Patrón epidemiológico de la obesidad en Castilla y León y su relación con otros factores de riesgo de enfermedad cardiovascular / Obesity in Castile and Leon, Spain: epidemiology and association with other cardiovascular risk factors

Estudio transversal de la obesidad en una muestra aleatoria de 4.012 personas de edad >=≥ 15 años en Castilla y León. Se estimó la prevalencia de obesidad (índice de masa corporal ≥ 30) y de obesidad abdominal (cintura > 102cm en varones y > 88cm en mujeres) y se calculó la relación de ambos tipos de obesidad con otros factores de riesgo cardiovascular. La prevalencia de obesidad fue del 21,7% (intervalo de confianza [IC] del 95%, 20,3%-23,2%), mayor en mujeres —23,2% (IC del 95%, 20,9%-25,5%) que en varones —20,4% (IC del 95%, 18%-22,7%)—. La prevalencia de obesidad abdominal fue del 36,7% (IC del 95%, 34,6%-38,9%), mayor también en mujeres —50,1% (IC del 95%, 47%-53,1%)— que en varones —22,8% (IC del 95%, 20,3%-25,2%). Todos los factores de riesgo cardiovascular, excepto el tabaquismo, estuvieron asociados a la obesidad. El riesgo SCORE y Framingham a 10 años fue superior en obesos (AU)

A cross-sectional study of obesity in a random sample of 4012 individuals aged >=15 years in Castile and Leon, Spain, was carried out. The prevalence of obesity (i.e. a bodymass index >=30 kg/m2) and abdominal obesity (i.e. a waist circumference >102 cm in males or >88 cm in females) was determined and associations between both types of obesity and other cardiovascular risk factors were investigated. The overall prevalence of obesity was 21.7% (95% confidence interval [CI], 20.3%-23.2%): it was higher in women, at 23.2% (95% CI, 20.9%-25.5%), than in men, at 20.4% (95% CI, 18.0%-22.7%). The prevalence of abdominal obesity was 36.7% (95% CI, 34.6%-38.9%): again it was higher in women, at 50.1% (95% CI, 47%-53.1%) than inmen, at 22.8% (95% CI, 20.3%-25.2%). Associations were found between obesity and all classic cardiovascular risk factors, except smoking. The 10-year Systematic Coronary Risk Evaluation (SCORE) and Framingham risk scores were higher in obese individuals (AU)

Obesity in Castile and Leon, Spain: epidemiology and association with other cardiovascular risk factors.

A cross-sectional study of obesity in a random sample of 4012 individuals aged ≥ 15 years in Castile and Leon, Spain, was carried out. The prevalence of obesity (i.e. a body mass index ≥ 30 kg/m²) and abdominal obesity (i.e. a waist circumference > 102 cm in males or > 88 cm in females) was determined and associations between both types of obesity and other cardiovascular risk factors were investigated. The overall prevalence of obesity was 21.7% (95% confidence interval [CI], 20.3%-23.2%): it was higher in women, at 23.2% (95% CI, 20.9%-25.5%), than in men, at 20.4% (95% CI, 18.0%-22.7%). The prevalence of abdominal obesity was 36.7% (95% CI, 34.6%-38.9%): again it was higher in women, at 50.1% (95% CI, 47%-53.1%) than in men, at 22.8% (95% CI, 20.3%-25.2%). Associations were found between obesity and all classic cardiovascular risk factors, except smoking. The 10-year Systematic Coronary Risk Evaluation (SCORE) and Framingham risk scores were higher in obese individuals.

Dislipidemias y riesgo cardiovascular en la población adulta de Castilla y León / Dyslipidemia and cardiovascular risk in the adult population of Castile-Leon (Spain)

ObjetivoLa hipercolesterolemia es uno de los factores de riesgo cardiovascular más sensible a las medidas de prevención y control. Este estudio pretende conocer las características clínicas y epidemiológicas de las personas dislipidémicas en Castilla y León.MétodosSe realizó un muestreo bietápico-estratificado y se obtuvieron datos de 4.013 personas, representativas de la población de 15 o más años de edad en Castilla y León. Se recogieron las variables relacionadas con la enfermedad cardiovascular de la historia clínica, la anamnesis y la exploración. Se determinaron el colesterol total y las distintas fracciones lipídicas (c-HDL, c-LDL y triglicéridos).ResultadosEl colesterol total, el c-HDL, el c-LDL y los triglicéridos aumentan con la edad, y todos excepto el primero presentan diferencias según el sexo. El c-LDL y los triglicéridos están más elevados en los hombres que en las mujeres hasta los 60 años de edad, pero luego el patrón se invierte, mientras que el c-HDL siempre es más alto en las mujeres. El 14,6% de la población tiene un colesterol total ≥250mg/dl y un 56,3% lo tiene ≥200mg/dl. Sólo el 49,6% de las personas con ≥250mg/dl tenían antecedentes en su historia clínica, y únicamente un 15,2% recibían tratamiento. El colesterol total ajustado por la edad se correlacionaba positivamente con todos los demás factores de riesgo cardiovascular. Además, más del 70% de la población presenta al menos un factor de riesgo cardiovascular.ConclusionesDestacan los altos valores de colesterol total y c-LDL, así como los bajos de c-HDL en los hombres, y el infradiagnóstico en las historias clínicas. La asociación de hipercolesterolemia con otros factores de riesgo cardiovascular es similar a la observada en otros estudios (AU)

