Dislipemia en población diabética tratada con estatinas. Resultados del estudio DYSIS en España / Dyslipemia in diabetics treated with statins. Results of the dysis study in spian

Fundamento y objetivo: La diabetes mellitus tipo 2 (DM2) se asocia con un elevado riesgo cardiovascular (RCV), siendo de gran importancia tratar intensivamente los distintos factores de RCV, como la dislipemia. El tratamiento hipocolesterolemiante es necesario para conseguir reducir el RCV asociado a la DM2, siendo el colesterol unido a lipoproteínas de baja densidad (colesterol LDL) el principal objetivo terapéutico. En este trabajo se analiza el perfil lipídico de pacientes diabéticos en tratamiento con estatinas. Pacientes y método: El estudio DYSIS (Dyslipidemia International Study) es un estudio observacional, internacional, en el que se analiza el perfil lipídico de pacientes tratados con estatinas, en prevención primaria o secundaria. Resultados: De los 3703 pacientes analizados, el 39% eran diabéticos. El 59,2% de los diabéticos presentaban el colesterol LDL fuera de control. En conjunto, el 43,6% de diabéticos presentaba triglicéridos elevados y el 36,4% tenían el colesterol unido a lipoproteínas de alta densidad (colesterol HDL) bajo. De los pacientes con cardiopatía isquémica y diabetes, el 31% tenían colesterol LDL, colesterol HDL y triglicéridos fuera de control. De los pacientes diabéticos con síndrome metabólico el 60% tiene el colesterol LDL fuera de objetivos, el 39,8% tienen el colesterol HDL bajo y el 46,6% triglicéridos elevados. El 57% de los pacientes diabéticos obesos presentaba falta de control del colesterol LDL, aún en tratamiento con estatinas. Conclusiones: Las enfermedades cardiovasculares son la primera causa de morbimortalidad en pacientes con DM2. El estudio DYSIS muestra que la mayoría de los pacientes tratados con estatinas no alcanzan los objetivos lipídicos recomendados por las guías. En el presente estudio se constata que más de la mitad de los diabéticos tratados con estatinas tiene el colesterol LDL fuera de control, el grado de control de la dislipemia es muy limitado a pesar del tratamiento con estatinas, lo que puede determinar la necesidad de una terapia combinada para el tratamiento eficaz de la dislipemia diabética (AU)

Background and objective: Type 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk (CVR). This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the CVR in diabetic patients. Therefore, low-density lipoproteins cholesterol (LDL-C) is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent CVR in such individuals. Patients and methods: The Dyslipidemia International Study (DYSIS) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients. Results: Of the total patients enrolled in the DYSIS, the present study included 3,703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low high-density lipoproteins cholesterol (HDL-C). In diabetic patients with coronary heart disease, 31% had uncontrolled levels of all 3 lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46.6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment. Conclusions: Cardiovascular diseases remain the main cause of morbimortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-C. More than half of diabetic patients treated with statins had LDL-C out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients (AU)

[Dyslipemia in diabetics treated with statins. Results of the DYSIS study in Spian]. / Dislipemia en población diabética tratada con estatinas. Resultados del estudio DYSIS en España.

BACKGROUND AND OBJECTIVE: Type 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk. This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the cardiovascular risk in diabetic patients. Therefore, LDL-cholesterol is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent cardiovascular risk in such individuals. PATIENTS AND METHODS: The DYSIS (Dyslipidemia International Study) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients. RESULTS: Of the total patients enrolled in the DYSIS, the present study included 3703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low HDL-C. In diabetics patients with coronary heart disease, 31% had uncontrolled levels of all three lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46,6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment. CONCLUSIONS: Cardiovascular diseases remain the main cause of morbidity-mortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-cholesterol. More than half of diabetic patients treated with statins had LDL-cholesterol out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients.

Prevalencia y características de la dislipemia en pacientes en prevención primaria y secundaria tratados con estatinas en España. Estudio DYSIS-España / Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain. DYSIS-Spain study

Introducción y objetivos. Los pacientes con alto riesgo de sufrir eventos cardiovasculares requieren tratamiento médico para optimizar su perfil lipídico. Dentro del estudio internacional DYSIS, se evaluaron las alteraciones del perfil lipídico de pacientes tratados con estatinas en España. Métodos. DYSIS es un estudio multinacional y transversal llevado a cabo en Canadá y Europa (n = 22.063). En España se incluyó a 3.710 pacientes tratados con estatinas durante al menos 3 meses. Se compararon los datos demográficos y el perfil de riesgo cardiovascular. Resultados. Se obtuvo el perfil lipídico de 3.617 pacientes. De los pacientes con alto riesgo cardiovascular con perfil lipídico completo (n = 2.273), el 78,9% presentaba concentraciones alteradas de alguno de los tres parámetros lipídicos principales: colesterol de las lipoproteínas de baja densidad (cLDL), colesterol de las lipoproteínas de alta densidad (cHDL) y/o triglicéridos. Dentro de este grupo, el cLDL no se encontraba en objetivo en el 61,4%, el cHDL estaba por debajo de lo normal en el 25,3% y los triglicéridos estaban elevados en el 37,8%. En general, el cLDL se encontraba fuera de objetivo en el 63,1% y sólo el 20,7% (n = 668) presentaba concentraciones normales o las recomendadas para los tres parámetros. Conclusiones. La mayoría de los pacientes tratados con estatinas, sobre todo aquellos con alto riesgo cardiovascular, no alcanzan los objetivos propuestos por las guías para los parámetros lipídicos. Aunque se deberá esperar a los resultados finales de estudios actuales sobre el uso de tratamientos combinados modificadores de lípidos, el manejo de los lípidos en España es mejorable (AU)

