Cardiovascular risk in subjects over 55 years of age and cognitive performance after five years. NEDICES2-RISK study. Study protocol.

BACKGROUND: Cognitive impairment and dementia have a high prevalence among the elderly and cause significant socio-economic impact. Any progress in their prevention can benefit millions of people. Current data indicate that cardiovascular risk (CVR) factors increase the risk of developing cognitive impairment and dementia. Using models to calculate CVR specific for the Spanish population can be useful for estimating the risk of cognitive deterioration since research on this topic is limited and predicting this risk is mainly based on outcomes in the Anglo-Saxon population. The aim of this study is to assess the relationship between CVR in the Spanish population, as calculated using the FRESCO (Función de Riesgo Española de acontecimientos Coronarios y Otros) and REGICOR (Registre Gironí del Cor) CVR tables, and the change in cognitive performance at a 5-year follow-up. METHODS: Design: Observational, analytic, prospective cohort study, with a 5-year follow-up. Ambit: Population. Population: Subjects 55 to 74 years of age, included in the NEDICES2 (2014-2017) cohort, who did not present dementia and had undergone the neuropsychological evaluation (N = 962). Variables: Exposure factors (CVR factors and estimated risk according to the CVR predictors by REGICOR and FRESCO), dependent variables (change in the score of the brief neuropsychological test in the study NEDICES2 five years after the first evaluation), and clinical and socio-demographic variables. Statistical analysis: Analysis of data quality. Descriptive analysis: socio-demographic and clinical variables of subjects. Bivariate analysis: relationship between basal CVR and change in neuropsychological tests. Multivariate analysis: relationship between basal CVR and change in neuropsychological tests adjusted by co-variables. Analysis and comparison of the reliable change in independent samples. DISCUSSION: The Spanish population can benefit from determining if individuals with high CVR, which is commonly detected in usual clinical practice, will present decreased cognitive performance compared to subjects with lower CVR. This study can affect how to address CVR factors and the design of effective prevention strategies for cognitive deterioration. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03925844.

Incidence of type 2 diabetes in the elderly in Central Spain: Association with socioeconomic status, educational level, and other risk factors.

AIMS: To analyze the incidence of type 2 diabetes (T2D) in Central Spain and its association with the socioeconomic status (SES), educational level, and other risk factors (RF) in the elderly population of three communities. METHODS: Data for 5278 elderly participants (≥65 years old) were obtained using a census population-based survey. There was a first and a second survey three years later. The association between SES, educational level, RF, and T2D incidence was analyzed. RESULTS: The incidence rate for T2D was 9.8/1000 person-years without gender differences. Incident T2D was associated with low SES and lower educational levels. Baseline and follow-up BMI were also the main RFs for T2D. Communities' incidence rates were: (1) Margarita, working-class area: 11.3/1000 person-years; (2) Arévalo, agricultural region: 10.1/1000 person-years and; (3) Lista, professional high-income class area: 7.6/1000 person-years. CONCLUSION: We found an incidence rate of 9.8/1000 person-years of T2D in the elderly population. The risk of T2D was associated with a lower income and educational level. An increase in BMI may mediate this association. Our results emphasize the necessity of strategies for the prevention of diabetes that includes an approach to SES, educational levels, and other RF among older individuals in Spanish community settings.

Hypercholesterolemia in elders is associated with slower cognitive decline: a prospective, population-based study (NEDICES).

BACKGROUND: Studies investigating the association between hypercholesterolemia in the elderly and cognitive decline report discrepant outcomes. We determined in a prospective population-based cohort (NEDICES) in elders whether hypercholesterolemia was associated with slower cognitive decline. METHODS: Participants were evaluated at baseline and 3 years later. Baseline demographic variables were recorded. Hypercholesterolemia was defined by total cholesterol of >200mg/dl or current use of lipid-lowering drugs. At baseline and at follow-up, a 37-item version of the Mini-Mental State Examination (37-MMSE) was administered. RESULTS: The final sample, 2015 participants (72.9 ± 6.1 years), comprised 1166 (57.9%) hypercholesterolemic and 849 (42.1%) non-hypercholesterolemic participants (reference category). The mean follow-up was 3.4 ± 0.5 years. During the three year follow-up period, the 37-MMSE declined by 0.7 ± 4.3 points (median=0 point) in non-hypercholesterolemic participants vs. 0.3 ± 3.9 points in hypercholesterolemic participants (median=0 points) (Mann-Whitney test, p=0.007). In analyses adjusted for baseline age and other potential confounders, this difference remained robust. We also assessed the cognitive decline per unit time (i.e., the rate of cognitive decline). The rate of cognitive decline was 0.2 ± 1.3 (median=0.0) points/year for non-hypercholesterolemic participants and 0.1 ± 1.2 (median=0.0) points/year for hypercholesterolemic participants (Mann-Whitney test, p=0.028). CONCLUSIONS: In this prospective population-based cohort study, cognitive test scores among hypercholesterolemic elders declined more slowly than observed in their non-hypercholesterolemic counterparts. Additional studies are needed to confirm these results.

