Risk of partial school closure for COVID-19 by socio-economic level in the period 2020-22.

BACKGROUND: The objective was to analyse the risk of partial school closure by economic level in Barcelona city. METHODS: In this ecological study, the risk of partial school closure for the academic years 2020-21 and 2021-22 was estimated by dividing the total number of days that each child was in quarantine or isolation by the total number of days that each child was at risk to be in quarantine or isolation in the academic year. The association between partial school closure risk and mean income by district was estimated with the Spearman rho. RESULTS: The lower the mean income, the higher the risk of partial closure (Spearman rho = 0.83; P-value = 0.003) during the academic year 2020-21. Specifically, the children from the district with the lowest income had a six times greater risk of partial school closure compared with those from the highest-income district. This risk did not show a significant socioeconomic gradient in the academic year 2021-22. CONCLUSIONS: The risk of partial school closure presented an inverse socioeconomic gradient in the city of Barcelona according to average income by district in the academic year 2020-21. This distribution was not observed in the academic year 2021-22.

Prevalence of lower extremity peripheral arterial disease in individuals with chronic immune mediated inflammatory disorders.

OBJECTIVE: To compare the prevalence of lower extremity peripheral artery disease (PAD) and to assess whether age-associated progression in ankle-brachial index (ABI) differs between individuals with chronic immune-mediated inflammatory diseases (CIID) and the general population. METHODS: Pooled analysis with data from individuals aged 50 years and older with ABI measurements, obtained from population-based cross-sectional studies conducted in Catalonia (Spain). Information on three CIID diagnoses (i.e., inflammatory bowel disease, systemic connective tissue disorders, and inflammatory polyarthropathies and spondylopathies, considered as one entity for purposes of analysis) was obtained from electronic medical records. To ascertain the statistical association between PAD and CIID, logistic regression models were fitted and adjusted for age, sex, and cardiovascular risk factors. We tested the interaction between age and CIID diagnosis for ABI values. RESULTS: We included 8799 individuals, 312 (3.6%) with CIID. The age-standardized prevalence of PAD was higher in the CIID group (12% vs. 6% in general population, p = 0.001), and the model adjusted for age, sex, and cardiovascular risk factors also showed higher risk in individuals with CIID [Odds Ratio (95% confidence interval) = 1.65 (1.15-2.38); p = 0.007]. The inflammatory polyarthropathies/spondylopathies diagnosis was significantly associated with PAD in the fully adjusted model [1.80 (1.18-2.75); p = 0.006]. The atherosclerotic process was accelerated in individuals with CIID, compared to the general population (p for interaction<0.001). CONCLUSION: In individuals with CIID, age-standardized prevalence of PAD was significantly higher than in the general population and the atherosclerotic process was accelerated. However, only inflammatory polyarthropathies/spondylopathies was associated with significant risk of PAD.

Determinants of the transition from a cardiometabolic normal to abnormal overweight/obese phenotype in a Spanish population.

PURPOSE: There is limited prospective evidence at population scale of the impacts of lifestyle and surrogate measures of general and abdominal adiposity on the transition of a metabolically healthy (absence of a metabolic disorder) overweight/obese (MHOO) phenotype to a metabolically abnormal overweight/obese (MAOO) phenotype. Therefore, we determined the relationship between 10-year body mass index (BMI), waist circumferences (WC), waist to height ratio (WHtR), and lifestyle changes and the transition of the MHOO phenotype. METHODS: We conducted a prospective population-based study of 3,052 male and female Spaniards aged 25-74 years who were followed from 2000 through 2009. Diet and leisure-time physical activity were recorded on validated questionnaires. Weight, height, WC, blood lipids, glycemia, and blood pressure were measured. All variables were obtained at baseline (BL) and follow-up (FL). Participants with a BMI ≥ 25 kg/m(2) and free from hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, and low HDL and high LDL cholesterol levels were characterized as the MHOO phenotype. A composite healthy lifestyle index (HLI) was constructed by including temporary changes in 3 lifestyle variables (diet, leisure-time physical activity, and smoking). RESULTS: Initially, 20.8% of subjects had the MHOO phenotype; 49.2% of these shifted to MAOO phenotype. In multivariate analysis, changes in BMI, WC, WHtR were positively associated (p = 0.004, p = 0.018, and p = 0.016, respectively) with this transition. One unit increase in the HLI was associated with a 33% lower risk (p = 0.025) to the MAOO phenotype transition after adjusting for age, sex, educational level, and baseline energy intake, BMI, WC, and WHtR. CONCLUSIONS: The presence of metabolic disorders in the MHOO phenotype is predicted by an increase in anthropometric surrogate measures of general and abdominal adiposity. In contrast, a healthy lifestyle protects against a transition to the MAOO phenotype.

Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol.

BACKGROUND: Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers. METHODS/DESIGN: An cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis). DISCUSSION: If our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines. TRIAL REGISTRATION: The study is registered as NCT01291953 (ClinicalTrials.gob).