Introduction and objectives. Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. Methods. DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. Results. Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n=668) of those treated with statins were normal for all parameters. Conclusions. Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement (AU)

[Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain. DYSIS-Spain Study]. / Prevalencia y características de la dislipemia en pacientes en prevención primaria y secundaria tratados con estatinas en España. Estudio DYSIS-España.

INTRODUCTION AND OBJECTIVES: Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. METHODS: DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. RESULTS: Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters. CONCLUSIONS: Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement.

High-density lipoprotein cholesterol and cardiovascular disease in Spanish hypertensive women. The RIMHA study.

INTRODUCTION AND OBJECTIVES: To determine the prevalence of a low high-density lipoprotein cholesterol (HDL-C) concentration in 11,042 hypertensive Spanish women aged >or=55 years, to identify factors associated with a low concentration, and to evaluate its relationship with cardiovascular disease (CVD). METHODS: Analysis of RIMHA cross-sectional study findings. Data on demographic, biochemical and clinical variables were obtained. Relationships between a low HDL-C concentration (<46 mg/dL) and CVD and between the HDL-C concentration (in quintiles) and CVD were studied by multivariate logistic regression modeling. RESULTS: The prevalence of a low HDL-C concentration was 24.3% (95% confidence interval [CI], 23.5-25.1%), and was higher in women with diabetes or CVD. A low HDL-C concentration was independently associated with excess weight, smoking, diabetes and the presence of CVD, and inversely with age. The prevalence of CVD was higher in women with a low HDL-C concentration (24.7% vs. 18.4% in those with a normal concentration; P< .001). There was an independent association between a low HDL-C concentration and CVD after adjustment for other risk factors (odds ratio [OR]=1.42; 95% CI, 1.26-1.60; P< .001) and with silent target organ damage (OR=1.31; 95% CI, 1.15-1.49; P< .001). Similarly, there was an independent inverse association between the HDL-C concentration (in quintiles) and the prevalence of CVD, particularly for HDL-C concentrations <58 mg/dL. CONCLUSIONS: One in four hypertensive women aged >or=55 years had a low HDL-C concentration, which was independently associated with the presence of CVD. Moreover, there was an inverse association between the HDL-C concentration and the prevalence of CVD, even at normal HDL-C concentrations.

[Prevalence of metabolic syndrome in Spanish population aged 60 years-old or more. PREV-ICTUS, a population-based study]. / Prevalencia del síndrome metabólico en la población española de 60 años o más. Estudio de base poblacional PREV-ICTUS.

BACKGROUND AND OBJECTIVE: Information about the prevalence of the metabolic syndrome (MS) in elderly population is scarce. The objectives of this study were to assess the prevalence of MS in Spanish population=60 years-old and the associated factors. PATIENTS AND METHOD: Epidemiological population-based cross-sectional study carried out on a randomized representative simple of subjects aged=60 years-old across the Spanish territory, stratified according to autonomous communities, census and population setting. Demographic, clinical, biochemical and electrocardiographic data were collected. MS was defined following the National Education Cholesterol Program (NCEP) criteria. RESULTS: 7331 subjects -53.4% women; mean age (standard deviation): 71.6 (6.9) years- were included. The prevalence of MS was 39.9% (95% confidence interval [CI], 34.5-42.4) and was greater in women (45.2%; 95% CI, 43.7-46.8%) than in men (33.8%; 95% CI, 32.3-35.4%) (p<0.001), and lower in the urban setting. High blood pressure (HBP) was the most prevalent criterion, followed by abdominal obesity and hypertriglyceridemia. Subjects with MS were younger, with higher body mass index and blood pressure, and had more prevalence of organ damage and cardovascular disease (p<0,001). In the multivariate analysis, female gender, HBP, diabetes and abdominal obesity were the most strongly related factors. CONCLUSIONS: Four out of 10 subjects aged 60 years-old or more had MS, and this was related mainly to female gender, HBP, obesity and diabetes.

