La glucemia basal alterada es un factor de riesgo para el infarto cerebralaterotrombótico o lacunar. Estudio de casos y controles / Impaired fasting glucose as a risk factor for atherothrombotic or lacunar cerebral infarction. A case-control study

Introducción. Los factores de riesgo vasculares modificables(FRVM) para los infartos cerebrales aterotrombóticos y lacunares sonbien conocidos, pero hay pocos estudios poblacionales y desconocemosel riesgo de estados glucémicos previos a la diabetes mellitus(DM). El objetivo del trabajo es estudiar la relación entre la glucemiabasal alterada (GBA) y otros FRVM con los infartos cerebrales aterotrombóticosy lacunares.Métodos. Estudio de casos y controles de base poblacional realizadoen dos centros de salud urbanos. Casos: 236 pacientes con infartoscerebrales aterotrombótico o lacunar diagnosticados mediante tomografíacomputarizada o resonancia magnética. Se excluyeron los infartoscerebrales cardioembólicos de causa infrecuente o indeterminada ylas hemorragias intracerebrales. Controles: 441 pacientes sin infartocerebral, apareados por edad y sexo, seleccionados por muestreo aleatoriosimple. Mediante regresión logística se estudiaron las odds ratio(OR) de los factores de riesgo GBA, DM, tabaquismo, hipertensión arterial(HTA), hipercolesterolemia, hipertrigliceridemia y obesidad.Resultados. La edad media fue de 71,1 años, con un 62% devarones. La prevalencia en los casos de los FRVM fue: GBA, 32,9%;DM, 49,6%; tabaquismo, 26,3%; HTA, 78,8%; hipercolesterolemia,29,3%; hipertrigliceridemia, 18,2 %, y obesidad, 63,5%. Todos losFRVM se asociaron en el análisis crudo con un aumento del riesgo deinfarto cerebral. En el análisis multivariante se asociaron de manerasignificativa la GBA (OR: 3,2; intervalo de confianza [IC] del 95%:1,1-7,9), la DM (OR: 4,5; IC 95%: 1,4-14,9), la HTA (OR: 2,6; IC 95%:1,5-4,5), la hipercolesterolemia (OR: 2,3; IC 95%: 1,4-3,9) y la obesidad(OR: 1,7; IC 95%: 1,0-2,9).Conclusiones. Las alteraciones del metabolismo de la glucosaGBA y DM son un importante FRVM para el IC aterotrombótico ylacunar por la elevada magnitud de la OR y elevada prevalencia en lapoblación con infarto cerebral (AU)

Introduction. Modifiable vascular risk factors (MVRF) foratherotrombotic or lacunar cerebral infarction have been clearlyestablished, even though only a few population studies havebeen conducted and we do not know the risk of glycemic statusprior to the diabetes mellitus (DM). This study has aimed todetermine the relationship between impaired fasting glucose(IFG) and others MVRF with atherothrombotic or lacunar cerebralinfarctions.Methods. A population based case-control study was conductedin two urban health care centers. Cases: 236 patientswith atherothrombotic or lacunar CI, diagnosed by computedtomography scan magnetic resonance imaging. Unusual, indeterminateand cardioembolic cerebral infarction and cerebralhemorrhage were excluded. Controls: 441 patients withoutcerebral infarction, matched by age and gender, selected bymeans of simple random sampling. The odds ratios (OR) of IFG,DM, smoking, high blood pressure, hypercholesterolemia,hypertriglyceridemia, and obesity were measured with logisticregression.Results. Mean age was 71.1 years old, 62 % being male.Prevalence in cases of MVRF was: IFG, 32.9%; DM, 49.6 %;smoking, 26.3%; high blood pressure, 78.8%; hypercholesterolemia,29.3%; hypertriglyceridemia, 18.2%, and obesity, 63.5%.All MVRFs were associated in the crude analysis with increasedrisk of cerebral infarction. In the multivariate analysis, significantassociations were found for IFG (OR: 3.2; 95 % confidenceinterval [CI]:1.1-7.9), DM (OR: 4.5; 95 % CI: 1.4-14.9),high blood pressure (OR: 2.6; 95 % CI: 1.5-4.5), hypercholesterolemia(OR: 2.3; 95 % CI: 1.4-3.9), and obesity (OR: 1.7; 95%CI: 1.0-2.9).Conclusions. Alterations of the glucose metabolism IFG andDM are important MVRF for atherothrombotic or lacunar cerebralinfarction as seen by the high rate of OR and high prevalence inthe population with cerebral infarction (AU)