Prevalencia y características clínicas de la enfermedad arterial periférica en la población general del estudio Hermex / Prevalence and clinical characteristics of peripheral arterial disease in the study population hermex

Introducción y objetivos. Determinar la prevalencia de enfermedad arterial periférica mediante el índice tobillo-brazo y evaluar los factores de riesgo, clínicos y diagnósticos asociados. Métodos. Estudio transversal realizado entre 2007 y 2009, con muestra aleatoria de 2.833 sujetos entre 25 y 79 años representativa del área de salud de Don Benito (Badajoz). Se consideró diagnóstico de enfermedad arterial periférica un índice tobillo-brazo < 0,90. Se utilizó el cuestionario de Edimburgo para identificar formas sintomáticas. Se evaluaron las recomendaciones actuales de cribado, los cambios del riesgo coronario estimado conseguidos con su uso y la asociación con los factores de riesgo. Resultados. La prevalencia de enfermedad arterial periférica fue del 3,7% (intervalo de confianza del 95%, 3,0-4,5%); el 5,0% (3,9-6,3%) en varones y el 2,6% (1,8-3,5%) en mujeres (p=0,001). Las prevalencias acumuladas a partir de 50, 60 y 70 años fueron del 6,2, el 9,1 y el 13,1% respectivamente. La enfermedad era sintomática en el 13,3% (6,8-19,8%) de los casos. Las recomendaciones actuales de cribado no detectaron al 29,6% de los enfermos asintomáticos. El uso del índice aumentó el 32,7% los casos de riesgo coronario alto. Se halló asociación positiva de la enfermedad con edad, tabaquismo, hipercolesterolemia, sedentarismo, microalbuminuria y enfermedad cardiovascular, y negativa con el consumo de alcohol. Conclusiones. El uso del índice tobillo-brazo es aconsejable para el diagnóstico de esta enfermedad, dada la baja prevalencia de formas sintomáticas y su capacidad para cambiar el riesgo coronario estimado. Se debería adaptar los grupos de cribado a la población española. Tabaquismo e hipercolesterolemia son los principales factores de riesgo (AU)

Introduction and objectives. To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. Introduction and objectives. The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors. To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. Methods. El uso del índice tobillo-brazo es aconsejable para el diagnóstico de esta enfermedad, dada la baja prevalencia de formas sintomáticas y su capacidad para cambiar el riesgo coronario estimado. Se debería adaptar los grupos de cribado a la población española. Tabaquismo e hipercolesterolemia son los principales factores de riesgo. Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. La prevalencia de enfermedad arterial periférica fue del 3,7% (intervalo de confianza del 95%, 3,0-4,5%); el 5,0% (3,9-6,3%) en varones y el 2,6% (1,8-3,5%) en mujeres (p=0,001). Las prevalencias acumuladas a partir de 50, 60 y 70 años fueron del 6,2, el 9,1 y el 13,1% respectivamente. La enfermedad era sintomática en el 13,3% (6,8-19,8%) de los casos. Las recomendaciones actuales de cribado no detectaron al 29,6% de los enfermos asintomáticos. El uso del índice aumentó el 32,7% los casos de riesgo coronario alto. Se halló asociación positiva de la enfermedad con edad, tabaquismo, hipercolesterolemia, sedentarismo, microalbuminuria y enfermedad cardiovascular, y negativa con el consumo de alcohol. Methods. Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. Results. The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. Results. The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. Conclusions: The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors (AU)

Prevalence and clinical characteristics of peripheral arterial disease in the study population Hermex.

INTRODUCTION AND OBJECTIVES: To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. METHODS: Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. RESULTS: The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. CONCLUSIONS: The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors.

Prevalencia de síndrome metabólico en una población de niños y adolescentes con obesidad / Prevalence of metabolic syndrome in a population of obese children and adolescents

Introducción La obesidad infantil es un problema sanitario creciente y de primer orden para la sociedad, ya que aumenta el riesgo de padecer enfermedades cardiovasculares, diabetes mellitus tipo 2 e hipertensión arterial. Así, cuando los niños obesos se convierten en adultos obesos, los efectos sobre su salud y expectativas de vida pueden ser devastadores.Objetivos1). Determinar la prevalencia de síndrome metabólico (SM) en una población infanto-juvenil con obesidad, y 2). Comparación de parámetros antropométricos y bioquímicos en pacientes con 1 o 2 parámetros de SM frente a los pacientes que cumplen criterios de SM. Material y métodos Estudio transversal descriptivo en niños y adolescentes con obesidad (>p97) tratados en el Servicio de Endocrinología del Hospital de Getafe. Las variables estudiadas fueron: edad, sexo, talla, peso, índice de masa corporal (IMC), circunferencia de cintura (CC), glucemia basal y tras sobrecarga oral de glucosa (SOG), insulinemia, resistencia a la insulina (RI) medida mediante HOMA, triglicéridos (TG), HDL, tensión arterial sistólica y diastólica (TAS y TAD). La definición de SM en adolescentes se hizo de acuerdo a criterios de la International Diabetes Federation (IDF) de 2007.Resultados133 pacientes, 67 varones (50,4%) y 66 mujeres (49,6%), con edad media de 12,17±3,27 años. Todos los pacientes presentaban obesidad superior al p97 para edad y sexo. La prevalencia de los distintos parámetros del SM fue la siguiente: 100% CC>p90 para edad y sexo; 26,08% hipertensión arterial; 15,94% hipertrigliceridemia superior a 150mg/dl; 10,86% HDL < 40mg/dl; 7,97% glucemia en ayunas por encima de 100mg/dl. En conjunto, la prevalencia de SM fue del 19,6%. Cuando comparamos distintos parámetros antropométricos y bioquímicos en los pacientes con 1 o 2 criterios de SM frente a los que presentan SM completo, se observa que a mayor número de criterios de SM, el grado de obesidad y la (..) (AU)

