Ultrasound screening for abdominal aortic aneurysm in primary care. / Utilidad de la ecografía en el cribado del aneurisma de aorta abdominal en atención primaria.

INTRODUCTION: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain. OBJECTIVES: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. MATERIAL AND METHODS: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care. SUBJECTS: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MEASUREMENTS: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). RESULTS: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01. CONCLUSIONS: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.

Subclinical atherosclerosis burden in non-diabetic hypertensives treated in primary care center: the IMTABI study.

BACKGROUND: Identifying patients at high risk of cardiovascular disease in primary prevention is a challenging task. This study aimed at detecting subclinical atherosclerosis burden in non-diabetic hypertensive patients in a primary care centre. METHODS: Clinical, anthropometric and analytical data were collected from patients with hypertension who were free from clinical vascular disease and diabetes. The cardiovascular risk was assessed using the SCORE system. Subclinical atherosclerosis burden was assessed by carotid ultrasonography (intima-medial thickness [IMT] and plaque) and measurement of the ankle-brachial index (ABI). RESULTS: Out of 140 patients, 59 (42%) have carotid plaque, 32 (23%) have IMT higher than 75% and 12 (9%) have an ABI < 0.9. Total atherosclerosis burden was present in 91 (65%) of the subjects. Consequently, 59 (42%) patients were re-classified into the very high-risk category. In multivariate analyses, smoking, creatinine levels and duration of hypertension were associated with atherosclerosis burden. In contrast, only smoking and age were associated with the presence of carotid plaque. Almost 90% of patients were treated with hypotensive drugs, half of them combined several drugs and 60% were well-controlled. Only 30% received statins in monotherapy and only less than 20% had an LDL cholesterol < 100 mg/dL. CONCLUSIONS: In non-diabetic hypertensive patients managed at a primary care centre, 4 out of 10 had subclinical atherosclerosis burden and were re-classified into the very high- risk category. There was clear undertreatment with lipid-lowering drugs of most LDL cholesterol inappropriate levels, according to current clinical guidelines.

Actividad física, condición física y calidad de vida en los adultos mayores. Revisión sistemática / Physical activity, physical condition and quality of life in older adults. Systematic review

Introducción: El envejecimiento de la población junto al sedentarismo, puede ocasionar un deterioro funcional que conduciría a la disminución de la condición física y de la calidad de vida. La promoción del envejecimiento activo puede mejorar la calidad de vida y la condición física de nuestros mayores. Objetivo: Evaluar la evidencia científica disponible sobre el efecto de la actividad física en los mayores, en términos de calidad de vida, condición física y mantenimiento de la independencia funcional. Material y método: Revisión sistemática en las bases de datos WOS, SCOPUS y PubMed. Selección de artículos: Se incluyeron estudios de intervención que evaluaban la calidad de vida y capacidad funcional de los adultos mayores. Los estudios fueron evaluados según la calidad metodológica con la escala PEDro. Resultados: Se encontraron 1331 artículos, de los que se incluyeron 17. Las intervenciones incluyeron ejercicios de resistencia, fuerza, equilibrio, coordinación y velocidad de la marcha. Los hallazgos principales indicaron que un mayor índice de actividad física se relacionó con un menor deterioro de las funciones físicas y cognitivas de los mayores y, por lo tanto, con una mejor calidad de vida. Conclusiones: Un estilo de vida activo se asocia a una mejor calidad de vida, mejor condición física y mantenimiento de la independencia funcional. Serían convenientes otros estudios, con una mayor homogeneidad en los instrumentos de recogida de datos, con mayor frecuencia de intervenciones, para definir los programas de ejercicios más adecuados y para incrementar la evidencia científica.(AU)

Background: The aging of the population together with sedentary lifestyle, can cause a functional deterioration that leads to the decrease of physical condition and quality of life. Promoting active aging can improve the quality of life and physical condition of our elders. Objective: This work aims to investigate the available scientific evidence on the effect of physical activity in older adults, in terms of quality of life, physical condition, and maintenance of functional independence. Material and method: A systematic review was performed in the WOS, SCOPUS and PubMed databases. Selection of articles: Intervention studies evaluating the quality of life and functional capacity of older adults were included. The studies were evaluated according to methodological quality with the PEDro scale. Results: 1331 articles were found, of which 17 were included. Interventions included resistance, strength, balance, coordination, and gait speed exercises. The main findings indicated that a higher rate of physical activity was associated with less impairment of physical and cognitive functions in older adults and, therefore, with a better quality of life. Conclusions: an active lifestyle is associated with a better quality of life, better physical condition and maintenance of functional independence. Other studies, with greater homogeneity in the data collection instruments, with greater frequency of interventions, would be convenient to define the most appropriate exercise programs and to increase the scientific evidence.(AU)

Variation in chemokines plasma concentrations in primary care depressed patients associated with Internet-based cognitive-behavioral therapy.

