Framingham risk score for prediction of cardiovascular diseases: a population-based study from southern Europe.

BACKGROUND: The question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity. METHODS: The cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated. RESULTS: The mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (P<0.001, both). Cardiovascular disease events occurred in the top risk tertiles. Of note were the negative predictive values in both sexes, and a good specificity in women (85.6%) and sensitivity in men (79.1%) when their risk for cardiovascular disease was high. This model overestimates the risk in older women and in middle-aged men. The cumulative probability of individual survival by tertiles was significant in both sexes (P<0.001). CONCLUSIONS: The results support the proposal for "reclassification" of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe.

[Association of insulin resistance to different anthropometric measures and cardiovascular risk factors in a non-diabetic population]. / Relación de la resistencia a la insulina con diferentes medidas antropométricas y factores de riesgo cardiovascular en una población no diabética.

BACKGROUND AND OBJECTIVE: Insulin resistance (IR) has been directly related to obesity, particularly central obesity, and to other cardiovascular risk factors (CVRFs). Direct IR quantification is difficult in clinical practice, and indirect methods such as HOMA (homeostasis model assessment) have therefore been developed. The aim of this study was to assess the association of IR, as measured by HOMA, with different anthropometric measures and some CVRFs. MATERIALS AND METHODS: A cross-sectional, observational study was carried out in a general population sample older than 18 years in the province of Albacete, Spain. Sample size was 678 subjects. Participants completed a survey and underwent physical examinations and laboratory tests. Obesity measures included body mass index, waist perimeter, and sagittal abdominal diameter. Data analysis was performed using SPSS 15.0 software. RESULTS: Mean values of obesity measures were higher in males as compared to females and increased with age. IR prevalence was 39.8%. All assessed anthropometric measures, decreased HDL (high density lipoprotein) cholesterol and increased non-HDL cholesterol were independently associated to the risk of IR. CONCLUSIONS: A clear association exists between different anthropometrical measures and IR in the general population. There is also an association between lipid profile cahnges and the risk of experiencing IR.

[Trends in prevalence of risk factors and global cardiovascular risk in general population of albacete, Spain (1992-94 a 2004-06)]. / Evolución de la prevalencia de los factores de riesgo y del riesgo cardiovascular global en población mayor de 18 años de la provincia de Albacete (1992-94 a 2004-06).

BACKGROUND: To establish strategies for prevention of cardiovascular disease implies to know its epidemiology and evolution in time. The objective of this study is to know the prevalence of risk factors and cardiovascular risk in two moments during the following of a grownup general population. METHODS: Study of cohorts, followed at random selected general population during 12 years (1992-94 to 2204-06). Two transversal studies were made, one at the beginning and the other one at the end of this follow-up. The population in this study was 18 years and older registered in the province of Albacete. Random sampling, stratified and two-stage. The sample size for the first cut was 2121 subjects and for second one 1577. One specific anamnesis was made, physical examination, measurement of blood pressure, electrocardiogram and extraction of venous blood. The studied variables were: age, sex, personal and familiar antecedents, risk factors and global cardiovascular risk. RESULTS: 1322 subjects went to the appointment for the first examination (mean age 48.2 years. 53.6% women) and 997 for the second (mean age 52.8 years. 56.7% women). Has Increased the prevalence of hypertension (32.7% to 41,2%), diabetes (9,8 to 11,4%), obesity (27,8 to 34,3%) and hypercolesterolemia (47,5 to 53,5%), whereas smokers have decreased (32,6 to 23,7%) and have handicapped the average values of arterial pressure (132/81 to 129/73 mmHg), glycaemia (100,8 to 92,8 mg/dl) and LDL-cholesterol (128,7 to 116,7 mg/dl) and also a lowering of cardiovascular risk with Framingham (10,8% to 8,2%) and Score (2,3% to 1,6%). CONCLUSIONS: In the last years an increasing prevalence of risk factors has been seen (hypertension, diabetes and hypercolesterolemia), a better control of them, and lower prevalence of smoking and cardiovascular risk in the population has also be seen.

