Metástasis intracardiacas múltiples. Hallazgo inesperado en el diagnóstico de cáncer de pulmón / Multiple intracardiac metastases. Unexpected finding in the diagnosis of lung cancer

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Prevalencia de obesidad y comorbilidad cardiovascular asociada en los pacientes incluidos en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal) / Prevalence of obesity and cardiovascular comorbidity associated in patients included in the IBERICAN study

OBJETIVOS: Analizar la prevalencia de obesidad y su asociación con otros factores de riesgo cardiovascular y la enfermedad cardiovascular en una muestra de pacientes del estudio IBERICAN. MATERIAL Y MÉTODOS: Análisis de la visita de inclusión de los primeros 5.013 individuos reclutados del estudio IBERICAN, estudio longitudinal, observacional y multicéntrico en el que se están incluyendo individuos de 18 a 85 años en las consultas de Atención Primaria en las diferentes comunidades autónomas de España. En este trabajo se definió la obesidad como índice de masa corporal ≥ 30 kg/m2. RESULTADOS: La prevalencia de obesidad fue del 35,7% (IC 95%: 35,0-36,4%), 36,6% en varones y 34,9% en mujeres (p = 0,214), que se incrementa con la edad de manera significativa (p < 0,001). Los obesos presentaron, respecto a los no obesos, mayor prevalencia de hipertensión arterial (62,8 vs. 39,4%; p < 0,001), dislipidemia (56,9 vs. 47,1%; p < 0,001), sedentarismo (40,6 vs. 24,6%; p < 0,001), diabetes mellitus (27,5 vs. 14,8%; p < 0,001), hiperuricemia (23,6 vs. 12,7%; p < 0,001), lesión subclínica de órgano (33,7 vs. 26,5%; p <0,001) y enfermedad cardiovascular (21,2 vs. 15,3%; p < 0,001). El análisis multivariante mostró que las variables asociadas con la obesidad fueron: hipertensión arterial (p < 0,001), hiperuricemia (p < 0,001), sedentarismo (p < 0,001), diabetes mellitus (p < 0,001), edad (p <0,001), bajo nivel educativo (p < 0,001) y menor consumo de tabaco (p < 0,001). CONCLUSIONES: El análisis del estudio IBERICAN muestra que aproximadamente una tercera parte de la población analizada cumple criterios de obesidad y que los factores de riesgo cardiovascular, lesión en órganos diana y enfermedad cardiovascular eran más frecuentes en los obesos

OBJECTIVES: To analyse the prevalence of obesity and its association with other cardiovascular risk factors and cardiovascular disease in a sample of patients from the (Identification of the Spanish population at cardiovascular and renal risk) IBERICAN study. MATERIAL AND METHODS: Analysis of the inclusion visit of the first 5,013 patients of the IBERICAN longitudinal, observational, and multicentre study in which individuals aged 18 to 85 years were included in Primary Care Clinics in the different regions of Spain. In this work obesity was defined as a body mass index ≥ 30 kg/m2. RESULTS: The prevalence of obesity was 35.7% (95% CI: 35.0-36.4%), of which 36.6% were men and 34.9% were women (P = 0.214), and significantly increasing with age (0.001). The obesity had the associated higher prevalence of hypertension (62.8% vs. 39.4%, P < 001), dyslipidaemia (56.9% vs. 47.1%, P <0.001), sedentary lifestyle (40.6% vs. 24.6%, P <.001), diabetes (27.5% vs. 14.8%, P <.001), hyperuricaemia (23.6% vs. 12.7%, P <.001), subclinical organ injury (33.7% vs. 26.5%, P < .001) and cardiovascular disease (21.2% vs. 15.3%, P <.001). The multivariate analysis showed that the variables associated with obesity were: arterial hypertension (P <.001), hyperuricemia (P < .001), sedentary lifestyle (P < .001), diabetes mellitus (P < 0.001), age (P < 0.001), low educational level (P < 0.001) and lower consumption of tobacco (P < 0.001). CONCLUSIONS: The analysis of the IBERICAN study shows that approximately one third of the analysed population meets criteria of obesity and cardiovascular risk factors. Target organ damage and cardiovascular disease were more frequent in obese patients

