Mortalidad, riesgo cardiovascular y estado de salud actual de una cohorte de varones iniciada en el año 1968. Estudio Manresa / Mortality, cardiovascular risk, and health status in a male cohort initiated in 1968. The Manresa study

Objetivos: Analizar la mortalidad y sus causas en la cohorte Manresa de varones seguida durante 42 años; comparar el riesgo de mortalidad cardiovascular al inicio del seguimiento con la mortalidad acontecida; describir el estado de salud de los participantes al final del estudio. Métodos: Estudio observacional prospectivo. Se calculó la incidencia de mortalidad acumulada de la cohorte. La asociación de los factores de riesgo cardiovasculares (FRCV) con la mortalidad fue calculada mediante análisis de regresión logística de efectos mixtos. Se evaluó la curva ROC comparando cada ecuación predictiva con la mortalidad real. Se llevó a cabo un análisis descriptivo del estado de salud en la última encuesta del estudio. Resultados: Las defunciones fueron 457 (43%). La incidencia acumulada fue del 10,6% para las enfermedades cardiovasculares. Los factores de riesgo cardiovasculares asociados significativamente a la mortalidad cardiovascular fueron: edad, colesterol y tabaquismo. El uso de tablas para el cálculo del riesgo cardiovascular resultó ser útil, con pocas diferencias según la tabla utilizada. Entre los factores de riesgo cardiovasculares analizados en el último examen de salud, y por tanto en una población anciana, destacan la alta prevalencia de hipertensión y de actividad física regular, junto con la baja prevalencia en tabaquismo. Conclusión: La mortalidad cardiovascular se mantuvo alta, aunque ha pasado a ser la segunda causa tras las enfermedades tumorales. Se compararon en nuestro medio las predicciones de las tablas de riesgo de mortalidad cardiovascular con la mortalidad real durante más de 4 décadas, mostrándose la importancia de estimar el riesgo cardiovascular en la población adulta.(AU)

Objectives: To analyse mortality and its causes in the Manresa male cohort followed over 42 years; to compare the initial risk of cardiovascular mortality with actual mortality; and to describe the health status of the participants at the end of the study. Methods: Prospective observational study, in which an analysis of the cumulative incidence of mortality was performed. The association of cardiovascular risk factors with mortality was calculated with a logistic regression analysis of mixed effect. The risk of mortality of individuals was evaluated and compared with true cardiovascular mortality using ROC curves. At the end of the study, a descriptive analysis of CVRF and health status of participants in the last survey was performed. Results: The number of deaths was 457 (43%). Cumulative incidence for cardiovascular diseases was 10.6%. Cardiovascular risk factors significantly associated with cardiovascular mortality were age, cholesterol, and smoking. The use of risk score charts for cardiovascular mortality was found to be useful, and there were no differences between tables. In the last health screening of cardiovascular risk factors levels in an elderly population, a high prevalence was found of hypertension and of regular physical activity, together with a low prevalence of smoking. Conclusions: Cardiovascular mortality remained high, although it has become the second cause after tumoural diseases. The comparison of predictions from cardiovascular mortality risk tables with actual mortality rates in our area over more than 4 decades demonstrated the importance of assessing cardiovascular risk in the adult population.(AU)

[Mortality, cardiovascular risk, and health status in a male cohort initiated in 1968. The Manresa study]. / Mortalidad, riesgo cardiovascular y estado de salud actual de una cohorte de varones iniciada en el año 1968. Estudio Manresa.