How the presence of inflammation has repercussions for brain function is a topic of active research into depression. Signals released from immune system-related cells, including chemokines, might be indicative of active depression and can, hypothetically, serve as biomarkers of response to interventions, both pharmacological and psychological. The objective of this study is to analyze the peripheral plasma concentrations of CXCL12, CCL11, CX3CL1 and CCL2 in a cohort of depressed primary-care patients, as well as their evolution after an internet-based cognitive-behavioral intervention. The concentrations of those chemokines were measured in 66 primary-care patients with mild and moderate depression, before and after the intervention, as well as 60 controls, using multiplex immunoassays. Concentrations of CXCL12 and CCL2 were significantly higher in the clinical sample in comparison with controls. A stable multivariate discriminative model between both groups was found. Concentrations of all chemokines decreased after the internet-based psychological intervention. These findings support the implication of chemokines in depression, even in a sample of patients with mild and moderate severity. Furthermore, they demonstrate the need for further multidisciplinary research that confirms how biomarkers such as plasma chemokines can serve as a marker for depression and are sensitive to non-pharmacological interventions.

Evaluación de la carga aterosclerótica en hipertensos con prediabetes / Evaluation of the atherosclerotic burden in hypertensive patients with prediabetes

Objetivo: Conocer la carga aterosclerótica (carga ATC) de pacientes hipertensos prediabéticos sin enfermedad cardiovascular. Pacientes y métodos: Seleccionamos pacientes hipertensos en situación de prediabetes (glucemia en ayunas 100-125 mg/dl y/o glicohemoglobina A1c 5,7-6,4%), excluyendo aquellos con enfermedad cardiovascular establecida o de muy alto riesgo. Registramos los principales factores de riesgo vascular. Se calculó el índice tobillo/brazo (ITB) y el grosor íntima-media (GIM) carotídeo. Se consideró enfermedad arteriosclerosa ligera cuando el GIM fue > percentil75 para edad y sexo y/o ITB de 0,70-0,90 y moderada-grave en presencia de placa ateromatosa y/o ITB < 0,7. Resultados: Incluimos 53 pacientes, de 63 ± 7años; mujeres: 50,9% (IC95%: 36,8-64,9). Se detectó carga ATC en el 66,0% (IC95%: 51,7-78,5) de los sujetos. El 24,5% (IC95%: 13,8-38,3) de los pacientes presentaron enfermedad arteriosclerosa ligera y un 41,5% (IC95%: 28,1-55,9) moderada-grave. Esto nos permitió reclasificar como de riesgo vascular muy alto a un 41,5% (IC95%: 28,1-55,9) de los pacientes. Un 45,4% (IC95%: 16-74,8) de los sujetos de riesgo inicial moderado pasaron a considerarse de alto o muy alto riesgo. En el análisis multivariante los fumadores o exfumadores presentaron 2,3 veces más riesgo (odds ratio = 2,3; IC95%: 0,6-7,6) de presentar carga ATC, aunque sin alcanzar significación estadística. Conclusiones: Dos tercios de los pacientes hipertensos con prediabetes tienen enfermedad arteriosclerótica silente cuando se evalúan mediante el ITB y la ecografía carotídea. Aproximadamente un 40% de los sujetos fueron reclasificados como de muy alto riesgo. Cerca de la mitad de los hipertensos prediabéticos clasificados inicialmente como de riesgo moderado pasaron a considerarse de riesgo alto o muy alto. El tabaquismo parece ser el factor de riesgo más relacionado con la presencia de carga ATC

Aim: To assess the atherosclerotic burden in hypertensive patients with prediabetes without cardiovascular disease. Patients and methods: We included patients with hypertension and prediabetes (fasting blood glucose: 100-125 mg/dL and/or glycohemoglobin A1c: 5.7-6.4%), excluding those with established cardiovascular disease or those at very high risk. We recorded major vascular risk factors. Subclinical arteriosclerosis was measured by the ankle/brachial index (ABI) and carotid intima-medial thickness (IMT). Subclinical arteriosclerosis was mild if IMT was > 75p adjusted by age and sex and/or ABI was 0.7-0.9 and was considered moderate-severe when there was plaque and/or ABI < 0.7. Results: We included 53 patients, 63±7 years-old; women: 50,9% (95%CI: 36.8-64.9). Atherosclerotic burden was detected in 66.0% (95%CI: 51.7-78.5) of subjects. 24,5% (95%CI: 13.8-38.3) of patients had mild arteriosclerosis disease and 41.5% (95%CI: 28.1-55.9) had moderate-severe. This allowed us to re-stratified as very high vascular risk the 41.5% (95%CI: 28.1-55.9) of patients. 45.4% (95%CI: 16-74.8) of subjects with moderate initial risk were considered high or very high risk. In multivariate analyses, only smoking was associated with atherosclerotic burden (P = .07). Conclusions: Two thirds of hypertensive patients with prediabetes had subclinical arteriosclerotic disease when they were evaluated by the ankle/brachial index and carotid ultrasonography. Approximately forty percent of patients were re-stratified as very high vascular risk. Nearly half of the prediabetic hypertensive patients initially classified as moderate risk were considered high or very high risk

