the Dutch Lipid Clinic Network Criteria cited by WHO which is based on a history of premature CVD, family history, tendon xanthoma, arcus cornealis, and LDL C levels.Methods: With informed consent, clinical history, physical examination and lipid profile data were determined. Blood samples were extracted, processed to isolate DNA specimens at the National Institutes of Health, Institute of Human Genetics, and sent to Canterbury Health Laboratories at Christchurch, New Zealand for DNA analysis. Descriptive statistics, Fisher's exact test and Student's t-test using Stata version 6.0 software. Sixty patients with a mean age of 55 y/o were included, including 39 (65%) females. The mean LDL level was 227 mg/dl. Cardiovascular Disease and a family history of dyslipidemia were present in 55 & 60% of the samples, respectively. Twenty percent had documented LDL-R gene mutations. Six of the mutations were considered novel. A family history of dyslipidemia, an elevated LDL-C level, and a high FH score exhibited a statistically significant association with mutations. The study population has a high prevalence of CVD at an average age of 55 years with a strong family history of dyslipidemia and very high average LDL-C levels. One out of every 5 patients had LDL-R gene mutations, 6 of which were considered novel. LDL-R gene mutation was significantly associated with family history of dyslipidemia, LDL-C Level and FH score. CLINICAL AND RESEARCH IMPLICATION: This is the first international collaborative genetic study among Filipinos with FH. Data could allow the country to participate in the WHO/MEDPED global program. Collaborative efforts will lead to more effective detection, treatment and prevention of CV events. Novel mutations were discovered and further analysis of these genes will be done.
Article title: National Nutrition and Health Survey (NNHeS): Atherosclerosis-related diseases and risk factors
Authors: Antonio Dans, Dante Morales, Felicidad Velandria, Maria Teresa Bacnis Abola, Rody G. Sy., et. al.
Publication title: Philippine Journal of of Internal Medicine 43, June 2005
Abstract:
No abstract available
Article title: Prevalence of metabolic syndrome among adult Filipinos
Authors: Felix Eduardo Punzalan, Rody G. Sy, Tommy Ty-Willing
Publication title: International Congress Series 1262, May 2004
Abstract:
Metabolic syndrome is a common condition worldwide. Until recently, there is no universal definition for metabolic syndrome. Its prevalence in the Philippines has never been studied before. Objectives: To determine the prevalence of metabolic syndrome among adult Filipino population. Sample Population: 4541 individuals aged ≥20 years. Methods: Nationwide survey using two-stage stratified sampling design was done in 1998. Measurement of risk factors was done by blood pressure and waist circumference determination; and laboratory testing for lipid profile and fasting blood sugar using Cholestech LDX machine. Metabolic syndrome was defined based on NCEP and International Atherosclerosis Society (IAS) criteria. For IAS criteria, the waist circumference was based on Asia Pacific criterion (>90 and 80 cm, for male and female, respectively). Results: Based on NCEP criteria, the prevalence of metabolic syndrome is 14.2% (95% CI: 13.2–15.2). Using the IAS criteria, the prevalence is 19.3% (95% CI: 18.1–20.4). Stratifying the prevalence based on age revealed a prevalence of 6.6%, 17.7%, and 18.3% for ages 20–39, 40–59, 60 years and older, respectively, by NCEP criteria. IAS criteria showed a prevalence of 10.0%, 23.6%, and 24.1% for ages 20–39, 40–59, 60 years and older, respectively. Conclusion: Metabolic syndrome is common among Filipino adult population. There is an increasing prevalence with age. Using NCEP criteria instead of the IAS with waist circumference criterion adjusted for Asia Pacific population may underestimate the prevalence of metabolic syndrome.
