Jose A. Maderuelo-Fernandez

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.

Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review.

OBJECTIVE To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings. METHODS Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached. RESULTS Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups. CONCLUSION Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.

La prevención según el Comité Español Interdisciplinario para la Prevención Cardiovascular: una valoración crítica

Se realiza una valoracion critica de la adaptacion que ha realizado el Comite Espanol Interdisciplinario para la Prevencion Cardiovascular (CEIPC) de la Cuarta Guia Europea de Prevencion Cardiovascular en la Practica Clinica, que se fundamenta en: 1) la eliminacion por parte del CEIPC de importantes restricciones para el inicio del tratamiento farmacologico que contiene la guia europea; 2) la existencia de contradicciones internas y de distintas recomendaciones en las distintas publicaciones de la adaptacion CEIPC respecto a los objetivos de LDL; y 3) la casi total ausencia de la necesaria discusion sobre las tablas de riesgo en Espana. Ademas se realiza una valoracion critica de algunas de las recomendaciones clinicas mas importantes que CEIPC y guia europea comparten y que no se sustentan en evidencias, como la propuesta implicita de la utilizacion del riesgo cardiovascular estimado como objetivo de tratamiento, los criterios de inicio del tratamiento farmacologico antihipertensivo y los objetivos terapeuticos de presion arterial, LDL-colesterol y HbA1c. Sociedades cientificas y Administracion Publica han de garantizar la transparencia e independencia en la redaccion de los documentos avalados por ellas, que incluya el manejo y declaracion de los potenciales conflictos de interes de redactores y miembros de grupos.

Glycemic index, glycemic load, and pulse wave reflection in adults

BACKGROUND AND AIMS Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patients diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.

Glycemic markers and relation with arterial stiffness in Caucasian subjects of the MARK study

Background Effect of prediabetes and normal glucose on arterial stiffness remains controversial. The primary aim of this study was to investigate the relationship of fasting plasma glucose (FPG), postprandial glucose (PG) and glycosylated haemoglobin (HbA1c) with brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) in Caucasian adults. The secondary aim was to analyse this relationship by glycaemic status. Methods Cross-sectional study. Setting: Primary care. Participants: 2,233 subjects, 35–74 years. Measures: FPG (mg/dL) and HbA1c (%) of all subjects were measured using standard automated enzymatic methods. PG (mg/dL) was self-measured at home two hours after meals (breakfast, lunch and dinner) for one day using an Accu-chek ® glucometer. CAVI was measured using a VaSera VS-1500® device (Fukuda Denshi), and baPWV was calculated using a validated equation. Results CAVI and baPWV values were significantly higher in subjects with diabetes mellitus than in glucose normal and prediabetes groups (p<0.001). FPG, PG and HbA1c were positively associated with CAVI and baPWV. The β regression coefficient for: HbA1c was 0.112 (CI 95% 0.068 to 0.155) with CAVI, 0.266 (CI 95% 0.172 to 0.359) with baPWV; for PG was 0.006 (CI 95% 0.004 to 0.009 and for FPG was 0.005 (CI 95% 0.002 to 0.008) with baPWV; and for PG was 0.002 (CI 95% 0.001 to 0.003) and 0.003 (CI 95% 0.002 to 0.004) with CAVI (p<0.01 in all cases). When analysing by hyperglycaemic status, FPG, PG and HbA1c were positively associated with CAVI and baPWV in subjects with type 2 diabetes mellitus. Conclusion FPG, PG and HbA1c show a positive association with CAVI and baPWV, in Caucasian adults with intermediate cardiovascular risk factors. When analysing by hyperglycaemic status, the association is only maintained in subjects with type 2 diabetes mellitus. Trial registration Clinical Trials.gov Identifier: NCT01428934. Registered 2 September 2011. Retrospectively registered. Last updated September 8, 2016.

Diet and physical activity in people with intermediate cardiovascular risk and their relationship with the health-related quality of life: results from the MARK study

BackgroundTo analyze the interplay between diet, physical activity and health-related quality of life in a Spanish randomly selected sample of individuals attended in general practitioners offices with intermediate cardiovascular risk.MethodsThis study analyzed 314 subjects, aged 35–74 years (50.6% women), from the MARK study, conducted in Spain. Health related quality of life was measured by the SF-12 questionnaire. The assessment of the lifestyles included the diet quality index, the adherence to the Mediterranean diet and the leisure time physical activity practice.ResultsThe highest values of health related quality of life were obtained in the area of vitality (51.05 ± 11.13), while the lowest were found in the general health (39.89 ± 8.85). In the multiple linear regression analysis, after adjustment for age, gender and other confounders, for each point of increase in the Mediterranean diet adherence score, there was an increase of 1.177 points in the mental component value (p < 0.01). Similarly, for each point of increase in the Diet Quality Index Score, there was an increase in the mental component of 0.553 (p < 0.05). Likewise, the physical activity was positively associated with the physical function and vitality (β = 0.090 and 0.087, (p < 0.01 and p < 0.05), respectively).ConclusionsIn people with intermediate cardiovascular risk, better food habits and greater adherence to the Mediterranean diet are associated with higher scores on the mental component of quality of life. Likewise, increased physical activity is related with positive scores on the physical function.

