José Miguel Baena Díez

COMPARACIÓN DE LOS MODELOS SCORE Y REGICOR PARA EL CÁLCULO DEL RIESGO CARDIOVASCULAR EN SUJETOS SIN ENFERMEDAD CARDIOVASCULAR ATENDIDOS EN UN CENTRO DE SALUD DE BARCELONA

Fundamento: No se dispone de estudios que hayan comparado SCORE, REGICOR y Framingham. El objetivo de este trabajo es estudiar como clasifican el riesgo cardiovascular las funciones REGICOR y SCORE, su correlacion y concordancia respecto a Framingham (1998) y si presentan diferencias respecto a los factores de riesgo cardiovascular en los casos de riesgo alto. Metodos: Estudio descriptivo transversal realizado en atencion primaria. Se incluyo a 851 personas entre 35-74 anos, libres de enfermedades cardiovasculares y seleccionadas por muestreo aleatorio simple. Se estudio la proporcion de pacientes de riesgo alto con Framingham (≥20% a 10 anos), SCORE (≥5% a 10 anos) y REGICOR con puntos de corte ≥20%, ≥15%, ≥10% y ≥5% a 10 anos, ya que con REGICOR ≥20% apenas hay casos con riesgo alto. Se comparo la correlacion (r de Pearson) y concordancia (coeficiente Kappa) de las personas de riesgo alto de REGICOR y SCORE respecto a Framingham. Resultados: Presentaron riesgo alto 23,3% con Framingham, 15,2% con SCORE y un 1,4%, 5,8%, 17,6% y 57,0% con REGICOR con los puntos de corte descritos, respectivamente. REGICOR tuvo una correlacion de 0,99 y SCORE de 0,78. REGICOR ≥10% tuvo mejor concordancia (Kappa 0,83) que SCORE (Kappa 0,61). Al comparar los factores de riesgo cardiovascular de los casos con riesgo alto (≥20% Framingham, ≥5% SCORE y ≥10% REGICOR), el segundo presento mayor prevalencia de diabetes y menor de hipercolesterolemia (p<0,05). Conclusiones: REGICOR presento una buena correlacion con Framingham. Con el punto de corte ≥10% clasifica como riesgo alto a un numero de personas similar a SCORE e inferior a Framingham. El modelo SCORE trataria con hipolipemiantes a un numero parecido de pacientes que el modelo REGICOR ≥10%, pero con menor evidencia de efectividad del tratamiento.BACKGROUND: No studies have been published to date comparing SCORE, REGICOR and Framingham models. This study is aimed at analyzing how the REGICOR and SCORE functions classify cardiovascular risk, their correlation and concordance with Framingham (1998) and whether any differences exist among them with regard to the cardiovascular risk factors in high-risk groups. METHODS: Descriptive cross-sectional study conducted in primary care. A total of 851 individuals within the 35-74 age range, free of cardiovascular diseases and selected by simple random sampling were included. A study was made of the percentage of high-risk patients with Framingham (> or = 20% ten-year risk), SCORE (> or = 5% ten-year risk) and REGICOR with cutoff points > or = 20%, > or = 15%, > or = 10% and > or = 5% at 10 years, given that with REGICOR > or = 20% there are hardly any high-risk cases. A comparison was drawn between the correlation (Pearsons r) and concordance (Kappa index) of the REGICOR and SCORE high-risk individuals as compared to Framingham. RESULTS: The high-risk percentages respectively found were: 23.3% with Framingham; 15.2%; with SCORE; and 1.4%, 5.8%, 17.6% and 57.0% with REGICOR with the cutoff points described. REGICOR has a 0.99 correlation, SCORE a 0.78 correlation. REGICOR > or = 10% showed a better concordance (Kappa 0.83) than SCORE (Kappa 0.61). On comparing the cardiovascular risk factors of the high-risk cases (> or = 20% Framingham, > or = 5% SCORE and > or = 10% REGICOR), SCORE showed higher prevalence of diabetes and a lower prevalence of hypercholesterolemia (p or = 10% cutoff point, it classifies a number of individuals as high-risk similar to SCORE and fewer than Framingham. The SCORE model would treat a number of patients similar to the REGICOR > or =10% model with hypolipemiant drugs, however showing lesser evidence of effectiveness of the treatment.

