Miguel Ángel Royo-Bordonada

Guía Europea de Prevención Cardiovascular en la Práctica Clínica: adaptación Española del CEIPC 2008

espanolPresentamos la adaptacion espanola del Comite Espanol lnterdisciplinario para la Prevencion Cardiovascular (CEIPC) 2008 de la Guia Europea de Prevencion Cardiovascular (IV Cuarto Grupo de Trabajo Conjunto de la ESC y otras sociedades). Esta guia se centra en la prevencion de la enfermedad cardiovascular en su conjunto, incluyendo las distintas manifestaciones clinicas (coronaria, cerebrovascular, periferica y otras) y mantiene la recomendacion del modelo SCORE de bajo riesgo en la poblacion espanola para la valoracion del riesgo cardiovascular global, con un punto de corte en el 5% para definir alto riesgo. El objetivo es prevenir la mortalidad y morbilidad debidas a las ECV, mediante la prevencion y el manejo adecuado de sus factores de riesgo en la practica clinica. Se enfatiza la prevencion primaria basada en la modificacion de los habitos y estilos de vida, buscando o manteniendo el perfil de las personas sanas. Se requiere una intervencion profesional adecuada y duradera, generalmente multidisciplinar, para que la poblacion y los pacientes en riesgo incrementen su actividad fisica, sigan una alimentacion saludable y abandonen el tabaco si son fumadores. Respecto a las guias previas, se subraya el papel del medico y enfermeria de Atencion Primaria, por su proximidad y accesibilidad en los cuidados e intervenciones preventivas y en la promocion de un estilo de vida cardiosaludable. La decision de iniciar el tratamiento para reducir la presion arterial dependera de sus valores, del riesgo cardiovascular y de la existencia o no de lesiones de organos diana o ECV asociada. La meta terapeutica es, en general, PA EnglishWe are pleased to present the Spanish adaptation from the Spanish Committee for Cardiovascular Disease Prevention (CEIPC) of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (IV Joint Task Force of the European Society of Cardiology and Other Societies). This guide is focused on the prevention of cardiovascular disease (CVD) as a whole, including coronary, cerebrovascular, periphery and others, recommending the SCORE model for risk assessment with a 5% threshold for the definition of high-risk. We empathize the need of primary prevention based on lifestyle changes included stop smoking, suitable nutrition and diary physical exercise, with the focus on the health people. The objective is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. A maintained and multidisciplinary professional intervention is required in order to obtain an increase of physical activity, healthy alimentation and smoking cessation in smokers, to the general population and individuals at risk. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs or definite CVD. The treatment goal is to achieve BPThe present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Adaptación española de la Guía Europea de Prevención Cardivascular

We are pleased to present the European Guidelines on Cardiovascular Disease Prevention, translated and adapted by the Interdisciplinary Spanish Committee for Cardiovascular Disease Prevention. This guide is focused on the prevention of cardiovascular disease as a whole, recommending the SCORE model for risk assessment and placing priority on the care of patients and high-risk individuals. The objective is to prevent premature death due to CVD by means of dealing with its related risk factors in clinical practice. Hence, a maintained professional intervention is required in order to obtain an increase of physical activity and of healthy diets in patients high-risk individuals, and smoking cessation in smokers. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs. The treatment goal is to achieve BP <140/90 mmHg, but among patients with diabetes, chronic kidney disease, a past history of ictus, coronary heart disease or heart failure, lower levels must be pursued. Serum cholesterol must be below 200 mg/dl and LDL cholesterol below 130 mg/dl, although among patients with CVD or diabetes, levels respectively below 175 mg/dl and 100 mg/dl must be pursued. Advice of a professional dietitian is always required in order to keep blood sugar levels controlled. Proper insulin therapy is required in Type I diabetes. Patients with Type II diabetes and those with metabolic syndrome must lose weight and increase their physical activity, drugs being administered wherever applicable. Lastly, an appendix is included providing diet recommendations adapted to our environment and criteria related to referral or seeing a specialist for hypertensive or dyslipemic patients.