Evaluation of the atherosclerotic burden in hypertensive patients with prediabetes. / Evaluación de la carga aterosclerótica en hipertensos con prediabetes.

AIM: To assess the atherosclerotic burden in hypertensive patients with prediabetes without cardiovascular disease. PATIENTS AND METHODS: We included patients with hypertension and prediabetes (fasting blood glucose: 100-125mg/dL and/or glycohemoglobin A1c: 5.7-6.4%), excluding those with established cardiovascular disease or those at very high risk. We recorded major vascular risk factors. Subclinical arteriosclerosis was measured by the ankle/brachial index (ABI) and carotid intima-medial thickness (IMT). Subclinical arteriosclerosis was mild if IMT was >75p adjusted by age and sex and/or ABI was 0.7-0.9 and was considered moderate-severe when there was plaque and/or ABI<0.7. RESULTS: We included 53 patients, 63±7 years-old; women: 50,9% (95%CI: 36.8-64.9). Atherosclerotic burden was detected in 66.0% (95%CI: 51.7-78.5) of subjects. 24,5% (95%CI: 13.8-38.3) of patients had mild arteriosclerosis disease and 41.5% (95%CI: 28.1-55.9) had moderate-severe. This allowed us to re-stratified as very high vascular risk the 41.5% (95%CI: 28.1-55.9) of patients. 45.4% (95%CI: 16-74.8) of subjects with moderate initial risk were considered high or very high risk. In multivariate analyses, only smoking was associated with atherosclerotic burden (P=.07). CONCLUSIONS: Two thirds of hypertensive patients with prediabetes had subclinical arteriosclerotic disease when they were evaluated by the ankle/brachial index and carotid ultrasonography. Approximately forty percent of patients were re-stratified as very high vascular risk. Nearly half of the prediabetic hypertensive patients initially classified as moderate risk were considered high or very high risk.

Antropometría y grado de maduración en nadadores adolescentes / Anthropometry and maturity in adolescent swimmers

Mediante la antropometria se realiza el estudio de la forma, composición y proporción del cuerpo humano para conocer mejor el desarrollo, rendimiento y nutrición del deportista. Por otra parte existen diferencias en los resultados de las pruebas fisicas en función del ritmo de maduración puberal y del grado de desarrollo, debido fundamentalmente a las diferencias en el desarrollo del componente muscular. Con el objetivo de conocer las características antropométricas y el grado de maduración y desarrollo en nadadores adolescentes, hemos estudiado a 38 nadadores del equipo de natación de Mijas-Costa (Málaga). Se les realizó una anamnesis y explora- ción médico-deportiva completa, valoración madurativa mediante los estadios de Tanner y estudio cineantropométrico siguiendo las normas del Grupo Español de Cineantropometria. De los 38 nadadores, 15 eran varones de 14 ñ1,3 años y 23 mujeres de 13,3 ñ1,8 años; con un rango de edad para ambos grupos entre 11-17 años. La mayoría estaban en el estadío intermedio de la adolescencia; con una alta correlación entre edad cronológica y estadío de adolescencia ( r = 0,74; p<0,00 l). Los percentiles de peso y talla estaban por encima del P50 correspondiente a su edad. El peso graso por la fórmula de Carter fue significativamente mayor en las mujeres que en los varones (p=0,002), en cambio por la fórmula de Faulkner no hubo diferencias significativas; los pesos magro, óseo y residual fueron mayores en los varones (p<0,001). Los varones presentaron un somatotipo medio con predominio del componente mesomórfico (2,5-4,68-3,01); en las mujeres los tres componentes estuvieron prácticamente equilibrados (3,2-3,4-3,0); no se encontró asociación significativa entre los componentes del somatotipo y la edad. La composición corporal y el somatotipo de nuestro grupo es similar a la de otros nadadores de alta competición de nuestro entorno y de otros ámbitos; esto indica una buena preselección deportiva. Creemos necesario el seguimiento antropométrico y del estadío madurativo del deportista en estas edades de desarrollo, que permitan detectar cualquier posible alteración (AU)