OBJECTIVES: To analyse mortality and its causes in the Manresa male cohort followed over 42 years; to compare the initial risk of cardiovascular mortality with actual mortality; and to describe the health status of the participants at the end of the study. METHODS: Prospective observational study, in which an analysis of the cumulative incidence of mortality was performed. The association of cardiovascular risk factors with mortality was calculated with a logistic regression analysis of mixed effect. The risk of mortality of individuals was evaluated and compared with true cardiovascular mortality using ROC curves. At the end of the study, a descriptive analysis of CVRF and health status of participants in the last survey was performed. RESULTS: The number of deaths was 457 (43%). Cumulative incidence for cardiovascular diseases was 10.6%. Cardiovascular risk factors significantly associated with cardiovascular mortality were age, cholesterol, and smoking. The use of risk score charts for cardiovascular mortality was found to be useful, and there were no differences between tables. In the last health screening of cardiovascular risk factors levels in an elderly population, a high prevalence was found of hypertension and of regular physical activity, together with a low prevalence of smoking. CONCLUSIONS: Cardiovascular mortality remained high, although it has become the second cause after tumoural diseases. The comparison of predictions from cardiovascular mortality risk tables with actual mortality rates in our area over more than 4 decades demonstrated the importance of assessing cardiovascular risk in the adult population.

[Risk factors and coronary morbimortality in a Mediterranean industrial cohort over 28 years of follow-up. The Manresa Study]. / Factores de riesgo y morbimortalidad coronaria en una cohorte laboral mediterránea seguida durante 28 años. Estudio de Manresa.

OBJECTIVE: To study the incidence and mortality of coronary heart disease (CHD) and all-cause mortality in a cohort of men followed during 28 years, and their association with serum cholesterol, systolic blood pressure, glycemia, cigarette smoking and body mass index measured at baseline. RESEARCH DESIGN AND METHODS: A cohort of 1,059 men aged 30 to 59 years and free of cardiovascular diseases at baseline in 1968, was examined every five years until 1988. The last examination was performed in 1996. Information was collected in 96.4% of the participants. RESULTS: Incidence and mortality rates from CHD and from all-causes of death per 105 person-years of observation were 499.80, 235.80 and 925.33, respectively. At the end of follow-up, high levels of serum cholesterol and smoking were independently associated with the incidence and mortality from CHD adjusted for age, blood pressure, glycemia and BMI. Serum cholesterol, hyperglycemia and smoking were independently associated with all-cause mortality. CONCLUSIONS: In this industrial cohort of men, with a relatively low incidence of CHD, smoking and serum cholesterol at baseline were independently associated with the incidence of CHD over 28 years of observation.

Resumen del documento "Control de la colesterolemia en España 2000. Un instrumento para la prevención cardiovascular" / Cholesterolemia control in Spain, 2000. A tool for cardiovascular disease prevention

El documento "Control de la colesterolemia en España 2000: un instrumento para la prevención cardiovascular" revisa la evidencia existente en el campo de la prevención cardiovascular y los avances terapéuticos producidos en los últimos años con el objetivo de ayudar a tomar decisiones clínicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Su impacto demográfico, sanitario y social está aumentando y va a continuar haciéndolo en las próximas décadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicación e intensidad del tratamiento. Basándose en dicha estratificación se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevención primaria en los pacientes de riesgo alto el objetivo terapéutico se establece en un c-LDL inferior a 130 mg/dl. En prevención secundaria el tratamiento farmacológico se instaurará con un c-LDL 130 mg/dl y el objetivo terapéutico será c-LDL < 100 mg/dl. Las estatinas son los fármacos de primera elección en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y c-HDL bajo se emplearán los fibratos. En el síndrome coronario agudo el tratamiento hipolipidemiante, cuando esté indicado, debe iniciarse precozmente. Los pacientes con cardiopatía isquémica se deben incluir en programas de prevención secundaria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)

[Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention]. / Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular.

The document "Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular / Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention

El control de la hipertensión arterial mediante monoterapia farmacológica en Atención Primaria El documento 'Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular' revisa la evidencia existente en el campo de la prevención cardiovascular y los avances terapéuticos producidos en los últimos años con el objetivo de ayudar a tomar decisiones clínicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Su impacto demográfico, sanitario y social está aumentando y va a continuar haciéndolo en las próximas décadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicación e intensidad del tratamiento. Basándose en dicha estratificación se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevención primaria en los pacientes de riesgo alto el objetivo terapéutico se establece en un c-LDL inferior a 130 mg/dl. En prevención secundaria el tratamiento farmacológico se instaurará con un c-LDL 130 mg/dl y el objetivo terapéutico será c-LDL < 100 mg/dl. Las estatinas son los fármacos de primera elección en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y c-HDL bajo se emplearán los fibratos. En el síndrome coronario agudo el tratamiento hipolipidemiante, cuando esté indicado, debe iniciarse precozmente. Los pacientes con cardiopatía isquémica se deben incluir en programas de prevención secundaria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)

[Guidelines of the Spanish Society of Cardiology for cardiovascular disease prevention and cardiac rehabilitation]. / Guías de práctica clínica de la Sociedad Española de Cardiología en prevención cardiovascular y rehabilitación cardíaca.

