Bettsy Y. Recalde

Universidad de Especialidades Espíritu Santo

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Robertino M. Mera

Freenome (United States)

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Óscar H. Del Brutto

Universidad de Especialidades Espíritu Santo

Denisse A. Rumbea

Universidad de Especialidades Espíritu Santo

Aldo F. Costa

Hospital Universitario Reina Sofía

Mark J. Sedler

Stony Brook University

Victor J. Del Brutto

University of Miami

Héctor H. Garcı́a

Universidad Peruana Cayetano Heredia

Pablo R. Castillo

Jacksonville College

Pedro Pérez

Stony Brook School

Javier A. Bustos

Instituto Nacional de Enfermedades Neoplásicas

Cooperative Institutions

Neurological Surgery

Stony Brook University

Instituto de Neurología Cognitiva

University of Miami

Universidad de Especialidades Espíritu Santo

Fondation de Rothschild

Shiraz University of Medical Sciences

Chinese Academy of Sciences

Fondation Ophtalmologique Adolphe de Rothschild

Hamad Medical Corporation

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Table of Contents

Journal of Stroke and Cerebrovascular Diseases (2020)

Jared Cooper Anubhav G. Amin Michael G. Kim Alan Stein José Manuel García‐Domínguez

Table (database)

10.1016/s1052-3057(20)30698-4

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Citations (0)

The association between white matter hyperintensities of presumed vascular origin and disability is mediated by age: a population-based study in stroke-free older adults

Aging Clinical and Experimental Research (2023)

Óscar H. Del Brutto Denisse A. Rumbea Bettsy Y. Recalde Robertino M. Mera

Association (psychology)

Stroke

10.1007/s40520-023-02355-5

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Citations (1)

De novo appearance of cerebral microbleeds in community-dwelling older adults. Neuroimaging and clinical correlates

The Neuroradiology Journal (2022)

Óscar H. Del Brutto Bettsy Y. Recalde Denisse A. Rumbea Robertino M. Mera

Background and Purpose Prospective studies on cerebral microbleeds (CMB) have departed from individuals who already have CMB at baseline. Therefore, main outcomes have usually been the composite of new lesions appearing on the follow-up among patients who already had CMB together with those who de novo developed CMB. Using the Atahualpa Project Cohort, we aimed to assess correlates of incident CMB in community-dwelling older adults free of CMB at baseline. Methods Atahualpa residents aged ≥ 60 years received baseline clinical interviews and a brain MRI. Those who were free of CMB at baseline and received follow-up brain MRI at the end of the study were included. Multivariate logistic and Poisson regression models were fitted to assess the association and the incidence rate ratio (IRR) of incident CMB according to clinical and neuroimaging variables. Results The mean age of 241 study participants was 65.6 ± 6.1 years (57% women). After 6.5 years of follow-up, 25 subjects (10.4%) developed incident CMB. A total of 37 CMB were noticed in these 25 patients. A parsimonious logistic regression model demonstrated an association between the Edmonton Frail Scale (EFS) and incident CMB ( p = .043). Multivariate logistic regression models showed an association between WMH progression and incident CMB ( p = .011). Using Poisson regression models, the IRR for WMH progression at follow-up was increased in subjects with incident CMB ( p = .029). Conclusions Study results show a significant relationship between the EFS, WMH progression, and incident CMB. This knowledge will allow the implementation of preventive policies to reduce incident CMB and its consequences.

Rate ratio

10.1177/19714009221141401

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Life’s simple 7 and all-cause mortality. A population-based prospective cohort study in middle-aged and older adults of Amerindian ancestry living in rural Ecuador

Preventive Medicine Reports (2021)

Óscar H. Del Brutto Robertino M. Mera Bettsy Y. Recalde Denisse A. Rumbea Mark J. Sedler

Life's Simple 7 is an initiative of the American Heart Association developed for stratifying risk factors associated with adverse vascular outcomes and premature mortality. While this scale has been widely used, there is limited information on its applicability to individuals living in remote communities where risk factors and lifestyles differ from those found in urban settings. This longitudinal prospective study aimed to assess, according to the Life's Simple 7 scale, all-cause mortality in community-dwelling middle-age and older adults of Amerindian ancestry living in rural Ecuador. A total of 933 Atahualpa residents aged ≥ 40 years who received baseline interviews and procedures for measurement of cardiovascular health (CVH) metrics were enrolled and followed-up for a median of 8 years (interquartile range: 4-9 years). Using a Poisson regression model (adjusted for age at baseline, gender and the level of education), the predicted incidence rate of mortality was 4.22 per 100 person-years (95% C.I.: 2.48-5.97) for individuals with 0-1 CVH metrics in the ideal range, which decreased to 1.23 (95% C.I.: 0.24-2.21) for those with five ideal metrics. In an adjusted Cox-proportional hazard model that included all the CVH metrics, having three or more metrics in the ideal range significantly reduced the mortality hazard ratio when compared with individuals having 0-2 ideal metrics. Study results emphasize the usefulness of the Life's Simple 7 scale to estimate mortality risk in Amerindians living in remote communities. Control of CVH metrics should prove cost-effective for reducing premature deaths in underserved populations.

