Miguel Angel Sánchez-Chaparro

Prevalencia de factores de riesgo vascular en la población laboral española

Introduccion y objetivos Los reconocimientos de la salud de los trabajadores constituyen una oportunidad de deteccion precoz de factores de riesgo vascular. El presente estudio investiga la prevalencia de factores de riesgo vascular en la poblacion laboral espanola. Metodos Se incluyo a 216.914 trabajadores (edad media, 36,4 anos; intervalo, 16-74 anos; el 73,1% eran varones) en los que se realizo un reconocimiento en una mutua laboral, que incluyo un cuestionario estructurado, una exploracion fisica y determinaciones bioquimicas. Resultados Tenian diagnostico previo de enfermedad cardiovascular el 0,7%, de hipertension arterial el 6,2%, de diabetes el 1,2% y de dislipidemia el 8,9%. Durante el reconocimiento se detecto la presencia de tabaquismo en el 49,3% (el 51,3% varones y el 43,8% mujeres), presion arterial elevada (≥ 140/90 mmHg) en el 22,1% (el 27,0% varones y el 8,8% mujeres), obesidad (indice de masa corporal ≥ 30) en el 15,5% (el 18,3% varones y el 13,3% mujeres), hiperglucemia (> 110 mg/dl) en el 6,2% (el 7,8% varones y el 1,9% mujeres) y alguna forma de dislipidemia (colesterol total ≥ 200 mg/dl, cLDL ≥ 160 mg/dl, trigliceridos ≥ 200 mg/dl o cHDL Conclusiones Hay una alta prevalencia de factores de riesgo en la poblacion laboral espanola, especialmente en varones y en determinados sectores de actividad.

Occupation-Related Differences in the Prevalence of Metabolic Syndrome

OBJECTIVE—To investigate the prevalence of metabolic syndrome in the Spanish working population and determine how the prevalence varies according to occupation and sex. RESEARCH DESIGN AND METHODS—This was a cross-sectional study of 259,014 workers (mean age 36.4 years, range [16–74]; 72.9% male) who underwent a routine medical checkup. The Adult Treatment Panel III (2001) definition for metabolic syndrome was used. RESULTS—The prevalence of metabolic syndrome was 11.6% (95% CI 11.5–11.7) in male subjects and 4.1% (4.0–4.2) in female subjects and increased with age. The prevalence of metabolic syndrome varied in the different categories of occupational activity depending on the sex considered. Among female subjects, the age-adjusted prevalence of metabolic syndrome was higher in blue-collar than in white-collar workers, but this difference was not evident among male workers. CONCLUSIONS—The prevalence of metabolic syndrome varies in the different categories of occupational activity in the Spanish working population. This variation also depends on sex.

Omega 3 fatty acids induce a marked reduction of apolipoprotein B48 when added to fluvastatin in patients with type 2 diabetes and mixed hyperlipidemia: a preliminary report

BackgorundMixed hyperlipidemia is common in patients with diabetes. Statins, the choice drugs, are effective at reducing lipoproteins that contain apolipoprotein B100, but they fail to exert good control over intestinal lipoproteins, which have an atherogenic potential. We describe the effect of prescription omega 3 fatty acids on the intestinal lipoproteins in patients with type 2 diabetes who were already receiving fluvastatin 80 mg per day.MethodsPatients with type 2 diabetes and mixed hyperlipidemia were recruited. Fasting lipid profile was taken when patients were treated with diet, diet plus 80 mg of fluvastatin and diet plus fluvastatin 80 mg and 4 g of prescription omega 3 fatty acids. The intestinal lipoproteins were quantified by the fasting concentration of apolipoprotein B48 using a commercial ELISA.ResultsThe addition of 4 g of prescription omega 3 was followed by significant reductions in the levels of triglycerides, VLDL triglycerides and the triglyceride/HDL cholesterol ratio, and an increase in HDL cholesterol (P < 0.05). Fluvastatin induced a reduction of 26% in B100 (P < 0.05) and 14% in B48 (NS). However, the addition of omega 3 fatty acids enhanced this reduction to 32% in B100 (NS) and up to 36% in B48 (P < 0.05).ConclusionOur preliminary findings therefore suggest an additional benefit on postprandial atherogenic particles when omega 3 fatty acids are added to standard treatment with fluvastatin.