The priorities for the prevention of cardiovascular diseases should be focused on patients with established disease and high risk subjects, with individual global risk always being taken into account. The current evidence on the influence of the main risk factors are unanimous (dyslipemia, tobacco, hypertension and diabetes mellitus), being somewhat less so in cases of sedentarism, obesity and the metabolic syndrome. The evidence concerning other risk factors still remains controversial. Guidelines for the control of the different risk factors should be based on the evidence derived from both epidemiological or clinical trials. The recommendations published by several scientific societies should also be followed. There are, at present, important evidence on the efficacy of smoking cessation, the treatment of arterial hypertension and particularly on the successful control of lipid levels with lipid-lowering drugs, especially with statins. There is also evidence on the need for rigorous control of diabetic patients not only in relation to the glucose levels but also to dyslipemia. The most efficient measures for a reduction in morbidity and mortality are cessation of smoking, appropriate hypertensive therapy, a comprehensive program of cardiac rehabilitation and overall the successful control of lipid levels with statins.

[Control of cholesterolemia in Spain, 2000. A tool for cardiovascular prevention]. / Control de la colesterolemia en España, 2000. Un instrumento para la prevención cardiovascular.

The document "Cholesterolemia Control in Spain, 2000: A Tool for Cardiovascular Disease Prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

[Incidence, mortality and risk factors for stroke in the Manresa Study: 28 years of follow-up]. / Accidente vascular cerebral: incidencia, mortalidad y factores de riesgo en 28 años de seguimiento. Estudio de Manresa.

INTRODUCTION AND OBJECTIVES: The information concerning stroke mortality is limited in Spain, and the information on morbidity is even scarcer similarly to other countries. This is true also for the decrease of frequency observed in the last decades. The objective of this paper is to provide data in the incidence, mortality and cardiovascular risk factors associated to stroke in our surrounding through by the prolonged observation of a working population. MATERIAL AND METHODS: In the Manresa Study, which began in 1968, a cohort of 1,059 men, from 30 to 59 years old, was followed for 28 years. We recorded new cases of fatal and nonfatal stroke and the relationship between stroke incidence and risk factors of cardiovascular disease found in the initial examination. RESULTS: Incidence rate for stroke was 183 x 100,000 per year, 64% of the cases were registered after they turned 60 years of age. Mortality rate due to stroke was 88 x 100,000 per year, 91.6% of fatal cases were over 60 years old. Factors associated to the stroke morbimortality incidence were age, high blood pressure and overweight. In a bivariate regression model, stroke mortality was found significantly associated to the presence of atrial fibrillation, diabetes, hypercholesterolemia and tobacco smoking. CONCLUSIONS: Stroke frequency rates in the Manresa cohort are ranged at a medium level compared to data from other general population studies. The role of atrial fibrillation in the stroke morbimortality has been confirmed. The associated factors, age, high blood pressure and overweight, are similar role to that which was found in other research studies. The priorities in the cerebrovascular disease prevention in our surroundings are discussed.

[Spanish Society of Cardiology practice guidelines on arterial hypertension]. / Guías de práctica clínica de la Sociedad Española de Cardiología en hipertensión arterial.

