Manuel de Oya

La prevención secundaria del infarto de miocardio en España. Estudio PREVESE

Introduccion y objetivos Se presentan los datos del estudio PREVESE llevado cabo en dos fases: la basal para conocer las medidas de prevencion secundaria recomendadas en nuestro pais a los pacientes que son dados de alta tras un infarto de miocardio y la de control a los 6 meses para conocer su cumplimiento. Metodos Se estudiaron datos de 1.242 pacientes de 39 hospitales. Se analizaron sus antecedentes, factores de riesgo, situacion laboral, pruebas diagnosticas y valorativas practicadas durante la hospitalizacion, hallazgos analiticos y tratamiento prescrito al alta. En el control posterior se revisaron el estado de los factores de riesgo, la situacion laboral, las nuevas pruebas practicadas, la mortalidad y otros acontecimientos adversos. Resultados Los antecedentes y los factores de riesgo estudiados parecen dibujar un perfil de riesgo elevado entre la poblacion global de pacientes que sufre un infarto de miocardio. Entre el tratamiento indicado al alta llama la atencion la escasa prescripcion de farmacos hipolipemiantes(6,7%). A los 6 meses se constato una mejoria en el perfil de riesgo, al reducirse sustancialmente el numero de fumadores, seguir siendo muy escasos los hipertensos y reducirse el sedentarismo. Sin embargo, no hubo modificaciones favorables en las concentraciones de colesteroltotal. Conclusiones El cumplimiento de las medidas de prevencion no abarca de forma similar a todos los factores de riesgo: asi como parece existir exito en el tratamiento y prevencion del tabaquismo y la hipertension arterial, no ocurre lo mismo con las cifras elevadas de lipidosplasmaticos.

Consumption of bakery products, sweetened soft drinks and yogurt among children aged 6-7 years: association with nutrient intake and overall diet quality.

The present study tests the hypothesis that higher consumption of bakery products, sweetened soft drinks and yogurt is associated with higher intake of energy, saturated fats, sugars and worse overall diet quality among Spanish children. This is a cross-sectional study covering 1112 children aged 6.0-7.0 years in four Spanish cities. Nutrient and food intake were obtained through a food-frequency questionnaire, and overall diet quality calculated using the healthy-eating index (HEI) developed by Kennedy et al. (1995). Standardized methods were used to measure anthropometric variables. Associations of interest were summarized as the difference in nutrient and food consumption between the value of the fifth and the first quintile of consumption (dq) of bakery products, sweetened soft drinks or yogurt, adjusted for energy intake and BMI. Bakery products, sweetened soft drinks and yogurt supplied 15.5, 1.0 and 5.6 % energy intake respectively. Higher consumption of these three foods was associated with greater energy intake (P<0.001), but not with higher BMI. Consumption of bakery products was associated with the proportion of energy derived from intake of total carbohydrates (dq 4.5 %, P<0.001) and sugars (dq 2 %, P<0.001), but did not show association with the HEI. Consumption of sweetened soft drinks was associated with a lower consumption of milk (dq -88 ml, P<0.001) and Ca (dq -175 mg/d, P<0.001), and worse HEI (dq -2, P<0.01). Consumption of yogurt, while associated with higher energy intake from saturated fats (dq 1.77 %, P<0.001) and sugars (dq 2.02 %, P<0.001), showed no association with the HEI. Differences in the intake of nutrients and foods across quintiles of consumption of bakery products, sweetened soft drinks and yogurt were usually very small. We conclude that the impact of the consumption of bakery products, sweetened soft drinks and yogurt on the quality of the diet of Spanish children is only modest, although it may contribute to aggravating certain unhealthy characteristics of their diet, particularly excess energy, saturated fats and sugars. Therefore, consumption of bakery products and sweetened soft drinks should be moderated, and priority given to consumption of low-fat, low-sugar yogurt.