Prevalencia del síndrome metabólico en la población española de 60 años o más. Estudio de base poblacional PREV-ICTUS / Prevalence of metabolic syndrome in Spanish population aged 60 years-old or more. PREV-ICTUS, a population-based study

Fundamento y objetivos: se dispone de poca información sobre el síndrome metabólico (SM) en población de edad avanzada. Los objetivos de este estudio han sido estimar su prevalencia en población general española de 60 años o más y los factores asociados. Pacientes y método: se realizó un estudio transversal de ámbito poblacional en una muestra aleatoria y representativa de individuos de 60 años o más de todo el territorio español, estratificada por comunidades autónomas según censo y hábitat de residencia, entre septiembre y diciembre de 2005. Se recogieron datos sociodemográficos, clínicos, bioquímicos y electrocardiográficos. Para la definición del SM se utilizaron los criterios del National Education Cholesterol Program (NCEP). Resultados: se incluyó a 7.331 personas (un 53,4% mujeres) con una edad media (desviación estándar) de 71,6 (6,9) años. El 39,9% (intervalo de confianza [IC] del 95%, 34,5¿42,4%) presentó SM, cuya prevalencia fue mayor en mujeres (45,2%; IC del 95%, 43,7¿46,8%) que en varones (33,8%; IC del 95%, 32,3¿35,4%) (p<0,001), y menor en medio urbano. La hipertensión arterial (HTA) fue el componente del SM más prevalente, seguido de la obesidad abdominal y la hipertrigliceridemia. Las personas con SM tenían menor edad, mayor índice de masa corporal y presión arterial, más lesión de órgano diana y más enfermedad cardiovascular (p<0,001). En el análisis multivariante, los factores que más se asociaron al SM fueron: sexo femenino, HTA, diabetes y obesidad abdominal. Conclusiones: cuatro de cada 10 individuos de 60 años o más presentan SM. La presencia de SM se relaciona principalmente con el sexo femenino, la HTA, la obesidad y la diabetes (AU)

Background and objective: Information about the prevalence of the metabolic syndrome (MS) in elderly population is scarce. The objectives of this study were to assess the prevalence of MS in Spanish population=60 years-old and the associated factors. Patients and method: Epidemiological population-based cross-sectional study carried out on a randomized representative simple of subjects aged=60 years-old across the Spanish territory, stratified according to autonomous communities, census and population setting. Demographic, clinical, biochemical and electrocardiographic data were collected. MS was defined following the National Education Cholesterol Program (NCEP) criteria. Results: 7331 subjects ¿53.4% women; mean age (standard deviation): 71.6 (6.9) years¿ were included. The prevalence of MS was 39.9% (95% confidence interval [CI], 34.5¿42.4) and was greater in women (45.2%; 95% CI, 43.7¿46.8%) than in men (33.8%; 95% CI, 32.3¿35.4%) (p<0.001), and lower in the urban setting. High blood pressure (HBP) was the most prevalent criterion, followed by abdominal obesity and hypertriglyceridemia. Subjects with MS were younger, with higher body mass index and blood pressure, and had more prevalence of organ damage and cardovascular disease (p<0,001). In the multivariate analysis, female gender, HBP, diabetes and abdominal obesity were the most strongly related factors. Conclusions: Four out of 10 subjects aged 60 years-old or more had MS, and this was related mainly to female gender, HBP, obesity and diabetes (AU)

The impact of occult renal failure on the cardiovascular risk stratification in an elderly population: the PREV-ICTUS study.

BACKGROUND AND OBJECTIVES: To analyze the impact of occult renal failure (ORF) in the individual risk stratification and on the blood pressures (BP) and low-density lipoprotein (LDL) goals in an aged population, according to the ESH/ESC Hypertension Guidelines. METHODS: A cross-sectional, population-based study on individuals aged 60 years or more carried out in Primary Care Centers of Spain. Kidney function was estimated from calculated creatinine clearance (eGFR), Cockroft and Gault formula. Ten-year cardiovascular risk was estimated through the ESH/ESC table including or not including the eGFR. Estimates of the modification in BP and LDL-cholesterol (cLDL) goals were calculated. RESULTS: In 6419 subjects, 4242 subjects (66%) had normal renal function, 1971 (31%) had ORF (normal creatinine and low eGFR) and 206 (3%) had insufficient renal function (high creatinine and all of them low eGFR). Inclusion of ORF as target organ damage resulted in an increase in the estimated risk in 10.8% of the total sample, increasing the percentage of high-risk subjects. In the latter case, new BP and cLDL goals (<130/80 mmHg and <100 mg/dl) should be needed in 475 (7.4%) and 413 (6.4%) additional subjects, respectively. CONCLUSION: Inclusion of the ORF resulted in a significant increase in the percentage of subjects with estimated high cardiovascular risk.

Independent impact of obesity and fat distribution in hypertension prevalence and control in the elderly.