Evolución de la prevalencia de los factories de riesgo y del riesgo cardiovascular global en población mayor de 18 añor de la provincia de Albacete (1992-94 a 2004-06) / Trends in prevalence of risk factors and global cardiovascular risk in general population of Albacete, Spain (1992-94 a 2004-06)

Fundamento: Establecer estrategias de prevención de la enfermedad cardiovascular implica conocer su epidemiología y evolución en el tiempo. El objetivo del estudio es conocer las prevalencias de los factores de riesgo y del riesgo cardiovascular en dos momentos de seguimiento de una población general adulta. Métodos: Dentro de un estudio longitudinal y prospectivo con población general seleccionada al azar seguida durante 12 años (1992-94 a 2004-2006) se hacen dos análisis trasversales al inicio y en el último corte de seguimiento. La población objeto de estudio fueron personas mayores de 18 años censadas en la provincia de Albacete. Muestreo aleatorio, estratificado y bietápico. Tamaño muestral 2.121 y 1.577 sujetos en cada uno de los cortes. Se hizo anamnesis, exploración física, medida de presión arterial, electrocardiograma y extracción de sangre venosa. Las variables estudiadas fueron: edad, sexo, antecedentes personales y familiares, factores de riesgo y riesgo cardiovascular global. Resultados: En el primer examen acudieron a la cita 1.322 sujetos (edad media 48,2 años. 53,6% mujeres) y 997 en el segundo (edad media 52,8 años. 56,7% mujeres). Hubo un aumento en la prevalencia de hipertensión (32,7% a 41,2%) diabetes mellitus (9,8 a 11,4%), obesidad (27,8 a 34,3%) e hipercolesterolemia (47,5 a 53,5%), una disminución de fumadores (32,6 a 23,7%), de valores medios de presión arterial (132/81 a 129/73 mmHg), glucemia (100,8 a 92,8 mg/dl) y col-LDL (128,7 a 116,7 mg/dl) y un descenso del riesgo cardiovascular con Framingham (10,8% a 8,2%) y Score (2,3% a 1,6%). Conclusiones: En los últimos años se observa un aumento en la prevalencia de factores de riesgo (hipertensión, diabetes e hipercolestrerolemia), un mejor control de los mismos, una menor prevalencia de fumadores y menor riesgo cardiovascular en la población(AU)

Background: To establish strategies for prevention of cardiovascular disease implies to know its epidemiology and evolution in time. The objective of this study is to know the prevalence of risk factors and cardiovascular risk in two moments during the following of a grownup general population. Methods: Study of cohorts, followed at random selected general population during 12 years (1992-94 to 2204-06). Two transversal studies were made, one at the beginning and the other one at the end of this followup. The population in this study was 18 years and older registered in the province of Albacete. andom sampling, stratified and two-stage. The sample size for the first cut was 2121 subjects and for second one 1577. One specific anamnesis was made, physical examination, measurement of blood pressure, electrocardiogram and extraction of venous blood. The studied variables were: age, sex, personal and familiar antecedents, risk factors and global cardiovascular risk. Results: 1322 subjects went to the appointment for the first examination (mean age 48.2 years. 53.6% women) and 997 for the second (mean age 52.8 years. 56.7% women). Has Increased the prevalence of hypertension (32.7% to 41,2%), diabetes (9,8 to 11,4%), obesity (27,8 to 34,3%) and hypercolesterolemia (47,5 to 53,5%), whereas smokers have decreased (32,6 to 23,7%) and have handicapped the average values of arterial pressure (132/81 to 129/73 mmHg), glycaemia (100,8 to 92,8 mg/dl) and LDL-cholesterol (128,7 to 116,7 mg/dl) and also a lowering of cardiovascular risk with Framingham (10,8% to 8,2%) and Score (2,3% to 1,6%). Conclusions: In the last years an increasing prevalence of risk factors has been seen (hypertension, diabetes and hypercolesterolemia), a better control of them, and lower prevalence of smoking and cardiovascular risk in the population has also be seen(AU)

[Current situation of hypertensive patients over 75 years old: the DISEHTAE study]. / Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE.

