Antonio Segura

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.

Prevalencia, distribución y variabilidad geográfica de los principales factores de riesgo cardiovascular en España. Análisis agrupado de datos individuales de estudios epidemiológicos poblacionales: estudio ERICE

Introduccion y objetivos Estimar la prevalencia y la distribucion geografica de los principales factores de riesgo cardiovascular en la poblacion espanola. Investigar la existencia de diferencias geograficas. Metodos Agregacion de ocho estudios epidemiologicos transversales, realizados en Espana entre 1992 y 2001, que superaron criterios de calidad metodologica. Reanalisis conjunto de los datos individuales por grupos de edad (20-44, 45-64 y ≥ 65 anos), sexo y grandes areas geograficas. Poblacion de estudio: 19.729 sujetos. Estimacion de valores medios y prevalencias crudas y ajustadas. Resultados Por orden decreciente, los factores de riesgo cardiovascular mas frecuentes en la poblacion espanola fueron la hipercolesterolemia (colesterol total > 200 mg/dl, 46,7%), hipertension arterial (37,6%), tabaquismo (32,2%), obesidad (22,8%) y diabetes mellitus (6,2%). Los valores medios de presion arterial, indice de masa corporal, colesterol de las lipoproteinas de alta densidad y glucemia varian ampliamente con la edad, el sexo y las areas geograficas. La mayor carga de factores de riesgo cardiovascular se observa en las zonas sureste y mediterranea y la menor, en las areas norte y centro. Conclusiones En Espana la prevalencia de los principales factores de riesgo cardiovascular es elevada. Hay marcadas diferencias geograficas en su distribucion.

Variabilidad en el manejo hospitalario del infarto agudo de miocardio en España. Estudio IBERICA (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda)*

Introduccion y objetivos Los datos sobre el manejo de los pacientes con infarto agudo de miocardio (IAM) que llegan a un hospital en Espana no garantizan la exhaustividad en el registro. El objetivo de este trabajo es conocer las caracteristicas y el manejo de los pacientes con IAM que llegan a todos los hospitales de distintas areas de 8 comunidades autonomas espanolas. Metodos El estudio IBERICA es un registro poblacional de IAM entre 25 y 74 anos de edad realizado en ocho comunidades autonomas espanolas. Para este trabajo se incluyeron los casos de IAM que llegaron vivos al hospital durante 1997. Se recogen las caracteristicas, tratamiento y evolucion a los 28 dias del episodio. Se realizo un analisis descriptivo y se calculo el coeficiente de variacion. Resultados Se registraron 4.041 casos de IAM: el 79,9% eran varones y la edad media fue de 61,1 anos. El 10,9% (IC del 95%: 9,9-11,9%) no ingresaron en una unidad de cuidados intensivos cardiologicos, existiendo una gran variabilidad entre las zonas (coeficiente de variacion del 53%). Existe tambien una gran variabilidad en la realizacion e indicacion de tecnicas diagnosticas y terapeuticas invasivas y no invasivas, asi como en el tratamiento farmacologico empleado: unicamente la utilizacion de antiagregantes (91,5%) y trombolisis (41,8%) presenta un coeficiente de variacion Conclusion Las caracteristicas de los pacientes varian entre las zonas estudiadas. Las diferencias geograficas en el manejo y pronostico sugieren que puede existir desigualdades en la atencion al enfermo con IAM en Espana.

Regional variability in population acute myocardial infarction cumulative incidence and mortality rates in Spain 1997 and 1998

Background: Myocardial infarction (MI) incidence and mortality display a high geographic variation. Aims: The objective of the present study was to analyze MI mortality, cumulative incidence rate variability in seven regions of Spain from 1997 to 1998. Methods and Results: Standardized methods were used to identify, find, register, and classify MI cases that were classified as definite, possible,insufficient-dataMI, and non-MI. The total population of the seven monitored regions was 7,364,682 inhabitants. Of the 11,256 cases fulfilling eligibility criteria to investigate, 10,660 were selected to calculate MI rates: 6554 (61.5%)non-fatal definite MI, 1179 (11.1%)fatal definite MI, 1859 (17.4%)fatal possible MI, 1068 (10.0%)fatal cases with insufficient data. The IBERICA 25–74 years age-standardized cumulative incidence rates for men and women, were 207 (range: 175–252) and 45 (range: 36–65) per 100,000, respectively. The age-standardized mortality rates for men and women, were 73 (range: 62–94) and 20 (range: 13–29) per 100,000, respectively. Age-standardized case-fatality was 31.4 and 24.2% in men aged 25–74 and 35–64 years, respectively, and 32.7 and 27.0%, respectively, in women. Conclusions: MI cumulative incidence and mortality rates are low compared with other industrialized countries but, vary considerably among regions in a Mediterranean country like Spain.