BACKGROUND: Studies on the impact of weight excess and fat distribution on blood pressure are usually limited to young and middle-aged population, and data on the elderly are scarce. METHODS AND RESULTS: We performed an analysis of the Prevencion de Riesgo de Ictus, a population-based study on individuals aged 60 years or more in Spain, to assess the impact of weight excess, stratified by body mass index (normal <25; overweight 25-29.9; obesity > or =30 kg/m), and waist circumference [increased if > or =88 cm (women) or > or =102 (men)] on the prevalence on hypertension and lack of blood pressure control. In 6263 individuals (mean age 71.9 years old, 53.3% women; 73.0% with diagnosed hypertension), prevalence of obesity was 35.0%, and 65.6% showed an increased waist circumference. Body mass index and waist circumference showed an independent impact on the prevalence and absence of hypertension control. In a multivariate model including age, sex, body mass index, and waist circumference, prevalence of hypertension was higher in the overweight and obesity groups (odds ratio 1.41 and 1.96, respectively, compared to normal weight), and in those with increased waist circumference (odds ratio 1.25) compared with normal waist circumference. After further adjustment for antihypertensive therapy, overweight, and obesity (odds ratio 1.40 and 1.59, respectively) as well as increased waist circumference (odds ratio 1.39) were independently related to absence of blood pressure control. The impact of waist circumference on hypertension and blood pressure control was shown in each category of body mass index. CONCLUSION: In this cross-sectional study in an elderly population, body mass index and waist circumference showed an independent and direct impact on the prevalence of hypertension and on the absence of blood pressure control.

[Prevalence and related factors of overweight and obesity in Spanish population aged 60 years-old or older. The PREV-ICTUS study]. / Prevalencia de sobrepeso y obesidad en población española de 60 años o más y factores relacionados. Estudio PREV-ICTUS.

BACKGROUND AND OBJECTIVE: Data on the prevalence of obesity in elderly population in Spain are scarce. The objective of this work was to describe the prevalence of obesity and the related factors in a random sample of Spanish population aged 60 years-old or more, stratified by autonomous communities. SUBJECTS AND METHOD: We analyzed the PREV-ICTUS study, a population-based study carried out between September and December 2005 in a random sample stratified by autonomous communities according to the census of inhabitants and the habitat in each community. Subjects were classified as with normal weight (body mass index [BMI] < 25 kg), overweight (BMI 25-29.9) and obesity (BMI > or = 30 kg). RESULTS: In 6,843 subjects -mean age (standard deviation): 71.9 (7.1) years-old; 53.3% women-, prevalence of obesity was 34.5% (95% confidence interval [CI], 33.3-35.5%), higher in women (38.4%; 95% CI, 36.8-39.9%) than in men (30.0%; 95% CI, 28.4-31.6%; p < 0.001), with a tendency to decrease in the older population. In total, 81.7% of the population showed overweight (BMI > or = 25). Prevalence differed among communities from 46.4% to 20.7% (p < 0.001). In the multivariate analysis, obesity was inversely related to age (odds ratio [OR] = 0.98 per each year increment), and directly to female gender (OR = 1.25), rural (OR = 1.50) or semi-urban habitat (OR = 1.38), sedentary lifestyle (OR = 1.86) and non-smoking history (OR = 1.19). CONCLUSIONS: Obesity was present in one out of 3 individuals of this reasonably representative sample of the Spanish population in an age range, 60 years-old or more, which concentrates a high cardiovascular risk. Differences in the prevalence among autonomus communities were detected.

Prevalencia de sobrepeso y obesidad en población española de 60 años o más y factores relacionados. Estudio PREV-ICTUS / Prevalence and related factors of overweight and obesity in Spanish population aged 60 years-old or older. The PREV-ICTUS study

FUNDAMENTO Y OBJETIVO: Los datos sobre prevalencia de obesidad en población de edad avanzadaen España son escasos. El objetivo de este trabajo ha sido describir la prevalencia de obesidady los factores relacionados en una muestra aleatoria de la población española de 60 años o más, estratificada por comunidades autónomas (CC.AA.).SUJETOS Y MÉTODO: Se analizó el estudio PREV-ICTUS, realizado en una muestra seleccionadaaleatoriamente entre septiembre y diciembre de 2005, estratificada por CC.AA. según el censo yel hábitat de atención. Se clasificó a los sujetos según su índice de masa corporal (IMC) enaquellos con peso normal (IMC < 25), sobrepeso (IMC de 25-29,9) y obesos (IMC 30).RESULTADOS: En 6.843 sujetos –edad media (desviación estándar) de 71,9 (7,1) años; 53,3%mujeres– la prevalencia de obesidad fue del 34,5% (intervalo de confianza [IC] del 95%, 33,3-35,5%), mayor en mujeres (38,4%; IC del 95%, 36,8-39,9%) que en varones (30,0%; IC del95%, 28,4-31,6%; p < 0,001), con tendencia a disminuir en edades más avanzadas. En total,el 81,7% mostró exceso ponderal (IMC 25). La prevalencia varió entre las CC.AA., del 46,4al 20,7% (p < 0,001). En el análisis multivariante, la obesidad guardó una relación inversa conla edad (odds ratio [OR] = 0,98 por cada incremento en un año) y directa con el sexo femenino(OR = 1,25), el medio rural (OR = 1,50) o semiurbano (OR = 1,38), el sedentarismo (OR =1,86) y el antecedente de no fumador (OR = 1,19).CONCLUSIONES: La obesidad estuvo presente en uno de cada 3 individuos en esta muestra razonablementerepresentativa de la población española de un intervalo de edad, 60 años o más, que ademásconcentra un gran riesgo cardiovascular. Se observaron diferencias en la prevalencia entre las CC.AA