Medidas antropométricas de obesidad general y central y capacidad discriminativa sobre el riesgo cardiovascular: estudio RICARTO / Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study

INTRODUCCIÓN Y OBJETIVOS: El sobrepeso y la obesidad predisponen a la enfermedad cardiovascular y a la mortalidad general. No está claro qué índices de obesidad se deben utilizar en clínica. El objetivo es examinar la relación entre el índice de masa corporal (IMC), la circunferencia de la cintura (C-cintura), el cociente cintura/talla (cociente-CT) y el índice de conicidad (I-conicidad) con el riesgo cardiovascular (RCV) a 10 años estimado por la ecuación de Framingham. MATERIAL Y MÉTODOS: Estudio transversal poblacional en ≥ 18 años del Área Sanitaria de Toledo. Selección por muestreo aleatorio. Medición de IMC, C-cintura, talla y peso con métodos estandarizados. RCV Framingham. Cálculo de áreas bajo la curva ROC (ABC) y puntos de corte óptimo. RESULTADOS: Se analizaron 1.309 personas, con edad media de 48,9 ± 15,8años; el 55% fueron mujeres. Tasa de respuesta: 36,6%. En mujeres, el índice que mejor se asoció con el RCV ≥ 10% es el cociente-CT con ABC = 0,85 (IC95%: 0,81-0,88). En hombres es el I-conicidad, con ABC = 0,81 (IC95%: 0,77-0,84). Puntos de corte: para IMC similar en mujeres (27,08 kg/m2) y hombres (26,99 kg/m2). Para C-cintura, inferior en mujeres (87,75 cm) que en hombres (94,5 cm). Para cociente-CT, superior en mujeres (0,59) que en hombres (0,56). Para I-conicidad, ligeramente inferior en mujeres (1,25) que en hombres (1,28). En mujeres, todas las curvas ROC estuvieron más próximas entre sí. CONCLUSIONES: Los índices de obesidad central (C-cintura y cociente-CT) discriminan el RCV mejor que el IMC. En mujeres, todos los índices tienen mayores áreas bajo la curva que en los hombres, excepto el I-conicidad

INTRODUCTION AND OBJECTIVES: Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS: Population cross-sectional study in subjects ≥ 18 years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS: The study included 1,309 subjects, with mean age of 48.9 ± 15.8 years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC = 0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC = 0.81 (95% CI: 0.77-0.84). Cut points for BMI were similar in women (27.08 kg/m2) and men (26.99 kg/m2). The WC was lower in women (87.75 cm) than in men (94.5 cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS: The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]. / Medidas antropométricas de obesidad general y central y capacidad discriminativa sobre el riesgo cardiovascular: estudio RICARTO.

INTRODUCTION AND OBJECTIVES: Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS: Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS: The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m2) and men (26.99kg/m2). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS: The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

[Prevalence of obesity and cardiovascular comorbidity associated in patients included in the IBERICAN study]. / Prevalencia de obesidad y comorbilidad cardiovascular asociada en los pacientes incluidos en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal).

OBJECTIVES: To analyse the prevalence of obesity and its association with other cardiovascular risk factors and cardiovascular disease in a sample of patients from the (Identification of the Spanish population at cardiovascular and renal risk) IBERICAN study. MATERIAL AND METHODS: Analysis of the inclusion visit of the first 5,013 patients of the IBERICAN longitudinal, observational, and multicentre study in which individuals aged 18 to 85 years were included in Primary Care Clinics in the different regions of Spain. In this work obesity was defined as a body mass index ≥ 30kg/m2. RESULTS: The prevalence of obesity was 35.7% (95% CI: 35.0-36.4%), of which 36.6% were men and 34.9% were women (P=0.214), and significantly increasing with age (0.001). The obesity had the associated higher prevalence of hypertension (62.8% vs. 39.4%, P<001), dyslipidaemia (56.9% vs. 47.1%, P<0.001), sedentary lifestyle (40.6% vs. 24.6%, P<.001), diabetes (27.5% vs. 14.8%, P<.001), hyperuricaemia (23.6% vs. 12.7%, P<.001), subclinical organ injury (33.7% vs. 26.5%, P<.001) and cardiovascular disease (21.2% vs. 15.3%, P<.001). The multivariate analysis showed that the variables associated with obesity were: arterial hypertension (P<.001), hyperuricemia (P<.001), sedentary lifestyle (P<.001), diabetes mellitus (P<0.001), age (P<0.001), low educational level (P<0.001) and lower consumption of tobacco (P<0.001). CONCLUSIONS: The analysis of the IBERICAN study shows that approximately one third of the analysed population meets criteria of obesity and cardiovascular risk factors. Target organ damage and cardiovascular disease were more frequent in obese patients.

Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes / Reliability study on the interpretation of electrocardiograms by general practitioners and trainees

Objetivo. Conocer la fiabilidad en la interpretación del electrocardiograma (ECG) por médicos de familia en ejercicio y médicos residentes en periodo de formación, utilizando para ello la comparación con la interpretación realizada por el cardiólogo. Material y métodos. Estudio observacional. Se incluyeron médicos de familia en ejercicio del Área de Salud de Toledo, médicos internos residentes de Medicina Familiar y Comunitaria y los médicos internos residentes de Cardiología de los 3 años iniciales del periodo formativo (R1-R3). Se utilizó un cuestionario con 13 ECG sin datos clínicos del paciente. Los 13 ECG fueron seleccionados y sus diagnósticos consensuados por 2 cardiólogos del Complejo Hospitalario de Toledo. Resultados. El porcentaje de respuestas correctas más alto (82,3%) correspondió al ECG 5 (fibrilación auricular), y el más bajo (26,5%), al ECG 11 (ritmo de la unión). La competencia diagnóstica más alta fue alcanzada por los médicos residentes de Cardiología, los médicos de familia en ejercicio, los tutores de residentes y los médicos con trabajo en el Servicio de Urgencias del hospital. Los valores más altos de odds ratio para una mayor competencia diagnóstica fueron trabajar en el Servicio de Urgencias y ser médico de familia en ejercicio, ambas con resultados casi significativos (p<0,10). Conclusiones. Los médicos de familia y los médicos residentes tienen un grado de fiabilidad medio en la interpretación del ECG con relación al cardiólogo

Objective. To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. Material and methods. An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. Results. The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). Conclusions. Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist

Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio / Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: data from the first 1.500 individuals included in the study

Introducción. El objetivo fue investigar prevalencias de factores de riesgo cardiovascular (FRCV), lesión de órgano diana (LOD) y enfermedad cardiovascular (ECV) en población general del Área Sanitaria de Toledo para determinar el riesgo cardiovascular (RCV). Material y métodos. Estudio epidemiológico observacional que analizó una muestra de población general ≥18años seleccionada de la base de datos de tarjeta sanitaria por muestreo aleatorio sistemático estratificado por sexo y grupos de edad. Se realizaron anamnesis, exploración clínica y pruebas complementarias, congelándose a −85°C alícuotas de sangre total y suero para valorar posibles estudios genéticos. Se realizó análisis estadístico estándar. El RCV se estimó con las escalas del Proyecto SCORE calibrada para población española y del Framingham Heart Study. Resultados. Se incluyeron a 1.500 individuos (edad media 49,1±15,8años; 55,6% mujeres). Prevalencias: dislipemia 56,9% (intervalo de confianza al 95% [IC95%]: 54,3-59,4), hipertensión arterial 33,0% (IC95%: 30,6-35,4), diabetes mellitus 8,6% (IC95%: 7,17-10,1), tabaquismo 24,2% (IC95%: 22,0-26,4), obesidad 25,3% (IC95%:23,1-27,5) y sedentarismo 39,4% (IC95%: 36,9-41,8). El 21,1% no mostró ningún FRCV y el 18,6% presentó de 3 a 5. LOD: hipertrofia ventricular izquierda electrocardiográfica 4,3%, arteriopatía periférica con eco-doppler10,1% y con dispositivo oscilométrico 15,3%, microalbuminuria 4,3%, enfermedad renal oculta 3,2% y nefropatía 3,8% (CKD-EPI). El 9,2% padecía alguna ECV. El 44,6% mostró RCV (SCORE) bajo. Conclusiones. De cada 10 personas, 6 presentan dislipemia, 4 sedentarismo, 3 hipertensión, 2 tabaquismo, 2 obesidad, y casi una diabetes. Más de la mitad de los individuos muestran RCV moderado-alto-muy alto y las prevalencias de LOD y ECV son importantes