Polypharmacy in the Elderly: A Marker of Increased Risk of Mortality in a Population-Based Prospective Study (NEDICES).

BACKGROUND: Little information is available on the potential association between polypharmacy and risk of mortality. OBJECTIVE: To determine in a population-based study whether polypharmacy is associated with increased risk of mortality in elderly persons. METHODS: In this population-based, prospective study of 5,052 people aged 65 years and older (Neurological Disorders in Central Spain), current medications were recorded. Cox proportional hazards models, adjusted for sociodemographics and comorbidity factors, were used to assess the risk of death up to 13.3 years later, comparing the polypharmacy group (≥6 drugs) to those who were taking 1-5 drugs and those in a nonmedicated group (0 drugs). RESULTS: Out of 5,052 participants, 2,550 (50.5%) died over a median follow-up of 6.5 years, including 361 (28.8%) deaths among 931 nonmedicated participants, 1,946 (51.4%) deaths among 3,787 participants taking 1-5 drugs daily, and 243 (72.8%) among 334 participants on polypharmacy. In an unadjusted Cox model, risk of mortality was increased in participants on polypharmacy [hazard ratio (HR) = 2.78, 95% confidence interval [CI]: 2.36-3.27, p < 0.001) and in those taking between 1 and 5 drugs (HR = 1.47, 95% CI: 1.31-1.64, p < 0.001) versus those who were nonmedicated (reference group). In a Cox model that adjusted for a variety of demographic factors and comorbidities, HR remained increased in participants on polypharmacy (HR = 1.83, 95% CI: 1.51-2.21, p < 0.001). CONCLUSION: This study provides evidence that polypharmacy is associated with increased risk of mortality in elderly people. The extent to which polypharmacy is the proximate cause rather than a marker of this increase risk remains to be determined.

Metabolic syndrome, adiponectin, and cardiovascular risk in Spain (the Segovia study): impact of consensus societies criteria.

BACKGROUND: We aimed to investigate the prevalence of metabolic syndrome in rural and urban areas in the province of Segovia, Spain, and its relationship to lifestyle habits, cardiovascular risk, and serum adiponectin concentrations. METHODS: The study had a cross-sectional design and included 888 individual residents in the province of Segovia, Autonomous Community of Castilla-León. RESULTS: The age/sex standardized prevalence of the metabolic syndrome was by: (1) American Heart Association/National Heart Lung and Blood Institute criteria (AHA/NHLBI), 17%; (2) International Diabetes Federation (IDF), 24.3%; and (3) Consensus Societies/Joint Interim Statement (CS), 27.8%. A high correlation was found between the different criteria. No formal education [odds ratio (OR) 6.9 (2.4-20.2)] and primary education [6.7 (2.8-15.9)] were independently associated with metabolic syndrome. An inverse association with metabolic syndrome was found for subjects doing a high level of exercise during work [0.4 (0.2-0.7)] as well as those who were mild drinkers [alcohol intake of less than 15 grams/daily, 0.4 (0.3-0.8)]. Among subjects with low estimated cardiovascular risk, adiponectin levels are higher in those who do not meet criteria of metabolic syndrome. A total of 29.7% of subjects meeting CS criteria had >20% 10-year predicted risk of cardiovascular disease (CVD) by the Framingham risk score criteria [4.5 (2.4-8.5)]. CONCLUSIONS: Our results show: (1) A higher estimated prevalence of metabolic syndrome according to IDF and CS criteria. (2) Low educational level was independently associated with metabolic syndrome. A high level of physical activity and a daily alcohol intake of less than 15 grams/day were inversely associated with metabolic syndrome. (3) Metabolic syndrome increases the predicted CVD risk. (4) Adiponectin levels are not inversely related to insulin resistance in subjects with high cardiovascular risk and metabolic syndrome.

