Jorge González-Esteban

Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS

Introduction and objectives. The aims of this study were to determine the prevalence of atrial fibrillation in individuals aged 60 years or more in Spain using a random sample of the population and to identify associated factors. Methods. An analysis of the PREV-ICTUS study, a randomized cross-sectional population-based study of individuals aged 60 years or more, was carried out. Data on demographic variables, cardiovascular risk factors, and cardiovascular disease were obtained from medical records. The diagnosis of atrial fibrillation was based on the patient’s medical history and an electrocardiogram performed during the study. Results. In the 7108 individuals studied (mean age, 71.9 [7.1] years, 53.6% female), the prevalence of atrial fibrillation was 8.5% (95% confidence interval [CI], 7.99.2%). It was higher in males (9.3% vs 7.9% in females; P=.036) and increased from 4.2% in individuals aged 6064 years to 16.5% in those aged 85 years or more (χ 2 test for linear trend, P<.001). Multivariate analysis showed that existing cardiovascular disease, hypertension, age, and left ventricular hypertrophy had the strongest associations with atrial fibrillation. Although there was a strong relationship between hypertension and atrial fibrillation (odds ratio, 2.53; 95% CI, 1.60-4.01), no association was found between poor blood pressure control and atrial fibrillation. A weak association with diabetes mellitus was found only when arterial pressure was included in the model, but not when a diagnosis of hypertension was included.

Differences in Blood Pressure Control and Stroke Mortality Across Spain The Prevención de Riesgo de Ictus (PREV-ICTUS) Study

The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population >60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese, and 27.1% diabetic subjects) were analyzed. A total of 73% were already diagnosed with hypertension. Among hypertensive subjects, 29.1% had blood pressure on therapeutic objective, and, of the total population, 35.7% had blood pressure under control. ECG–left ventricular hypertrophy was present in 12.9% of the subjects. The estimated stroke risk was 19.6%. Stroke mortality rates were significantly related to the estimated 10-year stroke risk (r=0.41; P<0.05) in each autonomic community. Poor hypertension control (P=−0.42; P<0.05) and prevalence of ECG–left ventricular hypertrophy (P=0.52; P<0.05) were the main factors related to the stroke mortality rates after controlling by age, sex, obesity, diabetes, and urban setting. Differences in stroke mortality throughout the autonomic communities of Spain were associated with indexes of worse blood pressure handling, low control rates, and high left-ventricular hypertrophy.

Kidney function and cardiovascular disease in the hypertensive population: the ERIC-HTA study.

Background and objectives Epidemiological data on the incidence and prevalence of cardiovascular disease in chronic renal failure are scant The objective of the present study is to assess the relationship between renal function, measured by the estimated glomerular filtration rate, and the presence of early or established cardiovascular disease, in a population of hypertensives from primary care. Patients and methods Cross-sectional, multicentre study carried out in primary care centres all over Spain. Hypertensive subjects, older than 55 years, were included. In all of them a structured interview including cardiovascular risk factors or disease was performed. Blood pressure was measured following a standard procedure, and serum biochemistry and an electrocardiogram were obtained. Renal function was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease Study Group) equation. For each glomerular filtration rate stratum the odds ratio and 95% confidence interval (CI) of left ventricular hypertrophy or cardiovascular disease were calculated, adjusted by confounding variables. Results A total of 13 687 patients (mean age 68.1 years, women 55.4%, diabetics 30.6%, body mass index 28.6 kg/m2) were included. Of these, 26.4% had established cardiovascular diseases and 20.3% electrocardiographic left ventricular hypertrophy. The average serum creatinine was 1.01 mg/dl, creatinine clearance 70.0 ml/min, and glomerular filtration rate 74.0 ml/min per 1.73 m2. Thirty-three patients (0.24%) had glomerular filtration rate < 5 ml/min per 1.73 m2; 89 (0.65%) from 15 to 29; 3745 (27.36%) from 30 to 59; 7798 (56.97%) from 60 to 89; and 2019 (14.75%) higher than 89 ml/min per 1.73 m2. In a multiple regression analysis, after adjusting by age, sex, body mass index, diabetes, systolic and diastolic blood pressure, and smoking, a lower glomerular filtration rate was associated with a higher prevalence of left ventricular hypertrophy. Likewise, a reduction in the glomerular filtration rate was also associated with a higher prevalence of cardiovascular disease. Conclusions In hypertensive patients from primary care, the prevalence of cardiovascular disease is inversely proportional to the level of renal function. Estimated glomerular filtration is easy to determine and complements evaluation of the hypertensive patient.

Hipertrofia ventricular izquierda en la población hipertensa española. Estudio ERIC-HTA☆

Introduccion y objetivos El objetivo del presente estudio es evaluar la prevalencia de hipertrofia del ventriculo izquierdo (HVI) en el electrocardiograma y el perfil epidemiologico en pacientes hipertensos atendidos en atencion primaria. Pacientes y metodo Estudio transversal, multicentrico, realizado en 15.798 pacientes hipertensos ≥ 55 anos de centros de atencion primaria. Se midio la presion arterial y se recogieron los antecedentes cardiovasculares de la historia clinica de los pacientes. La HVI se evaluo segun los criterios de Cornell. Resultados Se evaluo a 15.798 pacientes (edad media, 68,0 anos; 55,3% mujeres; 30,4% diabeticos). El 20,3% presento HVI en el electrocardiograma. La prevalencia fue mayor en varones, diabeticos, fumadores, pacientes con presion arterial no controlada y pacientes con enfermedad renal o con cualquier antecedente de enfermedad cardiovascular. Respecto a los pacientes sin HVI, los pacientes con HVI eran de edad mas avanzada, habia un mayor porcentaje de varones, y mas prevalencia de diabetes mellitus (el 40,5 frente al 27,8%), enfermedad renal (el 34,2 frente al 26,9%) y enfermedad cardiovascular (el 52,1 frente al 20,2%). En el analisis multivariante, la HVI se asocio, de forma independiente, con una edad mas avanzada, el sexo masculino, la diabetes, el tabaquismo, la ausencia de control de la presion arterial, y la presencia de enfermedad cardiovascular y renal. El porcentaje de pacientes que cumplian objetivos de control de presion arterial fue menor entre los pacientes con HVI respecto a aquellos sin HVI. Conclusiones La prevalencia de HVI en el electrocardiograma es elevada y se asocia con una mayor prevalencia de diabetes, y enfermedad renal y cardiovascular, ademas de un control de la presion arterial deficiente.

Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain The PREV-ICTUS Study

Background and Purpose— The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. Methods— This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. Results— We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic–left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; P<0.001). Conclusion— The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

Regressive changes in finasteride‐treated human hyperplastic prostates correlate with an upregulation of TGF‐β receptor expression

Prostatic atrophy has been documented histologically as a consequence of finasteride action on human hyperplastic prostates. An increase in apoptotic rates has also been reported in androgen‐deprived hyperplastic prostates. Transforming growth factor beta (TGF‐β) signaling is implicated in apoptotic cell death. TGF‐βs have been detected in normal and diseased human prostate. In the normal prostate, TGF‐β acts as a predominantly negative growth regulator. TGF‐β signaling receptors TβRI and TβRII have been shown to be negatively regulated by androgens.

Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERIC-HTA study.

The aim of this study is to assess the relationship among metabolic syndrome (MS), target organ damage (TOD) and established cardiovascular disease (CVD) in non‐diabetic hypertensive elderly patients. ERIC‐HTA is cross‐sectional, multicentre study carried out in primary care, on hypertensive patients aged 55 or older. MS was defined by the NCEP‐ATP III criteria, using body mass index (>28.8 kg/m2) instead of abdominal perimeter. In 8331 non‐diabetic hypertensive patients (3663 men and 4668 women, mean age 67.7 years), the prevalence of MS was 32.6% (men: 29.0%; women: 36.8%). A linear association was observed between a greater number of components of MS and a greater prevalence of left ventricle hypertrophy (LVH) on the electrocardiogram (p<0.001), impaired kidney function (p<0.001) and established CVD (p = 0.001). In a multivariate model, MS in non‐diabetic hypertensive patients was related to a greater prevalence of LVH (OR 1.31 [95% CI: 1.15–1.48]), impaired kidney function (OR 1.45 [95% CI: 1.29–1.63]) and established CVD (OR 1.22 [95% CI: 1.08–1.37]). This relationship persisted after stratifying by gender. In conclusion, in this elderly non‐diabetic hypertensive population, the presence of MS was independently related to a greater prevalence of hypertensive TOD and established CVD, suggesting a role of MS as a cardiovascular risk marker in hypertension.

Expression of basic fibroblast growth factor and its receptors FGFR1 and FGFR2 in human benign prostatic hyperplasia treated with finasteride.

The development of benign prostatic hyperplasia (BPH) is an androgen‐dependent process which may be mediated by a number of locally produced growth factors. One of these, the basic fibroblast growth factor (bFGF or FGF2), has a mitogenic effect on prostatic stroma. High expression levels of bFGF have been reported in BPH. FGFR1 and FGFR2 receptors, that exhibit affinity for bFGF, have been identified in normal and hyperplastic prostate. Finasteride, a 5α‐reductase inhibitor, is an effective drug in the treatment of BPH, inducing regressive changes in the prostate of treated patients, even though its mechanisms of action are not yet completely elucidated. This study was designed to assess the effects of finasteride on the expression levels of bFGF, FGFR1, and FGFR2 in patients with BPH.

Evaluación del riesgo de un primer ictus en la población hipertensa española en atención primaria. Estudio ERIC-HTA

BACKGROUND AND OBJECTIVE Stroke is a major cause of morbidity and mortality in hypertensive population. The aim of this study is to estimate the 10-year risk of a first stroke in Spanish hypertensive population using the Framingham scale. PATIENTS AND METHOD Cross-sectional multicenter study in primary care environment, on hypertensive patients aged 55 or more (10 consecutive patients each physician). Blood pressure (BP) was measured according to standardized rules. Stroke and coronary risk were estimated using the Framingham scale. RESULTS 16,129 patients (mean age 67.7 years; 57.1% women; 30.4% with diabetes mellitus; 26.6% with previous history of cardiovascular disease) were analyzed. 20.3% showed electrocardiographic left ventricular hypertrophy (more prevalent in males, diabetics, with systolic BP > or = 140 mmHg; p < 0.001). The goal of BP control was reached in 30.1% of non-diabetic patients and only in 5.9% of diabetics. The estimated 10-year risk of a first stroke (standard deviation) was estimated to be 19.9% (16.8), and the coronary risk 19.2% (14.0). While males had an estimated risk of coronary disease above the stroke risk, women had an estimated risk of a first stroke greater than the estimated risk of coronary disease. CONCLUSIONS The estimated risk of stroke among Spanish hypertensive population is high, and the main risk factors (age, systolic BP, diabetes and left ventricular hypertrophy) tend to aggregate. In women estimated risk of stroke in greater than estimated coronary risk. The risk of stroke must be taken into account in the assessment and treatment of hypertensive patients.

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

BACKGROUND AND OBJECTIVE Data 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. SUBJECTS AND METHOD We 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). RESULTS In 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). CONCLUSIONS Obesity 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.