BACKGROUND AND OBJECTIVE: Data on the prevalence of obesity in elderly population in Spain are scarce. The objective of this work was to describe the prevalence of obesity and the related factors in a random sample of Spanish population aged 60 years-old or more, stratified by autonomous communities. SUBJECTS AND METHOD: We analyzed the PREV-ICTUS study, a population-based study carried out between September and December 2005 in a random sample stratified by autonomous communities according to the census of inhabitants and the habitat in each community. Subjects were classified as with normal weight (body mass index [BMI] < 25 kg), overweight (BMI 25-29.9) and obesity (BMI 30 kg). RESULTS: In 6,843 subjects –mean age (standard deviation): 71.9 (7.1) years-old; 53.3% women–, prevalence of obesity was 34.5% (95% confidence interval [CI], 33.3-35.5%), higher in women (38.4%; 95% CI, 36.8-39.9%) than in men (30.0%; 95% CI, 28.4-31.6%; p < 0.001), with a tendency to decrease in the older population. In total, 81.7% of the population showed overweight (BMI 25). Prevalence differed among communities from 46.4% to 20.7% (p < 0.001). In the multivariate analysis, obesity was inversely related to age (odds ratio [OR] = 0.98 per each year increment), and directly to female gender (OR = 1.25), rural (OR = 1.50) or semiurban habitat (OR = 1.38), sedentary lifestyle (OR = 1.86) and non-smoking history (OR = 1.19). CONCLUSIONS: Obesity was present in one out of 3 individuals of this reasonably representative sample of the Spanish population in an age range, 60 years-old or more, which concentrates a high cardiovascular risk. Differences in the prevalence among autonomus communities were detected

Serum lipid profiles and their relationship to cardiovascular disease in the elderly: the PREV-ICTUS study.

OBJECTIVE: To assess the relationship between different serum lipid profiles and the prevalence of established cardiovascular disease (CVD) in an elderly population. RESEARCH DESIGN AND METHODS: An analysis was undertaken of the PREV-ICTUS population-based study on Spanish subjects aged > or =60 years. The following definitions were used: abnormal LDL cholesterol (LDL-C): > or =130 mg/dl (> or =3.3 mmol/L), or > or =100 mg/dl (> or =2.5 mmol/L) in those with diabetes or CVD, or treatment with any hypolipidaemic drug; low HDL cholesterol (HDL-C): <40 mg/dl (<1 mmol/L) (men), or <50 mg/dl (<1.3 mmol/L) (women), and abnormal triglycerides (TG): > or =150 mg/dl (> or =1.7 mmol/L) or treatment with fibrates. We defined eight groups: A (normal lipid profile), B (isolated abnormal LDL-C), C (isolated abnormal TG), D (isolated low HDL-C), E (abnormal LDL-C and HDL-C), F (abnormal LDL-C and TG), G (abnormal TG and HDL-C), H (abnormal LDL-C, HDL-C and TG). A multivariate analysis was performed to assess the relationship between each lipid profile and CVD. RESULTS: A total of 6010 subjects (mean age 71.7 years, 53.5% women, 73.2% with hypertension, 29.2% with diabetes mellitus, 24.3% with CVD), were included in the analysis. LDL-C elevation was present in 78.1%, 23.3% had low HDL-C and 35.7% abnormal TG. Combined dyslipidaemias were frequent (40.3%). Odds ratios (95% confidence intervals) for CVD, compared with those with a normal lipid profile, were 2.07 (1.24-3.46) for abnormal HDL-C (p = 0.005), 4.09 (3.10-5.39) for abnormal LDL-C; 6.41 (4.59-8.95) for abnormal LDL-C plus HDL-C, 5.33 (3.98-7.14) for abnormal LDL-C plus TG and 7.59 (5.51-10.5) for those with the three parameters altered (all p < 0.001). Compared with those with isolated LDL-C elevation, those with abnormal LDL-C plus HDL-C had 1.57 (1.30-1.97) higher odds of having CVD (p < 0.001), the figures being 1.30 (1.11-1.53) for those with abnormal LDL-C plus TG and 1.86 (1.52-2.28) for those with abnormal LDL-C, TG plus HDL-C (p < 0.001). CONCLUSIONS: Lipid abnormalities are frequent in the elderly, and are associated with the presence of CVD. Low HDL-C and/or abnormal TG levels, when added to abnormal LDL-C, are associated with a higher prevalence of CVD, suggesting the advisability of a comprehensive lipid evaluation and treatment earlier in life.

[Prevalence of low glomerular filtration rate in the elderly population of Spain. The PREV-ICTUS study]. / Prevalencia de filtrado glomerular disminuido en la población española de edad avanzada. Estudio PREV-ICTUS.