bjectiveHypercholesterolemia is one of the cardiovascular risk factors more sensitive to preventive and control interventions. This study aims to determine the epidemiological pattern of dyslipidemic people in Castilla y Leon.MethodsA representative stratified two-stage sample of the population resident in Castilla y León (Spain) was obtained. A total of 4,013 people age 15 years and older were interviewed. Cardiovascular disease related variables were gathered from clinical records and medical examination. Total cholesterol, HDL-c, LDL-c, and triglycerides were measured.ResultsTotal cholesterol, HDL-c, LDL-c and triglycerides increase with age and, all but total cholesterol present gender differences. LDL-c and triglycerides are higher in men than in women under the age of 60, and lower from that age on, while HDL-c is always higher in women. Total cholesterol was ≥250mg/dl in 14.6% of the sample and ≥200mg/dl in the 56.3%. Only 49.6% of people with total cholesterol ≥250mg/dl had been diagnosed and only 15.2% were under treatment. Age-adjusted total cholesterol was positively correlated with all cardiovascular risk factors. Furthermore, over 70% of the population presented, at least, one cardiovascular risk factor.ConclusionsThe results above shows high levels of total cholesterol and LDL-c, low levels of HDL-c in males and the under diagnosis in clinical records. The association between hypercholesterolemia and other cardiovascular risk factors is similar to previous studies (AU)

[Dyslipidemia and cardiovascular risk in the adult population of Castile-Leon (Spain)]. / Dislipidemias y riesgo cardiovascular en la población adulta de Castilla y León.

OBJECTIVE: Hypercholesterolemia is one of the cardiovascular risk factors more sensitive to preventive and control interventions. This study aims to determine the epidemiological pattern of dyslipidemic people in Castilla y Leon. METHODS: A representative stratified two-stage sample of the population resident in Castilla y León (Spain) was obtained. A total of 4,013 people age 15 years and older were interviewed. Cardiovascular disease related variables were gathered from clinical records and medical examination. Total cholesterol, HDL-c, LDL-c, and triglycerides were measured. RESULTS: Total cholesterol, HDL-c, LDL-c and triglycerides increase with age and, all but total cholesterol present gender differences. LDL-c and triglycerides are higher in men than in women under the age of 60, and lower from that age on, while HDL-c is always higher in women. Total cholesterol was ≥250mg/dl in 14.6% of the sample and ≥200mg/dl in the 56.3%. Only 49.6% of people with total cholesterol ≥250mg/dl had been diagnosed and only 15.2% were under treatment. Age-adjusted total cholesterol was positively correlated with all cardiovascular risk factors. Furthermore, over 70% of the population presented, at least, one cardiovascular risk factor. CONCLUSIONS: The results above shows high levels of total cholesterol and LDL-c, low levels of HDL-c in males and the under diagnosis in clinical records. The association between hypercholesterolemia and other cardiovascular risk factors is similar to previous studies.

[Prevalence of hypertension in the population of Castile-Leon (Spain)]. / Prevalencia de la hipertensión arterial en la población de Castilla y León.