Interquartile range

Cardiovascular Health

10.1016/j.pmedr.2021.101668

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Citations (14)

Dietary oily fish intake and progression of diffuse subcortical damage of vascular origin: A longitudinal prospective study in community-dwelling older adults

European Stroke Journal (2022)

Óscar H. Del Brutto Robertino M. Mera Victor J. Del Brutto Bettsy Y. Recalde Denisse A. Rumbea

Oily fish intake may reduce the progression of white matter hyperintensities (WMH) of presumed vascular origin due to their high content of omega-3 polyunsaturated fatty acids and other nutrients. However, information on this relationship is limited. We aimed to assess the association between oily fish intake and WMH progression in older adults living in rural coastal Ecuador.Participants of the Atahualpa Project Cohort received baseline clinical interviews and brain MRIs. Oily fish intake was calculated at every annual door-to-door survey from enrollment to the end of the study. Individuals who also received a follow-up brain MRI were included. Poisson regression models were fitted to assess the incidence rate ratio (IRR) of WMH progression according to the amount of oily fish intake, after adjusting for demographics, level of education and traditional vascular risk factors.The study included 263 individuals of Amerindian ancestry aged ⩾60 years (mean age: 65.7 ± 6.2 years; 57% women). The mean oily fish intake was 8.3 ± 4 servings per week. Follow-up MRIs demonstrated WMH progression in 103 (39%) individuals after a median follow-up of 6.5 years. A multivariate Poisson regression model showed an inverse relationship between oily fish intake and WMH progression (IRR: 0.89; 95% CI: 0.84-0.95; p < 0.001). A similar model also revealed an inverse relationship between tertiles of oily fish intake and probabilities of WMH progression, which became significant when individuals allocated to the third tertile were compared to those in the first and second tertiles.Study results show an inverse relationship between the amount of oily fish intake and WMH progression in frequent fish consumers of Amerindian ancestry.

10.1177/23969873221100162

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Height is Inversely Associated with Biomarkers of Intracranial Atherosclerotic Disease in Older Adults of Amerindian Ancestry: Exploring the Obesity Paradox

Journal of Stroke and Cerebrovascular Diseases (2021)

Óscar H. Del Brutto Robertino M. Mera Bettsy Y. Recalde Pedro Pérez José Ortega-Tola

ICAD

Odds

Waist-to-height ratio

10.1016/j.jstrokecerebrovasdis.2021.106200

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Dietary Oily Fish Intake is Inversely Associated with Severity of White Matter Hyperintensities of Presumed Vascular Origin. A Population-Based Study in Frequent Fish Consumers of Amerindian Ancestry

Journal of Stroke and Cerebrovascular Diseases (2021)

Óscar H. Del Brutto Bettsy Y. Recalde Robertino M. Mera

Quartile

Fish products

10.1016/j.jstrokecerebrovasdis.2021.105778

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Citations (11)

Cerebral small vessel disease score and atherosclerosis burden – A population study in community-dwelling older adults

Clinical Neurology and Neurosurgery (2020)

Óscar H. Del Brutto Robertino M. Mera Victor J. Del Brutto John P. Hill Andrew P. Torpey

Stroke

10.1016/j.clineuro.2020.105795

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Citations (14)

Total cerebral small vessel disease score and all-cause mortality in older adults of Amerindian ancestry: The Atahualpa Project

European Stroke Journal (2021)

Victor J. Del Brutto Robertino M. Mera Bettsy Y. Recalde Denisse A. Rumbea Aldo F. Costa

Introduction Cerebral small vessel disease (SVD) predicts all-cause mortality in Eastern Asian and Caucasian populations. However, little is known about SVD impact in individuals of different races/ethnic groups. In this study, we sought to estimate the mortality risk according to the total SVD (tSVD) score in older adults of Amerindian ancestry. Methods Participants aged ≥60 years from the prospective population-based Atahualpa Project cohort underwent brain MRI between June 2012 and June 2017. The tSVD score was calculated based on the presence of moderate-to-severe white matter hyperintensities, enlarged perivascular spaces, one or more lacune, and one or more cerebral microbleed. We ascertained all-cause mortality during post-MRI follow-up. Poisson regression and Cox-proportional hazards models adjusted for demographics and cardiovascular risk were obtained to estimate mortality risk according to the tSVD score. Results Analysis included 375 participants with available brain MRI and clinical data (mean age 69.0 ± 8.3 years, 56.3% women). The tSVD score was 0 point in 216 individuals (57.6%), 1 point in 71 (18.9%), 2 points in 53 (14.1%), and 3–4 points in 35 (9.3%). Increasing tSVD score was associated with advancing age, hypertension, low level of education, and physical inactivity. Using tSVD score of 0 as reference, a multivariate Poisson regression model showed an increased mortality for individuals with a tSVD score 3–4 points (IRR: 2.27; 95% CI: 1.20–4.28). Likewise, in the Cox-proportional model adjusted for demographics and cardiovascular risk, participants with a tSVD score 3–4 maintained a greater than two-fold mortality risk when compared to those with tSVD score of 0 points (HR: 2.32; 95% CI: 1.23–4.39). Conclusions High-burden SVD as determined by the tSVD score predicts mortality in community-dwelling older adults of Amerindian ancestry. Incidental diagnosis of covert SVD should prompt aggressive control of cardiovascular health.

Demographics

10.1177/23969873211060803

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Risk for Subsequent SARS-CoV-2 Infection and Severe COVID-19 Among Community-Dwellers With Pre-Existing Cervicocephalic Atherosclerosis: A Population-Based Study

Journal of Primary Care & Community Health (2022)

Óscar H. Del Brutto Robertino M. Mera Victor J. Del Brutto Bettsy Y. Recalde Denisse A. Rumbea

Background: COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19. Methods: Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity. Results: Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers ( P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis ( P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant. Conclusions: Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.

Pandemic

10.1177/21501319211070685

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Citations (4)