[Consumption of antibiotics of the general population of Segovia area during the period between 1999 to 2007]. / Consumo de antibióticos en la población general del área de Segovia durante el período 1999 a 2007.

INTRODUCTION: The antibiotics are the medicaments most used after the analgesics, being prescribed more than 85 % in Primary Care. The aim of the study is to analyze the evolution of the prescription of antibiotics of systemic use in the general population of the Area of Segovia, during the years 1999-2007 and to know his trends evolution. MATERIAL AND METHODS: Antibiotics prescribed to the general population on the part of the Family physicians were processed using the information system of drugstore "CONCYLIA" that supplies the information in the shape of defined daily dose (DDD), transformed later into the indicator DHD (DDD for 1.000 inhabitants per day) taking as a base the population information of sanitary card. RESULTS: The global prescription of antibiotics of systemic use was high, 18,06 DHD (IC:17,22-18,90), with a variable evolution along the study in the shape of basin of low concavity. The percentage of prescription of penicillins was 64.42 % of the total of prescriptions corresponding to the group J01. CONCLUSIONS: The prescription in the Area of Segovia has presented a contained consumption in relation to other studies, showing differences in the volume of prescription from each the subgroups. The centralization of the consumption emphasizes in the subgroup of penicillins that supposed almost two third parts of the prescribed DDD. A change in the habits of prescription is observed detailing a decrease of the amoxicillin use and an increase of amoxicillin-clavulanic acid.

Consumo de antibióticos en la población general del área de Segovia durante el período 1999 a 2007 / Consumption of antibiotics of the general population of Segovia area during the period between 1999 to 2007

Introducción. Los antibióticos son los fármacos más utilizados tras los analgésicos, siendo prescritos más del 85% en Atención Primaria. El objetivo del estudio ha sido el analizar la evolución de la prescripción de antibióticos de uso sistémico en la población general del Área de Segovia, durante los años 1999 a 2007 y conocer su evolución temporal. Material y métodos. Se procesaron los antibióticos prescritos a la población general por parte de los Médicos de Familia utilizando el sistema de información de farmacia “CONCYLIA” que suministra la información en forma de dosis diaria definida (DDD), transformada posteriormente en el indicador DHD (DDD por 1.000 habitantes por día) teniendo como base los datos poblacionales de tarjeta sanitaria. Resultados. La prescripción global de antibióticos de uso sistémico fue alta, 18,06 DHD (IC:17,22-18,90), con una evolución variable a lo largo del estudio en forma de cubeta de concavidad inferior. El porcentaje de prescripción de penicilinas fue del 64,42 % del total de prescripciones correspondientes al grupo J01. Conclusiones. La prescripción en el Área de Segovia ha presentado un consumo contenido en relación con la hallada en otros estudios, existiendo diferencias en cuanto al volumen de prescripción de cada uno de los subgrupos. Destaca la centralización del consumo en el subgrupo de penicilinas que supusieron casi las dos terceras partes de las DDD prescritas. Se observa un cambio en los hábitos de prescripción detallándose una disminución del uso de la amoxicilina y un incremento de la amoxicilina clavulánico(AU)

Introduction. The antibiotics are the medicaments most used after the analgesics, being prescribed more than 85 % in Primary Care. The aim of the study is to analyze the evolution of the prescription of antibiotics of systemic use in the general population of the Area of Segovia, during the years 1999-2007 and to know his trends evolution. Material and methods. Antibiotics prescribed to the general population on the part of the Family physicians were processed using the information system of drugstore “CONCYLIA” that supplies the information in the shape of defined daily dose (DDD), transformed later into the indicator DHD (DDD for 1.000 inhabitants per day) taking as a base the population information of sanitary card. Results. The global prescription of antibiotics of systemic use was high, 18,06 DHD (IC:17,22-18,90), with a variable evolution along the study in the shape of basin of low concavity. The percentage of prescription of penicillins was 64.42 % of the total of prescriptions corresponding to the group J01. Conclusions. The prescription in the Area of Segovia has presented a contained consumption in relation to other studies, showing differences in the volume of prescription from each the subgroups. The centralization of the consumption emphasizes in the subgroup of penicillins that supposed almost two third parts of the prescribed DDD. A change in the habits of prescription is observed detailing a decrease of the amoxicillin use and an increase of amoxicillin-clavulanic acid(AU)

Cognitive and motor functional activity in non-demented community-dwelling essential tremor cases.

