Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

[Evaluation of the research performed in Spanish hospitals]. / Valoración de la investigación que se realiza en los hospitales españoles.

OBJECTIVES: No study that analyzes how the investigators who work in the Spanish hospitals perceived and evaluate the current research system has been performed. This work, carried out by the Scientific Forum of the Lilly Foundation, aims to improve the level of information on the research activity performed in the hospitals. SUBJECTS AND METHODS: By means of a «self-administered¼ interview made up of 34 items and aimed at physicians and other research professionals who work in the Spanish hospitals (272 surveyed), 3 questions were analyzed: a) general situation of biomedical research in Spain; b) administration of available resources: need for better resources, and c) evaluation and giving priority to biomedical research. RESULTS: The use of the data has shown strengths in the system such as the initiatives to promote research through contracts with FIS and post-residency (7.6/10 points); the beneficial effects of research and care quality (7.3/10); or support of the pharmaceutical industry through the sponsoring of clinical trials (6.9/10). However, it has also shown that there are some weaknesses in the organization of the centers, as for example, those referring to the differentiated allocation of the care cost of the research activity (5.1/10); to the coordination between them and the health care centers (2.8/10); to the integration and organization among care, teaching and research (3.6/10); and to decide the priorities (5.2/10) and evaluation (5.2/10) of the research activities. Furthermore, the value of the research as a fundamental activity of the hospitals is emphasized (4.7/10). CONCLUSIONS: The investigators surveyed consider that biomedical research in recent decades in the hospital setting has significantly improved and has had a positive effect in the number of publications. The subjects surveyed consider that research should have greater institutional support and recognition, and a more translational orientation, which would be translated into better quality of life of the citizens and registry of patents.

La medicina, una ciencia y un arte humanos / Medicine, a human science and art

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Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (II) micronutrient intake. Dieta y Riesgo de Enfermedades Cardiovasculares en España.

OBJECTIVE: To evaluate the dietary micronutrient intake in the adult Spanish population participating in the DRECE study. METHODS: The cross-sectional study was performed in two stages in 1991 and 1996 in 43 primary care clinics. One thousand two hundred people 'with cardiovascular risk' and 600 'without risk' answered a food frequency questionnaire. RESULTS: Significant increases in vitamin C, retinol, lycopenes, beta-cryptoxanthin and vitamin E intakes were found. Vitamin A, alpha-carotenoid and lutein intakes decreased. Vitamin B(12), B(6) and folic acid intakes increased in people with cardiovascular risk, whereas only the last two increased in the control group. Nearly 100% of the people consumed the recommended dietary allowances for vitamins B(12) and B(6) and >70% for folic acid. Calcium, iron, and zinc intake increased in both groups, but magnesium and selenium intake increased only in people at risk. Vitamin A, B(1) and zinc intakes have decreased, and >50% of the people do not consume the recommended dietary allowance. CONCLUSION: Antioxidant vitamins and vitamin B(12), B(6) and folic acid intakes seem to be adequate in the adult Spanish population, no significant differences appear regarding their cardiovascular risk status. Vitamin A, B(1) and zinc intakes are not appropriate.

Estudio DRECE: dieta y riesgo de enfermedades cardiovasculares en España. Hábitos alimentarios en la población española / DRECE Study: dietary habits and risk from cardiovascular diseases in Spain. Nutritional pattern, in the Spanish population