OBJECTIVE: Cardiovascular disease causes one out of 3 deaths in Spain. Hypertension is involved in ischemic heart disease and in other diseases provoking high morbidity and mortality. The aim of the present study was to describe the prevalence of hypertension and other indicators of this disorder in Castile-Leon in 2004. METHODS: We performed a cross-sectional study in a random sample of 4,012 persons aged 15 years old or above, extracted through a two-stage, stratified design. Systolic and diastolic blood pressure was measured, a history was taken and clinical records were reviewed. A person was considered to be hypertensive when there was known hypertension (hyper-tension was recorded in the clinical records or the person was receiving treatment for hypertension) or when systolic blood pressure was 140 mmHg or more and diastolic blood pressure was 90 mmHg or more. RESULTS: The prevalence of hypertension in the population was 38.7% (95%CI: 36.5-40.9). The prevalence was higher in men (40.4% [95%CI: 37.4-43.4]) than in women (37.4% [95%CI: 34.7-40]). Hypertension was already known in 22.2%, representing 57.4% of all hypertensive individuals. In the remainder of the sample, 44% had prehypertension, 17.5% had stage 1 hypertension and 4% had stage II hypertension, according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. CONCLUSIONS: The prevalence of hypertension in the population studied was consistent with that reported in other Spanish studies. A substantial proportion of hypertensive individuals were unaware of their status as such. Equally, a large proportion had prehypertension, which carries a high risk of cardiovascular disease.

Prevalencia de la hipertensión arterial en la población de Castilla y León / Prevalence of hypertension in the population of Castile-Leon [Spain]

Objetivo: Las enfermedades cardiovasculares causan unade cada 3 defunciones en España. La hipertensión arterialestá implicada en la enfermedad isquémica cardíaca y en otras afecciones de alta morbilidad y mortalidad. El objetivo de este trabajo es describir la prevalencia y otros indicadores de la presión arterial en Castilla y León en 2004.Métodos: Estudio transversal en una muestra aleatoria de4.012 personas 15 años de edad extraída de un diseño bietápico y estratificado. Se revisó la historia clínica, se realizó una anamnesis y una exploración de la presión arterial sistólica y diastólica. Se consideró a una persona como hipertensa cuando era hipertensa conocido (en su historia clínica constaba como tal o recibía tratamiento con antihipertensivos) o presentaba una cifra de presión arterial sistólica 140 mmHgo una presión arterial diastólica 90 mmHg.Resultados: La prevalencia de hipertensión arterial en la población fue de 38,7% (intervalo de confianza [IC] del 95%: 36,5-40,9). Los hombres presentaron un mayor porcentaje, 40,4% (IC del 95%: 37,4-43,4), que las mujeres, 37,4% (IC del 95%: 34,7-40). El 22,2% estaba ya diagnosticado, lo que representa el 57,4% de los hipertensos. En el resto de la muestra, el 44%estaba en un estadio prehipertensivo, el 17,5% en estadio I y el 4% en estadio II de la clasificación del séptimo informe del Joint National Committee sobre Prevención, Detección, Evaluación y Tratamiento de la Hipertensión Arterial.Conclusiones: La prevalencia de la hipertensión arterial en la población estudiada es consistente con otros estudios españoles. Una gran proporción de hipertensos no sabe que lo es, y otra gran parte se encuentra en estadios prehipertensivos, con el riesgo cardiovascular que conlleva esta situación

Objective: Cardiovascular disease causes one out of 3 deaths in Spain. Hypertension is involved in ischemic heart disease and in other diseases provoking high morbidity and mortality. The aim of the present study was to describe the prevalence of hypertension and other indicators of this disorder in Castile-Leon in 2004.Methods: We performed a cross-sectional study in a randomsample of 4,012 persons aged 15 years old or above, extracted through a two-stage, stratified design. Systolic and diastolic blood pressure was measured, a history was taken and clinical records were reviewed. A person was considered to be hypertensive when there was known hypertension (hypertension was recorded in the clinical records or the person was receiving treatment for hypertension) or when systolic blood pressure was 140 mmHg or more and diastolic blood pressure was 90 mmHg or more.Results: The prevalence of hypertension in the populationwas 38.7% (95%CI: 36.5-40.9). The prevalence was higherin men (40.4% [95%CI: 37.4-43.4]) than in women (37.4%[95%CI: 34.7-40]). Hypertension was already known in 22.2%, representing 57.4% of all hypertensive individuals. In the remainder of the sample, 44% had prehypertension, 17.5% had stage 1 hypertension and 4% had stage II hypertension, according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatmentof High Blood Pressure.Conclusions: The prevalence of hypertension in the population studied was consistent with that reported in other Spanish studies. A substantial proportion of hypertensive individuals were unaware of their status as such. Equally, a large proportion had prehypertension, which carries a high risk of cardiovascular disease

[Design of a population-based study of cardiovascular risk in Castile and Leon [Spain] through primary care teams]. / Diseño de un estudio poblacional del riesgo cardiovascular en Castilla y León a través de los equipos de atención primaria.