Prevalence, Geographic Distribution, and Geographic Variability of Major Cardiovascular Risk Factors in Spain. Pooled Analysis of Data From Population-Based Epidemiological Studies: The ERICE Study

INTRODUCTION AND OBJECTIVES To determine the prevalence and geographic distribution of major cardiovascular risk factors in the Spanish population. To investigate whether geographic variability exists. METHODS Data were pooled from eight cross-sectional epidemiologic studies carried out in Spain between 1992 and 2001 whose methodological quality satisfied predefined criteria. Individual data were reassessed and analyzed by age group (20-44 years, 45-64 years, and 365 years), sex and geographic area. The study population included 19,729 individuals. Mean values and unadjusted and adjusted prevalence rates were derived for various risk factors. RESULTS The most common cardiovascular risk factors in the Spanish population were, in descending order: hypercholesterolemia (i.e., total cholesterol >200 mg/dL) in 46.7%, hypertension in 37.6%, smoking in 32.2%, obesity in 22.8%, and diabetes mellitus in 6.2%. The mean values for blood pressure, body mass index, high-density lipoprotein cholesterol and glycemia varied considerably with age, sex and geographic area. The highest levels of cardiovascular risk factors were observed in Mediterranean and south-eastern areas of the country and the lowest, in northern and central areas. CONCLUSIONS The prevalence of major cardiovascular risk factors in Spain was high. Their distribution varied considerably with geographic area.

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.

Recursos hospitalarios y letalidad por infarto de miocardio. Estudio IBERICA

Determinar el porcentaje depacientes con infarto agudo de miocardio (IAM) que noingresan en una unidad de cuidados intensivos corona-rios (UCIC), las variables asociadas al ingreso en unaUCIC y si el ingreso en una UCIC, su disponibilidad y lade hemodinamica en el hospital se asocian a la letalidada 28 dias.

Hospital resources and myocardial infarction case fatality. The IBERICA study

INTRODUCTION AND OBJECTIVES To determine the proportion of patients with myocardial infarction (MI) not admitted to a coronary care unit (CCU), the variables associated with admission into a CCU, and whether admission to a CCU, and the availability of coronary angiography in the same hospital, were associated with 28-day case fatality. PATIENTS AND METHOD Population-based registry of MI in patients 25 to 74 years of age, admitted during 1996-1998. Demographic and clinical characteristics were recorded, as well as management, clinical course and survival after 28 days. Hospitals were classified according to the availability of a CCU and catheterization laboratory (advanced hospital), CCU only (intermediate hospital) or neither (basic hospital). Admission to the CCU was also recorded. RESULTS In all, 9046 cases of MI were recorded; in 11.3% the patient was not admitted to a CCU. Age, smoking (OR=1.33; 95% CI, 1.08-1.64), non-Q MI (OR=0.62; 95% CI, 0.49-0.78) or undetermined location of MI (OR=0.34; 95% CI, 0.23-0.50), Killip 4 score on admission (OR=0.63; 95% CI, 0.40-1.00) and delay in arrival at the hospital >6 h were associated with CCU admission. Patients admitted to a CCU showed a lower case fatality in the first 24 h (4.2% vs 23.5%), which was independent of comorbidity, severity and treatment. The 24-hour survivors admitted to a basic hospital had higher case fatality (17.3% vs 7.8%) than other groups, which was related to differences in treatment. CONCLUSIONS CCU admission is associated with a lower case fatality in the first 24 h. Admission to a basic hospital is associated with a higher 28-day case fatality even in patients who survive 24 h.

Ocular syphilis--back again: understanding recent increases in the incidence of ocular syphilitic disease.

Purpose: The clinical findings and outcomes of 12 cases of luetic uveitis are reported. Methods: Review of clinical records. Results: Patients included 10 men and 2 women; 7 were homosexual, 9 HIV-positive. Six patients presented a medical history suggestive of syphilis. All patients presented with iritis and vitritis. Visual acuity improved in 11 patients after treatment. Conclusions: Syphilis has reemerged in developed countries. This may be related to the post-AID S/HAART era, with a growing pool of HIV-positive men who oftenly practice unsafe sex. We underscore the importance of a high index of suspicion of ocular syphilis in patients with these characteristics.

Derivation and validation of a set of 10-year cardiovascular risk predictive functions in Spain: The FRESCO Study

OBJECTIVE To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. METHOD Pooled analysis of 11 population-based Spanish cohorts (1992-2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. RESULTS The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. CONCLUSIONS The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.