Antecedentes. Las tasas de mortalidad por enfermedades cardiovasculares en las poblaciones están íntimamente ligadas con los valores de lípidos sanguíneos, y éstos, a su vez, dependen de los hábitos alimentarios. En España, la alimentación ha cambiado notablemente en las últimas 3 décadas, orientándose hacia un patrón menos cardiosaludable. Nuestro objetivo fue estudiar los hábitos alimentarios de la población española y analizar la asociación con las concentraciones plasmáticas de lípidos. Población y métodos. En 1992 realizamos un estudio epidemiológico transversal (estudio DRECE) a partir de una muestra representativa de la población española, con la finalidad de estudiar los hábitos alimentarios y los factores de riesgo cardiovasculares. Participaron 4.787 individuos de ambos sexos, con edades entre 5 y 59 años, seleccionados aleatoriamente por todo el territorio nacional. A todos los sujetos se les realizó una encuesta validada de frecuencias de consumo alimentario semicuantitativo y se procedió a una extracción de sangre para determinación de diferentes parámetros lipídicos (colesterol total, triglicéridos, colesterol unido a lipoproteínas de alta densidad [cHDL]), colesterol unido a lipoproteínas de baja densidad [cLDL]). A partir del cuestionario alimentario se estima la energía y los siguientes macronutrientes: hidratos de carbono, proteínas, grasas totales, grasas saturadas, grasas monoinsaturadas, grasas poliinsaturadas, colesterol dietético, fibra, alcohol y cálculo del índice colesterol grasa-saturada (expresados en g/día, porcentajes o ajustados/1.000 kcal). Todos los datos se muestran de manera descriptiva para la totalidad de la población española o siguiendo la distribución por ocho grandes regiones: noreste (Cataluña, Aragón, Baleares); norte (País Vasco, Navarra, Rioja, Cantabria); noroeste (Galicia, Asturias); Castilla-León; centro-sur (Madrid, Castilla-La Mancha, Extremadura), Levante (Valencia, Murcia), Andalucía y Canarias. Por último, se estudia la correlación entre los parámetros lipídicos y los nutrientes grasas totales, grasas saturadas, colesterol e índice colesterol-grasa saturada para las regiones analizadas. Resultados. El consumo promedio de grasas saturadas (14 por ciento) y de colesterol dietético (514 mg/día) de la población española sobrepasa las recomendaciones de una dieta prudente. El mayor consumo de grasas saturadas y colesterol corresponde principalmente a las regiones de Levante y Andalucía, siendo Castilla-León la comunidad con los valores más bajos. Las concentraciones de cLDL y triglicéridos son igualmente elevadas en las comunidades de Levante, Andalucía y Canarias. Existe una correlación positiva y significativa entre las grasas totales, grasas saturadas, índice de colesterol-grasas saturadas, colesterol dietético con el colesterol total. Además el índice colesterol-grasa saturada se correlaciona positivamente con las concentraciones de cLDL y triglicéridos, mientras que la correlación es negativa con las concentraciones de cHDL, para el conjunto de las 8 regiones estudiadas. Conclusiones. Los resultados de este estudio ponen de manifiesto una asociación entre ingestión de grasas saturadas y colesterol dietético con las concentraciones plasmáticas de lípidos en diferentes regiones españolas (AU)

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (I). Diet and Cardiovascular Events Risk in Spain.

BACKGROUNDS/AIMS: To investigate dietary habits and their evolution with regard to cardiovascular risk status in Spain. METHODS: Cross-sectional study performed in two phases in 1991 and 1996 in 43 primary care clinics. One thousand and two hundred people classified as 'with cardiovascular risk' and 600 'without risk' were studied. Each participant answered a food frequency questionnaire. RESULTS: The risk group did not change oil, cereals and dairy products consumption, decreased egg, legume and meat, and increased fish, fruits and vegetables intake. The control group differed in increasing dairy products and not decreasing eggs and vegetables consumption. A small decrease in energy intake happened, from 11,315. 1 to 10,941.5 kJ in the risk group (p < 0.05). Carbohydrates intake showed a not statistically significant falling trend from 41.3 to 40.6% in people at risk and 41.8 to 40.7% in those without risk. Protein intake increased in both groups up to 16.5% and fat consumption kept at around 42.9% in both groups. The decrease in saturated fat and increase in polyunsaturated fat were statistically significant in people at risk (p = 0.000). High cholesterol intakes were found. CONCLUSION: People with cardiovascular problems changed their dietary habits in a 'healthier' way than people without risk.

[Diet and cardiovascular risk in Spain. Description of the evolution of cardiovascular prolile]. / Dieta y riesgo cardiovascular en España (DRECE II). Descripción de la evolución del perfil cardiovascular.

BACKGROUND: To describe the evolution of cardiovascular profile in a sample of the Spanish general population. PATIENTS AND METHODS: Study cohort of 1,800 subjects from the Diet and Cardiovascular Risk in Spain study (DRECE I) with and without cardiovascular risk according to Spanish Society of Arteriosclerosis guidelines (CRSSA) followed during five years. RESULTS: Mean follow up was 4.8 years. High blood pressure (>= 140/90 mmHg), total cholesterol > 200 mg/dl, triglycerides > 150 mg/dl and HDLc < 35 mg/dl were present in a 55.6, 85.8. 42.9 and 13.4%, respectively of the individuals with CRSSA. A 31% of those without CRSSA developed hypercholesterolemia and a 11.5% hypertension. Stroke, transient isquemic attack, angor and acute myocardial infarction appeared in 4, 3, 12 and 12 cases in the group with CRSSA and 5, 0, 1 and 1 in the grup without CRSSA. The incidence of acute myocardial infarction was 3.3 and 1.2/1,000 persons-year in the groups with/without CRSSA, respectively. Triglycerides were associated to the presence of acute myocardial infarction (OR = 10.08; IC95%; 2.1-46.4). CONCLUSIONS: There is a worsening of the cardiovascular risk profile in the cohort. Individuals with CRSSA have a worse cardiovascular risk profile than those without CRSSA. The cardiovascular risk factors tend to be grouped in the same subjects.

[Lipid profile of the Spanish population: the DRECE (diet and risk of cardiovascular disease in Spain) study. DRECE study group]. / Perfil lipídico de la población española: estudio DRECE (Dieta y Riesgo de Enfermedad Cardiovascular en España). Grupo de estudio DRECE.