OBJECTIVE: To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. DESIGN: Descriptive, multi-centre study, covering the whole of Spain. SETTING: A total of 107 health centres from 14 autonomous communities. PARTICIPANTS: Hypertensive patients over 75: 1,369 clinical charts. INTERVENTIONS AND MAIN MEASUREMENTS: The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. RESULTS: The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. CONCLUSIONS: Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients.

Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE / Current situation of hypertensive patients over 75 years old. The DISEHTAE study

Objetivo. Valorar, en el paciente mayor de 75 años, el grado de cumplimiento de las recomendaciones de seguimiento, control y tratamiento de la hipertensión arterial. Diseño. Estudio descriptivo, multicéntrico, de ámbito nacional. Emplazamiento. Ciento siete centros de salud de 14 comunidades autónomas de España. Participantes. Un total de 1.369 historias clínicas de pacientes hipertensos mayores de 75 años. Intervenciones y mediciones principales. Las variables estudiadas fueron edad y sexo, lugar de seguimiento, cifras de presión arterial, cribado y diagnóstico de diabetes, hipercolesterolemia, hábito tabáquico, hipertrofia ventricular izquierda y obesidad. También se estudiaron la creatinina plasmática, proteinuria, tratamiento farmacológico prescrito y variables de infraestructura. Resultados: El factor de riesgo cardiovascular más cribado fue la obesidad (76,1%), mientras que el más prevalente fue la hipercolesterolemia (31,3%). El 25,5% de los pacientes presentaba diabetes asociada, y el 48,5% de la muestra presentaba un índice de masa corporal (IMC) superior a 25. Se observó un bajo cribado de la microalbuminuria (8,4%). La proporción de pacientes con la presión arterial controlada es mayor entre los que se siguen en atención primaria, con un 32,8%, respecto a los seguidos fuera del ámbito de la atención primaria, con un 23,2%. A un 7,9% no se le había prescrito tratamiento farmacológico alguno, únicamente medidas higiénico-dietéticas. El grupo farmacológico más utilizado fueron los diuréticos, seguidos de inhibidores de la enzima conversiva de la angiotensina (IECA) y antagonistas de los receptores de la angiotensina II (ARA II). Conclusiones: Se puede llegar a la conclusión de que el grado de control de la hipertensión arterial en el paciente anciano va aumentando de forma progresiva, pero aún está muy lejos de lograrse un control óptimo en la mayoría de los pacientes

Objective. To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. Design. Descriptive, multi-centre study, covering the whole of Spain. Setting. A total of 107 health centres from 14 autonomous communities. Participants. Hypertensive patients over 75: 1369 clinical charts. Interventions and main measurements. The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. Results. The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. Conclusions. Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients

Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample.

BACKGROUND AND AIM: The ankle-brachial index (ABI) is being used increasingly to diagnose peripheral arterial disease (PAD) that predicts cardiovascular morbidity and mortality. The aim of this study is to determine the prevalence of PAD and associated risk factors in a Spanish random population sample of age > or =40. METHODS AND RESULTS: PAD is defined as an ABI<0.9 in either leg. 784 participants of age > or =40 were randomly selected in a Spanish province. 55.4% of them were female. The prevalence of PAD in this sample was 10.5% (95% confidence interval (CI) 8.4-12.8); 9.7% in females and 11.4% in males. In logistic regression analyses, adjusted for age and gender, smoking per 10 pack-years (odds ratio (OR) 1.40, 95% CI 1.23-1.58), hypertension (OR 1.85, 95% CI 1.05-3.28), hypercholesterolemia (OR 1.76, 95% CI 1.04-2.98), and diabetes (OR 1.80, 95% CI 1.04-3.11) were positively associated with prevalent PAD. More than 91% of persons with PAD had one or more cardiovascular disease risk factors. CONCLUSIONS: We conclude that in our study hypertension, hypercholesterolemia, diabetes mellitus and smoking are associated with PAD. The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment.