Antonio Cabrera de León

Factores de riesgo cardiovascular en España en la primera década del siglo xxi: análisis agrupado con datos individuales de 11 estudios de base poblacional, estudio DARIOS ☆

INTRODUCTION AND OBJECTIVES To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spains autonomous communities and determine the geographic variation of cardiovascular risk factors distribution. METHODS Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory cross-validation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor. RESULTS In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol ≥ 250 mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol ≥ 190 and ≥ 250 mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent. CONCLUSIONS Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies.

Sex hormones and autoimmunity.

Autoimmune diseases occur more in women than in men, and this may be attributable to the role of estrogens. Androgens promote autoimmune diseases with a profile of type 1 cytokines, such as rheumatoid arthritis, whereas estrogens promote autoimmune diseases with a type 2 cytokine profile, like systemic lupus erythematosus. Both androgens and estrogens regulate the Th1/Th2 balance. Type 1 autoimmune diseases are improved when decrease type 1 cytokines (i.e. during fasting), or when there is a rise in type 2 cytokines (increased estrogens, as in pregnancy). Type 2 autoimmune diseases improve when type 2 cytokines are diminished (decreased estrogen, as in post-partum period) or when type 1 response is stimulated.

Sedentary Lifestyle: Physical Activity Duration Versus Percentage of Energy Expenditure

INTRODUCTION AND OBJECTIVES To compare different definitions of a sedentary lifestyle and to determine which is the most appropriate for demonstrating its relationship with the metabolic syndrome and other cardiovascular risk factors. METHODS A cross-sectional study of 5814 individuals was carried out. Comparisons were made between two definitions of a sedentary lifestyle: one based on active energy expenditure being less than 10% of total energy expenditure, and the other, on performing less than 25-30 minutes of physical activity per day. Reported levels of physical activity, anthropometric measurements, and biochemical markers of cardiovascular risk were recorded. The associations between a sedentary lifestyle and metabolic syndrome and other risk factors were adjusted for gender, age and tobacco use. RESULTS The prevalence of a sedentary lifestyle was higher in women (70%) than in men (45-60%, according to the definition used). The definitions based on physical activity duration and on energy expenditure were equally useful: there were direct associations between a sedentary lifestyle and metabolic syndrome, body mass index, abdominal and pelvic circumferences, systolic blood pressure, heart rate, apolipoprotein B, and triglycerides, and inverse associations with high-density lipoprotein cholesterol and paraoxonase activity, which demonstrated the greatest percentage difference between sedentary and active individuals. An incidental finding was that both definitions of a sedentary lifestyle were more strongly associated with the metabolic syndrome as defined by International Diabetes Federation criteria than by Adult Treatment Panel III criteria. CONCLUSIONS Given that it is relatively easy to determine whether a patient performs less than 25 minutes of physical activity per day, use of this definition of a sedentary lifestyle is recommended for clinical practice. The serum paraoxonase activity level could provide a useful marker for studying sedentary lifestyles.

Síndrome metabólico en España: prevalencia y riesgo coronario asociado a la definición armonizada y a la propuesta por la OMS. Estudio DARIOS

INTRODUCTION AND OBJECTIVES To update the prevalence of metabolic syndrome and associated coronary risk in Spain, using the harmonized definition and the new World Health Organization proposal (metabolic premorbid syndrome), which excludes diabetes mellitus and cardiovascular disease. METHODS Individual data pooled analysis study of 24,670 individuals from 10 autonomous communities aged 35 to 74 years. Coronary risk was estimated using the REGICOR function. RESULTS Prevalence of metabolic syndrome was 31% (women 29% [95% confidence interval, 25%-33%], men 32% [95% confidence interval, 29%-35%]). High blood glucose (P=.019) and triglycerides (P<.001) were more frequent in men with metabolic syndrome, but abdominal obesity (P<.001) and low high-density lipoprotein cholesterol (P=.001) predominated in women. Individuals with metabolic syndrome showed moderate coronary risk (8% men, 5% women), although values were higher (P<.001) than in the population without the syndrome (4% men, 2% women). Women and men with metabolic syndrome had 2.5 and 2 times higher levels of coronary risk, respectively (P<.001). Prevalence of metabolic premorbid syndrome was 24% and the increase in coronary risk was also proportionately larger in women than in men (2 vs 1.5, respectively; P<.001). CONCLUSIONS Prevalence of metabolic syndrome is 31%; metabolic premorbid syndrome lowers this prevalence to 24% and delimits the population for primary prevention. The increase in coronary risk is proportionally larger in women, in both metabolic syndrome and metabolic premorbid syndrome.

Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS

INTRODUCTION AND OBJECTIVES The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. METHODS Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure < 140/90 mm Hg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. RESULTS We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P<.001), 66% and 69% respectively, of patients with diabetes (P=.03), and 39% and 42% respectively, of those with hypercholesterolemia (P<.001). Control was good in 34% of men and 42% of women with hypertension (P<.001); 65% and 63% respectively, of those with diabetes (P=.626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P=.092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P<.001). The proportion of uncontrolled participants increased with coronary risk (P<.001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥ 10% coronary risk than to men (59% vs. 50%, P = 0,024). [corrected] CONCLUSIONS The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.

Is Mitochondrial DNA Variation Associated with Sporadic Breast Cancer Risk

To the Editor: In the May 15, 2007 issue of Cancer Research , Bai et al. ( [1][1]) claimed that individuals carrying haplogroup K mitochondrial DNA (mtDNA) lineages are at significantly increased risk of developing breast cancer, whereas those bearing haplogroup U lineages have a significantly

Sedentarismo: tiempo de ocio activo frente a porcentaje del gasto energético

Introduccion y objetivos Comparar 2 definiciones diferentes de sedentarismo y averiguar cual es mas efectiva para detectar su relacion con el sindrome metabolico (SM) y otros factores de riesgo cardiovascular. Metodos Estudio transversal de 5.814 individuos. Se compara el concepto de sedentarismo basado en consumir activamente menos del 10% del gasto energetico total con el concepto basado en no realizar al menos 25-30 min diarios de ocio activo. Se analizan la actividad fisica declarada, la antropometria y los marcadores bioquimicos de riesgo cardiovascular. La relacion del sedentarismo con el SM y los marcadores de riesgo se ajusto por el sexo, la edad y el tabaquismo. Resultados La prevalencia de sedentarismo en mujeres (70%) fue superior a la de los varones (un 45-60%, segun el concepto empleado). El tiempo de ocio mostro la misma efectividad que la energia consumida: el sedentarismo se asocio directamente con el SM, el indice de masa corporal, las cinturas abdominal y pelvica, la presion arterial sistolica, la frecuencia cardiaca, la apolipoproteina B y los trigliceridos, e inversamente con el colesterol unido a lipoproteinas de alta densidad (cHDL) y la actividad de la paraoxonasa (esta presento el mayor porcentaje de variacion entre sedentarios y activos). Como resultado collateral se obtuvo que la definicion de SM propuesta por la Federacion Internacional de Diabetes se asocia con mayor fuerza que la del ATP-III a cualquier concepto de sedentarismo. Conclusiones Dada su mayor facilidad de obtencion, en la practica clinica es recomendable el uso del concepto de sedentarismo basado en averiguar si el paciente realiza al menos 25 min diarios de ocio activo. La actividad de la paraoxonasa es un marcador de interes para el estudio del sedentarismo.