Introduction. The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. Material and methods. Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at −85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. Results. A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. Conclusions. Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant

Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo) / Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study

Introducción. El objetivo principal es conocer en la población del Área Sanitaria de Toledo las prevalencias de factores de riesgo cardiovascular (FRCV), lesión de órgano diana (LOD) y enfermedad cardiovascular (ECV), así como los hábitos de vida (ejercicio físico y consumo de alcohol y de dieta mediterránea), para determinar el riesgo cardiovascular (RCV). Material y métodos. Estudio epidemiológico observacional que analizará una muestra de población general≥ 18 años seleccionada de la base de datos de tarjeta sanitaria por muestreo aleatorio sistemático estratificado por sexo y grupos de edad. Se realizarán anamnesis, exploración clínica y pruebas complementarias, y se congelarán a -85°C alícuotas de sangre total y suero para valorar futuros estudios genéticos. El RCV se estimará con las escalas del proyecto SCORE calibrada para población española y del Framingham Heart Study. Alcanzado el tamaño muestral estimado y transcurridos al menos 5 años de la inclusión, se realizará seguimiento de la muestra final de sujetos, analizando la evolución de FRCV, LOD, ECV y del control de FRCV, y los eventos sucedidos mortales y no mortales. Discusión. El estudio RICARTO pretende conocer las prevalencias de los principales FRCV, LOD y ECV, para determinar el RCV de la población general del Área Sanitaria de Toledo, y realizar un seguimiento de la muestra final de individuos cuando hayan transcurrido al menos 5 años de la inclusión para analizar la incidencia de eventos cardiovasculares y la evolución temporal de los estilos de vida, las prevalencias de FRCV, LOD y ECV

Introduction. The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). Material and methods. Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of -85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. Discussion. The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD

Control de la presión arterial mediante el uso de una aplicación para teléfono inteligente con estrategia de retroalimentación y competitividad. Proyecto Control HTApp / Control of blood pressure by using an intelligent telephone application with feedback and competitiveness strategy. HTApp Control project

Introducción y objetivo. La hipertensión arterial es un factor de riesgo cardiovascular de gran importancia y con bajos porcentajes de control. Las nuevas tecnologías pueden ayudar a obtener un mejor control de esta enfermedad, por lo que se pretende conocer si una aplicación móvil puede ayudar a conseguir este objetivo. Método. Se utiliza una aplicación para teléfonos móviles que permite dar información de retroalimentación a los médicos con intención de generar competitividad en la consecución de objetivos. La aplicación permitía conocer en todo momento la tasa de pacientes controlados (<140/90mmHg) por cada médico, y compararlos con la media de pacientes controlados por el grupo. También se analizan los posibles cambios en la actitud terapéutica de los médicos y se comparan diferencias en consecución de objetivos en función de determinadas características de los pacientes. Resultados. Se incluyeron 220 pacientes, de 18 a 80 años, con cifras de presión arterial>140/90mmHg a pesar de tratamiento médico, seguidos durante 4 visitas. Al final del seguimiento, el 69,03% logró un buen control, en comparación con el 12,8% en el estudio basal (p<0,001), sin que se observaran diferencias entre ambos sexos (control del 68,6 y 69,29% en mujeres y hombres, respectivamente) ni entre los distintos niveles de riesgo cardiovascular. Conclusiones. El uso de herramientas interactivas que permitan el proceso dinámico de retroalimentación sobre los propios resultados favorece la motivación y mejora la inercia terapéutica en el control de la presión arterial (AU)

Introduction and objective. Arterial hypertension is a highly important cardiovascular risk factor, with low control percentages. New technologies can help to obtain a better control of this disease. The intention is to know if a mobile application can help achieve this goal. Method. A mobile phone application is used to give feedback to physicians with the aim of generate competitiveness in achieving objectives. The application could, at any time, determine the rate of controlled patients (<140/90mmHg) by each physician, and compare them with the mean number of the patients controlled by the group. The possible changes in the therapeutic attitude of physicians are also analysed and the differences in achieving objectives are compared based on specific characteristics of patients. Results. The study included 220 patients aged 18-80 years, with mean blood pressure>140/90mmHg, despite medical treatment, tracked for 4 visits. At the end of the follow-up, 69.03% achieved good control, compared to 12.8% in the baseline study (P<.001), with no differences between gender (control of 68.6 and 69.29% of women and men, respectively), nor among the different levels of cardiovascular risk. Conclusions. The use of interactive tools that allow the dynamic process of feedback on the results fosters the motivation and improves the therapeutic inertia in the control of blood pressure (AU)

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study]. / Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo).

INTRODUCTION: The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). MATERIAL AND METHODS: Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. DISCUSSION: The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD.

[Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: Data from the first 1,500 individuals included in the study]. / Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio.

INTRODUCTION: The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. MATERIAL AND METHODS: Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at -85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. RESULTS: A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. CONCLUSIONS: Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant.

[Reliability study on the interpretation of electrocardiograms by general practitioners and trainees]. / Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes.

OBJECTIVE: To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. MATERIAL AND METHODS: An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. RESULTS: The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). CONCLUSIONS: Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist.

[Control of blood pressure by using an intelligent telephone application with feedback and competitiveness strategy. HTApp Control project]. / Control de la presión arterial mediante el uso de una aplicación para teléfono inteligente con estrategia de retroalimentación y competitividad. Proyecto Control HTApp.

INTRODUCTION AND OBJECTIVE: Arterial hypertension is a highly important cardiovascular risk factor, with low control percentages. New technologies can help to obtain a better control of this disease. The intention is to know if a mobile application can help achieve this goal. METHOD: A mobile phone application is used to give feedback to physicians with the aim of generate competitiveness in achieving objectives. The application could, at any time, determine the rate of controlled patients (<140/90mmHg) by each physician, and compare them with the mean number of the patients controlled by the group. The possible changes in the therapeutic attitude of physicians are also analysed and the differences in achieving objectives are compared based on specific characteristics of patients. RESULTS: The study included 220 patients aged 18-80 years, with mean blood pressure>140/90mmHg, despite medical treatment, tracked for 4 visits. At the end of the follow-up, 69.03% achieved good control, compared to 12.8% in the baseline study (P<.001), with no differences between gender (control of 68.6 and 69.29% of women and men, respectively), nor among the different levels of cardiovascular risk. CONCLUSIONS: The use of interactive tools that allow the dynamic process of feedback on the results fosters the motivation and improves the therapeutic inertia in the control of blood pressure.

[Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008]. / Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008.

INTRODUCTION AND OBJECTIVES: To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. METHODS: Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. RESULTS: 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8±12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0±43.4, LDL-cholesterol 115±38.0, HDL-cholesterol 44.1±12.3, and triglyceride 145.3±92.4mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3±37.8 vs 111.6±38.5mg/dL; p=0.04) and HDL-cholesterol (42.3±11.6 vs 48.4±13.2mg/dL; p=0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1±43.1 and 174.5±44.1 (p<0.05), LDL-cholesterol 116.5±38.4 and 110±36.5 (p=0.007), HDL-cholesterol 44.1±12.2 and 44.2±12.9 (p<0.05), and triglyceride 141.2±81.7 and 158.5±119.7 (p=0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. CONCLUSIONS: While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control.

Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008 / Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008