Introduction Childhood obesity is a major and increasing health problem for society because it increases the risk of cardiovascular disease, type 2 diabetes mellitus, and hypertension. Thus, when obese children become obese adults, effects on their health and life expectation may be devastating. Objectives(1) To assess the prevalence of metabolic syndrome (MS) in a child population with obesity and (2) to compare anthropometric and biochemical parameters in patients with one or two parameters of MS syndrome to those of patients who meet MS criteria. Patients and methods A descriptive, cross-sectional study was conducted in children and adolescents with severe obesity (weight >p97) seen at the endocrinology department of Hospital de Getafe. Variables examined included age, sex, height, weight, body mass index (BMI), waist circumference (WC), oral glucose tolerance test (OGTT), insulin, insulin resistance (IR) measured by HOMA, triglycerides (Tg), high density lipoprotein (HDL), and systolic and diastolic blood pressure (SBP and DBP). The definition of MS in adolescents was made according to criteria of the International Diabetes Federation (IDF), 2007.ResultsA total of 133 patients, 67 males (50.4%) and 66 females (49.6%) with a mean age of 12.17±3.27 years, were enrolled into the study. All patients were obese, with a weight greater than the 97h percentile for age and sex. Prevalence of several cardiovascular risk factors was as follows: WC ≥90th percentile for age and sex, 100%; hypertension, 26.08%; hypertriglyceridemia ≥150mg/dL, 15.94%; HDL <40mg/dL, 10.86%; fasting blood glucose levels ≥100mg/dL, 7.97%. The overall prevalence of (..) (AU)

Prevalencia de obesidad y riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Estudio Hermex / Prevalence of obesity and cardiovascular risk in the general population of a health area in Extremadura (Spain). The Hermex study

Introducción y objetivos Estimar la prevalencia de la obesidad y el riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Material y métodos Estudio transversal sobre una muestra aleatoria de población entre 25 y 79 años procedente del área de salud de Don Benito-Villanueva (Badajoz). Se estudió la presencia de factores de riesgo y enfermedad cardiovascular. Se recogieron medidas antropométricas, de presión arterial y muestra sanguínea. Se categorizó a la población obesa en distintos niveles de riesgo tal como propone la Sociedad Española para el Estudio de la Obesidad y se estudió la influencia de la obesidad en la estimación del riesgo de cardiopatía isquémica según la función de Framinghan adaptada para España. Resultados De los 3.521 sujetos seleccionados participaron 2.833 (80,5%). La edad media fue 51,2 años (DE 14,7) y el 46,5% fueron hombres. La prevalencia de sobrepeso y obesidad fue superior en hombres (46,2 y 37,7%) con respecto a las mujeres (37,7 y 32,6%) (p<0,005 y p<0,05 respectivamente). Solo el 10% de los obesos no mostraron un riesgo cardiovascular aumentado. La obesidad se asoció a un incremento de presentar riesgo alto de cardiopatía isquémica de 8 veces en la mujer (p<0,001) por 1,4 veces en el hombre (p=0,095).Conclusiones La obesidad es muy prevalente y afecta junto al sobrepeso al 74,1% de la población de un área de salud de Extremadura. La amplia mayoría de los obesos tienen un riesgo cardiovascular aumentado, siendo de gran magnitud para la cardiopatía isquémica en la mujer (AU)

Introduction and objectives To estimate the prevalence of obesity and its associated cardiovascular risk in the general population of a health area in Extremadura. Materials and methods A cross-sectional study on a random population sample aged 25-79 years from the Don Benito-Villanueva (Badajoz) health area. Risk factors and cardiovascular disease were examined. Anthropometric and blood pressure measurements were collected, and a blood sample was taken. Obese subjects were categorized into different risk levels as proposed by the Spanish Society for the Study of Obesity, and the influence of obesity on estimation of the risk of ischemic heart disease was studied using the Framingham function, as adapted for Spain. Results A total of 2833 of the 3521 subjects screened (80.5%) participated in the study. Mean age was 51.2 years (SD 14.7), and 46.5% were males. Male subjects had a greater prevalence of overweight and obesity (46.2% and 37.7% respectively) as compared to females (37.7% and 32.6%) (p<0.005 and p<0.05, respectively). Only 10% of obese subjects had no increased cardiovascular risk. Obesity was associated to an 8-fold increase in the presence of a high risk for ischemic heart disease in females (p<0.001), as compared to a 1.4-fold increase in males (p=0.095).Conclusions Obesity is highly prevalent and affects, together with overweight, 74.1% of the population in an Extremadura health area. A vast majority of obese subjects have an increased cardiovascular risk, which is very marked for ischemic heart disease in females (AU)

[Prevalence of obesity and cardiovascular risk in the general population of a health area in Extremadura (Spain): the Hermex study]. / Prevalencia de obesidad y riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Estudio Hermex.