Human apolipoprotein A-I gene promoter mutation influences plasma low density lipoprotein cholesterol response to dietary fat saturation

Previous studies have shown that the A to G transition occurring at position -75 bp upstream of the transcriptional start site in the human apolipoprotein A-I gene may affect plasma high density lipoprotein cholesterol (HDL-C) levels and low density lipoprotein cholesterol (LDL-C) response to changes in amount of dietary fat. We have examined the response to dietary fat saturation as a function of this mutation in 50 men and women. Subjects were first fed a saturated (SAT) fat diet (35% fat, 17% SAT) for 28 days, followed by a diet rich in monounsaturated fatty (MUFA) acids (35% fat, 22% MUFA) for 35 days and a diet rich in polyunsaturated (PUFA) fat (35% fat, 13% PUFA) for 35 days. All meals were prepared and consumed at the study sites. Lipoproteins were measured at the end of each diet period. The allele frequency for the A allele was 0.13. Subjects carrying the A allele had higher plasma cholesterol, LDL-C and triglyceride levels than those homozygotes for the G allele. As compared to the SAT diet, a PUFA diet induced significantly greater plasma total (P = 0.003) and LDL-C decreases (P = 0.001) in G/A women (-1.62 and -1.32 mmol/l, respectively) than in G/G subjects (-0.87 and -0.74 mmol/l for plasma and LDL-C, respectively). Multiple regression analysis demonstrated that in women, the variability in LDL-C response from a diet rich in SAT fat to a diet rich in PUFA was primarily due to LDL-C levels (during the SAT phase), accounting for 55.1% of the variance, waist to hip ratio (W/H; 11.4%) and the G/A polymorphism (10%). Whereas in men the major determinant of this response was smoking (21.4%). In conclusion, the G/A polymorphism appears to have a small but significant effect on plasma LDL-C responsiveness to changes in dietary fat saturation specially in women.

Influence of birth weight on the apo E genetic determinants of plasma lipid levels in children.

To evaluate the influence of birth weight on apolipoprotein (apo) E genetic determinants of plasma lipids levels in prepubertal children we studied 933 healthy children (491 males and 442 females) 6 to 8 years old (mean age of 6.7 y), whose weight was recorded at birth. Plasma lipid and apolipoprotein concentrations and apo E genotypes were determined. We observed a greater effect of the apo E polymorphism on total cholesterol (TC), LDL-cholesterol (LDL-C) and especially apo B levels in children with birth weight in the lower tertile compared with those with birth weights in higher tertiles. Taking the ε3 allele homozygosity as reference, in boys with birth weights in the low tertile the overall lowering effect of the ε2 allele on TC, LDL-C and apo B was greater (10.5% (p < 0.01), 20.2% (p < 0.01) and 18.8% (p < 0.01), respectively) than in those in the highest tertile (5.6% on TC, 10.3% on LDL-C and 12.6% (p < 0.01) on apo B). A similar trend in this effect between tertiles of birth weight was also observed in girls. For both sexes, linear regression analysis demonstrates a positive and significant interaction between birth weight and ε2, which may explain the fact that the decrease in TC, LDL-C and apo B associated with the ε2 allele is more marked the lower the birth weight. Taking into account the prevalence of apo E polymorphism, and that appears to be the main genetic factor affecting plasma lipids, the interaction of apo E genotype and birth weight could be an important determinant of TC, LDL-C and apo B levels, and, as a consequence, of atherosclerosis.

Factores de riesgo cardiovascular en la edad infantil. Resultados globales del estudio Cuatro Provincias

La aterosclerosis es un proceso que se inicia en las primeras decadas de la vida y evoluciona de forma asintomatica, en general, sin expresion clinica hasta la edad adulta. En el estudio Cuatro Provincias hemos analizado, en 1.275 ninos de edad prepuberal, factores de riesgo (dieta, variables antropometricas, concentraciones de lipidos, vitaminas y algunos determinantes geneticos) que pueden estar relacionados con la aparicion de la enfermedad coronaria en la edad adulta. En esta revision resumimos de forma global, las principales aportaciones del estudio. El estudio 4P ha reflejado que los aspectos relacionados con el sindrome metabolico (obesidad, concentraciones elevadas de glucosa y trigliceridos) que conducen a la enfermedad coronaria en el adulto estan ya expresados en la edad escolar. En este sentido, los ninos de las provincias con una alta mortalidad coronaria pesan mas y tienen unas concentraciones mas altas de trigliceridos y glucosa. El porcentaje de ninos que supera las concentraciones recomendables de colesterol total y colesterol unido a lipoproteinas de baja densidad es elevado en todas las provincias. A pesar de que hay aspectos positivos, como que las concentraciones de colesterol unido a lipoproteinas de alta densidad son tambien elevadas y que la prevalencia del alelo ?4 del gen de la apo-E, claramente relacionada con el riesgo cardiovascular, es baja en el conjunto de la poblacion, si las alteraciones metabolicas descritas persisten, la situacion de Espana respecto al riesgo cardiovascular puede empeorar en el futuro. Estos aspectos metabolicos se asocian con una alimentacion rica en grasas y con un bajo consumo de hidratos de carbono, alejada de las recomendaciones actuales para la infancia. Su correccion en edades tempranas tendria enormes beneficios en la prevencion de la enfermedad coronaria.