Estimación del riesgo coronario en la población de Canarias aplicando la ecuación de Framingham

Fundamento y objetivo: La mortalidad por cardiopatia isquemica en Canarias se situa entre las mas altas de Espana. Dada la ausencia de tablas de riesgo coronario especificas para la poblacion del archipielago, este estudio las elabora y compara a la poblacion canaria con la de Gerona, cuya prevalencia y tablas de riesgo se han publicado previamente. Sujetos y metodo: Estudio transversal de 4.915 sujetos, de entre 25 y 74 anos de edad, incluidos en la cohorte CDC de Canarias. Se les efectuo una entrevista personal, ademas de exploracion fisica y extraccion de sangre, para estimar las prevalencias estandarizadas de tabaquismo, sobrepeso, obesidad, diabetes e hipertension arterial. Con ellas se calibro la ecuacion derivada de la cohorte de Framingham y se elaboraron las tablas de riesgo coronario. Resultados: La prevalencia bruta de obesidad fue del 30% (intervalo de confianza [IC] del 95%, 28,7-31,3), la de sobrepeso del 39% (IC del 95%, 37,6-40,4), la de tabaquismo del 26% (IC del 95%, 24,8-27,2), la de hipertension arterial del 40% (IC del 95%, 38,6-41,4) y la de diabetes mellitus del 12% (IC del 95%, 11,1-12,9). Comparada con la estimada en Gerona, la prevalencia de casi todos estos factores de riesgo es desfavorable a la poblacion de las islas desde las edades mas jovenes hasta las mas avanzadas. En promedio, el riesgo coronario calibrado en Canarias es un 89% mas alto (un 94% en varones y un 87% en mujeres), lo cual se corresponde con la distancia entre ambas poblaciones en las estadisticas nacionales de mortalidad. Conclusiones: La elevada prevalencia de obesidad y otros factores en la poblacion canaria genera importantes riesgos coronarios y explica su posicion en las estadisticas de mortalidad por cardiopatia isquemica. El uso de tablas calibradas como las que aqui presentamos puede ser de ayuda para intensificar la prevencion cardiovascular.

Inverse Association Between Obesity and Antinuclear Antibodies in Women

To the Editor: More than 70% of all autoimmune illnesses occur in women, a figure that has been attributed to stimulation of the Th2 response by estrogens. However, a little-explored relationship is that which may exist between obesity and autoimmune disorders in women. Since the discovery of leptin1 it has been known that the cytokine-producing capacity of adipose tissue is high. Serum concentration of leptin is 3- to 4-fold higher in women than in men. However, little is known about the reasons for this difference. To date no studies have investigated the relationship between leptin and autoimmune disease in the…

Efficiency of different strategies to detect autoantibodies to extractable nuclear antigens.

Autoantibodies to extractable nuclear antigens (anti-ENA) are identified mainly in samples positive for antinuclear antibodies (ANA). Although the method of choice for ANA screening is indirect immunofluorescence (IIF), several techniques are available to detect anti-ENA. The aim of this study was to compare the efficiency of five different strategies to determine anti-ENA. During a 2-year period we screened ANA in 30375 samples with IIF, and the 4475 samples ANA positive were tested for anti-ENA by double immune diffusion screening or fluoroenzymeimmunoassay (Screening FI); anti-ENA specificities were then determined by line immunoassay (LIA) or fluoroenzymeimmunoassay (FI). We compared five strategies that involved FI or LIA identification of anti-ENA with or without prior screening, or an algorithm that combined fluorescence pattern, number of anti-ENA specificities requested by the clinician and ANA dilution titer. One cost unit (CU) was defined as the cost of 1 test of ANA determination. We detected 553 anti-ENA positive samples. The most efficient strategy was the algorithm, at a cost of 3.3 CU per sample processed, the second most efficient strategy was screening plus FI identification (cost=3.8 CU), and the third most efficient strategy was screening plus LIA identification (cost=3.9 CU). The fourth most efficient strategy was FI identification without prior screening (13.3 CU per sample) and the least efficient was LIA identification without prior screening (13.6 CU per sample). In conclusion, an algorithm that combined techniques for detection, ANA titer, fluorescence pattern and number of specificities requested was the most efficient strategy for determining anti-ENA.