INTRODUCTION AND OBJECTIVES: To estimate the prevalence of obesity and its associated cardiovascular risk in the general population of a health area in Extremadura. MATERIALS AND METHODS: A cross-sectional study on a random population sample aged 25-79 years from the Don Benito-Villanueva (Badajoz) health area. Risk factors and cardiovascular disease were examined. Anthropometric and blood pressure measurements were collected, and a blood sample was taken. Obese subjects were categorized into different risk levels as proposed by the Spanish Society for the Study of Obesity, and the influence of obesity on estimation of the risk of ischemic heart disease was studied using the Framingham function, as adapted for Spain. RESULTS: A total of 2833 of the 3521 subjects screened (80.5%) participated in the study. Mean age was 51.2 years (SD 14.7), and 46.5% were males. Male subjects had a greater prevalence of overweight and obesity (46.2% and 37.7% respectively) as compared to females (37.7% and 32.6%) (p<0.005 and p<0.05 respectively). Only 10% of obese subjects had no increased cardiovascular risk. Obesity was associated to an 8-fold increase in the presence of a high risk for ischemic heart disease in females (p<0.001), as compared to a 1.4-fold increase in males (p=0.095). CONCLUSIONS: Obesity is highly prevalent and affects, together with overweight, 74.1% of the population in an Extremadura health area. A vast majority of obese subjects have an increased cardiovascular risk, which is very marked for ischemic heart disease in females.

Riesgo vascular, diabetes e índice tobillo-brazo. Respuesta / Vascular risk, diabetes, and the ankle-brachial index. Response

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Concurrent and construct validity of Mediterranean diet scores as assessed by an FFQ.

OBJECTIVE: The aim of the present study was to assess the concurrent and construct validity of two diet-quality indices, a modified Mediterranean diet score (mMDS) and a Mediterranean-like diet score (MLDS) additionally incorporating unhealthy food choices, as determined by an FFQ. DESIGN: A validation study assessing FFQ intake estimates compared with ten or more unannounced 24 h recalls. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Bland-Altman plots and the limits of agreement method were used to assess the between-method agreement of scores. Construct validity was shown using associations between nutrient intakes derived from multiple 24 h recalls and the mMDS and MLDS derived from the FFQ. SETTING: Gerona, Spain. SUBJECTS: A total of 107 consecutively selected participants from a population-based cross-sectional survey. RESULTS: Pearson's correlations for the energy-adjusted mMDS and MLDS compared with multiple recalls were 0·48 and 0·62, respectively. The average FFQ energy-adjusted mMDS and MLDS were 102 % and 98 % of the recall-based mMDS and MLDS estimates, respectively. The FFQ under- and overestimated dietary recall estimates of the energy-adjusted MLDS by 28 % and 25 %, respectively, with slightly wider boundaries for the mMDS (31 % and 34 %). The ICC, which assesses absolute agreement, was similar to Pearson's correlations (mMDS = 0·48 and MLDS = 0·61). The mean differences between methods were similar across the range of average ratings for both scores, indicating the absence of bias. The FFQ-derived mMDS and MLDS correlated in the anticipated directions with intakes of eleven (73·3 %) and thirteen of fifteen nutrients (86·7 %), respectively. CONCLUSIONS: The FFQ provides valid estimates of diet quality as assessed by the mMDS and MLDS.

El índice tobillo-brazo mejora la clasificación del riesgo cardiovascular: estudio ARTPER/PERART / Ankle-brachial index improves the classification of cardiovascular risk: PERART/ARTPER study

Introducción y objetivos. Las funciones de riesgo cardiovascular tienen una baja sensibilidad, pues frecuentemente los eventos cardiovasculares se producen en personas en riesgo bajo o intermedio. El objetivo de este trabajo es estudiar cómo el índice tobillo-brazo (ITB) reclasifica a estos pacientes. Métodos. Se realizó un estudio descriptivo transversal, multicéntrico (28 centros), con 3.171 pacientes de edad > 49 años seleccionados aleatoriamente. Se estudiaron variables demográficas, antecedentes y factores de riesgo cardiovasculares, ITB (patológico si era<0,9) y riesgo cardiovascular a 10 años con Framingham-Wilson, REGICOR y SCORE, con las siguientes categorías: bajo (Framingham<10%, REGICOR<5% y SCORE<2,5%), intermedio (10-19,9%, 5-9,9% y 2,5-4,9%, respectivamente) y alto (≥ 20%, ≥ 10% y ≥ 5%, respectivamente). Se reclasificó a los pacientes con riesgo bajo o intermedio a la categoría de riesgo alto si presentaban un ITB < 0,9. Resultados. Los pacientes con ITB < 0,9, comparados con los que lo tenían ≥ 0,9, eran significativamente mayores, con predominio de varones, peor perfil de antecedentes y factores de riesgo cardiovasculares y superior proporción de pacientes en riesgo alto, con Framingham-Wilson (el 42,7 contra el 18,5%), REGICOR (el 25,8 contra el 9,3%) y SCORE (el 42,2 contra el 15,9%). En varones la utilización del ITB supuso un aumento en la categoría de riesgo alto del 5,8% con Framingham-Wilson, el 19,1% con REGICOR y el 4,4% con SCORE. En mujeres fue del 78,6% con Framingham-Wilson, el 151,6% con REGICOR y el 50% con SCORE. Conclusiones. El ITB reclasifica a una importante proporción de personas hacia la categoría de riesgo alto, sobre todo en mujeres y con la función REGICOR(AU)