High blood pressure is a well-known cardiovascular risk factor that is responsible for an elevated morbidity and mortality. However, although efficacious drugs for treatment and numerous and updated scientific training programs are available, the reality is that only a low percentage of patients are followed up in accordance with the rates which are presently considered normal. The purpose of these guidelines is to provide medical guidance for the prevention, detection and evaluation of hypertension, and to provide the best diagnosis and treatment. The factors involved in cardiovascular complications in the hypertensive patient are multiple. That is why this report places more emphasis in the individual cardiovascular risk stratification as part of the treatment strategy. The information obtained in the most recent studies published confirms the interest in achieving the greatest decrease in rates of blood pressure. This treatment to lower levels is especially useful in the high-risk subgroup. It maintains the necessity of nonpharmacological measures or lifestyle modifications in all patients with high blood pressure who either need or do not need drug therapy. All pharmacological groups may be used, but it is appropriate to choose the specific antihypertensive agent adapted to the clinical and individual situation with the use of low doses of drugs to initiate therapy and the use of appropriate drug combinations.

[Recommendations for the control of cholesterolemia in Spain]. / Recomendaciones para el control de la colesterolemia en España.

A number of recommendations are provided regarding the detection, assessment and management in primary and secondary prevention, approaching hypercholesterolaemia from a multifactorial standpoint based on cardiovascular risk. Cardiovascular diseases are the leading cause of death in Spain. The major risks involved are coronary heart disease and cerebrovascular disease. The demographic, health-related and social impact thereof will be increasing over the coming decades. Controlling hypercholesterolaemia, in conjunction with eradicating the smoking habit and controlling hypertension, diabetes, obesity and physical inactivity comprise one of the main strategies for preventing cardiovascular diseases. Breaking down the risk of individuals based on the major cardiovascular risk factors is essential, given that these factors condition the frequency with which these individuals must be monitored and the type and degree of treatment entailed. Based on this breakdown, the priorities have been set for taking steps to prevent cardiovascular disease. In primary prevention, the therapeutic objective in high-risk persons (20% risk or higher or those persons involving two or more risk factors) has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol (130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Those patients having coronary heart disease must be included in secondary prevention programs that will ensure good, constant clinical and risk factor-related control.

[Cardiovascular risk in menopause: myth, paradox or reality. The importance of clinical observations vs statistical data interpretation]. / Riesgo cardiovascular en la menopausia: mito, paradoja o realidad. Importancia de las observaciones clínicas frente a la interpretación de los datos estadísticos.

Coronary mortality among men is higher than in women in all age groups. Women seem to be protected from coronary disease. After the age of 50, coronary mortality increases fast in women and slows down in men, so that the mortality curves tend to join at some level. This fact led to believe that menopause had some influence over the non-proportional increase of coronary risk in women. Estrogens would be responsible for this protection before menopause and their further decrease would be the cause of higher coronary mortality. Mortality rate data, taken from a population with a high rate disease or a low rate disease, do not prove the above statement. For this reason it is said to by a myth. If it were a myth, then to try to prevent by administrating a substitute of these estrogens during menopause would be a paradox. If we accept that coronary atherosclerosis disease has many etiological factors, we should conclude that, besides hormones, there are other elements involved. The kind of personality, the way of life together with genetic factors related to gender would explain differences in frequency and mortality due to coronary heart disease, which, in this case, clearly advocates for women.

[Evolution of ischemic cardiomyopathy and risk factors in Spain]. / Evolución de la cardiopatía isquémica y de los factores de riesgo en España.

Cardiovascular mortality rates in Spain, as in many mediterranean countries are low. However, it is the first cause of death in our population. In the decade of seventies, cardiovascular mortality rates in Spain began to decrease, basically because of the important reduction in cerebro-vascular death and, secondly, by a reduction in coronary heart disease mortality. Decrease in coronary mortality rates may be explained as a consequence of better treatments for acute myocardial infarction. It is also important the role of cardiovascular prevention and health education campaigns for the population done, in the last years. As in many other studies, we have observed the influence of traditionally coronary risk factors as predictors for coronary heart disease in populations with low rates of coronary heart disease incidence and mortality.

[Research methods in clinical cardiology (II). Observational studies (II): natural history and prognosis in cardiology. Methodology]. / Métodos de investigación en cardiología clínica (II). Estudios observacionales (II): historia natural y pronóstico en cardiología. Metodología.

