[Cardiovascular risk factor progression in young males at 15-year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study]. / Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA).

INTRODUCTION AND OBJECTIVES: The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. METHODS: In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. RESULTS: In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m(2), cholesterol +68.0 mg/dL, HDL cholesterol -5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. CONCLUSIONS: Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups.

Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA) / Cardiovascular risk factor progression in young males at 15-Year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study

Introducción y objetivos. La cohorte AGEMZA son varones militares cuyos factores de riesgo fueron estudiados en 1985 a la edad de 20 años. A la edad de 35 años se estudian la antropometría, los lípidos y la presión arterial y se investiga su estabilidad, sus cambios y la interdependencia en su evolución. Métodos. En 2000, se obtuvieron datos (encuesta transversal) que se compararon con los originales: índice de masa corporal (IMC), colesterol y sus fracciones, triglicéridos y presiones arteriales. La persistencia o tracking se evalúa mediante el coeficiente de regresión estandarizado y la permanencia en quintiles. Se crearon modelos de regresión multivariante para los datos actuales. Resultados. Tras estudiar a 250 sujetos, se observaron modificaciones significativas de los siguientes factores: peso, +12,1 kg; IMC, +3,9 kg/m², colesterol, +68,0 mg/dl; colesterol unido a lipoproteínas de alta densidad, -­5,2 mg/dl; colesterol unido a lipoproteínas de baja densidad (cLDL), +57,9 mg/dl, y triglicéridos, +76,3 mg/dl. Todos los factores presentaron una persistencia elevada, excepto la presión arterial diastólica. Es más pronunciada la persistencia de IMC, colesterol y cLDL. Estos cambios suponen un peor riesgo cardiovascular independientemente de la diferente edad. El perfil de lípidos se vio influido por el incremento del IMC experimentado y los valores de presión arterial por el IMC alcanzado. Ser fumador activo también se asoció a peores valores de las fracciones de colesterol y triglicéridos. Conclusiones. Durante la tercera década de la vida los factores de riesgo cardiovascular se incrementan. Estudios precoces (en la postadolescencia) permiten identificar sujetos con mayor riesgo posterior. Se constató la influencia en el perfil final de circunstancias modificables (incremento ponderal, tabaquismo). Es razonable planificar medidas preventivas orientadas a estos colectivos

Introduction and objectives. The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. Methods. In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. Results. In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m², cholesterol +68.0 mg/dL, HDL cholesterol ­-5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. Conclusions. Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups

Temas de actualidad en cardiología preventiva: el síndrome metabólico / Current Topics in Cardiovascular Prevention: the Metabolic Syndrome

Se citan los principales ensayos clínicos en prevención cardiovascular concluidos en el último año. Se revisan el concepto y la fisiopatología del síndrome metabólico, su prevalencia en nuestro medio, los medios diagnósticos más adecuados y la necesidad de establecer medidas preventivas (AU)

This paper refers to the main clinical trials in cardiovascular prevention in the previous year. Further, it reviews the concept and pathophysiology of metabolic syndrome, its prevalence in our setting, the most appropriate diagnosis and the need to establish preventive measures (AU)

Introducción: Síndrome Metabólico: retos y esperanzas / No disponible

No disponible

Prevención y tratamiento del síndrome metabólico / Metabolic syndrome: prevention and treatment

La prevención de SM debe basarse esencialmente en la adopción de medidas generales destinadas a controlar el peso, por medio de la dieta adecuada, con una composición equilibrada de hidratos de carbono complejos, proteínas, grasas, fibra y micronutrientes. La dieta mediterránea, rica en verduras y frutas, hidratos de carbono complejos, pescados, y aceite de oliva y antioxidantes, muestra unas características apropiadas para la prevención del SM. Se debe recomendar una actividad física, acorde con la edad, el sexo y demás características de cada caso. Todas estas medidas deben establecerse desde la infancia y la adolescencia, dado el incremento importante de la prevalencia de la obesidad infantil y juvenil. El tratamiento del SM se basa también en las medidas generales de dieta y actividad física. No obstante, más de la mitad de los pacientes con SM necesita, además, tratamiento farmacológico, ya que la reducción ponderal y el aumento de la actividad física no consiguen el control conveniente de los factores de riesgo cardiovascular. En el tratamiento antihipertensivo, tanto los inhibidores de la enzima de conversión de la angiotensina como los antagonistas de los receptores de la angiotensina II mejoran la resistencia insulínica y previenen el deterioro vascular y renal. El tratamiento antidiabético con metformina, glitazonas y acarbosa, cuando estén indicados, induce mejoría, tanto del perfil glucémico como de la resistencia insulínica. Son vías prometedoras abiertas a la investigación en el tratamiento del SM tanto los receptores activados de los proliferadores de los peroxisomas, como los inhibidores de los receptores endocanabinoides (AU)

The prevention of metabolic syndrome must be based on the implementation of lifestyle modifications. The aim is to control weight by the adoption of an appropriate diet comprising a good balance of complex carbohydrates, proteins, fats, fiber, and micronutrients. The Mediterranean diet, being rich in vegetables, fruit, complex carbohydrates, fish, olive oil and antioxidants, has characteristics suited to the prevention of metabolic syndrome. Physical exercise, adapted to the individual’s age, sex and other characteristics, is also important. Given the significant increase in obesity in children and adolescents, all these measures must be implemented in these age groups. The treatment of metabolic syndrome is also based on these lifestyle changes involving weight control, diet and physical exercise. However, more than 50% of patients with metabolic syndrome require additional pharmacological measures to control the cardiovascular risk factors associated with the condition. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists which are indicated for the control of hypertension, decrease insulin resistance and prevent the progression of renal and vascular dysfunction. When appropriate, antidiabetic treatment with metformin, glitazone, or acarbose can bring about an improvement in glycemia as well as a decrease in insulin resistance. Promising future treatments for metabolic syndrome and the control of fatty acid metabolism include peroxisome proliferator-activated receptor activators and rimonabant, an endocannabinoid receptor inhibitor (AU)