Introduction and objectives: The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients. Methods: We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged >49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if <0.9) and 10-year cardiovascular risk with the Framingham- Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham < 10%, REGICOR < 5% and SCORE < 2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high ( 20%, 10% and 5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI <0.9. Results: We compared patients with ABI <0.9 and patients with ABI 0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE. Conclusions: The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores(AU)

Ankle-brachial index improves the classification of cardiovascular risk: PERART/ARTPER Study.

INTRODUCTION AND OBJECTIVES: The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients. METHODS: We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged >49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if <0.9) and 10-year cardiovascular risk with the Framingham-Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham<10%, REGICOR<5% and SCORE<2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high (≥20%, ≥10% and ≥5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI <0.9. RESULTS: We compared patients with ABI <0.9 and patients with ABI ≥0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE. CONCLUSIONS: The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores.

Obesity is an independent risk factor for heart failure: Zona Franca Cohort study.

BACKGROUND: Heart failure (HF) is a major problem in developed countries. However, its relationship with obesity remains unclear, especially in low-risk populations. The objective of the study was to analyze the relationship between obesity and HF in a low-risk Mediterranean population. HYPOTHESIS: Obesity is an independent predictor for HF. METHODS: A prospective community-based population cohort study with 10 years' follow-up was conducted at 2 healthcare centers in the city of Barcelona, Spain. From a registered population of 35 275, the study included 932 randomly selected patients without HF, age 35-84 years. Obesity was defined as body mass index (BMI) ≥30 and HF according to European Society of Cardiology guidelines, confirmed by echocardiography. Cox proportional hazards regression was used to examine the association between obesity and heart failure. RESULTS: The difference in HF incidence between obese subjects (4.7%) and nonobese subjects (1.6%) was 3.1% (95% confidence interval [CI]: 0.7-5.5). In the unadjusted model, incident HF was significantly associated with BMI: the hazard ratio [HR] was 1.09 for every 1 kg/m² increase (95% CI: 1.05-1.14) and 3.01 for BMI ≥30 (95% CI: 1.34-6.77). After adjusting for age, sex, hypertension, ischemic heart disease, and diabetes mellitus, the results were similar: HR 1.06 (95% CI: 1.01-1.10) and HR 2.45 for BMI ≥30 (95% CI: 1.02-5.61). Overweight was not associated with HF in any of the models. The population-attributable risk of HF due to obesity was 43.0% (95% CI: 13.9-74.9). CONCLUSIONS: High rate differences, HRs, and attributable risk indicate that obesity is an important risk factor for incident HF.

The epidemiology of cardiovascular disease in primary care. the Zona Franca Cohort study in Barcelona, Spain.

INTRODUCTION AND OBJECTIVES: Knowledge about the incidence of cardiovascular disease in Spain is limited, particularly about emergent conditions such as peripheral arterial disease and heart failure. The objective of this study was to determine the incidence of these conditions in a primary care setting. METHODS: A prospective population-based cohort study was carried out in two health centers in Barcelona, Spain. It included 931 randomly selected individuals, aged 35 to 84 years, without cardiovascular disease who were followed for 10 years. We assessed the incidence of ischemic heart disease (i.e. myocardial infarction and angina), cerebrovascular disease (i.e. stroke and transient ischemic attack), peripheral arterial disease of the lower extremities, and heart failure. RESULTS: The most frequently occurring condition was ischemic heart disease (cumulative incidence, 6.1%), followed by cerebrovascular disease (4.3%), heart failure (3.0%), and peripheral arterial disease (1.9%). These conditions were more frequent in patients aged >65 years (cumulative incidence, 9.6%, 8.9%, 4.6% and 3.1%, respectively). The most frequent comorbid conditions were ischemic heart disease and cerebrovascular disease. The incidence of acute myocardial infarction was greater in men (P< .001), but there was no significant difference for other conditions. The adjusted incidence (European population) per 100,000 inhabitants per year in men and women, respectively, was: 605 and 115 for acute myocardial infarction; 238 and 220 for angina; 300 and 327 for stroke; 125 and 115 for transient ischemic attack; 136 and 178 for peripheral arterial disease; and 219 and 267 for heart failure. CONCLUSIONS: The incidence of cardiovascular disease was lower than in other developed countries. Disease occurred more frequently in patients aged >65 years. Ischemic heart disease remained the most common, with heart failure being a notable emergent condition.