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Article title: Comparing the efficacy and safety of atorvastatin and simvastatin in Asians with elevated low-density lipoprotein-cholesterol - A multinational, multicenter, double-blind study
Authors: Rody G. Sy, Chau-Chung Wu, Vichai Tanphaichitr, Arthur Tan Teow Hin
Publication title: Journal of Formosan Medical Association 101(7), August 2002
Abstract:
There have been few reports on the efficacy and safety of statins in the Asian population. The study objectives were to compare the efficacy and safety of atorvastatin and simvastatin in Asian people. This was a 16-week, double-blind, double-dummy, randomized, multicenter study involving eight medical centers in six Asian countries or areas. After a 6-week, diet-controlled, placebo lead-in period, 157 patients with low-density lipoprotein cholesterol (LDL-C) of between 160 and 250 mg/dL and serum triglyceride (TG) of less than 400 mg/dL were randomized to receive 10 mg of either atorvastatin (n = 79) or simvastatin (n = 78). After 8 weeks of treatment, all patients had the dose of study medication increased to 20 mg, irrespective of LDL-C concentration. Data obtained by monitoring lipid profiles, adverse events, and laboratory tests during the 16 weeks of study were used to assess the efficacy and safety of both treatments. After 8 weeks of treatment, LDL-C concentrations were reduced by 42.5% from baseline in patients receiving atorvastatin and 34.8% in those receiving simvastatin (p = 0.0006). Patients treated with atorvastatin also had a significantly greater reduction in very-low-density lipoprotein cholesterol (VLDL-C), TG, and total cholesterol (TC) after 8 weeks of treatment. The significantly greater reductions in LDL-C, VLDL-C, TG, and TC from baseline achieved with atorvastatin were still observed after an additional 8 weeks of treatment with 20 mg study medication. Both drugs increased high-density lipoprotein cholesterol (HDL-C) concentrations after 16 weeks of treatment, with no significant difference between the two treatments. After 16 weeks of treatment, 93% of atorvastatin and 85% of simvastatin patients had achieved their National Cholesterol Education Program LDL-C goals. No deaths occurred in the study population and the incidence of treatment-emergent adverse events was the same in the two groups (28%). Only one patient who was treated with simvastatin had a transaminase or creatine phosphokinase concentration that was more than three-fold the upper limit of normal. Asian people with primary hypercholesterolemia treated with atorvastatin had lower LDL-C, VLDL-C, TG, and TC after 8 weeks and 16 weeks of treatment than those treated with simvastatin. Both drugs demonstrated acceptable safety profiles.
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Article title: Hypertension and stroke in Asia: Prevalence, control and strategies in developing countries for prevention
Authors: Ram Kushal Singh, I. L. Suh, V. P. Singh, Rody G. Sy, et al.
Publication title: Journal of Human Hypertension 14(10-11), October 2000
Abstract:
Reliable statistics related to the prevalence, incidence and mortality of hypertension and stroke are not available from Asia. The data may be in national or institutional reports or journals published in the local language only. The mortality rate for stroke has been on the decline since the mid 1960s in the developed countries of Asia, such as Australia, New Zealand, and Japan, with some improvement in Singapore, Taiwan and Hong Kong, some areas of China and Malaysia about 15 years later. In India, China, Philippines, Thailand, Sri Lanka, Iran, Pakistan, Nepal, there has been a rapid increase in stroke mortality and prevalence of hypertension. The prevalence of hypertension according to new criteria (>140/90 mm Hg) varies between 15-35% in urban adult populations of Asia. In rural populations, the prevalence is two to three times lower than in urban subjects. Hypertension and stroke occur at a relatively younger age in Asians and the risk of hypertension increases at lower levels of body mass index of 23-25 kg/m2. Overweight, sedentary behaviour, alcohol, higher social class, salt intake, diabetes mellitus and smoking are risk factors for hypertension in most of the countries of Asia. In Australia, New Zealand and Japan, lower social class is a risk factor for hypertension and stroke. Population-based long-term follow-up studies are urgently needed to demonstrate the association of risk factors with hypertension in Asia. However prevention programmes should be started based on cross-sectional surveys and case studies without waiting for the cohort studies.
Article title: Efficacy and Tolerability of Amlodipine in the General Practice Treatment of Essential Hypertension in an Asian Multinational Population
Authors: Stanley H. Taylor, Ming-Fong Chen, Simon Jong Koo Lee, Banhan Koanantakul, Rody G. Sy, et al.