Spanish children's diet: compliance with nutrient and food intake guidelines.

Objective: To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake.Design and setting: Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire.Participants: The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6–7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level.Main Outcome Measures: Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI).Results: Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly- and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile.Conclusions: Children aged 6–7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish childrens eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.

Food sources of nutrients in the diet of Spanish children: the Four Provinces Study

The aim of the present study was to assess the principal food sources of energy and nutrients among Spanish children. We used a cross-sectional study design, based on results obtained from a food-frequency questionnaire. The sample included 1112 children, aged 6-7 years, from Cadiz, Madrid, Orense and Murcia, Spain. Children were selected through random cluster-sampling in schools. We analysed the percentage contributed by each food item to total energy and nutrient intake. The most important food sources were: white bread in the case of carbohydrate (13.4 %); olive oil in the case of total lipids (18.3 %) and monounsaturated fatty acids (29.2 %); whole milk in the case of protein (10.2 %) and saturated fatty acids (14.9 %); chips (French fried potatoes) in the case of polyunsaturated fatty acids (30.4 %). The greatest proportion of Na, consumed in excess, came from salt added to meals. Ham ranked second as a source of saturated fats. Fruits and green leafy vegetables proved to have great relevance as sources of fibre and vitamins, though with regard to the latter, it was observed that fortified foods (breakfast cereals, dairy products, fruit juices, etc.) had come to play a relevant role in many cases. In conclusion, the nutritional profile of Spanish school-aged children aged 6-7 years could be improved by nutritional policies targeted at limiting their consumption of ham (cured or cooked) and of salt added to meals, replacing whole milk with semi-skimmed milk, encouraging the consumption of products rich in complex carbohydrates already present in childrens diets (bread, pasta, rice) and promoting less fatty ways of cooking food.

Riesgos asociados a la dieta occidental y al sedentarismo: la epidemia de obesidad

We describe the magnitude and trends of obesity in Spain and of its main determinants, associated both with the incre- ase in energy intake and the reduction of energy expenditu- re. Such determinants include factors from the individual sub- jects and from their environment. We also present the main features of the strategy for the Nutrition, Physical Activity, and the Prevention of Obesity, fostered by the Ministry of Health, as well as plans and activities carried out by the Regional Go- vernments, to control this health disorder. We conclude that effective and sustained implementation of these activities is badly needed. It should be made along with the monitoring of obesity and its determinants in the general population. Re- search in this field should also be strengthened because so- cial determinants of obesity are not known in depth, and the effectiveness of many of the interventions proposed by the na- tional and regional initiatives is not well established yet. Mo- reover, in the next future, the effectiveness of intervention mo- dels applied to control the smoking epidemic must be assessed to examine its usefulness in the control of obesity. An example of this type of interventions is the limitation of the publicity of nutrient-poor and energy-dense foods addressed to children. words: Obesity. Trends. Determinants. Interventions.

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

BackgroundThe successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs.MethodsA cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire.ResultsMore than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations.ConclusionsMost PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools.

Greater dietary variety is associated with better biochemical nutritional status in Spanish children: The Four Provinces Study

BACKGROUND AND AIM Although dietary variety has been associated with a better nutritional profile, its possible role in obesity raises doubts about its overall health benefits. In this study, we examined the association between dietary variety and anthropometric variables, food intake and various food intake biomarkers in Spanish children. METHODS AND RESULTS This was a cross-sectional study of 1112 children aged 6-7 years from Cadiz, Murcia, Orense and Madrid, who were selected by means of the random cluster-sampling of schools. Information concerning food and nutrient intake was obtained using a food frequency questionnaire, and a dietary variety index (DVI) was calculated on the basis of the number of different foods consumed more than once a month. The anthropometric variables (weight and height), and plasma lipid and vitamin levels were determined using standardised methods. Our results show that the body mass index (BMI) did not vary substantially as a function of DVI: it was 16.9 in the lowest DVI tertile and 17.2 in the highest (p=0.20). Unlike BMI, the DVI positively correlated (p<0.05) with the plasma levels of alpha and beta-carotene, lycopene, retinol, alpha-tocopherol and vitamin E, with energy intake, and with most of the foods, particularly vegetables, fruit and sausages (respective correlation coefficients of 0.43, 0.26 and 0.23). CONCLUSIONS Dietary variety is associated with a better food and nutritional profile in Spanish children. Nevertheless, the presence of a positive association between the DVI and energy intake, and the consumption of sausages and pre-cooked products calls for the recommendation of a varied diet of healthy foods, such as cereals (especially whole grains), fruits and vegetables.