We describe the design and the response indicators in a cross sectional study to estimate several factors associated with cardiovascular risk in the population of Castile and Leon. A sample of 4,950 individuals aged 15 years and above was obtained in two stages: in the first stage, 198 primary care physicians were selected and in the second stage a sample of 25 persons from each primary care physician's list was obtained. The response rate was 98% among primary care physicians and 80% among the population. Statistically significant differences were found in age distribution between the frame sample and the definitive sample. After applying design adjustments, only the group aged 35-64 years was significantly overdimensioned. Access to the general population in primary health care is a feasible and effective procedure. A high response rate contributes to the validity of the information.

Diseño de un estudio poblacional del riesgo cardiovascular en Castilla y León a través de los equipos de atención primaria / Design of a population-based study of cardiovascular risk in Castile and Leon [Spain] through primary care teams

Se describe el diseño y los indicadores de respuesta de un estudio transversal para estimar diferentes parámetros del riesgo cardiovascular en la población de Castilla y León. Se obtuvo una muestra de 4.950 personas de 15 y más años de edad en dos etapas: en la primera etapa se eligieron 198 médicos de atención primaria, y en la segunda se seleccionó una muestra de 25 personas del cupo de cada médico. Las tasas de respuesta de los médicos alcanzaron el 98%, y las de la población superaron el 80%. Se encontraron diferencias estadísticamente significativas en la distribución por edad del marco muestral y la muestra definitiva. Después de realizar las ponderaciones derivadas del diseño, sólo el grupo de edad de 35-64 años se encuentra significativamente sobredimensionado. El acceso a la población general en atención primaria es un procedimiento factible y eficaz. La alta tasa de respuesta contribuye a la validez de la información

We describe the design and the response indicators in a cross sectional study to estimate several factors associated with cardiovascular risk in the population of Castile and Leon. A sample of 4,950 individuals aged 15 years and above was obtained in two stages: in the first stage, 198 primary care physicians were selected and in the second stage a sample of 25 persons from each primary care physician's list was obtained. The response rate was 98% among primary care physicians and 80% among the population. Statistically significant differences were found in age distribution between the frame sample and the definitive sample. After applying design adjustments, only the group aged 35-64 years was significantly overdimensioned. Access to the general population in primary health care is a feasible and effective procedure. A high response rate contributes to the validity of the information

Normas técnicas sobre tratamiento farmacológico en la cartera de servicios de atención primaria / Technical norms on drug treatment in the catalogue of services in primary care

El objetivo de este trabajo es describir el procedimiento seguido para el diseño de normas técnicas de tratamiento (NTT) para su inclusión en la cartera de servicios de atención primaria, presentar la redacción de las 4 normas incluidas y los resultados del estudio de concordancia en su evaluación. Se recogió el fundamento científico técnico del contenido de la norma en un informe técnico que incluyó un repertorio bibliográfico y una copia de los principales artículos. La propuesta inicial de las normas se publicó en un número especial del boletín Ojo de Markov, dirigido a profesionales sanitarios. Se promovió un debate entre los profesionales, tanto acerca del contenido como de la pertinencia de este tipo de normas. Las opiniones y sugerencias se recogieron mediante una encuesta. Se realizó un estudio para valorar la concordancia en la evaluación de las normas entre 3 observadores independientes, en una muestra de 300 historias clínicas. Un grupo de expertos valoró el respaldo científico, las sugerencias de los profesionales y redactó la versión final de las normas. La propuesta de inclusión de NTT en la cartera de servicios de atención primaria como herramienta de calidad y de apoyo a las decisiones clínicas se recibió por los profesionales con distinto nivel de acuerdo. El cuerpo de la norma define el tratamiento de elección, y como aclaraciones a la evaluación se incluyen otras variantes clínicas admitidas en los consensos. Las NTT propuestas han mostrado buena concordancia entre evaluadores

This study aims to describe the procedure followed to design treatment technical norms (TTN) to be included in the catalogue of services in primary care, the wording of the four TTN included, and interobserver agreement. The technical-scientific bases of the TTN were written in a technical report that included a list of references and a copy of the most important articles. The initial proposals were published in a special issue of the bulletin Ojo de Markov (Markov's Eye), which is aimed at health professionals. Simultaneously, a debate among professionals was fostered on both the contents and the pertinence of this kind of norms. Suggestions and opinions were collected by means of a poll. A study to estimate the level of agreement among three independent observers was performed in a sample of 300 clinical records. The scientific evidence and health professionals' suggestions were evaluated by panel of experts who wrote the final version of the TTN. The proposal to include the TTN in the catalogue of services in primary care as a tool for measuring quality and supporting clinical decisions was received by health professionals with different degrees of agreement. The main part of each norm defines the treatment of choice, while other clinical situations based on guidelines were included as an explanation for the evaluation. The NTT defined showed good interobserver agreement