BACKGROUND AND OBJECTIVE: To assess the prevalence of low glomerular filtration rate (GFR < 60 ml/min/1.73 m2) in general population of subjects aged 60 years or older of Spain, and the related factors. PATIENTS AND METHOD: Analysis of PREV-ICTUS, a population-based study carried out in a sample of subjects aged 60 years or more, randomly selected and stratified by Autonomic Communities according to the census of inhabitants and the habitat in each Community. Demographic data, cardiovascular risk factors and diseases were collected. GFR was calculated using the MDRD (Modification of Diet in Renal Disease) equation. RESULTS: In 6,799 subjects (age 71.9 years-old; 53.6% women; 72.9% with arterial hypertension [HT]; 27.0% with diabetes mellitus [DM]; 24.3% with cardiovascular disease), 25.9% had low GFR (95% confidence interval, 24.8-26.9). The prevalence increased linearly, from 16.5% in subjects aged 60-64 years to 46.5% in those aged 85 or more (p < 0.001), and was higher in women (36.1% vs 14.1% in men, p < 0.001). In the multivariate analysis, low GFR was independently related to advanced age (odds ratio [OR] between 1.30 y 4.20), female gender (OR = 5.82), HT older than 7 years (OR = 1.23), uric acid (OR = 1.52 for each increment of 1 mg/dl) and cardiovascular disease (OR = 1.68). The association with DM did not reach statistical significance. In a model without cardiovascular disease, related factors remained the same, increasing the significance of HT older than 7 years (OR = 1.31) and of DM (OR = 1.19). CONCLUSION: One out or 4 subjects of this sample showed low GFR. The variables directly associated with low GFR were advanced age, female gender, HT of longer evolution, cardiovascular disease, increased uric acid, and, in one model, DM.

Prevalencia de filtrado glomerular disminuido en la población española de edad avanzada. Estudio PREV-ICTUS / Prevalence of low glomerular filtration rate in the elderly population of Spain. The PREV-ICTUS study

Fundamento y objetivo: Estimar la prevalencia de filtrado glomerular (FG) disminuido (< 60 ml/min/1,73 m2) en población general española de 60 años o más y los factores asociados. Pacientes y método: Se analizó el estudio PREV-ICTUS, realizado en una muestra de individuos de 60 años o más seleccionada aleatoriamente, estratificada por comunidades autónomas según el censo y el hábitat de atención. Se recogieron datos demográficos, factores de riesgo y enfermedades cardiovasculares. Se calculó el FG utilizando la fórmula de MDRD (Modification of Diet in Renal Disease). Resultados: En 6.799 individuos (edad media 71,9 años; 53,6% mujeres; 72,9% con hipertensión arterial [HTA]; 27,0% con diabetes mellitus [DM]; 24,3% con enfermedad cardiovascular), el 25,9% presentó FG disminuido (intervalo de confianza del 95%, 24,8­26,9). La prevalencia aumentó linealmente con la edad, del 16,5% en individuos de 60-64 años al 46,5% en los de 85 años o más (p < 0,001), y fue superior en mujeres (36,1%) frente a varones (14,1%) (p < 0,001). En el análisis multivariante, el FG disminuido se asoció significativamente con edad avanzada (odds ratio [OR] entre 1,30 y 4,20), sexo femenino (OR = 5,82), HTA de más de 7 años de evolución (OR = 1,23), ácido úrico elevado (OR = 1,52 por cada incremento de 1 mg/dl) y presencia de enfermedad cardiovascular (OR = 1,68). La asociación con DM no alcanzó significación estadística. En un modelo sin la enfermedad cardiovascular, las asociaciones fueron las mismas, ganando significación la HTA de más de 7 años (OR = 1,31) y la DM (OR = 1,19). Conclusión: Uno de cada 4 individuos en esta muestra mostró un FG calculado disminuido. Las variables directamente asociadas con la presencia de FG disminuido fueron edad avanzada, sexo femenino, HTA de mayor evolución, enfermedad cardiovascular, cifras de ácido úrico elevadas y, sólo en un modelo, la DM

Background and objective: To assess the prevalence of low glomerular filtration rate (GFR < 60 ml/min/1.73 m2) in general population of subjects aged 60 years or older of Spain, and the related factors. Patients and method: Analysis of PREV-ICTUS, a population-based study carried out in a sample of subjects aged 60 years or more, randomly selected and stratified by Autonomic Communities according to the census of inhabitants and the habitat in each Community. Demographic data, cardiovascular risk factors and diseases were collected. GFR was calculated using the MDRD (Modification of Diet in Renal Disease) equation. Results: In 6,799 subjects (age 71.9 years-old; 53.6% women; 72.9% with arterial hypertension [HT]; 27.0% with diabetes mellitus [DM]; 24.3% with cardiovascular disease), 25.9% had low GFR (95% confidence interval, 24.8­26.9). The prevalence increased linearly, from 16.5% in subjects aged 60-64 years to 46.5% in those aged 85 or more (p < 0.001), and was higher in women (36.1% vs 14.1% in men, p < 0.001). In the multivariate analysis, low GFR was independently related to advanced age (odds ratio [OR] between 1.30 y 4.20), female gender (OR = 5.82), HT older than 7 years (OR = 1.23), uric acid (OR = 1.52 for each increment of 1 mg/dl) and cardiovascular disease (OR = 1.68). The association with DM did not reach statistical significance. In a model without cardiovascular disease, related factors remained the same, increasing the significance of HT older than 7 years (OR = 1.31) and of DM (OR = 1.19). Conclusion: One out or 4 subjects of this sample showed low GFR. The variables directly associated with low GFR were advanced age, female gender, HT of longer evolution, cardiovascular disease, increased uric acid, and, in one model, DM

