ABSTRACT
BACKGROUND: The aim is to describe the prognosis role of the change in the atrial fibrillation (AF) type in an unselected population of patients with AF currently attending primary care in a single health-service area in Galicia, north-western Spain. METHODS: AFBAR is a cohort study that was carried out by 35 primary care providers in 2008. Participants were followed up for a mean of 2.8 ± 0.7 years. 798 patients with the diagnosis of AF who presented at their clinics during a three-month period were recruited. Primary endpoint was mortality or hospital admission. RESULTS: 778 patients (413 male) were analyzed; mean age 74.8 years old. Hypertension was the most prevalent risk factor (76.5%). Permanent AF was diagnosed in 529 patients (68.0%). Change of AF status occurred in 76 patients (9.8%). During follow-up 52.1% of the patients underwent a primary endpoint and the overall survival was 83.4%. The following independent determinants of primary endpoint were identified: change in AF status (Hazard Ratio (HR) 1.41 (95%-confidence interval (CI) 1.04-1.92); p=0.026); previous heart failure (HR 1.28 (95%-CI 1.00-1.65); p=0.050); previous cardiovascular admission (HR 1.54 (95%-CI 1.16-2.03); p=0.002); stroke (HR 2.02 (95%-CI 1.35-3.03); p=0.001);ischemic heart disease (HR 1.28 (95%-CI 1.00-1.65); p=0.050); chronic obstructive pulmonary disease (HR 1.28 (95%-CI 1.00-1.64);p=0.042); anemia (HR 1.37 (95% CI 1.08-1.75); p=0.010); or AF-related complications (HR 1.45 (95%-CI 1.18-1.78); p<0.001). CONCLUSIONS: The change in AF status showed to be an important prognosis marker for death or hospital admissions in a primary care cohort.
Subject(s)
Atrial Fibrillation/epidemiology , Hospitalization/trends , Risk Assessment/methods , Aged , Aged, 80 and over , Atrial Fibrillation/physiopathology , Disease Progression , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Prognosis , Prospective Studies , Risk Factors , Spain/epidemiology , Time FactorsABSTRACT
INTRODUCTION: Patients with cerebrovascular disease (CVD) are a group with a very high cardiovascular risk, in addition to that arising from their own vascular pathology, probably due to an inadequate control of risk factors and owing to the presence of comorbidities. PATIENTS AND METHODS: This research consisted in a multi-centre study involving the collaboration of 34 primary care physicians and recording of the features of 473 patients with a previous history of a CVD event that required hospitalisation. After a clinical follow-up of the cohort, hospital readmissions, mortality and causes were analysed. RESULTS: The mean age of patients (52% males) was 75 ± 10 years and the most prevalent risk factors were arterial hypertension (79%), dyslipidaemia (66%), obesity (43%) and diabetes (29%). Sixty-eight per cent of patients had been diagnosed with stroke and 32% with transient ischaemic attack. The mean amount of time elapsed since the first CVD event was 6.6 ± 5.5 years. Twenty-nine per cent of patients had a situation of dependence and only one third showed good blood pressure and lipid control. During a follow-up lasting 8.2 ± 2.3 months, 7.2% of patients suffered some kind of cardio-vascular event (death or hospitalisation), which independent determinants were found to be previous heart failure (hazard ratio, HR = 2.74; 95% confidence interval, CI 95% = 1.3-5.9); cardiomyopathy (HR = 3.32; CI 95% = 1.4-8.2); anaemia (HR = 3.09; CI 95% = 1.6-6.2); renal failure (HR = 2.4; CI 95% = 1.0-5.6); the situation of dependence (HR = 2.57; CI 95% = 1.3-5.7) and cardiovascular admissions over the past year (HR = 3.05; CI 95% = 1.5-5.6). CONCLUSIONS: Patients with CVD followed up in the area of primary care present a high prevalence of arterial hypertension and little is done to control it. Their prognosis is conditioned by cardiovascular comorbidities and sequelae of their cerebro-vascular disease.
