The cumulative effect of core lifestyle behaviours on the prevalence of hypertension and dyslipidemia

Background: Most cardiovascular disease (CVD) occurs in the presence of traditional risk factors, including hypertension and dyslipidemia, and these in turn are influenced by behavioural factors such as diet and lifestyle. Previous research has identified a group at low risk of CVD based on a cluster of inter-related factors: body mass index (BMI) < 25 Kg/m2, moderate exercise, alcohol intake, non-smoking and a favourable dietary pattern. The objective of this study was to determine whether these factors are associated with a reduced prevalence of hypertension and dyslipidemia in an Irish adult population. Methods: The study was a cross-sectional survey of 1018 men and women sampled from 17 general practices. Participants completed health, lifestyle and food frequency questionnaires and provided fasting blood samples for analysis of glucose and insulin. We defined a low risk group based on the following protective factors: BMI <25 kg/m2; waist-hip ratio (WHR) <0.85 for women and <0.90 for men; never smoking status; participants with medium to high levels of physical activity; light alcohol consumption (3.5–7 units of alcohol/week) and a "prudent" diet. Dietary patterns were assessed by cluster analysis. Results: We found strong significant inverse associations between the number of protective factors and systolic blood pressure, diastolic blood pressure and dyslipidemia. The prevalence odds ratio of hypertension in persons with 1, 2, 3, ≥ 4 protective factors relative to those with none, were 1.0, 0.76, 0.68 and 0.34 (trend p < 0.01). The prevalence odds ratio of dyslipidemia in persons with 1, 2, 3, ≥ 4 protective factors relative to those with none were 0.83, 0.98, 0.49 and 0.24 (trend p = 0.001). Conclusion: Our findings of a strong inverse association between low risk behaviours and two of the traditional risk factors for CVD highlight the importance of 'the causes of the causes' and the potential for behaviour modification in CVD prevention at a population level.

'Muchos Méxicos': widening the lens in Rulfo's cinematic texts

It is difficult to overstate the importance of Juan Rulfo’s two major pieces of fictional narrative work—his haunting, enigmatic novel Pedro Páramo (1955) and his unrelenting depictions of the failures of post-revolutionary Mexico in his short story collection El Llano en llamas (1953). In her foreword to the Margaret Sayers Peden English translation, Susan Sontag hails Pedro Páramo as ‘not only one of the masterpieces of 20th Century world literature, but one of the most influential of the century’s books’. García Márquez has compared the influence of Rulfo on 20th Century world literature to that of Sophocles: ‘No son más de 300 páginas, pero son casi tantas y creo tan perdurables como las que conocemos de Sófocles’ and, completing this oftrepeated triumvirate of recommendations, Jorge Luis Borges has referred to Pedro Páramo as: ‘una de las mejores novelas de las literaturas de lengua hispánica, y aun de la literatura.’ Despite the praise heaped upon Rulfo’s two most famous books, when his third book of fiction, El gallo de oro y otros textos para cine, was finally published in 1980, just six years before his death, it was greeted with almost critical silence. It is precisely this publication that provides the focus of this investigation. The collection contains three texts—El despojo, La fórmula secreta and El gallo de oro. Constituting a third of the fictional work he published in his lifetime, expanding upon themes present in El Llano en llamas and Pedro Páramo while, at the same time, examining new ground, no thematic discussion of Rulfo’s written output is complete without including these texts. Yet they are frequently dismissed. In this way this investigation attempts to go some way towards filling this critical gap in the work of one of the most influential writers of the twentieth century