Basilio Moreno

Tablas de evaluación del riesgo coronario adaptadas a la población española. Estudio DORICA

Fundamento y objetivo Los factores de riesgo independientes (consumo de tabaco, hipertensionarterial, hipercolesterolemia ydiabetes mellitus) son causa directa de cardiopatia isquemica y son frecuentes en la poblacion.Resulta mas apropiado estimar el riesgo global considerando la presencia de los diferentes factores de riesgo. El objetivo de este trabajo es presentar unas ta-blas de riesgo coronario confeccionadas a partir de la ecuacion de Framingham adaptada a la prevalencia de factores de riesgo en Espana Sujetos y metodo Se ha estimado la prevalencia de factores de riesgo en la poblacion espanola a partir del analisis de un conjunto de estudios poblacionales transversales. Se ha sustituido enla ecuacion de Framingham los datos estimados de prevalencia y la tasa de incidencia de acon-tecimientos coronarios. Se ha calculado la probabilidad de riesgo a 10 anos y se ha confeccio-nado una tablas que clasifican el riesgo con un codigo de colores Resultados La fraccion atribuible (FA) estimada para la hipertension arterial en la poblacionespanola es del 26,7% en varones y el 22,9% en mujeres, y para la hipercolesterolemia es del 15,7% en varones y el 12,7% en mujeres. El tabaquismo se situa en tercer lugar en orden de importancia en los varones (FA, 13,13%) y en cuarto en las mujeres (FA, 3,71%). Se estimouna prevalencia de obesidad del 13,2% en varones y el 17,5% en mujeres.En varones la FA a la obesidad es del 4% y en mujeres del 5% Conclusiones La adaptacion de la ecuacion de Framingham calibrada segun la prevalencia de los factores de riesgo independientes en la poblacion espanola y a la incidencia de aconteci-mientos coronarios en esta poblacion permiteconfeccionar herramientas utiles para estimar el riesgo coronario a 10 anos mientras no se disponga de estimaciones basadas en una ecuacionpropia a partir de un estudio de cohortes

Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism

BACKGROUNDnUntil now, preoperative parathyroid imaging has been considered unnecessary because currently available techniques do not provide any better results than an expert surgeon. We conducted a multicenter prospective study evaluating the capability of technetium 99m sestamibi scintigraphy in the preoperative identification of pathologic glands.nnnMETHODSnNinety-three patients with hyperparathyroidism, seven of them reoperative cases, were studied. In addition, 20 age-matched normocalcemic control subjects were also studied.nnnRESULTSnSurgical confirmation of scintigraphic images was obtained in 91 of 93 cases (sensitivity, 97.8%). In all reoperative cases (n = 7), in all cases of ectopic glands (whether operated or not; n = 6), and in all patients with a single-gland disease (n = 70), topographic identification of the pathologic gland was correct in 100%. In multiple-gland disease (n = 23), involvement of more than one gland was visualized in only 61% of the patients; however, in 91% of patients, at least one gland was localized. Surgical success-defined as postoperative normocalcemia-with this approach was 100%. All scans of normocalcemic control subjects were negative. Of 31 patients in whom a multinodular goiter coexisted, seven presented a significant radionuclide background at 120 minutes scan. False-positive images were found together with those corresponding to the pathologic glands in only three cases.nnnCONCLUSIONSn99mTc-sestamibi is a highly reliable, sensitive, and specific technique for imaging of pathologic glands in hyperparathyroidism, especially in single-gland disease. It may be considered as a first line single-procedure when a preoperative topographic diagnosis is required.

Relationship of abdominal obesity with cardiovascular disease, diabetes and hyperlipidaemia in Spain

Objectivesu2002 To evaluate the relevance of obesity and abdominal obesity in the prevalence of cardiovascular disease (CVD), diabetes mellitus, hyperlipidaemia and hypertension in primary care patients and to ascertain whether waist circumference (WC) measurement should be included in routine clinical practice in addition to body mass index (BMI).

Prevention of overweight and obesity from a public health perspective

International organizations have raised awareness of the increasing prevalence of overweight and obesity worldwide and the impact on morbidity, mortality, quality of life, and cost of healthcare. The development and implementation of obesity prevention strategies requires the identification and understanding of determinant factors that can be influenced by effective large-scale action plans over time. Strategies aimed at the primary prevention of obesity in a population should be multifaceted and designed to actively involve stakeholders and other major parties concerned; in addition, multiple settings for implementation should be considered. In this paper, an overview is presented of the strategies currently in place for obesity prevention, particularly in Spain.

Independent impact of obesity and fat distribution in hypertension prevalence and control in the elderly

Background Studies on the impact of weight excess and fat distribution on blood pressure are usually limited to young and middle-aged population, and data on the elderly are scarce. Methods and results We performed an analysis of the Prevencion de Riesgo de Ictus, a population-based study on individuals aged 60 years or more in Spain, to assess the impact of weight excess, stratified by body mass index (normal <25; overweight 25–29.9; obesity ≥30 kg/m2), and waist circumference [increased if ≥88 cm (women) or ≥102 (men)] on the prevalence on hypertension and lack of blood pressure control. In 6263 individuals (mean age 71.9 years old, 53.3% women; 73.0% with diagnosed hypertension), prevalence of obesity was 35.0%, and 65.6% showed an increased waist circumference. Body mass index and waist circumference showed an independent impact on the prevalence and absence of hypertension control. In a multivariate model including age, sex, body mass index, and waist circumference, prevalence of hypertension was higher in the overweight and obesity groups (odds ratio 1.41 and 1.96, respectively, compared to normal weight), and in those with increased waist circumference (odds ratio 1.25) compared with normal waist circumference. After further adjustment for antihypertensive therapy, overweight, and obesity (odds ratio 1.40 and 1.59, respectively) as well as increased waist circumference (odds ratio 1.39) were independently related to absence of blood pressure control. The impact of waist circumference on hypertension and blood pressure control was shown in each category of body mass index. Conclusion In this cross-sectional study in an elderly population, body mass index and waist circumference showed an independent and direct impact on the prevalence of hypertension and on the absence of blood pressure control.

Drugs in the treatment of obesity: sibutramine, orlistat and rimonabant

BACKGROUNDnModification of lifestyle is the main therapeutical approach in the treatment of obesity, but use to fail on long terms of time. Addition of anti-obesity drugs allows keeping the weight loss during years and improving obesity-related comorbidities.nnnMETHODSnThis review is an actualisation on efficacy, safety and tolerability of the approved drugs on the long-term treatment of obesity (orlistat and sibutramine). New indications and effects of their use far beyond the weight loss are as well commented. Finally, potential benefits of the administration of CB1 antagonist rimonabant on the weight loss and cardiometabolic risk factors are analysed in detail.nnnDISCUSSIONnA decade of experience on the use of orlistat and sibutramine has demonstrated their higher efficacy on the weight loss when compared to placebo either on adult or teenage population as well as safety and tolerability on long-term administration. Beneficial effects on the lipid profile, glycosilated haemoglobin on diabetic patients, blood pressure and levels of inflammatory cytokines, contribute to decrease the cardiovascular risk on obese patients. Phase III clinical trials using rimonabant show additional benefits to the expected weight loss, mainly reducing visceral fat and cardiometabolic risk factors.nnnCONCLUSIONnPharmacological treatment of obesity must be considered as a therapeutical tool that has to be used together with long-term lifestyle changes, contributing to the body weight reduction as well as to the improvement of the cardiometabolic risk related to obesity.

Recomendaciones y algoritmo de tratamiento del sobrepeso y la obesidad en personas adultas

Entre 1996 y 1999 se publicaron las primeras revisiones sistemáticas sobre la eficacia de diferentes intervenciones para el tratamiento del exceso de peso (sobrepeso y obesidad), momento en el que también se publicaron, en lengua inglesa, las 2 guías de práctica clínica (GPC) existentes para el abordaje clínico basado en la evidencia del sobrepeso y de la obesidad1,2. La GPC más reciente data de 1998, fue elaborada por el Panel de Expertos del Instituto Nacional del Corazón, el Pulmón y la Sangre de EE.UU. y alcanzó una gran difusión3. Desde entonces se ha acumulado gran cantidad de información científica, especialmente en aspectos relacionados con el tratamiento farmacológico y con el tratamiento quirúrgico para la reducción y el mantenimiento del peso corporal, información que posibilita la elaboración de una GPC actualizada sobre diagnóstico, valoración clínica y tratamiento del sobrepeso y de la obesidad en personas adultas.

Comparison of a very low-calorie-ketogenic diet with a standard low-calorie diet in the treatment of obesity

The global prevalence of obesity has significantly increased in most industrialized countries. Anti-obesity drugs are scarce, and indications to change their life style are impractical. Therefore, to identify diets able to produce significantly and maintained weight loss is mandatory. The present work evaluated the efficacy of a very low-calorie-ketogenic (VLCK) diet in obesity. A group of obese patients were randomized into two groups: the VLCK diet group and a standard low-calorie diet (LC group). The follow-up period was 12xa0months. Both groups received external support, counseling, to perform physical activity and adhered to the diet. The VLCK diet induced a 30–45xa0days ofxa0mild ketosis and significant effects on body weight within 15xa0days. At 2xa0months, the weight reductions in the VLCK diet and LC diet groups were 13.6xa0±xa03.9 and 4.8xa0±xa02.7xa0kg, respectively (pxa0<xa00.0001). At the end of the study, at 12xa0months, the weight reductions were 19.9xa0±xa012.3 and 7.0xa0±xa05.6xa0kg, respectively (pxa0<xa00.0001), and more than 88xa0% of patients in the VLCK diet group lost more of 10xa0% of their initial weight. Lean mass was practically unaffected. The VLCK diet was well tolerated and thexa0side effects werexa0moderate andxa0transitory. In a group of obese patients, the VLCK diet was significantly more effective than a standard LC diet. At one year follow-up in the group with VLCK diet, most of the patients loss more than 10xa0% of their initial weight and lean mass was well preserved.

Prevalencia de sobrepeso y obesidad en población española de 60 años o más y factores relacionados.: Estudio PREV-ICTUS

BACKGROUND AND OBJECTIVEnData on the prevalence of obesity in elderly population in Spain are scarce. The objective of this work was to describe the prevalence of obesity and the related factors in a random sample of Spanish population aged 60 years-old or more, stratified by autonomous communities.nnnSUBJECTS AND METHODnWe analyzed the PREV-ICTUS study, a population-based study carried out between September and December 2005 in a random sample stratified by autonomous communities according to the census of inhabitants and the habitat in each community. Subjects were classified as with normal weight (body mass index [BMI] < 25 kg), overweight (BMI 25-29.9) and obesity (BMI > or = 30 kg).nnnRESULTSnIn 6,843 subjects -mean age (standard deviation): 71.9 (7.1) years-old; 53.3% women-, prevalence of obesity was 34.5% (95% confidence interval [CI], 33.3-35.5%), higher in women (38.4%; 95% CI, 36.8-39.9%) than in men (30.0%; 95% CI, 28.4-31.6%; p < 0.001), with a tendency to decrease in the older population. In total, 81.7% of the population showed overweight (BMI > or = 25). Prevalence differed among communities from 46.4% to 20.7% (p < 0.001). In the multivariate analysis, obesity was inversely related to age (odds ratio [OR] = 0.98 per each year increment), and directly to female gender (OR = 1.25), rural (OR = 1.50) or semi-urban habitat (OR = 1.38), sedentary lifestyle (OR = 1.86) and non-smoking history (OR = 1.19).nnnCONCLUSIONSnObesity was present in one out of 3 individuals of this reasonably representative sample of the Spanish population in an age range, 60 years-old or more, which concentrates a high cardiovascular risk. Differences in the prevalence among autonomus communities were detected.Fundamento y objetivo: Los datos sobre prevalencia de obesidad en poblacion de edad avanzada en Espana son escasos. El objetivo de este trabajo ha sido describir la prevalencia de obesidad y los factores relacionados en una muestra aleatoria de la poblacion espanola de 60 anos o mas, estratificada por comunidades autonomas (CC.AA.). Sujetos y metodo: Se analizo el estudio PREV-ICTUS, realizado en una muestra seleccionada aleatoriamente entre septiembre y diciembre de 2005, estratificada por CC.AA. segun el censo y el habitat de atencion. Se clasifico a los sujetos segun su indice de masa corporal (IMC) en aquellos con peso normal (IMC < 25), sobrepeso (IMC de 25-29,9) y obesos (IMC

Guía clínica del manejo del prolactinoma y otros estados de hiperprolactinemia

30). Resultados: En 6.843 sujetos xadedad media (desviacion estandar) de 71,9 (7,1) anos; 53,3% mujeresxad la prevalencia de obesidad fue del 34,5% (intervalo de confianza [IC] del 95%, 33,3-35,5%), mayor en mujeres (38,4%; IC del 95%, 36,8-39,9%) que en varones (30,0%; IC del 95%, 28,4-31,6%; p < 0,001), con tendencia a disminuir en edades mas avanzadas. En total, el 81,7% mostro exceso ponderal (IMC