Características clínicas y pronóstico de pacientes con enfermedad cerebrovascular crónica (estudio ICBAR) / Clinical features and prognosis of patients with chronic cerebrovascular disease (ICBAR study)

Introducción. Los pacientes con enfermedad cerebrovascular (ECV) son un grupo de muy alto riesgo cardiovascular, ademásde por su propia patología vascular, probablemente por un inadecuado control de factores de riesgo y por la presencia de comorbilidades.Pacientes y métodos. Estudio multicéntrico, con participación de 34 médicos de atención primaria y registro de característicasde 473 pacientes con historia de episodio de ECV que precisó hospitalización. Tras seguimiento clínico de la cohorte, se analizaron reingresos hospitalarios, mortalidad y causas. Resultados. La edad media de los pacientes (el 52% varones) fue de 75 ± 10 años, y los factores de riesgo más prevalentesfueron hipertensión arterial (79%), dislipidemia (66%), obesidad (43%) y diabetes (29%). El 68% de los pacientes tenía diagnóstico de ictus y el 32%, de ataque isquémico transitorio. El tiempo medio transcurrido desde el primer episodio de ECV fue de 6,6 ± 5,5 años. Presentaban situación de dependencia el 29% y sólo un tercio mostraron buen control tensionaly lipídico. Durante un seguimiento de 8,2 ± 2,3 meses, el 7,2% de los pacientes sufrió algún episodio cardiovascular (muerte u hospitalización), del que resultaron determinantes independientes la insuficiencia cardíaca previa (hazard ratio, HR = 2,74; intervalo de confianza del 95%, IC 95% = 1,3-5,9), la miocardiopatía (HR = 3,32; IC 95% = 1,4-8,2), laanemia (HR = 3,09; IC 95% = 1,6-6,2), la insuficiencia renal (HR = 2,4; IC 95% = 1,0-5,6), la situación de dependencia (HR = 2,57; IC 95% = 1,3-5,7) y los ingresos cardiovasculares en el último año (HR = 3,05; IC 95% = 1,5-5,6).Conclusiones. Los pacientes con ECV seguidos en el ámbito de atención primaria presentan una prevalencia elevada y un escaso grado de control de hipertensión arterial. Su pronóstico está condicionado por comorbilidades cardiovasculares ysecuelas de su patología cerebrovascular (AU)

Introduction. Patients with cerebrovascular disease (CVD) are a group with a very high cardiovascular risk, in addition tothat arising from their own vascular pathology, probably due to an inadequate control of risk factors and owing to the presence of comorbidities. Patients and methods. This research consisted in a multi-centre study involving the collaboration of 34 primary carephysicians and recording of the features of 473 patients with a previous history of a CVD event that required hospitalisation.After a clinical follow-up of the cohort, hospital readmissions, mortality and causes were analysed.Results. The mean age of patients (52% males) was 75 ± 10 years and the most prevalent risk factors were arterial hypertension (79%), dyslipidaemia (66%), obesity (43%) and diabetes (29%). Sixty-eight per cent of patients had been diagnosed with stroke and 32% with transient ischaemic attack. The mean amount of time elapsed since the first CVDevent was 6.6 ± 5.5 years. Twenty-nine per cent of patients had a situation of dependence and only one third showed good blood pressure and lipid control. During a follow-up lasting 8.2 ± 2.3 months, 7.2% of patients suffered some kind of cardiovascular event (death or hospitalisation), which independent determinants were found to be previous heart failure (hazard ratio, HR = 2.74; 95% confidence interval, CI 95% = 1.3-5.9); cardiomyopathy (HR = 3.32; CI 95% = 1.4-8.2); anaemia (HR = 3.09; CI 95% = 1.6-6.2); renal failure (HR = 2.4; CI 95% = 1.0-5.6); the situation of dependence (HR = 2.57; CI 95% =1.3-5.7) and cardiovascular admissions over the past year (HR = 3.05; CI 95% = 1.5-5.6).Conclusions. Patients with CVD followed up in the area of primary care present a high prevalence of arterial hypertension and little is done to control it. Their prognosis is conditioned by cardiovascular comorbidities and sequelae of their cerebrovascular disease (AU)

Tobacco consumption and oral and pharyngeal cancer in a Spanish male population.

