Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

population study

 

Investigating Lack Of Adherence To Medications Used For Primary Or Secondary Stroke Prevention In Rural Ecuador: Rationale And Protocol Of A Population-Based Study Investigación de la Falta de Adherencia a Medicamentos Utilizados para la Prevención Primaria y Secundaria de Ictus en Zonas Rurales del Ecuador: Fundamentación y Protocolo de un Estudio Poblacional

Background: Stroke is an emerging public health crisis in Latin America, particularly in rural areas of low- and middle-income countries (LMIC), where limited healthcare access exacerbates disease burden. Medication adherence plays a fundamental role in stroke prevention, yet information on this topic remains insufficiently known due to issues related to socioeconomic, educational, and infrastructural barriers.

Aims: This study introduces a protocol designed to assess adherence to primary and secondary stroke prevention medications in rural Ecuador. By identifying behavioral patterns and underlying barriers, this research aims to provide evidence-based recommendations for improving adherence and informing public health interventions.

Methods: The study will be conducted in Atahualpa, Ecuador, using a population-based design with an initial cross-sectional assessment followed by a 10-year longitudinal follow-up. Medication adherence will be evaluated through validated questionnaires, clinical examinations, and annual updates on vascular risk factors and social determinants of health. Statistical analyses will assess the relationship between adherence levels, demographic variables, and cerebrovascular outcomes.

Comment: This research provides essential insights into adherence behaviors in underserved populations, offering a foundation for targeted interventions. Findings will support healthcare accessibility, strengthen patient education, and improve adherence strategies to reduce stroke incidence and improve health outcomes in rural LMIC settings.

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Palabras clave: Adherencia a medicación, ambientes rurales, Ecuador, enfermedad cerebrovascular, estudio poblacional, prevención,

Keywords: Ecuador, Medication adherence, population study, prevention, rural settings, stroke,

Limited value of blood pressure levels in predicting white matter hyperintensities progression among community dwelling older adults living in a rural setting. Utilidad limitada de los niveles de presión arterial como predictor de progresión de hiperintensidades de sustancia blanca en adultos mayores que viven en un entorno rural

Introduction: This study aims to assess the impact of blood pressure (BP) on progression of white matter hyperintensities (WMH) of presumed vascular origin in community-dwelling older adults living in rural Ecuador.

Methods: Atahualpa residents aged ≥60 years receiving baseline and follow-up brain MRIs after a median of 6.5 years were included. Multilevel logistic regression models, which accounted for WMH severity at baseline, were fitted to assess the risk of WMH progression according to BP levels and other covariates.

Results: Analysis included 263 participants. WMH progression increased 3.45 times (95% C.I.: 1.94 – 4.96) among non-hypertensive individuals but 6.15 times (95% C.I.: 3.18 – 9.12) among those with arterial hypertension. However, overlapping of confidence intervals make such difference non-significant. Likewise, no differences in WMH progression were noticed when steady and pulsatile components of BP were used as independent variables.

Conclusions: High BP is not an independent predictor of WMH progression in the study population. 

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Palabras clave: enfermedad cerebral de pequeño vaso, estudio poblacional, hiperintensidades de sustancia blanca, Hipertensión arterial, presión arterial, Pronóstico,

Keywords: Arterial hypertension, blood pressure, cerebral small vessel disease, population study, Prognosis, White matter hyperintensities,

The association between pineal gland calcification and intracranial atherosclerotic disease in older adults. Asociación entre calcificaciones de la glándula pineal y enfermedad aterosclerótica intracraneal en adultos mayores

Background: This study assesses whether pineal gland calcification (PGC) – a surrogate for reduced endogenous melatonin production – is associated with significant stenosis of large intracranial arteries – a biomarker of intracranial atherosclerotic disease (ICAD). 

Methods: Individuals aged ≥60 years enrolled in the Three Villages Study received head CT to assess PGC and MRA to estimate stenosis of large intracranial arteries. Multivariate logistic regression models were fitted to assess the association between PGC and ICAD, after adjusting for relevant confounders. Inverse probability of exposure weighting was used to estimate the effect of PGC on ICAD. 

Results: A total of 581 individuals were enrolled. PGC and ICAD were associated in a fully-adjusted logistic regression model (p=0.032). Inverse probability of exposure weighting showed an estimate for the proportion of ICAD among those without PGC of 3.7% and the adjusted-effect coefficient was 5.7% higher among those with PGC (p=0.031). 

Conclusions: PGC is associated with ICAD. Study results provide grounds for evaluating the role of melatonin deficiency in ICAD progression. 

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Palabras clave: Adultos Mayores, aterosclerosis intracraneal, calcificación de la glándula pineal, estenosis de arterias cerebrales de mediano calibre, estudio poblacional,

Keywords: intracranial atherosclerosis, melatonin, older adults, pineal gland calcification, population study, stenosis of large intracranial arteries,
 
 
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