On the problem of type 2 diabetes-related mortality in the Canary Islands, Spain. The DARIOS Study.

AIMS: To compare diabetes-related mortality rates and factors associated with this disease in the Canary Islands compared with other 10 Spanish regions. METHODS: In a cross-sectional study of 28,887 participants aged 35-74 years in Spain, data were obtained for diabetes, hypertension, dyslipidemia, obesity, insulin resistance (IR), and metabolic syndrome. Healthcare was measured as awareness, treatment and control of diabetes, dyslipidemia, and hypertension. Standardized mortality rate ratios (SRR) were calculated for the years 1981 to 2011 in the same regions. RESULTS: Diabetes, obesity, and hypertension were more prevalent in people under the age of 64 in the Canary Islands than in Spain. For all ages, metabolic syndrome and insulin resistance (IR) were also more prevalent in those from the Canary Islands. Healthcare parameters were similar in those from the Canary Islands and the rest of Spain. Diabetes-related mortality in the Canary Islands was the highest in Spain since 1981; the maximum SRR was reached in 2011 in men (6.3 versus the region of Madrid; p<0.001) and women (9.5 versus Madrid; p<0.001). Excess mortality was prevalent from the age of 45 years and above. CONCLUSIONS: Diabetes-related mortality is higher in the Canary Islands population than in any other Spanish region. The high mortality and prevalence of IR warrants investigation of the genetic background associated with a higher incidence and poor prognosis for diabetes in this population. The rise in SRR calls for a rapid public health policy response.

Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS / Risk factor treatment and control in relation to coronary disease Risk in the spanish population of the DARIOS study

Introducción y objetivos. Tratar y controlar los factores de riesgo cardiovascular es una estrategia fundamental de prevención primaria. El objetivo es analizar la proporción de población de prevención primaria de 35-74 años tratada y controlada, según niveles de riesgo coronario. Métodos. Análisis agrupado con datos individualizados de 11 estudios poblacionales de la primera década del siglo xxi . Se utilizaron cuestionarios estandarizados y medidas de presión arterial, glucohemoglobina y perfil lipídico. Se consideró buen control con presión arterial<140/90mmHg, glucohemoglobina < 7% y en la hipercolesterolemia con dos criterios: Sociedades Europeas y Programa de Actividades Preventivas y Promoción de la Salud. Resultados. Se incluyó a 27.903 participantes (el 54% mujeres). Recibían tratamiento farmacológico el 68 y el 73% de los varones y las mujeres con antecedentes de hipertensión, respectivamente (p<0,001), el 66 y el 69% de los diabéticos (p=0,03) y el 39 y el 42% de los hipercolesterolémicos (p<0,001). Tenían buen control el 34 y el 42% de los varones y las mujeres con hipertensión (p<0,001), el 65 y el 63% de los diabéticos (p=0,626), el 2 y el 3% de los hipercolesterolémicos según Sociedades Europeas (p=0,092) y el 46 y el 52% según Programa de Actividades Preventivas y Promoción de la Salud (p<0,001). La proporción de participantes no controlados aumentó con el riesgo coronario (todos, p<0,001), excepto en los varones diabéticos. Las mujeres con riesgo coronario ≥ 10% recibían más tratamiento hipolipemiante que los varones (el 59 frente al 50%; p<0,024). Conclusiones. La proporción de personas con buen control es del 65% en el mejor de los casos. Los criterios de control de la hipercolesterolemia de las Sociedades Europeas apenas se alcanzan. El tratamiento hipolipemiante no se prioriza en personas de riesgo coronario alto (AU)

Introduction and objectives. The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. Methods. Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. Results. We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P<.001), 66% and 69% respectively, of patients with diabetes (P=.03), and 39% and 42% respectively, of those with hypercholesterolemia (P<.001). Control was good in 34% of men and 42% of women with hypertension (P<.001); 65% and 63% respectively, of those with diabetes (P=.626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P=.092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P<.001). The proportion of uncontrolled participants increased with coronary risk (P<.001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P<.024). Conclusions. The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk (AU)

[Risk factor treatment and control in relation to coronary disease risk in the Spanish population of the DARIOS Study]. / Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS.

INTRODUCTION AND OBJECTIVES: The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. METHODS: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure < 140/90 mm Hg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. RESULTS: We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P<.001), 66% and 69% respectively, of patients with diabetes (P=.03), and 39% and 42% respectively, of those with hypercholesterolemia (P<.001). Control was good in 34% of men and 42% of women with hypertension (P<.001); 65% and 63% respectively, of those with diabetes (P=.626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P=.092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P<.001). The proportion of uncontrolled participants increased with coronary risk (P<.001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥ 10% coronary risk than to men (59% vs. 50%, P = 0,024). [corrected] CONCLUSIONS: The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.

Factores de riesgo cardiovascular en España en la primera década del siglo xxi: análisis agrupado con datos individuales de 11 estudios de base poblacional, estudio DARIOS / Cardiovascular risk factors in Spain in the first decade of the 21st century, a pooled analysis with individual data from 11 population-based studies: the DARIOS study

Introducción y objetivos. Analizar la prevalencia de factores de riesgo cardiovascular en personas de 35-74 años en 10 comunidades autónomas españolas y determinar el grado de variabilidad geográfica en la distribución de los factores de riesgo cardiovascular. Métodos. Análisis agrupado con datos individuales de 11 estudios desarrollados en la primera década del siglo xxi con un promedio de tasa de participación del 73%. Se midió el perfil lipídico (con validación cruzada de laboratorios), glucemia, presión arterial, perímetro de la cintura, peso y talla y se administraron cuestionarios estandarizados. Se estimó la prevalencia estandarizada a la población europea de tabaquismo, diabetes, hipertensión arterial, dislipemia y obesidad. Además, se estimó el coeficiente de variación entre estudios componentes en la prevalencia de cada factor de riesgo. Resultados. Se incluyó a 28.887 participantes. Los factores de riesgo cardiovascular más prevalentes fueron: hipertensión arterial (el 47% en varones y el 39% en mujeres), dislipemia con colesterol total >= 250 mg/dl (el 43 y el 40%), obesidad (el 29% en ambos sexos), tabaquismo (el 33 y el 21%) y diabetes mellitus (el 16 y el 11%). El colesterol total >= 190 y >= 250 mg/dl presentó el coeficiente de variación mínimo y máximo, respectivamente (el 7-24% en varones y el 7-26% en mujeres). La concordancia media en las determinaciones lipídicas entre laboratorios fue excelente. Conclusiones. La prevalencia de hipertensión arterial, dislipemia, obesidad, tabaquismo y diabetes mellitus, es elevada, con variabilidad relativamente baja en la población de 35 a 74 años entre comunidades autónomas. Canarias, Extremadura y Andalucía presentan mayor número de factores de riesgo cardiovascular significativamente más prevalentes que el promedio de los 11 estudios componentes (AU)

Introduction and objectives. To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spain's autonomous communities and determine the geographic variation of cardiovascular risk factors distribution. Methods. Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory cross-validation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor. Results. In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol >=250mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol >=190 and >=250mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent. Conclusions. Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies (AU)