Epidemiología de las enfermedades cardiovasculares en atención primaria. Estudio cohorte zona franca de barcelona / The epidemiology of cardiovascular disease in primary care. The zona franca cohort study in Barcelona, Spain

Introducción y objetivos. La incidencia de las enfermedades cardiovasculares no se conoce suficientemente en España, sobre todo en enfermedades emergentes como la arteriopatía periférica y la insuficiencia cardiaca. El objetivo es estudiar la incidencia de estas enfermedades en atención primaria. Métodos. Estudio prospectivo de cohortes de base poblacional, realizado en dos centros de salud de Barcelona (España). Se incluyó a 931 sujetos entre 35 y 84 años, sin enfermedades cardiovasculares, seleccionados aleatoriamente y seguidos 10 años. Se estudió la incidencia de cardiopatía isquémica (infarto agudo de miocardio y angina), enfermedad cerebrovascular (ictus y accidente isquémico transitorio), arteriopatía periférica de extremidades inferiores e insuficiencia cardiaca. Resultados. La enfermedad más frecuente fue la cardiopatía isquémica (incidencia acumulada, 6,1%), seguida de la enfermedad cerebrovascular (4,3%), la insuficiencia cardiaca (3%) y la arteriopatía periférica (1,9%). Fueron más frecuentes en mayores de 65 años (incidencias acumuladas, 9,6, 8,9, 4,6 y 3,1% respectivamente). La superposición más frecuente fue entre cardiopatía isquémica y enfermedad cerebrovascular. La incidencia de infarto agudo de miocardio fue superior en varones (p < 0,001), sin diferencias significativas en otras enfermedades. Las tasas ajustadas (población europea) cada 100.000 habitantes/año en varones y mujeres respectivamente fueron: infarto agudo de miocardio, 605 y 115; angina, 238 y 220; ictus, 200 y 327; accidente isquémico transitorio, 125 y 115; arteriopatía periférica, 136 y 178, e insuficiencia cardiaca, 219 y 267. Conclusiones. La incidencia de enfermedades cardiovasculares es inferior que en otros países desarrollados y son especialmente frecuentes en mayores de 65 años. La cardiopatía isquémica sigue siendo la más frecuente y destaca la insuficiencia cardiaca como enfermedad emergente (AU)

Introduction and objectives. Knowledge about the incidence of cardiovascular disease in Spain is limited, particularly about emergent conditions such as peripheral arterial disease and heart failure. The objective of this study was to determine the incidence of these conditions in a primary care setting. Methods. A prospective population-based cohort study was carried out in two health centers in Barcelona, Spain. It included 931 randomly selected individuals, aged 35 to 84 years, without cardiovascular disease who were followed for 10 years. We assessed the incidence of ischemic heart disease (i.e. myocardial infarction and angina), cerebrovascular disease (i.e. stroke and transient ischemic attack), peripheral arterial disease of the lower extremities, and heart failure. Results. The most frequently occurring condition was ischemic heart disease (cumulative incidence, 6.1%), followed by cerebrovascular disease (4.3%), heart failure (3.0%), and peripheral arterial disease (1.9%). These conditions were more frequent in patients aged >65 years (cumulative incidence, 9.6%, 8.9%, 4.6% and 3.1%, respectively). The most frequent comorbid conditions were ischemic heart disease and cerebrovascular disease. The incidence of acute myocardial infarction was greater in men (P<.001), but there was no significant difference for other conditions. The adjusted incidence (European population) per 100,000 inhabitants per year in men and women, respectively, was: 605 and 115 for acute myocardial infarction; 238 and 220 for angina; 300 and 327 for stroke; 125 and 115 for transient ischemic attack; 136 and 178 for peripheral arterial disease; and 219 and 267 for heart failure. Conclusions. The incidence of cardiovascular disease was lower than in other developed countries. Disease occurred more frequently in patients aged >65 years. Ischemic heart disease remained the most common, with heart failure being a notable emergent condition (AU)

Long-term cardiovascular risk in type 2 diabetic compared with nondiabetic first acute myocardial infarction patients: a population-based cohort study in southern Europe.

OBJECTIVE: The aim of this study was to determine whether long-term cardiovascular risk differs in type 2 diabetic patients compared with first acute myocardial infarction patients in a Mediterranean region, considering therapy, diabetes duration, and glycemic control. RESEARCH DESIGN AND METHODS: A prospective population-based cohort study with 10-year follow-up was performed in 4,410 patients aged 30-74 years: 2,260 with type 2 diabetes without coronary heart disease recruited in 53 primary health care centers and 2,150 with first acute myocardial infarction without diabetes recruited in 10 hospitals. We compared coronary heart disease incidence and cardiovascular mortality rates in myocardial infarction patients and diabetic patients, including subgroups by diabetes treatment, duration, and A1C. RESULTS: The adjusted hazard ratios (HRs) for 10-year coronary heart disease incidence and for cardiovascular mortality were significantly lower in men and women with diabetes than in myocardial infarction patients: HR 0.54 (95% CI 0.45-0.66) and 0.28 (0.21-0.37) and 0.26 (0.19-0.36) and 0.16 (0.10-0.26), respectively. All diabetic patient subgroups had significantly fewer events than myocardial infarction patients: the HR of cardiovascular mortality ranged from 0.15 (0.09-0.26) to 0.36 (0.24-0.54) and that of coronary heart disease incidence ranged from 0.34 (0.26-0.46) to 0.56 (0.43-0.72). CONCLUSIONS: Lower long-term cardiovascular risk was found in type 2 diabetic and all subgroups analyzed compared with myocardial infarction patients. These results do not support equivalence in coronary disease risk for diabetic and myocardial infarction patients.

Validez del cuestionario cardiovascular MONICA comparado con la historia clínica / Validity of the MONICA cardiovascular questionnaire compared with clinical records

ObjetivoEstudiar la validez del cuestionario cardiovascular Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) comparado con la historia clínica.MétodosEstudio descriptivo, prospectivo, multicéntrico, realizado en 3.329 personas >50 años de edad (estudio ARTPER [arteriografía periférica]). La muestra se seleccionó por muestreo aleatorio simple en 32 centros de salud de atención primaria. Los diagnósticos considerados fueron: infarto agudo de miocardio, ángor, enfermedad vascular cerebral, hipertensión arterial, diabetes mellitus e hipercolesterolemia. Se estudió además el tratamiento con antihipertensivos, hipolipemiantes o insulina, hipoglucemiantes y antiagregantes o anticoagulantes. La validez entre cuestionario y registro en la historia clínica se estudió con la sensibilidad, la especificidad, los valores predictivos y el índice kappa.ResultadosLa edad media fue de 65 años (desviación estándar: 8,9), y el 54,8% eran mujeres. La sensibilidad del cuestionario fue >90% en todas las variables, excepto en el ángor (89,9%) y la enfermedad vascular cerebral (86,5%). La especificidad también fue >90%, excepto en el ángor (88,3%) y la hipercolesterolemia (77,5%). El valor predictivo positivo fue >90% en todos los tratamientos farmacológicos; >80% en el ángor, el infarto agudo de miocardio y la hipertensión arterial; 79,4% en la enfermedad vascular cerebral; 79,1% en la hipercolesterolemia, y 73,4% en la diabetes mellitus. Los valores predictivos negativos fueron >90% en todos los casos. Los índices kappa fueron >0,80 en todas las variables, excepto en la hipercolesterolemia (0,69) y la diabetes mellitus (0,79)(AU)

ObjectiveTo assess the validity of the questionnaire Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) compared with clinical records.MethodsA descriptive, prospective, multicenter study was performed within the framework of the Peripheral Arterial Disease Study (PERART) in 3,329 persons aged >50 years old. The sample was selected by simple random sampling in 32 primary health care centers. The diagnoses included were acute myocardial infarction, angina pectoris, cerebrovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia. Treatment variables were also considered (antihypertensive, lipid-lowering and hypoglycemic agents or insulin, as well as antiplatelet or anticoagulant agents). The sensitivity, specificity, predictive values, and kappa index were computed to test the validity of the MONICA questionnaire.ResultsThe mean age was 65 years (SD 8.9) and 54.8% were women. The sensitivity of the questionnaire was >90% for all the variables apart from angina pectoris (89.9%) and cerebrovascular disease (86.5%). Specificity was also >90%, except for angina pectoris (88.3%) and hypercholesterolemia (77.5%). The positive predictive value was >90% for all the treatments; >80% for angina pectoris, acute myocardial infarction and hypertension; 79.4% for cerebrovascular disease; 79.1% for hypercholesterolemia and 73.4% for diabetes mellitus. The negative predictive value was >90% for all the variables. The kappa indexes were >0.80 for all the variables apart from hypercholesterolemia (0.69) and diabetes mellitus (0.79).ConclusionsThe MONICA cardiovascular questionnaire is valid in the assessment of cardiovascular disease, risk factors and treatments in patients aged >50 years old(AU)

The REGICOR-calibrated function provides a better classification of high-risk patients on statin treatment in the Spanish population than the Framingham or SCORE classifications.

INTRODUCTION AND OBJECTIVES: To determine which cardiovascular risk function is best for classifying high-risk individuals on statins. METHODS: Descriptive cross-sectional study of 804 randomly selected patients aged 35-74 years. Variables studied included statin treatment, high cardiovascular risk according to Framingham-REGICOR (10-year risk >or=10%), Framingham-Wilson (10-year risk >or=20%) and SCORE (10-year risk >or=5%) functions, age, sex, cardiovascular risk factors, and total and high-density lipoprotein (HDL) cholesterol. RESULTS: Overall, 83 patients (10.3%) were taking statins. The prevalence of hypercholesterolemia was 25.6%. When high-risk patients were compared with low- and medium-risk patients, the SCORE function only found a significant difference in HDL-cholesterol level (difference, 5.1 mg/dl; P< .001), whereas the Framingham-REGICOR and Framingham-Wilson functions showed that hypercholesterolemia was more prevalent (at 41% and 37.8%, respectively), the total cholesterol level was higher (difference, 15 mg/dl and 12.5 mg/dl, respectively), and the HDL-cholesterol level was lower (difference, 11.9 mg/ dl and 12 mg/dl, respectively; all P< .001). The percentage of patients on statins classified as high-risk by each function was 16% for Framingham-REGICOR (odds ratio [OR]=1.81; 95% confidence interval [CI], 1.01-3.27), 13.4% for Framingham-Wilson (OR=1.47; 95% CI, 0.87-2.47) and 10.6% for SCORE (OR=1.09; 95% CI, 0.50-2.37). Statin use was also significantly associated with hypertension (OR=1.89; 95% CI, 1.20-2.99) and hypercholesterolemia (OR=11.01; 95% CI, 6.55-18.53), and inversely associated with age in patients <65 years (OR=0.51; 95% CI, 0.32-0.81). CONCLUSIONS: The Framingham-REGICOR function was better at classifying high-risk patients on statins than the Framingham-Wilson or SCORE functions. Statin use was associated with hypercholesterolemia and hypertension and inversely with age in patients <65 years.