Subject(s)
Cerebrovascular Disorders/pathology , Cerebrovascular Disorders/physiopathology , Chronic Disease , Aged , Aged, 80 and over , Blood Pressure/physiology , Cardiovascular Diseases/etiology , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/diagnosis , Humans , Male , Prognosis , Risk FactorsABSTRACT
BACKGROUND AND OBJECTIVE: Changes in dietary habits are associated with an improvement of lipid profile. We decided to assess changes in lipid profile reached with a dietary enrichment with canned tuna in olive oil and compared them with those reached with canned tuna with additional supplementation. SUBJECTS AND METHOD: In a prospective, randomized, single blind study, 400 participants were assigned to a daily intake of canned tuna in olive oil alone (control group) or enriched with: isoflavones, omega-3 fatty acids of phytosterols, during three months. Plasmatic lipid levels were measured before and after intervention. Changes of lipid levels between basal and final visits and differences between the 4 types of supplementations were evaluated. RESULTS: The mean age of the study population was 53 years, 45% of them being males. In all 4 groups a significant reduction of total cholesterol, low-density lipoprotein (LDL)-cholesterol levels and total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio was observed after 3 months of follow-up; there were no significant changes of triglycerides nor HDL-cholesterol levels. The comparison between different types of supplementation revealed that only phytosterols addition reached a greater reduction of total cholesterol and LDL-cholesterol levels than canned tuna in olive oil alone (p < 0.05), and the differences between the remaining 2 supplementations and the control group were not significant. CONCLUSIONS: Regular intake of enrichment with canned tuna supplementation is associated with improvement of lipid profile. The addition of isoflavones, omega-3 fatty acids or phytosterols supplementations increases fish consume effect, although only the enrichment with phytosterols reaches significantly better results.
Subject(s)
Food Preservation , Food, Fortified , Lipids/blood , Tuna , Adult , Aged , Animals , Fatty Acids, Omega-3 , Female , Humans , Isoflavones , Male , Middle Aged , Olive Oil , Phytosterols , Plant Oils , Single-Blind MethodABSTRACT
Fundamento y objetivo: Las modificaciones en los hábitos dietéticos se asocian a cambios favorables en el perfil lipídico. Se trató de comprobar las modificaciones lipídicas tras suplementación dietética con conservas de atún en aceite de oliva, comparando sus efectos con los del atún enriquecido con aditivos. Sujetos y método: Se ha realizado un estudio prospectivo, de 3 meses de duración, aleatorizado y simple ciego, en el que participaron 400 individuos distribuidos en 4 grupos para suplementar su dieta con conserva de atún en aceite de oliva y con aditivos (ácidos grasos omega-3, isoflavonas y fitoesteroles). Se comparó la concentración plasmática de lípidos antes y después de la intervención, así como su modificación entre los distintos grupos. Resultados: La edad media de los participantes fue de 53 años y el 45% eran varones. En los 4 grupos se constataron reducciones significativas de los valores plasmáticos de colesterol total, colesterol unido a lipoproteínas de baja densidad (cLDL) y cociente colesterol total/colesterol unido a lipoproteínas de alta densidad (cHDL) después de los 3 meses de suplementación dietética; no se modificaron los triglicéridos ni el cHDL. En el grupo que tomó el atún enriquecido con fitoesteroles, la reducción del colesterol total y cLDL fue significativamente mayor (p < 0,05) que en el grupo que tomó el atún en aceite de oliva; las diferencias entre los restantes grupos no fueron significativas. Conclusiones: El consumo regular de conserva de atún se acompaña de modificaciones favorables en el perfil lipídico. La adición de suplementos de isoflavonas, fitoesteroles y ácidos grasos omega-3 potencia el efecto del pescado, aunque con una eficacia significativamente mayor de los fitoesteroles
Background and objective: Changes in dietary habits are associated with an improvement of lipid profile. We decided to assess changes in lipid profile reached with a dietary enrichment with canned tuna in olive oil and compared them with those reached with canned tuna with additional supplementation. Subjects and method: In a prospective, randomized, single blind study, 400 participants were assigned to a daily intake of canned tuna in olive oil alone (control group) or enriched with: isoflavones, omega-3 fatty acids of phytosterols, during three months. Plasmatic lipid levels were measured before and after intervention. Changes of lipid levels between basal and final visits and differences between the 4 types of supplementations were evaluated. Results: The mean age of the study population was 53 years, 45% of them being males. In all 4 groups a significant reduction of total cholesterol, low-density lipoprotein (LDL)-cholesterol levels and total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio was observed after 3 months of follow-up; there were no significant changes of triglycerides nor HDL-cholesterol levels. The comparison between different types of supplementation revealed that only phytosterols addition reached a greater reduction of total cholesterol and LDL-cholesterol levels than canned tuna in olive oil alone (p < 0.05), and the differences between the remaining 2 supplementations and the control group were not significant. Conclusions: Regular intake of enrichment with canned tuna supplementation is associated with improvement of lipid profile. The addition of isoflavones, omega-3 fatty acids or phytosterols supplementations increases fish consume effect, although only the enrichment with phytosterols reaches significantly better results