Validación de una versión reducida en español del cuestionario de actividad física en el tiempo libre de Minnesota (VREM)

Fundamentos: con el fin de disponer de una version breve y en espanol del Cuestionario de Actividad Fisica en el tiempo libre de Minnesota (CAFM) para poder utilizarlo en atencion primaria, el objetivo de este trabajo es presentar la elaboracion de la version reducida (VREM) y su validacion. Metodos: Estudio descriptivo de validacion del cuestionario, realizada en cinco centros de Atencion Primaria de Barcelona. Se seleccionaron 200 sujetos igual o mayores de 50 anos que consultaron por cualquier motivo, con una distribucion por edad y sexo similar a la de la poblacion de Cataluna . Dos fases: primera, se construyo el VREM mediante reduccion del numero de items. Segunda, se evaluo su validez de criterio respecto al CAFM (referencia) y la fiabilidad test-retest mediante el indice kappa y el coeficiente de correlacion intraclase (CCI). Resultados: Los 6 items incluidos en el VREM fueron: caminar, trabajar el huerto, hacer deporte o bailar, subir escaleras, ir a comprar a pie y limpiar la casa. La duracion de la entrevista mediante el VREM fue de 5 minutos (desviacion estandar 2). La validez de criterio entre ambos cuestionarios, usando 4 categorias de actividad fisica, fue del 95,5% (kappa=0,93). La fiabilidad test-retest del cuestionario fue del 92,5% (kappa=0,88). Usando un resultado continuo en forma de metabolic energy turnover (MET) el VREM tambien mostro una alta validez y fiabilidad (CCI=0,95 y CCI=0,96 respectivamente). Conclusiones: La version reducida del CAFM es valida y fiable en poblacion mayor o igual a 50 anos.

Cardiovascular Disease Epidemiology and Risk Factors in Primary Care

Introduction and objectives.To study the prevalence ofand risk factors for cardiovascular disease in primary care.Patients and method.A cross-sectional study was ca-rried out at an urban health center in Barcelona, Spain. Intotal, 2248 patients ≥15 years old were selected randomlyfrom medical records. The study investigated cardiovas-cular diseases such as ischemic heart disease, cerebro-vascular disease and peripheral arterial disease, and car-diovascular risk factors such as age, sex, smoking, highblood pressure, hypercholesterolemia, hypertriglyceride-mia, and diabetes mellitus.Results. The patients’ mean age was 49.1 (18.9) yearsand 53.5% were male. Cardiovascular risk factor prevalen-ces were: smoking, 35.2%; high blood pressure, 33.7%;hypercholesterolemia, 21.9%; hypertriglyceridemia,12.7%;and diabetes mellitus, 15.8%. Overall, 57.9% of patientshad at least 1 cardiovascular risk factor. Significantly moremales presented with each risk factor (P<.05), apart fromhigh blood pressure. The prevalence of all risk factors, ex-cept smoking, increased with age until 74 years and thenstabilized, except high blood pressure, which continued toincrease. Around 10% had cardiovascular disease, withmyocardial ischemia in 5.5%, cerebrovascular disease in3.7%, and peripheral arterial disease in 2.4%. All exceptcerebrovascular disease were significantly more commonin males (P<.05). The prevalence of cardiovascular disea-se was low in individuals <55 years old, particularly wo-men, and increased with age for all forms of disease.Some 68.3% were ≥65 years old.Conclusions. The high prevalence of cardiovascularrisk factors was confirmed. Cardiovascular disease wasmore common in males and the elderly.

Eficacia de una terapia secuencial en la erradicación de Helicobacter pylori: cuádruple terapia con omeprazol, metronidazol, tetraciclina y bismuto tras el fracaso de la combinación de omeprazol, claritromicina y amoxicilina

Fundamento Evaluar la eficacia de una terapia secuencial para erradicar a Helicobacter pylori (HP). Pacientes y metodo Un total de 151 pacientes, con ulcus peptico o gastritis cronica, infectados por HP, tratados (primera etapa) con una combinacion de omeprazol (20 mg/12 h), claritromicina (500 mg/12 h) y amoxicilina (1 g/12 h) (OCA) durante una semana y posteriormente (segunda etapa, si fracasaba la erradicacion) con una combinacion de omeprazol (20 mg/12 h), metronidazol (500 mg/12 h), tetraciclina (500 mg/6 h) y bismuto (120 mg/6 h) (OMTB) durante 14 dias. Resultados Por intencion de tratar se erradico con OCA en el 78,1% (IC del 95%: 71,6–84,7) y con OMTB en el 90,3% (IC del 95%: 74,2–98), siendo la proporcion acumulada del 96,7% (IC del 95%: 92,4–98,9). Conclusiones La eficacia de la estrategia estudiada es elevada. La combinacion OMTB es una buena opcion tras el fracaso de la OCA.

Sobretratamiento antihipertensivo en mayores de 80 años

BACKGROUND AND OBJECTIVE To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment. PATIENTS AND METHODS Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Laws meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications. RESULTS The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication. CONCLUSIONS The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription.