Emiliano Rodríguez-Sánchez

Abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive

BackgroundOur aim was to analyze the relationship between abdominal obesity and general obesity, with subclinical atherosclerosis, arterial stiffness and wave reflection in healthy, diabetics and hypertensive subjects.MethodsA cross-sectional descriptive study was made of 305 individuals (diabetics 32.8%, hypertensive subjects 37.0% and healthy individuals 30.2%). Measurements: Body mass index (BMI), waist circumference (WC), body fat percentage (BFP) and waist/height ratio (WHtR). Arterial stiffness was assessed according to pulse wave velocity (PWV), intima-media thickness of the common carotid artery (C-IMT), augmentation index (central and peripheral), ankle-brachial index (ABI), and central and peripheral pulse pressure.ResultsWC and WHtR showed a positive correlation to PWV and C-IMT in the studied groups. After adjusting for age, gender, high sensitivity c-reactive protein, serum glucose and the presence of diabetes, hypertension, smoking, dyslipidemia, antidiabetic drugs, lipid-lowering drugs, and atherosclerotic plaques, it was seen that for every 0.1 point increase in WHtR, and for every cm increase in WC, the PWV increased 0.041 and 0.029 m/sec, and C-IMT increased 0.001 mm and 0.001 mm, respectively.ConclusionsThe measures of abdominal obesity (WHtR and WC) correlates better than BMI and BFP with arterial stiffness evaluated by PWV, and with subclinical atherosclerosis evaluated by C-IMT, independently of the presence of diabetes or hypertension.Trial RegistrationClinical Trials.gov Identifier: NCT01325064

Ambulatory arterial stiffness indices and target organ damage in hypertension

BackgroundThe present study was designed to evaluate which arterial stiffness parameter - AASI or the home arterial stiffness index (HASI) - correlates best with vascular, cardiac and renal damage in hypertensive individuals.MethodsA cross-sectional study was carried out involving 258 hypertensive patients. AASI and HASI were defined as the 1-regression slope of diastolic over systolic blood pressure readings obtained from 24-hour recordings and home blood pressure over 6 days. Renal damage was evaluated by glomerular filtration rate (GFR) and microalbuminuria; vascular damage by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI); and left ventricular hypertrophy by the Cornell voltage-duration product (VDP) and the Novacode index.ResultsAASI and HASI were not correlated with microalbuminuria, however AASI and HASI- blood pressure variability ratio (BPVR) showed negative correlation with GRF. The Cornell PDV was positively correlated with AASI- BPVR-Sleep (r = 0.15, p < 0.05) and the left ventricular mass index with HASI-BPVR (r = 0.19, p < 0.01). Carotid IMT and PWV were positively correlated with all the parameters except the HASI, while ABI was negatively correlated with AASI and Awake-AASI. After adjusting for age, gender and 24 hours heart rate, statistical significance remains of the IMT with AASI, Awake AASI and AASI-BPVR. PWV with the AASI, Awake-AASI and Sleep-AASI. ABI with AASI and Awake-AASI. Odd Ratio to presence target organ damage was for AASI: 10.47(IC95% 1.29 to 65.34), Awake-AASI: 8.85(IC95% 1.10 to 71.04), Sleep-AASI: 2.19(IC95% 1.10 to 4.38) and AASI-BPVR-night: 4.09 (IC95% 1.12 to 14.92).ConclusionsAfter adjusting for age, gender and 24-hour heart, the variables that best associated with the variability of IMT, PWV and ABI were AASI and Awake-AASI, and with GFR was HASI-BPVR.

Relationships between quality of life and family function in caregiver

BackgroundThere are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregivers situation has not been the subject of much evaluation. The aim of this study is to analyse the relationship between the functionality of the family and the QoL of caregivers of dependent relatives.MethodsWe conducted a cross-sectional study including 153 caregivers. Setting: Two health centers in the city of Salamanca(Spain). Caregiver variables analysed: demographic characteristics, care recipient features; family functionality (Family APGAR-Q) and QoL (Ruiz-Baca-Q) perceived by the caregiver. Five multiple regressions are performed considering global QoL and each of the four QoL dimensions as dependent variables. The Canonical Correspondence Analysis (CCA) was used to study the influence of the family function questionnaire on QoL.ResultsFamily function is the only one of the variables evaluated that presented an association both with global QoL and with each of the four individual dimensions (p < 0.05). Using the CCA, we found that the physical and mental well-being dimensions are the ones which present a closer relationship with family functionality, while social support is the quality dimension that is least influenced by the Family APGAR-Q.ConclusionWe find an association between family functionality and the caregivers QoL. This relation holds for both the global measure of QoL and each of its four individual dimensions.