[Prevalence of atrial fibrillation in the Spanish population aged 60 years or more. The PREV-ICTUS study]. / Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS.

INTRODUCTION AND OBJECTIVES: The aims of this study were to determine the prevalence of atrial fibrillation in individuals aged 60 years or more in Spain using a random sample of the population and to identify associated factors. METHODS: An analysis of the PREV-ICTUS study, a randomized cross-sectional population-based study of individuals aged 60 years or more, was carried out. Data on demographic variables, cardiovascular risk factors, and cardiovascular disease were obtained from medical records. The diagnosis of atrial fibrillation was based on the patient's medical history and an electrocardiogram performed during the study. RESULTS: In the 7108 individuals studied (mean age 71.9 [7.1] years, 53.6% female), the prevalence of atrial fibrillation was 8.5% (95% confidence interval [CI] 7.9-9.2%). It was higher in males (9.3% vs 7.9% in females; P=.036) and increased from 4.2% in individuals aged 60-64 years to 16.5% in those aged 85 years or more (chi-squared test for linear trend, P< .001). Multivariate analysis showed that existing cardiovascular disease, hypertension, age, and left ventricular hypertrophy had the strongest associations with atrial fibrillation. Although there was a strong relationship between hypertension and atrial fibrillation (odds ratio 2.53, 95% CI, 1.60-4.01), no association was found between poor blood pressure control and atrial fibrillation. A weak association with diabetes mellitus was found only when arterial pressure was included in the model, but not when a diagnosis of hypertension was included. CONCLUSIONS: In this cross-sectional population-based study of elderly individuals, the prevalence of atrial fibrillation was 8.5%, and was strongly associated with existing cardiovascular disease, hypertension, age and left ventricular hypertrophy.

Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS / Prevalence of atrial fibrillation in the spanish population aged 60 years or more. The PREV-ICTUS study

Introducción y objetivos. El objetivo de este estudio fue analizar la prevalencia de fibrilación auricular (FA) en sujetos ≥ 60 años en España y los factores asociados, en una muestra aleatoria de base poblacional. Métodos. Análisis del estudio PREV-ICTUS, estudio transversal de base poblacional en sujetos ≥ 60 años. Se recogieron datos demográficos, factores de riesgo y enfermedades cardiovasculares. La FA fue diagnosticada por la historia médica y un electrocardiograma realizado en el momento del estudio. Resultados. En 7.108 sujetos (edad media 71,9 ± 7,1 años, el 53,6%, mujer), la prevalencia de FA fue del 8,5% (intervalo de confianza [IC] del 95%, 7,9-9,2), mayor en varones (del 9,3%, frente al 7,9% en mujeres; p = 0,036) y aumentó desde el 4,2% en sujetos de 60-64 años al 16,5% en los ≥ 85 años (χ⊃2; de la tendencia lineal; p < 0,001). En los modelos multivariables, la enfermedad cardiovascular establecida, la hipertensión, la edad y la hipertrofia ventricular izquierda tuvieron la asociación más fuerte con la FA, mientras que la hipertensión se relacionó con fuerza con la FA (odds ratio [OR] = 2,53; IC del 95%, 1,60-4,01) y no encontramos asociación entre peor control de la presión arterial y FA. La diabetes mellitus únicamente se asoció débilmente cuando en el modelo se introdujeron los valores de presión arterial y no el diagnóstico de hipertensión. Conclusiones. En este estudio poblacional en sujetos de edad avanzada, la prevalencia de FA fue del 8,5% y se asoció con fuerza con la presencia de enfermedad cardiovascular, la hipertensión, la edad y la hipertrofia ventricular izquierda (AU)