Publication title: Clinical Drug Investigation 16(3), September 1998
Abstract:
To evaluate the efficacy and tolerability of once-daily amlodipine (Pfizer Pharmaceuticals Inc.) alone or in combination with other antihypertensive drugs in an Asian population with essential hypertension. Patients: An open study was undertaken in 165 male and 158 female patients with uncomplicated hypertension (diastolic blood pressure 95 to 115mm Hg). Patients were recruited from 41 general practices in seven Asian countries and received amlodipine 5mg daily for 4 weeks and then 10mg once daily for a further 4 weeks if the target diastolic blood pressure of </=90mm Hg or a reduction from baseline by >/=10mm Hg had not been achieved. This one-step dose-adjustment period was followed by a 4-week maintenance period on a constant dose. Amlodipine was the sole medication in 284 patients and was added to other antihypertensive drugs in 39 patients uncontrolled on previous medication. Results: 263 patients, including 131 males, were evaluated for efficacy at the final treatment visit. 166 (63%) patients achieved the target reduction in diastolic blood pressure with amlodipine 5mg once daily, while 84 patients achieved the target reduction with 10mg once daily. Systolic and diastolic blood pressure reductions were similar irrespective of gender or age, and there were no significant changes in resting heart rate in any subgroup. In 68 patients who underwent ambulatory monitoring, the systolic and diastolic blood pressures were reduced by once-daily amlodipine throughout the 24-hour period without change in the intrinsic circadian pattern. Amlodipine was well tolerated in all patient subgroups; adverse events accounted for less than 1% of treatment discontinuations, and there were no hospitalisations or deaths during the study. Investigators rated both the antihypertensive efficacy and tolerability of amlodipine as excellent or good in 93% of patients. Conclusion: In 263 Asian patients with uncomplicated essential hypertension treated in general practice, once-daily amlodipine in a dose of 5 or 10mg provided significant antihypertensive efficacy either as monotherapy or in combination with other antihypertensive drugs while maintaining a favourable tolerability profile regardless of gender or age.
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Article title: Serum cholesterol and coronary artery disease in populations with low cholesterol levels: The Indian paradox
Authors: Ram Kushal Singh, Vipul Rastogi, Afzal Niaz, Sanjay Kumar Ghosh, Rody G. Sy, et al.
Publication title: International Journal of Cardiology 65(1), June 1998
Abstract:
To examine the relation between serum cholesterol and coronary artery disease prevalence below the range of cholesterol values generally observed in developed countries. Cross-sectional survey of two randomly selected villages from Moradabad district and 20 randomly selected streets in the city of Moradabad. 3575 Indians, aged 25-64 years including 1769 rural (894 men, 875 women) and 1806 urban (904 men, 902 women) subjects. The survey methods were questionnaires, physical examination and electrocardiography. The overall prevalences of coronary artery disease were 9.0% in urban and 3.3% in rural subjects and the prevalences were significantly (P<0.001) higher in men compared to women in both urban (11.0 vs. 6.9%) and rural subjects (3.9 vs. 2.6%). The average serum cholesterol concentrations were 4.91 mmol/l in urban and 4.22 mmol/l in rural subjects without any sex differences. The prevalences of coronary artery disease were significantly higher among subjects with low and high serum cholesterol concentration compared to subjects with very low cholesterol and showed a positive relation with serum cholesterol within the range of serum cholesterol level studied in both rural and urban in both sexes. Among subjects with low serum cholesterol, there was a higher prevalence of coronary risk factors, hypertension, diabetes, obesity and sedentary lifestyle. Serum cholesterol level showed a significant positive relation with low density lipoprotein cholesterol and triglycerides in all the four subgroups. Logistic regression analysis after pooling of data from both rural and urban, with adjustment of age showed that low serum cholesterol level (odds ratio: men 0.96, women 0.91) had a positive strong relation with coronary artery disease and there was no evidence of any threshold. Diabetes mellitus (men 0.73, women 0.74) and sedentary lifestyle (men 0.86, women 0.74) were significant risk factors of coronary disease in both sexes. Hypertension (men 0.82, women 0.64) and smoking (men 0.81, women 0.52) were weakly associated with coronary disease in men but not in women. Serum cholesterol level was directly related to prevalence of coronary artery disease even in those with low cholesterol concentration (<5.18 mmol/l). It is possible that some Indian populations may benefit by increased physical activity and decline in serum cholesterol below the range of desired serum cholesterol in developed countries.