La función calibrada REGICOR mejora la clasificación de los pacientes de alto riesgo tratados con estatinas respecto a Framingham y SCORE en la población española / The REGICOR-calibrated function provides a better classification of high-risk patients on statin treatment in the Spanish population than the Framingham or SCORE classifications

Introducción y objetivos. Estudiar qué función de riesgo cardiovascular clasifica mejor a los pacientes con riesgo cardiovascular alto que toman estatinas. Métodos. Estudio descriptivo transversal que incluye a 804 pacientes de 35-74 años, seleccionados aleatoriamente. Se estudiaron las variables tratamiento con estatinas, riesgo cardiovascular alto con las ecuaciones de Framingham-REGICOR (≥ 10% a 10 años), Framingham-Wilson (≥ 20% a 10 años) y SCORE (≥ 5% a 10 años), edad, sexo, colesterol total, colesterol de las lipoproteínas de alta densidad (cHDL) y factores de riesgo cardiovascular. Resultados. Tomaban estatinas 83 (10,3%) pacientes. La prevalencia de hipercolesterolemia fue del 25,6%. Comparando a los pacientes de bajo y medio riesgo con los de alto riesgo, SCORE sólo halló diferencias significativas en el cHDL más bajo (diferencia: 5,1 mg/dl; p < 0,001), mientras que Framingham-REGICOR y Framingham-Wilson mostraron (p < 0,001) mayor prevalencia de hipercolesterolemia (el 41 y el 37,8% respectivamente), colesterol total más elevado (diferencia, 15 y 12,5 mg/dl respectivamente) y cHDL más bajo (diferencia, 11,9 y 12 mg/dl respectivamente). Tomaba estatinas el 16% de pacientes de alto riesgo con Framingham-REGICOR (odds ratio [OR] = 1,81; intervalo de confianza [IC] del 95%, 1,01-3,27), el 13,4% con Framingham-Wilson (OR = 1,47; IC del 95%, 0,87-2,47) y el 10,6% con SCORE (OR = 1,09; IC del 95%, 0,50-2,37). Se asociaron significativamente al uso de estatinas la hipertensión (OR = 1,89; IC del 95%, 1,20-2,99) y la hipercolesterolemia (OR = 11,01; IC del 95%, 6,55-18,53), con una relación inversa con la edad < 65 años (OR = 0,51; IC del 95%, 0,32-0,81). Conclusiones. La función Framingham-REGICOR clasifica mejor que Framingham-Wilson y SCORE a los pacientes de riesgo alto que reciben tratamiento con estatinas. La prescripción se asoció al diagnóstico de hipercolesterolemia y HTA y fue menor en pacientes < 65 años (AU)

Introduction and objectives. To determine which cardiovascular risk function is best for classifying high-risk individuals on statins. Methods. Descriptive cross-sectional study of 804 randomly selected patients aged 35-74 years. Variables studied included statin treatment, high cardiovascular risk according to Framingham-REGICOR (10-year risk ≥10%), Framingham-Wilson (10-year risk ≥20%) and SCORE (10-year risk ≥5%) functions, age, sex, cardiovascular risk factors, and total and high-density lipoprotein (HDL) cholesterol. Results. Overall, 83 patients (10.3%) were taking statins. The prevalence of hypercholesterolemia was 25.6%. When high-risk patients were compared with low- and medium-risk patients, the SCORE function only found a significant difference in HDL-cholesterol level (difference, 5.1 mg/dl; P < .001), whereas the Framingham-REGICOR and Framingham-Wilson functions showed that hypercholesterolemia was more prevalent (at 41% and 37.8%, respectively), the total cholesterol level was higher (difference, 15 mg/dl and 12.5 mg/dl, respectively), and the HDL-cholesterol level was lower (difference, 11.9 mg/ dl and 12 mg/dl, respectively; all P < .001). The percentage of patients on statins classified as high-risk by each function was 16% for Framingham-REGICOR (odds ratio [OR]=1.81; 95% confidence interval [CI], 1.01-3.27), 13.4% for Framingham-Wilson (OR=1.47; 95% CI, 0.87-2.47) and 10.6% for SCORE (OR=1.09; 95% CI, 0.50-2.37). Statin use was also significantly associated with hypertension (OR=1.89; 95% CI, 1.20-2.99) and hypercholesterolemia (OR=11.01; 95% CI, 6.55-18.53), and inversely associated with age in patients <65 years or 95 ci 0 32-0 81 conclusions the framingham-regicor function was better at classifying high-risk patients on statins than framingham-wilson score functions statin use associated with hypercholesterolemia and hypertension inversely age in <65 years (AU)