Introducción y objetivos. Evaluar el perfil lipídico de los pacientes ingresados por síndrome coronario agudo en Toledo entre 2005 y 2008. Métodos. Se estudiaron los niveles de colesterol total, colesterol unido a las lipoproteínas de baja densidad (cLDL), colesterol unido a las lipoproteínas de alta densidad (cHDL) y triglicéridos. Se realizó estadística descriptiva y comparación de medias. Resultados. De los 3.986 ingresados por síndrome coronario agudo, 1.381 pacientes tenían perfil lipídico completo. El 76,3% eran primeros episodios. La edad media fue 67,8 ± 12,9 años (72,4% hombres). El colesterol total medio (± DE) fue 180,0 ± 43,4, cLDL 115 ± 38,0, cHDL 44,1 ± 12,3, y triglicéridos 145,3 ± 92,4 mg/dl, con diferencias significativas entre hombres y mujeres en el cLDL (116,3 ± 37,8 vs 111,6 ± 38,5 mg/dl; p = 0,04) y cHDL (42,3 ± 11,6 vs 48,4 ± 13,2 mg/dl; p = 0,0001). En primeros episodios y episodios recurrentes se halló, respectivamente, colesterol total 179,1 ± 43,1 y 174,5 ± 44,1 (p < 0,05), cLDL 116,5 ± 38,4 y 110,0 ± 36,5 (p = 0,007), cHDL 44,1 ± 12,2 y 44,2 ± 12,9 (p < 0,05), y triglicéridos 141,2 ± 81,7 y 158,5 ± 119,7 mg/dl (p = 0,03). Se observaron niveles óptimos de cLDL y cHDL en el 14,1 y en el 11,6%, respectivamente, de los episodios recurrentes. Conclusiones. Aunque la mayoría de pacientes ingresados por primeros episodios de síndrome coronario agudo presenta un perfil lipídico adecuado, solo el 10% de pacientes con episodios recurrentes muestran niveles óptimos de c-LDL y c-HDL, lo que sugiere la necesidad de ser más rigurosos en el control lipídico (AU)

Introduction and objectives. To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. Methods. Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. Results. 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8 ± 12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0 ± 43.4, LDL-cholesterol 115 ± 38.0, HDL-cholesterol 44.1 ± 12.3, and triglyceride 145.3 ± 92.4 mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3 ± 37.8 vs 111.6 ± 38.5 mg/dL; p = 0.04) and HDL-cholesterol (42.3 ± 11.6 vs 48.4 ± 13.2 mg/dL; p = 0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1 ± 43.1 and 174.5 ± 44.1 (p < 0.05), LDL-cholesterol 116.5 ± 38.4 and 110 ± 36.5 (p = 0.007), HDL-cholesterol 44.1 ± 12.2 and 44.2 ± 12.9 (p < 0.05), and triglyceride 141.2 ± 81.7 and 158.5 ± 119.7 (p = 0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. Conclusions. While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control (AU)

Interpretación computarizada del electrocardiograma para el diagnóstico de hipertrofia del ventrículo izquierdo. Proyecto ELECTROPRES / Computerized interpretation of the electrocardiogram in the diagnosis of left ventricular hypertrophy. The ELECTROPRES project

Antecedentes y objetivos. En la práctica clínica, el electrocardiograma (ECG) es la herramienta más utilizada para detectar la hipertrofia ventricular izquierda (HI) a pesar de su baja sensibilidad. Hemos evaluado el impacto de la interpretación computerizada del ECG en el diagnóstico de HVI en condiciones de práctica clínica. Métodos. ELECTROPRES es una plataforma informática de libre acceso que permite la interpretación completa del ECG on-line. Incluye 19 criterios de HVI previamente validados mediante ecocardiografía. Se analizan los datos de los primeros 669 pacientes con hipertensión arterial (HTA) esencial incluidos en la plataforma ELECTROPRES procedentes de 21 centros de Atención Primaria de 9 de las 17 comunidades autónomas. Resultados. Hasta abril de 2010 se han analizado 669 pacientes con HTA esencial (51,7% mujeres) con una edad media (+DE) de 66±12 años. La evolución media de la enfermedad fue de 8 años y recibían un promedio de 2,4 fármacos antihipertensivos. La presión arterial sistólica fue de 139±17mmHg y la diastólica de 76±11mmHg. La frecuencia de HVI conocida por el ECG fue del 3%. Con la plataforma ELECTROPRES la prevalencia de HVI aumentó hasta el 33,3% (p<0,001). Al analizar los criterios de HVI por separado, el índice de Lewis ([R-I+S-III]-[R-II+S-II]) y el producto de Cornell (R-aVL+S-V3 [+6 en mujeres]) fueron los que más diagnósticos de HVI ofrecieron (24,8 y 13,3% respectivamente). El producto de Cornell obtuvo un mejor rendimiento global para la detección de HVI, independientemente del estadio de HTA y de la presencia de complicaciones cardiovasculares. Conclusiones. En una población de hipertensos esenciales, la lectura computarizada del ECG (plataforma ELECTROPRES) aumenta sustancialmente la detección de HVI, en comparación con la detección convencional por ECG en condiciones de práctica clínica habitual(AU)

Introduction. Despite its low sensitivity, the electrocardiogram (ECG) is the tool used the most in the daily practice for detection of left ventricular hypertrophy (LVH). This study has aimed to assess the impact of the computerized interpretation of the ECG on the diagnosis of LVH in the practical clinical setting. Methods. ELECTROPRES is a project based on a free access computer platform that permits an online interpretation of the electrocardiogram. It includes 19 different left LVH criteria previously validated by echocardiography in a substudy. We analyzed the data from the first 669 patients with essential arterial hypertension (ATH) included in the ELECTROPRES platform from 21 primary care centers in 9 of the 17 Spanish autonomous communities. Results. Up to April 2010, a cohort of 669 hypertensive patients (51.7% women), with a mean age of 66.3±11.89 years, was analyzed. The mean evolution of the disease was 8 years, and the patients had been receiving an average of 2.4 antihypertensive agents. Systolic blood pressure was 139±17mmHg and diastolic blood pressure 76±11. The ECG-known frequency of LVH was 3%. The prevalence of LVH increased up to 33.3% (P<0.001) with the ELECTROPRES platform. When all the criteria were independently examined, the Lewis index (R-I+S-III) and the Cornell product [(R-aVL+S-V3 (+6 for women)] were those in which the most cases of left ventricular hypertrophy were detected (24.8% and 13.3%, respectively). The Lewis index and the Cornell product were the criteria that detected more cases of left ventricular hypertrophy, regardless of the AHT stage and of the presence of cardiovascular complications. Conclusions. The ECG computerized reading (ELECTROPRES platform) significantly increases detection of left ventricular hypertrophy in a population of essential hypertense subjects compared to conventional detection with the ECG by the physician in the usual clinical practice setting(AU)

[Computerized interpretation of the electrocardiogram in the diagnosis of left ventricular hypertrophy. The ELECTROPRES project]. / Interpretación computarizada del electrocardiograma para el diagnóstico de hipertrofia del ventrículo izquierdo. Proyecto ELECTROPRES.

INTRODUCTION: Despite its low sensitivity, the electrocardiogram (ECG) is the tool used the most in the daily practice for detection of left ventricular hypertrophy (LVH). This study has aimed to assess the impact of the computerized interpretation of the ECG on the diagnosis of LVH in the practical clinical setting. METHODS: ELECTROPRES is a project based on a free access computer platform that permits an online interpretation of the electrocardiogram. It includes 19 different left LVH criteria previously validated by echocardiography in a substudy. We analyzed the data from the first 669 patients with essential arterial hypertension (ATH) included in the ELECTROPRES platform from 21 primary care centers in 9 of the 17 Spanish autonomous communities. RESULTS: Up to April 2010, a cohort of 669 hypertensive patients (51.7% women), with a mean age of 66.3±11.89 years, was analyzed. The mean evolution of the disease was 8 years, and the patients had been receiving an average of 2.4 antihypertensive agents. Systolic blood pressure was 139±17 mmHg and diastolic blood pressure 76±11. The ECG-known frequency of LVH was 3%. The prevalence of LVH increased up to 33.3% (P<0.001) with the ELECTROPRES platform. When all the criteria were independently examined, the Lewis index (R-I+S-III) and the Cornell product [(R-aVL+S-V3 (+6 for women)] were those in which the most cases of left ventricular hypertrophy were detected (24.8% and 13.3%, respectively). The Lewis index and the Cornell product were the criteria that detected more cases of left ventricular hypertrophy, regardless of the AHT stage and of the presence of cardiovascular complications. CONCLUSIONS: The ECG computerized reading (ELECTROPRES platform) significantly increases detection of left ventricular hypertrophy in a population of essential hypertense subjects compared to conventional detection with the ECG by the physician in the usual clinical practice setting.