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Article title: Recommendations for the prevention of coronary artery disease in Asians: A scientific statement of the International College of Nutrition
Authors: Rody G. Sy, Ram Kushal Singh, Hideki Mori, Junshi Chen, et al.
Publication title: Journal of Cardiovascular Risk 3(6), January 1997
Abstract:
There has been a rapid increase in coronary artery disease (CAD) in most Asian countries in association with rapid economic development; however, there is no consensus of opinion on diet and lifestyle guidelines and desirable levels of risk factors for prevention of CAD in these countries. The proportion of deaths due to cardiovascular diseases in Asians may be about 15% but there are wide variations. In view of the lower fat intake of the low-risk rural populations of India, the People's Republic of China, Indonesia, Korea, Thailand and Japan compared with that of urban subjects, the limit for total energy from fat intake in an average should be 21% (7% each from saturated, polyunsaturated and mono-unsaturated fatty acids). The n-6: n-3 fatty acids ration should be < 5.0. The carbohydrates intake should be > 65% and mainly from complex carbohydrates (> 55%). A body mass index of 21 kg/m2 may be safe but the range may be 18.5-23.0 kg/m2 and someone with a body mass index > 23 kg/m2 should be considered overweight. A waist: waist:hip ratio > 0.88 for men and > 0.85 for women should be considered to define central obesity. The desirable limit for serum total cholesterol may be 170 mg/dl, the borderline high level may be 170-199 mg/dl and the high level 200 mg/dl or above. The corresponding values for low-density lipoprotein cholesterol may be 90, 90-109 and 110 mg/dl or above. Fasting serum triglycerides may be < 150 mg/dl and high-density lipoprotein cholesterol > 35 mg/dl, which are close to the levels in low-risk rural populations. Fasting blood glucose > 140 mg/dl and postprandial blood glucose > 200 mg/dl may be considered conditions for diabetes, and 140-200 mg/dl, glucose intolerance. An intake of 400 g/day fruit, vegetables and legumes, mustard or soybean oil (25 g/day) instead of hydrogenated fat, coconut oil or butter in conjunction with moderate physical activity (1255 kJ/day), cessation of tobacco consumption and moderation of alcohol intake may be an effective package of remedies for prevention of CAD in Asians.
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Article title: Efficacy of slow-release oral isradipine in moderate-to-severe hypertension with add-on spirapril
Authors: R. F. Abarquez, Rody G. Sy, R. R. Castillo
Publication title: American Journal of Hypertension 6(3), March 1993
Abstract:
The new slow-release oral formulation (SRO) of isradipine, a dihydropyridine calcium antagonist, was evaluated in 57 patients who had moderate-to-severe hypertension following a 2-week wash-out period and a 2-week placebo period. The angiotensin-converting enzyme (ACE) inhibitor spirapril, at a dose of 6 mg/day, was added to the treatment of those not responding to 5 mg/day isradipine SRO alone. After 4 weeks of active treatment, isradipine alone normalized blood pressure (diastolic blood pressure < or = 90 mm Hg) in 38 (66.6%) patients whereas a further 4 weeks of treatment with the combination of isradipine and spirapril led to normalization in 14 of the 19 (73.7%) patients with partial or nil blood pressure responses. Side-effects were mild and transient and were observed in nine patients (15.8%). Isradipine SRO is an effective and well-tolerated antihypertensive agent and combination with spirapril appears to enhance its efficacy without an increase in side-effects.
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