Sex hormone-binding globulin and lipid profile in pubertal children.

Men and women have different lipid profiles throughout life, related to changes in sex hormones; and this has been associated with sex-related differences in the prevalence of coronary heart disease. The influence of sex hormone changes during puberty on the lipid profile has been reported, but levels of sex hormone-binding globulin (SHBG) (the specific plasma binding protein of sex hormones) have not been evaluated even though its regulatory role might be crucial. The aim of this study was to analyze the relationship between sex hormones and SHBG and changes in plasma lipid levels during puberty. Our population-based sample included 370 healthy schoolchildren (175 male and 195 female), ranging from 12 to 15 years old. High-density lipoprotein cholesterol (HDL-C) levels were significantly lower in 15-year-olds than in younger boys, and apolipoprotein (apo) A-I levels steeply decreased across the studied age groups. Parallel to these changes, testosterone levels increased whereas SHBG decreased as age increases in boys. In girls, no significant differences were observed in these variables among the age groups. Testosterone and SHBG were highly correlated with anthropometric variables. Sex hormone-binding globulin was negatively associated with triglycerides (TG) in both sexes, remaining statistically significant after further adjustment for age and body mass index (BMI) in girls. Sex hormone-binding globulin was the only predictive variable for HDL-C and TG in multiple linear regression analysis, after adjustment by BMI, in both sexes, accounting for 10% of the variance of HDL-C in boys and for around 5% of the variance of TG in both sexes. In boys, testosterone and SHBG remained significantly correlated to apo A-I levels, even after adjusting for age and BMI, and were the most important predictive variables for apo A-I in multiple linear regression analysis. In conclusion, SHBG levels are related to a decrease in HDL-C and apo A-I levels during puberty in boys and to a decrease in TG levels during puberty in both sexes.

Estudio Cuatro Provincias: principales objetivos y diseño

Introduccion y objetivos Espana presenta una importante variacion geografica en la mortalidad por cardiopatia isquemica y por enfermedad cerebrovascular. En el presente articulo se describen los principales objetivos y el diseno del estudio Cuatro Provincias. En el se examina la contribucion de factores ambientales (dieta, perfil lipidico y antioxidantes plasmaticos), que actuan en la infancia, a la variacion provincial de la mortalidad cardiovascular en Espana. Metodos Se ha realizado un diseno ecologico, en el que las unidades de estudio y analisis son cuatro provincias espanolas con amplia variacion en la mortalidad cardiovascular en la edad adulta. El diseno compara la dieta, variables antropometricas y marcadores biologicos, fundamentalmente lipidos y antioxidantes plasmaticos, entre los ninos de 6–7 anos de las dos provincias de mayor mortalidad y ninos de las dos provincias de menor mortalidad. La informacion para cada provincia se recoge de forma transversal en muestras representativas de los ninos de cada provincia. Discusion Las evidencias recogidas en la bibliografia, referentes a paises del norte de Europa, sugieren la contribucion de factores ambientales en etapas tempranas de la vida a la aparicion de la enfermedad cardiovascular en la edad adulta. El estudio Cuatro Provincias proporcionara, por primera vez, informacion sobre la influencia de factores de la vida temprana sobre el riesgo cardiovascular en un pais del area mediterranea. Tambien aportara datos sobre la alimentacion en la edad escolar en cuatro provincias y permitira estimar valores poblacionales de las variables de interes en dichas provincias.