La duración de la incapacidad laboral y sus factores asociados

Objetivo: El objetivo de este estudio fue estimar la duracion media de la incapacidad laboral temporal (IT) y evaluar algunos de sus posibles determinantes. Metodos: En la poblacion del Area de Inspeccion de Alcala de Henares se registraron durante 1995 un total de 12.570 procesos de IT. Mediante un muestreo aleatorio simple se obtuvo una muestra de 600 procesos. Ademas de la duracion de la IT, se recogio informacion acerca de las caracteristicas sociodemograficas de los pacientes, regimen de la Seguridad Social (SS), diagnostico que justifico la IT y modelo de atencion primaria. La comparacion de medias se realizo mediante el analisis de la varianza y el efecto relativo de cada variable sobre la probabilidad de volver al trabajo se estimo mediante modelos de regresion de Cox. Resultados: La media y la mediana de la duracion de la IT fueron 44,5 y 11 dias. Los procesos de duracion inferior a un mes representaron el 72,9% del total. La duracion de la IT, similar en ambos sexos, presento una asociacion positiva con la edad (p=0,0002) y fue menor en el personal del Insalud y mayor en los regimenes de Autonomos y Empleadas del Hogar, comparados con el General (p<0,0001). El efecto relativo ajustado (e intervalos de confianza del 95%) sobre la probabilidad de volver a trabajar fue de 2 (1,07-3,73) para el personal del Insalud comparado con el regimen general y de 0,89 (0,88-0,90) por cada incremento de cinco anos en la edad. Conclusiones: Los factores mas influyentes en la duracion de la IT fueron la edad y el regimen de SS. La mejora en la accesibilidad al sistema sanitario es uno de los factores que podria incidir positivamente en la probabilidad de volver al trabajo.

Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC) on the 2012 European Cardiovascular Prevention Guidelines

Based on the two main frameworks for evaluating scientific evidence--SEC and GRADE--European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions, led by health professionals and with the participation of the patients family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions--such as smoking ban in public areas or the elimination of trans fatty acids from the food chain--are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure (BP) within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.

Evaluation of food and beverage television advertising during children's viewing time in Spain using the UK nutrient profile model.

OBJECTIVE To evaluate the nutritional quality of products advertised on television (TV) during children’s viewing time in Spain, applying the UK nutrient profile model (UKNPM). DESIGN We recorded 80 h of four general TV station broadcasts during children’s time in May and June 2008, and identified all advertisements for foods and beverages. Nutritional information was obtained from the product labels or websites and from food composition tables. Each product was classified as healthy (e.g. gazpacho, a vegetable juice) or less healthy (e.g. potato crisp snacks) according to the UKNPM criteria. SETTING Four free-of-charge TV channels in Spain: two national channels and two regional ones. SUBJECTS TV commercials of food and beverages. RESULTS A total of 486 commercials were broadcast for ninety-six different products, with a mean frequency of 5?1 advertisements per product. Some 61?5% of the ninety-six products were less healthy, and the percentage was higher for foods (74?1 %). All (100 %) of the breakfast cereals and 80% of the non-alcoholic drinks and soft drinks were less healthy. Of the total sample of commercials, 59?7% were for less healthy products, a percentage that rose to 71?2% during children’s reinforced protection viewing time. CONCLUSIONS Over half the commercials were for less healthy products, a proportion that rose to over two-thirds during the hours of special protection for children. This suggests that applying the UKNPM to regulate food advertising during this slot would entail the withdrawal of most food commercials in Spain. TV advertising of products with low nutritional quality should be restricted.