Epidemiology has been defined as "the study of the distribution and determinants of disease frequency in human populations". Therefore, epidemiology has developed study design strategies to provide different approaches to research etiology and causal inference. Among the analytic observational studies, prospective cohort designs are mainly used to test epidemiologic hypotheses. This paper describes the basic concepts of the design, conduct, analysis, and interpretation of these studies, we have emphasized the unique strengths and limitations of the cohort study design that must be taken into account.

Coronary risk factors and a 20-year incidence of coronary heart disease and mortality in a Mediterranean industrial population. The Manresa Study, Spain.

The association between coronary risk factors measured at entry and 20-year coronary heart disease (CHD) incidence and mortality was studied in an industrial cohort of 1059 men aged 30 to 59 years and free of CHD in 1968, in Spain. Myocardial infarction and fatal CHD cases were diagnosed according to recognized criteria. Mean serum cholesterol was 223.3 mg.dl-1 and 67% of men were current smokers. Rates of CHD incidence, CHD mortality and all-causes mortality, per 10(5) persons-year of observation, were 476, 194 and 617, respectively. Age, serum cholesterol, plasma glucose, cigarettes smoked and systolic blood pressure (SBP) contributed to the risk of CHD incidence. The first four variables predicted CHD death risk. All-causes death risk was positively associated with age, plasma glucose and SBP levels. Results are consistent with prior reported low CHD mortality and morbidity rates in the Mediterranean area, and confirm the importance of coronary risk factors in this low-risk population.

Dopamine treatment of locally procured donor hearts: relevance on postoperative cardiac histology and function.

UNLABELLED: Administration of catecholamines can lead to myocyte damage. Dopamine treatment is often used in potential cardiac donors to attain hemodynamic stability. Donor hearts exposed to dopamine are rejected or selected for transplantation without clearly defined criteria. A prospective study was undertaken to analyze the clinical relevance of dopamine-induced myocardial lesions in 25 hearts (21 male, 4 female; 15-40 years, mean: 26 +/- 7) that were later used for transplantation. Donors were divided into those who had received dopamine and those who had not. Dopamine doses ranged from 2-12.5 micrograms/kg/min (mean: 6.3 +/- 3). Time of administration was 3-26 hours (mean: 16 +/- 8). Use of dopamine was unrelated to donor electrocardiographic findings, intra- or postoperative death, or difficulty coming off by-pass. Postoperatively, filling pressures were similar in both groups of patients at 2 and 10 days postoperatively. Left ventricular ejection fraction was similar in the two groups. Dopamine requirements were significantly higher in the dopamine-treated hearts (P = 0.05). Histologic findings at first biopsy revealed infiltration and cell damage in a similar proportion of patients in both groups. IN CONCLUSION: donor hearts exposed to dopamine can be accepted for transplantation if doses ranging from 2-12.5 micrograms/kg/min have been administered up to 24 hours.

Indium-111 antimyosin scintigraphy to assess myocardial damage in patients with suspected myocarditis and cardiac rejection.

Indium-111 antimyosin scans were used to assess myocardial damage in patients with suspected myocarditis and cardiac transplant rejection. The calculation of a myocardium to lung ratio (AM index) to quantify antimyosin uptake was performed. AM index in normal subjects (n = 8) at 48 hr postinjection was 1.46 +/- 0.04. In patients with suspected myocarditis (16 studies in 13 patients), AM index was 2.0 +/- 0.5 (p less than 0.001); suggesting a considerable incidence of ongoing cell damage in this group, despite the small proportion of positive right ventricular endomyocardial biopsy (RVbx) (4/13). In patients studied after cardiac transplantation (37 studies in 17 patients), AM indexes correlated with RVbx. In patients with RVbx proven rejection (n = 14), AM index was 1.87 +/- 0.19 (p less than 0.001). In patients with RVbx showing infiltrates but not myocyte damage (n = 13), AM index was 1.80 +/- 0.27 (p = 0.02). In patients with normal RVbx (n = 10), AM index was 1.56 +/- 0.17 (p = NS versus controls; p = 0.001 versus those with positive RVbx). Calculated AM indexes correlated with graded visual analysis of the scans (r = 0.823; p = 0.001). Antimyosin scans are an appropriate method to assess myocardial damage in patients with suspected myocarditis and cardiac rejection.