Introduction and objectives. The aims of this study were to determine the prevalence of atrial fibrillation in individuals aged 60 years or more in Spain using a random sample of the population and to identify associated factors. Methods. An analysis of the PREV-ICTUS study, a randomized cross-sectional population-based study of individuals aged 60 years or more, was carried out. Data on demographic variables, cardiovascular risk factors, and cardiovascular disease were obtained from medical records. The diagnosis of atrial fibrillation was based on the patient's medical history and an electrocardiogram performed during the study. Results. In the 7108 individuals studied (mean age 71.9 [7.1] years, 53.6% female), the prevalence of atrial fibrillation was 8.5% (95% confidence interval [CI] 7.9­9.2%). It was higher in males (9.3% vs 7.9% in females; P=.036) and increased from 4.2% in individuals aged 60­64 years to 16.5% in those aged 85 years or more (chi-squared test for linear trend, P<.001). Multivariate analysis showed that existing cardiovascular disease, hypertension, age, and left ventricular hypertrophy had the strongest associations with atrial fibrillation. Although there was a strong relationship between hypertension and atrial fibrillation (odds ratio 2.53, 95% CI, 1.60­4.01), no association was found between poor blood pressure control and atrial fibrillation. A weak association with diabetes mellitus was found only when arterial pressure was included in the model, but not when a diagnosis of hypertension was included. Conclusions. In this cross-sectional population-based study of elderly individuals, the prevalence of atrial fibrillation was 8.5%, and was strongly associated with existing cardiovascular disease, hypertension, age and left ventricular hypertrophy (AU)

Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERIC-HTA study.

The aim of this study is to assess the relationship among metabolic syndrome (MS), target organ damage (TOD) and established cardiovascular disease (CVD) in non-diabetic hypertensive elderly patients. ERIC-HTA is cross-sectional, multicentre study carried out in primary care, on hypertensive patients aged 55 or older. MS was defined by the NCEP-ATP III criteria, using body mass index (>28.8 kg/m(2)) instead of abdominal perimeter. In 8331 non-diabetic hypertensive patients (3663 men and 4668 women, mean age 67.7 years), the prevalence of MS was 32.6% (men: 29.0%; women: 36.8%). A linear association was observed between a greater number of components of MS and a greater prevalence of left ventricle hypertrophy (LVH) on the electrocardiogram (p<0.001), impaired kidney function (p<0.001) and established CVD (p = 0.001). In a multivariate model, MS in non-diabetic hypertensive patients was related to a greater prevalence of LVH (OR 1.31 [95% CI: 1.15-1.48]), impaired kidney function (OR 1.45 [95% CI: 1.29-1.63]) and established CVD (OR 1.22 [95% CI: 1.08-1.37]). This relationship persisted after stratifying by gender. In conclusion, in this elderly non-diabetic hypertensive population, the presence of MS was independently related to a greater prevalence of hypertensive TOD and established CVD, suggesting a role of MS as a cardiovascular risk marker in hypertension.

Differences in blood pressure control and stroke mortality across Spain: the Prevención de Riesgo de Ictus (PREV-ICTUS) study.

The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population >60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese, and 27.1% diabetic subjects) were analyzed. A total of 73% were already diagnosed with hypertension. Among hypertensive subjects, 29.1% had blood pressure on therapeutic objective, and, of the total population, 35.7% had blood pressure under control. ECG-left ventricular hypertrophy was present in 12.9% of the subjects. The estimated stroke risk was 19.6%. Stroke mortality rates were significantly related to the estimated 10-year stroke risk (r=0.41; P<0.05) in each autonomic community. Poor hypertension control (P=-0.42; P<0.05) and prevalence of ECG-left ventricular hypertrophy (P=0.52; P<0.05) were the main factors related to the stroke mortality rates after controlling by age, sex, obesity, diabetes, and urban setting. Differences in stroke mortality throughout the autonomic communities of Spain were associated with indexes of worse blood pressure handling, low control rates, and high left-ventricular hypertrophy.

Blood pressure and estimated risk of stroke in the elderly population of Spain: the PREV-ICTUS study.

BACKGROUND AND PURPOSE: The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. METHODS: This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. RESULTS: We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic-left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; P<0.001). CONCLUSIONS: The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

Estimated risk of a first stroke and conditioning factors in Spanish hypertensive women. The RIMH study.

Stroke is the leading cause of mortality in women in Spain. RIMHA is a cross-sectional multicenter study in hypertensive women aged 55 or more in primary care to estimate the 10-year risk for a first stroke. Clinical history, cardiovascular risk factors and diseases, electrocardiogram, blood samples and blood pressure (BP) were recorded. Stroke and coronary risk were estimated using the appropriate Framingham scales; 12875 patients were included (mean age 68.0+/-8.5 years, 29.1% with diabetes, 19.7% with cardiovascular disease). Electrocardiographic left ventricular hypertrophy (LVH) was present in 19.2% BP was controlled in 42.9% of non-diabetic (BP<140/90 mmHg) and 9.7% of diabetic patients (BP<130/80 mmHg). The 10-year risk (+/- SD) for a first stroke was estimated as 15.8+/-16.3%, and the coronary risk as 12.0+/-6.3. In the multivariate analysis, the most contributing factors for stroke risk estimation were age, systolic BP, LVH and atrial fibrillation. In conclusion, the 10-year estimated stroke risk for Spanish hypertensive women aged 55 years or more was higher than the estimated coronary risk, in accordance with the high rates of morbidity and mortality due to stroke among women in Spain. The most powerful risk factors were older age, poor BP control, LVH and atrial fibrillation.