Riesgo cardiovascular del paciente hipertenso con seguimiento prolongado en atención primaria. El efecto del envejecimiento (ciclo risk study)

Background: The evolution of estimated cardiovascular risk can be for evaluating the effectiveness of the different treatment interventions which are carried out on patients with regular follow-up by family physicians. This study is aimed at evaluating the effect of aging on the evolution of cardiovascular risk among hypertensive patients with long-range Primary Care monitoring. Methods: Longitudinal, descriptive study with monitoring of 842 hypertensive patients within the 34-70 age range at two primary care centers, with a quality improvement intervention (improvement cycle) during the last year at one of these centers. The main variables were age and gender, blood pressure, lipids, smoking habit, diabetes and cardiovascular risk (CVR) (Framingham-Wilson) in the real-life situation and considering the age constant in the first case, and the risk factors in the second, plus the relative risk. Results: A drop was found in the systolic and diastolic blood pressure from 11.78 mmHg (95 IC: 10.51-13.05) and 8.83 mmHg (95 CI: 8.13-9.53), respectively, and LDL Cholesterol 15.94 mg/dl (95 CI: 11.77-20.12), a rise in HDL-Cholesterol of 7.53 mg/dl (95CI: 6.39-8.66), decreased smoking habit of 31% and an increase in diabetics. The Coronary risk decreased 1.40 percent points, Coronary risk with age constant decreased 3.84 (95 CI: 3.35-4.33), having increased with constant risk factors by 3.06(95 CI: 2.82-3.29). The Relative risk dropped from 2.50 to 1.85. Conclusions: Aging may mask the effect achieved by health care in the absolute cardiovascular risk check. The relative risk could be an alternative for monitoring the follow-up.

Physical Activity and Adiposity Among Older Adults of the EVIDENT Study

This study determined the relationship between self-reported and objective measurements of physical activity with adiposity markers in a random sample of community-dwelling older adults. The sample included 439 individuals over 65 years (age 71.1 ± 7.8; 54.2% women). Regular physical activity information was collected using self-reported (questionnaire, 7-day-PAR) and objective measurements (accelerometer ActiGraph GT3X) over 7 days. Anthropometric parameters included body mass index, body fat percentage, and waist circumference. The number of patients considered active was 28% according to the results of 7-day PAR, and 69% according to objective measures of accelerometry. With every daily increase of 10 min of sedentary activity, the BMI, body fat percentage, and waist circumference values increased by 0.04 units, 0.14%, and 0.14 cm, respectively. According to the accelerometry data, being active was a protective factor for presenting obesity criteria (OR = 0.34, CI 95% 0.19-0.59). Objective but non self-reported physical activity was associated with adiposity markers in older adults.

Evolution of target organ damage and haemodynamic parameters over 4 years in patients with increased insulin resistance: the LOD-DIABETES prospective observational study

Objectives We prospectively examined the impact of type 2 diabetes compared with metabolic syndrome (MetS) on the development of vascular disease over 4 years as determined by anatomic and functional markers of vascular disease. By comparing the vascular outcomes of the 2 disorders, we seek to determine the independent effect of elevated glucose levels on vascular disease. Setting 2 primary care centres in Salamanca, Spain. Participants We performed a prospective observational study involving 112 patients (68 with type 2 diabetes and 44 with MetS) who were followed for 4 years. Primary and secondary outcome measures Measurements included blood pressure, blood glucose, lipids, smoking, body mass index, waist circumference, Homeostasis Model Assessment Insulin Resistance (HOMA-IR), hs-c-reactive protein and fibrinogen levels. We also evaluated vascular, carotid intima media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index, heart and renal target organ damage (TOD). The haemodynamic parameters were central (CAIx) and peripheral (PAIx) augmentation indices. Results In year 4, participants with type 2 diabetes had increased IMT thickness. These patients had more plaques and an IMT>0.90 mm. In participants with MetS, we only found an increase in the number of plaques. We found no changes in PWV, CAIx and PAIx. The patients with diabetes had a greater frequency of vascular TOD. There were no differences neither in renal nor cardiac percentage of TOD in the patients with MetS or diabetes mellitus type 2. Conclusions This prospective study showed that the evolution of vascular TOD is different in participants with type 2 diabetes compared with those with MetS. While IMT and PWV increased in type 2 diabetes, these were not modified in MetS. The renal and cardiac TOD evolution, as well as the PAIx and CAIx, did not change in either group. Trial registration number NCT01065155; Results.

The role of retinal vessels caliber as a marker of vascular aging in large arteries.

Objective: To analyze the relationship between retinal vessel caliber and large arterial structure and function in a sample of the general population. Methods: A cross-sectional study was conducted among 229 participants from the EVIDENT trial (mean age 55.6±12.1 years, 61.1% women). Retinal photographs were digitized, temporal vessels were measured in an area of 0.5 to 1 disc diameter from the optic disc and the arterio-venous ratio (AVR) was estimated. Vascular structure and function were assessed by evaluating carotid intima–media thickness (IMT), pulse wave velocity (PWV), augmentation index (AIx), ankle brachial index and ambulatory arterial stiffness index. Results: The mean AVR was 0.792 ± 0.082, calculated from an arterial caliber of 109.1 ± 12.5 &mgr;m and a venous caliber of 138.7 ± 15.4 &mgr;m. A total of 13.1% of the patients presented vascular damage. The AVR was inversely correlated with carotid IMT (r = −0.190, P < 0.01), PWV (r = −0.178, P < 0.01) and AIx (r = −0.187, P < 0.01). In a multiple linear regression analysis, the associations with IMT and with AIx remained after adjusting for possible confounders (&bgr; = −0.152, P = 0.026; and &bgr; = −18.1, P = 0.037, respectively), but the association with PWV was lost when blood pressure was added (&bgr; = −1.520, P = 0.215). In a logistic regression analysis, the odds ratio of the first tertile of mean AVR (<0.76) of having a vascular injury was 7.09 (95% confidence interval 1.78–28.17, P = 0.011) after adjusting for possible confounders. Conclusion: In the general population, lower AVR values are associated with increases in carotid IMT, AIx and PWV. AVR may be a good predictor of asymptomatic vascular damage in large arteries.