The incidence of oral and pharyngeal cancer in Spain is among the highest in Europe. A hospital-based case-control study was carried out in NW Spain to investigate the role of tobacco. The study included 92 incident male cases and 230 male controls. Tobacco smoking was strongly associated with oral and pharyngeal cancer (OR(ever smokers)=27.7). The risk for black tobacco (OR=33.1) was approximately double that of blond tobacco (OR=15.4). Alcohol drinking increased the risk posed by tobacco consumption. Risks were significantly lower for subjects that started smoking later and was significantly reduced after 10 years of leaving the habit.

CYP1A1, mEH, and GSTM1 Polymophisms and Risk of Oral and Pharyngeal Cancer: A Spanish Case-Control Study.

Background. Genetic polymorphisms of drug metabolizing enzymes involved in the detoxification pathways of carcinogenic substances may influence cancer risk. Methods. Case-control study that investigates the relationship between CYP1A1 Ile/Val, exon 4 mEH, and GSTM1 null genetic polymorphism and the risk of oral and pharyngeal cancer examining the interaction between these genes, tobacco, and alcohol. 92 incident cases and 130 consecutive hospital-based controls have been included. Results. No significant associations were found for any of the genotypes assessed. The estimated risk was slightly elevated in subjects with the wild type of the mEH gene and the null GSTM1 genotype. For exon 4 mEH heterozygous polymorphism, the risk was slightly lower for heavy smokers than for light smokers. The inverse association was observed for the GSTM1 null genotype. Conclusions. The results suggest that exon 4 mEH and GSTM1 null polymorphisms might influence oral and pharyngeal cancer.

[Mortality by cause of death in the province of A Coruña: geographic distribution of age-adjusted rates, from 1961 to 1970 and 1971 to 1980]. / La mortalidad causal en la provincia de A Coruña: una distribución geográfica de las tasas ajustadas por edad, durante los decenios 1961-1970 y 1971-1980.

We have studied mortality due to general causes and to eight groups of causes (CIE-WHO) in 28 Basic Areas or parishes of the province of A Coruña (Galicia, Spain). We have calculated the direct adjusted rates for men and women, in 1961-1970 and 1971-1980, and we have compared them with the respective provincial rates, thereby identifying areas with excess or infra-mortality. We have found a decrease of general mortality between the two decades, larger in the case of women (4.5%) than in the case of men (0.9%), as well as an increase in the cardiovascular mortality (12% in men and 6% in women) and in mortality due to accidents (41.77% and 45.11% respectively). The rate of neoplasias in men has increased (7.62%) but decreased in women (2.32%). We have examined the geographical distribution criteria for tumoral rates and for accidents in areas which are mainly urban (men and women) and for cardiovascular rates in rural areas (for women, especially).

[2 methods for the study of differential mortality based on sex: rates ratio and orthogonal regression]. / Dos métodos de estudio de la mortalidad diferencial según sexo: la razón de tasas y la regresión ortogonal.

Sex mortality differential is studied for all the causes of death, in La Coruña (Galicia, Spain), according to geographic area, zone (urban, semiurban and countryside) and decade (1961-1970 y 1971-1980). Two study methods are compared: a) Rate ratio (with direct age-adjusted rates); and b): Differential (Dj) between observed rate (M) and expected rate (M), for male mortality, according to female level (orthogonal regression model). t-Student-Fisher tests have been used to compare an observed mean and a theoretic one, and to compare two observed means, with independent data. An increase in male overmortality is found, from one to the other decade (112.9% to 117.0%), confirmed by orthogonal method: respectively 5.38 deaths every 100,000 and 16.81 deaths. This over-mortality is more frequent in the urban areas, while inframortality appears mainly in countryside areas. Furthermore, male overmortality increases in urban zones and decreases in semiurban and rural zones.