BACKGROUND: Many investigators have observed mild cognitive deficits in essential tremor (ET), yet the functional significance of these deficits is unclear. Also, there are very few data in which functional activity in ET has been divided into cognitively based activities (remembering appointments) versus motor-based activities (writing cheques). OBJECTIVE: The authors (1) compared functional level in ET cases versus controls, assessing functional activities that are cognitively based and those that are dependent upon both motor and cognitive factors, and (2) determined whether lower mini mental status test scores in ET cases have a functional correlate. METHODS: In a population-based study of people > or = 65 years in central Spain (NEDICES), a 37-item version of the Mini-Mental State Examination (37-MMSE) and an 11-item version of the Pfeffer Functional Activities Questionnaire (FAQ) were administered to non-demented ET cases and controls. RESULTS: The FAQ was 55.5% higher (ie, lower function) in 208 cases than 3616 controls (2.8+/-4.8 vs 1.8+/-4.2, p<0.001). Cases reported more difficulty (ie, higher FAQ scores) with FAQ items that were cognitive measures as well as FAQ items that were cognitive-motor in nature. In cases, a lower 37-MMSE was associated with more difficulty on both cognitively based and cognitive-motor-based FAQ items (p<0.001). DISCUSSION: In this large, population-based study, ET cases reported more functional difficulty than controls, and this functional difficulty was present in both cognitive and cognitive-motor domains. Lower cognitive test scores were associated with more reported functional difficulty, indicating that lower cognitive test scores in ET, rather than being inconsequential, have a clear clinical-functional correlate.

[The EPICARDIAN project, a cohort study on cardiovascular diseases and risk factors among the elderly in Spain: methodological aspects and major demographic findings]. / El proyecto EPICARDIAN: un estudio de cohortes sobre enfermedades y factores de riesgo cardiovascular en ancianos españoles: consideraciones metodológicas y principales hallazgos demográficos.

BACKGROUND: Despite a greater incidence of ischemic heart disease among individuals over age 65, most cardiovascular research has been focused on the middle-aged adult population. To date no cohort study on this population have been made in Spain. This study is aimed as reviewing the role and methodology of cohort studies as an epidemiological tool absolutely essential for researching the prevalence and incidence of angina, AMI, stroke and the major cardiovascular risk factors. METHODS: Cohort study in three areas of Spain (Lista district in Madrid), Arevalo (Avila) and Begonte (Lugo). Age and sex stratified random sample by based on the municipal censuses of each area and municipality (n = 5.079). Two-stage initial cohort assessment: home survey structured for the screening ischemic heart disease and classic risk factors (hypertension, dyslipemia, diabetes and smoking habit) and clinical assessment for case confirmation. In the follow-up phase the MONICA project "cold pursuit" method modified for pinpointing and investigating indicent cases was used, employing all of the hospital and primary care clinical records for confirming the cardiovascular event. Data was also requested from the Spanish National Institute of Statistics as to the cause and date of death of the deceased individuals in the cohort. RESULTS: The overall AMI prevalence was 4% (95% CI: 3.4%, 4.5%); definite plus probable AMI being 6.2% (95% CI: 5.5-6.9). The definite AMI prevalence was higher among the mean 6.7% (95% CI: 5.63-7.79) than among the women, 2% (95% CI: 1.51-2.55) (p < 0.001). Hypertension prevalence according to JNCV1 criteria was 68%, hypercholesterolemia 26.4% according to NCEP criteria, diabetes prevalence 13.4% according to WHO criteria, and 11.3% were smokers. The cumulative incidence for a 3.2-year period for nonfatal definite AMI was 1.4% (95% CI: 1.1-1.8); 1.1% (95% CI: 0.74-1.37) probable AMI: 1.17 (IC95%: 0.824-1.48) for fatal definite AMI or death due to AMI and 1.13% (IC 95%: 0.824-1.48) for sudden death. CONCLUSIONS: The elderly population included in this study shows a high prevalence of cardiovascular risk factors, as well as ischemic heart disease incidence rates three times higher than those of the middle-aged adult population in Spain. The risk profile for women is significantly worse than for men, which may be due to the higher death rate at earlier ages among men.