BACKGROUND: In Spain the mortality rate due to cardiovascular disease (CVD) is relatively low compared to that of other developed countries. Until now few epidemiological studies have been performed among the global Spanish population to evaluate a relation between CVD risk factors and the lipid profile that could justify our privileged situation. For, this reason, the DRECE study was designed to know the situation at present in Spain respect to the risk of suffering from CVD in particular, the lipid profile. POPULATION AND METHODS: This study included 4,787 subjects (2,324 males and 2,463 females) with an age ranging from 5-60 years, representative of the total Spanish population with these characteristics during the period from 1992 to 1994. Medical history was made for all participants, who also underwent a physical examination. The following parameters were determined: total cholesterol (TC), triglycerides, high-density lipoproteins cholesterol HDLc, cholesterol transported by low-density lipoproteins, LDLc (estimated by the Friedewald's formula), apolipoprotein AI and apoliprotein B (immunoturbidimetry). RESULTS: The results obtained and expressed in mean (SD) show that, although the population has total cholesterol concentrations (190.1 [42.4] and 192.8 [44.8] mg/dl for females and males, respectively) and LDLc (113.9 [37.9] and 117.5 [38.1] mg/dl for females and males, respectively) with values as high as those found in developed countries, the HDLc concentrations (58.6 [13.2] and 51.5 [13.4] mg/dl for women and men, respectively) are also increased and this could be the reason why the mortality rate in Spain caused by CVD is lower than in other countries. CONCLUSIONS: The finding of high HDLc levels and their antiatherogenic role could justify that, at best in part, the rate mortality in Spain is lower than in other developed countries.

What food for the heart?

The relationship between food intake and cardiovascular disease is discussed with particular reference to the consumption of saturated fats. The education of the general public on this and related matters is vitally important.

[The polymetabolic syndrome. The experiences of the DRECE study. Dieta y Riesgo de Enfermedades Cardiovasculares en España]. / Síndrome polimetabólico. Experiencias del estudio DRECE.

Different risk factors frequent in NIDDM predispose to suffer an early atherosclerosis. Among these and beside lipidic disorders (hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol levels), hyperinsulinemia and/or insulin resistance, obesity and arterial hypertension are placed. In Spain, 135,000/year deaths from cardiovascular diseases (42% of total deaths) are produced. To plan a preventive strategy requires the knowledge and previous analysis among the population of the situation with regard to risk factors. In order to know in Spain the actual prevalence of cholesterol and other lipidic fractions and their relationship with different dietetic habits and other cardiovascular risk factors, a study on "Diet and Cardiovascular Risk Diseases in Spain": DRECE, was performed. Remains to be explained in the mediterranean countries the low incidence of coronary morbid/mortality, in spite of a high fat consume and cholesterol levels. In this direction, the role of a few micronutrients and other common elements in our diet, some of them with antioxidant properties, may have as protector agents in the atherosclerotic ischemic heart disease process, acquires interest.

Acetylated low-density lipoproteins promote the release and metabolism of arachidonic acid by murine macrophages.

We studied the effect of acetyl-LDL on the synthesis of eicosanoids by primary cultures of mouse-resident peritoneal macrophages. A dosis of 150 micrograms of acetyl-LDL proteins promotes a maximal release of arachidonic acid metabolites into extracellular medium. This process is very rapid and reaches the maximal value about ten minutes after stimulation. The pattern of arachidonic acid metabolites released is different from that obtained when the cells are stimulated with a phagocytosable particle like zymosan or calcium ionophore A23187. The data show that the metabolism of arachidonic acid by cycloxigenase is diminished. In an unusual way the amounts of prostaglandin PGE2, 6-keto-prostaglandin PGF1 alpha and thromboxane TXB2 synthesized are similar.

[Lipoprotein Lp(a): a risk factor for atherosclerosis]. / Lipoproteína Lp(a): factor de riesgo para la aterosclerosis.

To evaluate whether lipoprotein Lp(a) favors the development of coronary atherosclerosis and may be considered as a risk factor for acute myocardial infarction, we studied 185 patients with this conditions who where compared with a control group. Total cholesterol and cholesterol bound to the several lipoprotein fractions were simultaneously evaluated. Comparisons were carried out, the subjects being subdivided into age groups of 40-49, 50-59 and more than 60 years; they were also subdivided depending on the level of Lp(a) cholesterol (lower than 25 mg/dl, between 25 and 50 mg/dl and higher than 50 mg/dl). Lp(a) appeared as indicative of a vascular risk in the younger groups. The incidence of myocardial infarction was higher when Lp(a) level was greater than 50 mg/dl.

Concentration of clofibric acid in blood after the administration of delayed-release form of etofibrate.

The clofibric acid levels in blood are studied after the oral administration of 500 mg of etofibrate given as a unique dose in three different delayed-release tablets. These are enteric-coated, obtained by granule compression. An inert matrix containing the drug is the basis of these granules, differentiated by their granulometry and the chemical treatment applied. One of the three tablets presents a very interesting KE, which permits the substitution of three intakes throughout the day by only one dose daily.