[Impaired fasting glucose as a risk factor for atherothrombotic or lacunar cerebral infarction. A case-control study]. / La glucemia basal alterada es un factor de riesgo para el infarto cerebral aterotrombótico o lacunar. Estudio de casos y controles.

INTRODUCTION: Modifiable vascular risk factors (MVRF) for atherotrombotic or lacunar cerebral infarction have been clearly established, even though only a few population studies have been conducted and we do not know the risk of glycemic status prior to the diabetes mellitus (DM). This study has aimed to determine the relationship between impaired fasting glucose (IFG) and others MVRF with atherothrombotic or lacunar cerebral infarctions. METHODS: A population based case-control study was conducted in two urban health care centers. CASES: 236 patients with atherothrombotic or lacunar CI, diagnosed by computed tomography scan magnetic resonance imaging. Unusual, indeterminate and cardioembolic cerebral infarction and cerebral hemorrhage were excluded. CONTROLS: 441 patients without cerebral infarction, matched by age and gender, selected by means of simple random sampling. The odds ratios (OR) of IFG, DM, smoking, high blood pressure, hypercholesterolemia, hypertriglyceridemia, and obesity were measured with logistic regression. RESULTS: Mean age was 71.1 years old, 62 % being male. Prevalence in cases of MVRF was: IFG, 32.9%; DM, 49.6 %; smoking, 26.3%; high blood pressure, 78.8%; hypercholesterolemia, 29.3%; hypertriglyceridemia, 18.2%, and obesity, 63.5%. All MVRFs were associated in the crude analysis with increased risk of cerebral infarction. In the multivariate analysis, significant associations were found for IFG (OR: 3.2; 95 % confidence interval [CI]:1.1-7.9), DM (OR: 4.5; 95 % CI: 1.4-14.9), high blood pressure (OR: 2.6; 95 % CI: 1.5-4.5), hypercholesterolemia (OR: 2.3; 95 % CI: 1.4-3.9), and obesity (OR: 1.7; 95% CI: 1.0-2.9). CONCLUSIONS: Alterations of the glucose metabolism IFG and DM are important MVRF for atherothrombotic or lacunar cerebral infarction as seen by the high rate of OR and high prevalence in the population with cerebral infarction.

[Good morning, Mr. Representative. Anything new to tell us about? Analysis of the pharmacological products introduced by the drugs industry into a health district]. / Buenos días, señor Visitador. ¿Algo nuevo que contar? Análisis de las especialidades farmacológicas presentadas por la industria farmacéutica en un área básica de salud.

OBJECTIVE: To study whether the visits of technical health representatives (ITS) mean that new drugs are introduced. Design. Prospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: The products presented by 137 ITS from 83 drug laboratories in weekly sessions for a year were studied. MAIN MEASUREMENTS: The products presented, the year they were first marketed, intrinsic value (IV), newness and use potential, cost per package and defined daily dose and material handed over were studied. RESULTS: 472 drug products were introduced. The most common ones belonged to the cardiovascular group (27.3%), digestion and metabolism (14.8%) and anti-infection drugs (13.3%). 65.5% had been on the market for <5 years. 84.3% had a high IV. Only 31 products (6.6%) were new (95% CI, 4.5-9.2). 71% of these supposed no or very slight therapeutic improvement, 25.8% a modest improvement and 3.2% a major improvement. Mean cost was 19.3 euros per package and 2 euros per DDD, with significant differences found (P<.006) on stratifying by date of marketing (more recently marketed products cost more). 61% of the products were presented with additional material (leaflets, monographs, journals), 21.6% with gifts of symbolic value, and 19.9% with samples of the product. There were significant differences (P<.03) between the new drugs and the normal prescriptions issued at the centre. In the new drugs, there were fewer products with high IV and cost per package and per DDD was higher. CONCLUSIONS: The products introduced by the reps do not include any important new drugs. They are presented with abundant back-up and are more expensive than those normally prescribed.

Buenos días, señor visitador. ¿Algo nuevo que contar? Análisis de las especialidades famacológicas presentadas por la industria farmacéutica en un área básica de salud / Good morning Mr. Drug Industry Representative, what´s new? Analysis of drugs presented by the pharmaceutical industry in a basic health area

Objetivo. Estudiar si las visitas de los informadores técnicos sanitarios (ITS) suponen la presentación de novedades farmacológicas. Diseño. Estudio descriptivo, prospectivo. Emplazamiento. Centro de salud urbano. Participantes. Se estudiaron los productos presentados por 137 ITS de 83 laboratorios mediante sesiones semanales durante un año. Mediciones principales. Se estudiaron los productos presentados, el año de comercialización, el valor intrínseco (VI), la novedad y el potencial de uso, el coste por envase y dosis diaria definida (DDD) y el material entregado. Dichos productos se compararon con una muestra aleatoria de la prescripción anual del centro. Resultados. Se presentaron 472 productos farmacéuticos. Los más frecuentes fueron de los grupos siguientes: cardiovascular (27,3 por ciento), digestivo y metabolismo (14,8 por ciento) y antiinfecciosos (13,3 por ciento). El 65,5 por ciento llevaba comercializado menos de 5 años. El 84,3 por ciento tenía un VI elevado. Solamente 31 productos (6,6 por ciento) eran novedades (intervalo de confianza [IC] del 95 por ciento, 4,5-9,2). De ellos, el 71 por ciento supuso una nula o muy pequeña mejora terapéutica, el 25,8 por ciento una modesta mejora y el 3,2 por ciento una importante mejora. El coste medio fue de 19,3 euros por envase y de 2,0 euros por DDD, con diferencias significativas (p < 0,006) al estratificar por la fecha de comercialización (coste superior en los productos más recientemente comercializados). El 61 por ciento de los productos se presentó con material adicional (folletos, monografías, revistas, libros), el 21,6 por ciento, con regalos de valor simbólico, y el 19,9 por ciento, con muestras del producto. Se observaron diferencias significativas (p < 0,03) respecto a la prescripción habitual del centro: proporción inferior de productos con VI elevado y coste superior por envase y por DDD. Conclusiones. Los productos presentados por los ITS no suponen novedades importantes, se presentan con abundante soporte y son más caros que los prescritos habitualmente (AU)

[Modifiable risk factors for non-cardioembolic transient ischemic attacks. Case control studies in the general population]. / Factores de riesgo modificables para el accidente isquémico transitorio no cardioembólico. Estudio de casos y controles en población general.

INTRODUCTION: Transient ischemic attacks (TIA) often precede a stroke. AIMS: The purpose of this study is to examine the modifiable cardiovascular risk factors for non-cardioembolic TIA. PATIENTS AND METHODS: A population based case control study was conducted in a district within the city of Barcelona. The cases were 103 patients with non-cardioembolic TIA, who had been diagnosed by a neurologist, and with normal CAT or MRI scans. Subjects were paired by age and sex with 193 controls without TIA or stroke, who were selected by simple random sampling from the clinical records file at the centre. The risk factors were studied using a standardized questionnaire that included the following factors which were codified in a dichotomous manner: smoking, arterial hypertension (AHT), hypercholesterolemia, hypertriglyceridemia, obesity, impaired fasting glucose and diabetes mellitus (DM). RESULTS: The average age was 74.6 years and 52.3% of the subjects were females. All the modifiable cardiovascular risk factors were associated to a higher risk of TIA, although only AHT (OR: 1.9; CI 95%: 1.1-3.3) and obesity (OR: 2.1; CI 95%: 1.2-3.6) were associated in a significant way in the univariate analysis. In the multivariate analysis by logistic regression, the modifiable cardiovascular risk factors that were associated in a significant manner were AHT (OR: 1.9; CI 95%: 1.0-3.6), obesity (OR: 2.8; CI 95%: 1.4-12.3) and DM (OR: 1.7; CI 95%: 1.0-2.9). CONCLUSIONS: In the present study, AHT, obesity and DM were seen to be modifiable risk factors for non-cardioembolic TIA.

