F. Javier Jiménez

Omega-3 Fatty Acids in Adipose Tissue and Risk of Myocardial Infarction The EURAMIC Study

Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (+/-SD) proportion of alpha-linolenic acid was 0.77% (+/-0.19) of fatty acids in cases and 0.80% (+/-0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of alpha-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (+/-0.13) of fatty acids in cases and 0.25% (+/-0.13) of fatty acids in controls (P=0. 14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of alpha-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.

Control de la presión arterial de los pacientes diabéticos en el ámbito de atención primaria. Estudio DIAPA

Fundamento y objetivo Conocer el control de la presion arterial (PA) en pacientes con diabetesmellitus (DM) visitados en atencion primaria (AP), y determinar los factores asociados a uncontrol suboptimo de la PA. Pacientes y metodo Estudio transversal y multicentrico. Noventa investigadores incluyeron a875 pacientes con DM (57,8% mujeres), con edad media (DE) de 64 (11,8) anos. La PA semidio segun las recomendaciones del Sexto Informe del Joint National Committee (JNC-VI) yde la Organizacion Mundial de la Salud/Sociedad Internacional de Hipertension (OMS/ISH),calculandose la media aritmetica de tres tomas sucesivas. Se considero hipertensos a los pacientescon diagnostico previo establecido, y control optimo a los valores de PA inferiores a130/85 mmHg. Resultados El 66,7% (n = 583) de los pacientes con DM estaban previamente diagnosticadosde hipertension arterial (HTA); de estos, el 86,3% (intervalo de confianza [IC] del 95%, 83,0–89,1) de los pacientes con DM tipo 2 y el 87,8% (IC del 95%, 70,9–96,0) de los pacientescon DM tipo 1 no tenian un control optimo de la PA en la visita (PA mayor o igual de 130 y/o85 mmHg). El 56,8% (IC del 95%, 50,1–63,3) de los enfermos con DM tipo 2 y el 23,8% (ICdel 95%, 12,6–39,8) de los enfermos con DM tipo 1 sin HTA conocida tenian una PA igual osuperior a 130 y/o 85 mmHg en la visita. La mediana de farmacos antihipertensivos utilizadosfue de 1 (1–2). En el analisis multivariante, la edad, un mayor indice de masa corporal y los valoresde colesterol y acido urico se asociaron a un peor control de la PA (p Conclusiones En nuestro estudio, el 66,7% de los pacientes con DM atendidos en AP eran hipertensosconocidos y solo el 13,6% tenia un control optimo de la PA. Los pacientes diabeticoscon HTA estaban infratratados, con una mediana de un farmaco antihipertensivo.

Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe - The EURIKA Study

BackgroundPhysicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe.MethodsCross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account.ResultsThe average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27).ConclusionsLack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study.

Cost-Benefit Analysis of Haemophilus influenzae Type b Vaccination in Children in Spain

AbstractObjective: Invasive disease caused by Haemophilus influenzae type b (Hib), including meningitis, pneumonia, sepsis and epiglottitis, is associated with high mortality and serious neurological sequelae in children under 5 years of age. The availability of an efficacious vaccine suggests the need to perform an economic evaluation of its use. The objective of this study was to evaluate the costs and benefits of introducing a universal vaccination programme for children under 1 year of age in Spain. Design & Setting: A cost-benefit analysis (CBA) was conducted over a 5-year period from the societal perspective in the Spanish healthcare setting. Both direct and indirect costs were included in the analysis [using 1996 Spanish pesetas (Pta); Pta126.5 =

Consumo de pescado y mortalidad coronaria en la población general: meta-análisis de estudios de cohorte

US1 in April 1996]. Patients and participants: The target population used for cost and benefit estimation was the 384 883 Spaniards aged 1 year or less in the last Spanish Population and Housing Census of 1991. Main outcome measures and results: The introduction of the universal Hib vaccination programme would imply vaccinating 346 395 children under 1 year of age, with a global expense of Pta2 444 855 910. For an average incidence of 15 cases of invasive disease per 100 000 children per year nationwide, the programme would prevent 219 cases of invasive disease and 8 deaths over a 5-year period, with a benefit of Pta2 182 868 907, a net benefit (i.e. benefit minus cost) of–Pta261 987 003, a benefit/cost ratio of 0.89 and a benefit per case prevented of–Pta1 196 288. Benefit/cost ratios above 1 would be obtained in the regions of highest incidence of invasive disease. Conclusion: The decision to implement a universal vaccination programme should not be based only on economic factors, but our results suggest that the economic returns of the programme for children under 1 year of age in Spain would be at least of a similar magnitude as its expenses.

Prevalencia de dislipemia en las consultas ambulatorias del Sistema Nacional de Salud: estudio HISPALIPID

Resumen Con objeto de estimar el efecto del consumo de pescado sobre la mortalidad por cardiopatia isquemica en la poblacion general, se ha realizado un meta-analisis de los estudios epidemiologicos publicados sobre el tema que incluian individuos inicialmente as intomaticos. De los siete estudios publicados hasta la fecha, todos ellos de cohorte, solo cinco presentaban los resultados con el detalle suficiente como para poder ser utilizados en un meta-analisis formal. En estos, participaron un total de 27.656 personas, con un seguimiento medio que vario de 7,5 a 25 anos, y un numero total de muertes por cardiopatia isquemica de 1.731. El estimador combinado del riesgo relativo para un consumo de 30 g/dia de pescado frente al no consumo fue de 0,96 (IC al 95%: 0,93–1,00; P=0,058). Dada la presencia de heterogeneidad significativa entre los estudios, no explicada por factores a priori , se procedio a combinar los estudios utilizando un modelo de efectos aleatorios, obteniendo un estimador combinado de riesgo relativo de 0,92 (IC al 95%: 0,84–1,01; P=0,090). Estos resultados, considerados junto con los del unico ensayo clinico realizado de consumo de pescado en pacientes que se habian recuperado de un infarto de miocardio, en el que el consumo de 200 a 400 g/semana de pescado graso redujo la mortalidad subsiguiente en un 29% (riesgo relativo del consumo frente al no consumo de 0,71; IC al 95%; 0,54–0,93), sugieren un moderado efecto protector del consumo de pescado en relacion a la cardiopatia isquemica.