Cardiovascular Risk Factors in Children. Main Findings of the Four Provinces Study

Atherosclerosis is a process that begins during the first few decades of life, progresses asymptomatically, and generally shows no clinical manifestations until adulthood. The Spanish Four Provinces study, which involved 1275 prepubertal children, was an investigation into childhood risk factors for atherosclerosis (e.g., diet, anthropometric variables, lipid levels, and some genetic factors) that may be related to the occurrence of coronary artery disease in adults. In this review, we summarize the studys most important findings. The Four Provinces study showed that several factors associated with the metabolic syndrome (i.e., obesity, and raised glucose and triglyceride levels), which can lead to coronary disease in adults, are already present in schoolchildren. What is more, children from provinces with high coronary disease mortality weighed more and had higher plasma triglyceride and glucose levels. A high percentage of children in all provinces studied had total cholesterol and low-density lipoprotein cholesterol plasma levels above the recommended values. Despite the presence of some positive features in the population as a whole, such as a raised high-density lipoprotein cholesterol level and low prevalence of the apolipoprotein-E epsilon4 allele, which is known to be related to cardiovascular risk, if the metabolic changes described above persist, the risk of cardiovascular disease in Spain can only increase in the future. These metabolic characteristics are associated with a high-fat, low-carbohydrate diet which is far from that currently recommended for children. Correction of this poor diet at an early age would have significant benefits for the prevention of cardiovascular disease.

Relationship of adiponectin with metabolic syndrome components in pubertal children

OBJECTIVE Adiponectin is an adipose tissue-derived adipocytokine which appears in decreased concentrations in obese patients and in several processes related to cardiovascular disease, such as type 2 diabetes or metabolic syndrome. The aim of this study was to analyze the relationship between adiponectin and components of metabolic syndrome (lipid profile, blood pressure, insulin and insulin resistance) in pubertal Spanish children. METHODS The population-based sample included 810 healthy children (382 boys and 428 girls) 12-16 years of age. Anthropometric parameters and blood pressure were measured. Lipid levels were determined by standard methods, and insulin and adiponectin concentrations were measured by ELISA. Insulin resistance index was assessed by HOMA-IR. RESULTS Adiponectin levels were negatively correlated with insulin and HOMA in both boys and girls, and remained significant after adjustment for BMI z-score in girls. After this adjustment, adiponectin maintained a positive correlation with HDL-cholesterol and HDL-phospholipids in both genders, and correlated with triglycerides in girls. Multiple linear regression analysis showed that, after adjustment for BMI z-score, adiponectin accounted for 15.8% of the variation of HDL-cholesterol in girls and for 5% of its variation in boys; meanwhile, it accounted for 15.8% and 12.7% of the variation of HDL-phospholipids in girls and boys, respectively. CONCLUSIONS Adiponectin levels in 12- to 16-year-old children appear to be more strongly related to better lipid profile and insulin sensitivity in girls than in boys. Our study shows, for the first time to our knowledge, a significant positive correlation between adiponectin and HDL-phospholipids in pubertal children.

Factores metabÓlicos en la poblaciÓn escolar asociados a mortalidad cardiovascular en los adultos. Estudio Cuatro Provincias

Fundamento Existen evidencias sobre la contribucion de factores ambientales en etapas tempranasde la vida a la aparicion de la enfermedad cardiovascular en la edad adulta. Por ello, enel presente trabajo hemos examinado variables antropometricas y bioquimicas en ninos de 6–7anos de cuatro provincias espanolas con una gran variacion en la mortalidad por cardiopatia isquemica(CI). Pacientes y metodo Estudio transversal en 1.255 ninos en edad escolar (50,3% varones) de Cadizy Murcia, provincias con alta mortalidad por CI, y de Madrid y Orense, provincias con bajamortalidad por CI, en los que se han analizado peso, indice de masa corporal (IMC) y prevalenciade obesidad, y se han determinado los valores plasmaticos de glucosa y el perfil lipidicomediante metodos estandarizados. Resultados Los ninos de las provincias con mayor mortalidad tienen mayor peso (p Conclusiones La mayor prevalencia de sobrepeso y obesidad, junto con los elevados valores deglucosa y trigliceridos asociados a las provincias de alta mortalidad, indica que los ninos de estasprovincias son metabolicamente distintos de los de provincias de baja mortalidad. Estas alteracionespodrian contribuir a la distinta mortalidad cardiovascular en la edad adulta.