Prevalence of cognitive impairment in individuals aged over 65 in an urban area: DERIVA study

BackgroundFew data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors.MethodsDesign: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia.ResultsThe prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk.ConclusionsThe observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.

Relationship of 24-h blood pressure variability with vascular structure and function in hypertensive patients.

ObjectivesTo analyze the relationship of 24-h blood pressure variability (BPV) with vascular structure and function using the SD and the coefficient of variation (CV). Patients and methodsA cross-sectional study was carried out in 344 hypertensive patients (aged 54.1±11.7 years, 59.6% men). BPV was estimated with the SD and CV over 24-h, both awake and sleep, by ambulatory blood pressure monitoring. Vascular structure and function were evaluated by the ambulatory arterial stiffness index (AASI), the pulse wave velocity (PWV) using SphygmoCor and the carotid intima-media thickness (IMT) as assessed by ultrasound. ResultsThe systolic blood pressure (SBP) variability was greater than the diastolic blood pressure (DBP) variability using the SD and less using CV (P<0.001). SBP variability showed a positive correlation with the IMT, PWV and AASI. The CV of the DBP showed a positive correlation with the PWV and the AASI, whereas the SD of the DBP showed a negative correlation with the AASI. In the multiple regression analysis, after adjustment, the BPV measure that maintained their associations with the IMT was the CV of awake DBP and that with the PWV were the CV and the SD of 24-h and awake SBP/DBP. The AASI maintained the associations with the BPV measure in 24-h DBP, but not in SBP. The odds ratio of the SD and the CV for vascular damage varied between 1.182 and 1.276. ConclusionBPV in hypertensive patients, as evaluated by both SD and CV, is associated with arterial stiffness as evaluated with the PWV. The ambulatory blood pressure monitoring is more accessible at the clinic than the PWV; therefore, the assessment of BPV (24-h, awake and sleep) may be useful for assessment of arterial stiffness.

Protocol for measuring carotid intima-media thickness that best correlates with cardiovascular risk and target organ damage.

BACKGROUND To assess which measurement of common carotid intima-media thickness (CC-IMT) is associated to a greater overall cardiovascular risk (CVR), and vascular cardiac and renal target organ damage (TOD), in diabetic, hypertensive patients and healthy subjects. METHODS A cross-sectional study, inclusion of 305 patients (113 hypertensive, 100 diabetics, and 92 healthy), aged 30-75 years. MEASUREMENTS Mean CC-IMT and maximum CC-IMT in near and far walls and in the anterior, lateral and posterior projections. Ankle/brachial index (ABI), pulse wave velocity (PWV), glomerular filtration rate (GFR), albumin/creatinine ratio, Cornell voltage-duration product (VDP) and CVR with the Framingham equation and the SCORE. RESULTS CC-IMT shows a positive correlation with CVR, PWV, and Cornell VDP, and a negative correlation with ABI and GFR (P < 0.001), with no difference between mean and maximum values, near and far wall, or projections. The odds ratio (OR) for the presence of TOD was greatest in mean CC-IMT (OR = 1.85 (95% confidence interval (CI): 1.335-2.58)) and lowest in maximum CC-IMT in the posterior projections OR = 1.42 (95% CI: 1.12-1.80). For each unit increase in mean CC-IMT, a risk increase by 1.98 may be expected (95% CI: 0.69-3.26), whereas the risk increase for each unit increase in maximum CC-IMT is 1.75 (95% CI: 0.70-2.79) (P < 0.001) with Framingham and with no significant association with SCORE. CONCLUSIONS The CC-IMT measurement protocol best predicting for the occurrence of TOD and CVR estimated with Framingham is the mean of 120 measures of mean values in the near and far walls in all three projections of both carotid arteries.

Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

AbstractBackgroundDiabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome.Methods/DesignDesign: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up. Setting: The study will be carried out in the urban primary care setting. Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included. Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs.DiscussionThe results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus.Trial RegistrationClinicalTrials.gov Identifier: NCT01065155

Loneliness and Mental Health in a Representative Sample of Community-Dwelling Spanish Older Adults

ABSTRACT Research seems to support loneliness as a risk factor for mental health problems in the elderly. Most studies analyzing the effects of loneliness on older adults’ mental health have relied on convenience samples. In this study, the prevalence and predictors of feelings of loneliness were studied in a representative sample of 272 community-dwelling Spanish older adults. The potential of feelings of loneliness to significantly contribute to the explanation of mental health of the elderly was also explored. The percentage of people reporting feelings of loneliness was 23.1%. Being a woman, being older, living alone, having fewer economic resources, having lower perceived health, and being dissatisfied with the frequency of contact with relatives and friends were found to be significant predictors of feelings of loneliness. Loneliness contributed significantly to the explanation of mental health, even when other significant variables were statistically controlled. The results of this study suggest that loneliness is a relevant factor for the analysis and understanding of mental health in the elderly.

Relationship between objectively measured physical activity and cardiovascular aging in the general population – The EVIDENT trial

BACKGROUND Aging has been associated with an increase in arterial stiffness. We analyzed the relationship between regular physical activity and cardiovascular aging evaluated by the radial augmentation index (rAIx), ambulatory arterial stiffness index (AASI), pulse pressure (PP) and heart age in subjects without atherosclerotic disease. METHODS A cross-sectional study was performed including 1365 subjects from the EVIDENT trial (mean age 54.9±13.7 years; 60.3% women). As a measure of total volume of physical activity we used counts/minute recorded in an accelerometer (Actigraph GT3X) that participants wore for seven days, collecting data in 60-sec epochs, and respondents with ≥4 valid days were retained for the analysis. Arterial stiffness was evaluated using measures of rAIx, AASI, and central and peripheral PP on the B-pro device. rAIx was adjusted to 75 heart rate(rAIx75). Cardiovascular risk and heart age was estimated by the Framingham Risk Score. RESULTS The median (IQR) of counts/min was 236.9 (176.3-307.8), rAIx75 90 (77-100), sleep PP 40 mmHg (33-47), central PP 39 mmHg (32-47) and heart age 57 years (45-73) and the mean±SD of the ASSI was 0.44±0.07. We found an inverse correlation between counts/minute and rAIx75 (r=-0.086; p<0.01), AASI (r=-0.146; p<0.001), heart age (r=-0.163; p<0.001) and peripherals PP. These associations were remained after controlling for potential confounders, except for rAIx75. In the multiple regression analysis, after adjustment, an inverse association persisted between counts/minute and AASI, sleep PP and heart age, but not with rAIx75. Accordingly, for every 100 higher counts/minute of accelerometer measures, both AASI and sleep PP would be lower by one measurement unit (beta=-0.979 and -1.031 respectively, p<0.001) and the estimated heart age by half year (beta=-0.525, p=0.023). CONCLUSIONS Regular physical activity was inversely associated with parameters related to advanced cardiovascular aging after adjustment for potentially influencing variables. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01083082.

Relationship between objectively measured physical activity and vascular structure and function in adults

OBJECTIVES To analyze the relationship between regular physical activity, as assessed by accelerometer and 7-day physical activity recall (PAR) with vascular structure and function based on carotid intima-media thickness, pulse wave velocity, central and peripheral augmentation index and the ambulatory arterial stiffness index in adults. METHODS This study analyzed 263 subjects who were included in the EVIDENT study (mean age 55.85 ± 12.21 years; 59.30% female). Physical activity was assessed during 7 days using the Actigraph GT3X accelerometer (counts/minute) and 7-day PAR (metabolic equivalents (METs)/hour/week). Carotid ultrasound was used to measure carotid intima media thickness (IMT). The SphygmoCor System was used to measure pulse wave velocity (PWV), and central and peripheral augmentation index (CAIx and PAIx). The B-pro device was used to measure ambulatory arterial stiffness index (AASI). RESULTS Median counts/minute was 244.37 and mean METs/hour/week was 11.49. Physical activity showed an inverse correlation with PAIx (r = -0.179; p < 0.01) and vigorous activity day time with IMT (r = -0.174), CAIx (r = -0.217) and PAIx (r = -0.324) (p < 0.01, all). Sedentary activity day time was correlated positively with CAIx (r = 0.103; p < 0.05). In multiple regression analysis, after adjusting for confounding factors, the inverse association of CAIx with counts/minute and the time spent in moderate and vigorous activity were maintained as well as the positive association with sedentary activity day time (p < 0.05). CONCLUSION Physical activity, assessed by counts/minute, and the amount of time spent in moderate, vigorous/very vigorous physical activity, showed an inverse association with CAIx. Likewise, the time spent in sedentary activity was positively associated with the CAIx. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01083082.