Factores de riesgo modificables para el accidente isquémico transitorio no cardioembólico. Estudio de casos y controles en población general / Modifiable risk factors for non-cardioembolic transient ischemic attacks. Case-control studies in the general population

Introducción. Frecuentemente, el accidente isquémico transitorio (AIT) precede al ictus. Objetivo. Estudiar factores de riesgo cardiovascular modificables para el AIT no cardioembólico. Pacientes y métodos. Se realizó un estudio de casos y controles de base poblacional, realizado en un barrio urbano de la ciudad de Barcelona. Los casos fueron 103 pacientes con AIT no cardioembólico, diagnosticados por un neurólogo y con TAC o RM normales. Se aparearon por edad y sexo con 193 controles sin AIT ni ictus, seleccionados por muestreo aleatorio simple del archivo de historias clínicas del centro. Los factores de riesgo se estudiaron mediante un cuestionario estandarizado que recogió los siguientes factores codificados de manera dicotómica: tabaquismo, hipertensión arterial (HTA), hipercolesterolemia, hipertrigliceridemia, obesidad, intolerancia a la glucosa en ayuno y diabetes mellitus (DM). Resultados. La edad media fue de 74,6 años, con un 52,3 por ciento de mujeres. Todos los factores de riesgo cardiovascular modificables se asociaron a un superior riesgo de AIT, aunque sólo la HTA (OR = 1,9; IC 95 por ciento = 1,1-3,3) y la obesidad (OR = 2,1; IC 95 por ciento = 1,2-3,6) se asociaron de manera significativa en el análisis univariado. En el análisis multivariante mediante regresión logística, los factores de riesgo cardiovascular modificables asociados de manera significativa fueron la HTA (OR = 1,9; IC 95 por ciento = 1,0-3,6), la obesidad (OR = 2,8; IC 95 por ciento = 1,4-12,3) y la DM (OR = 1,7; IC = 95 por ciento = 1,0-2,9). Conclusiones. En el presente estudio, la HTA, la obesidad y la DM han sido factores de riesgo modificables para el AIT no cardioembólico (AU)

Introduction. Transient ischemic attacks (TIA) often precede a stroke. Aims. The purpose of this study is to examine the modifiable cardiovascular risk factors for non-cardioembolic TIA. Patients and methods. A population-based case-control study was conducted in a district within the city of Barcelona. The cases were 103 patients with non-cardioembolic TIA, who had been diagnosed by a neurologist, and with normal CAT or MRI scans. Subjects were paired by age and sex with 193 controls without TIA or stroke, who were selected by simple random sampling from the clinical records file at the centre. The risk factors were studied using a standardized questionnaire that included the following factors which were codified in a dichotomous manner: smoking, arterial hypertension (AHT), hypercholesterolemia, hypertriglyceridemia, obesity, impaired fasting glucose and diabetes mellitus (DM). Results. The average age was 74.6 years and 52.3% of the subjects were females. All the modifiable cardiovascular risk factors were associated to a higher risk of TIA, although only AHT (OR: 1.9; CI 95%: 1.1-3.3) and obesity (OR: 2.1; CI 95%: 1.2-3.6) were associated in a significant way in the univariate analysis. In the multivariate analysis by logistic regression, the modifiable cardiovascular risk factors that were associated in a significant manner were AHT (OR: 1.9; CI 95%: 1.0-3.6), obesity (OR: 2.8; CI 95%: 1.4-12.3) and DM (OR: 1.7; CI 95%: 1.0-2.9). Conclusions. In the present study, AHT, obesity and DM were seen to be modifiable risk factors for non-cardioembolic TIA (AU)