Higher red blood cell distribution width is associated with the metabolic syndrome: results of the Ibermutuamur CArdiovascular RIsk assessment study.

A high level of erythrocyte distribution width (RDW) is a novel prognostic marker that may reflect an underlying inflammatory state (1–3). Metabolic syndrome (MetS) is a chronic inflammatory disorder (4). We investigated the potential association between high levels of RDW and MetS. This cross-sectional study is part of the Ibermutuamur CArdiovascular RIsk Assessment (ICARIA) plan. A detailed description has been published elsewhere (5). A total of 217,567 workers (73.1% male, mean age 35.8 years) who underwent a routine medical checkup were included in the study. The Adult Treatment Panel III (ATPIII, 2001) definition for MetS was used. The mean RDW in the whole sample was 13.4% (SD 0.82%; range 10.1–33.4%; 75th percentile 14.0%). The …

Prevalence of cardiovascular risk factors in the Spanish working population

INTRODUCTION AND OBJECTIVES The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. METHODS The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. RESULTS Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (< or =140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index > or =30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol > or =200 mg/dL, LDL cholesterol > or =160 mg/dL, triglycerides > or =200 mg/dL, or HDL cholesterol < 40 mg/dL in males or < 50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. CONCLUSIONS The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment.

Association of moderate and severe hypertriglyceridemia with obesity, diabetes mellitus and vascular disease in the Spanish working population: results of the ICARIA study.

AIM To study the prevalence, risk factors, and vascular disease associated with moderate and severe hypertriglyceridemia in an active working population. DESIGN AND METHODS Cross-sectional study of 594,701 workers from all Spanish geographical areas, occupation sectors, ages, and sexes who underwent a yearly routine checkup. Data collected from participants included age, sex, anthropometric measurements, vascular risk factors, lipidic profile and basic biochemical analysis, from a fasting blood sample. A cardiovascular risk assessment was performed. RESULTS The study population included 428,334 males and 166,367 females, mean age 36+/-10 years. A total of 95,673 (16%) workers had mild hypertriglyceridemia (HTg) (Tg 150-399mg/dL), 7,081 (1.1%) had moderate HTg (400-999mg/dL), and 224 (0.03%) had severe HTg (>or=1000mg/dL). Of workers with hypertriglyceridemia, 90% were male. Age, obesity, type 1 and 2 diabetes, alcohol consumption, and vascular disease were associated with hypertriglyceridemia. Cardiovascular risk gradually increased for each HTg category. Amongst risk factors, the major independent predictor of mild-HTg was obesity (OR 2.42, CI 95% 2.37-2.48), whereas diabetes was a predictor of moderate HTg (OR 3.64, CI 95% 3.17-4.18) and severe HTg (OR 7.35, CI 95% 4.27-12.66). In multivariate analyses, HTg was gradually associated with vascular disease, even after adjusting for other risk factors. CONCLUSION In this working population, preventive programs for HTg and associated vascular disease should consider obesity-diabetes control as its first objective.

Influence of high cardiovascular risk in asymptomatic people on the duration and cost of sick leave: results of the ICARIA study

AIMS We investigated the potential influence of a moderate-to-high cardiovascular (CV) risk (CVR) (defined as a Systematic COronary Risk Evaluation model, or SCORE ≥ 4%), in the absence of an established CV disease, on the duration and cost of CV and non-CV sick leave (SL) resulting from common and occupational accidents or diseases. METHODS AND RESULTS We conducted a prospective cohort study on 690 135 workers with a 1-year follow-up and examined CV- and non-CV-related SL episodes. To obtain baseline values, CVR factors were initially assessed at the beginning of the year during routine medical examination. The CVR was calculated with the SCORE charts for all subjects. Moderate-to-high CVR was defined as SCORE ≥ 4%. A baseline SCORE ≥ 4% was associated with a higher risk for long-term CV and non-CV SL, as revealed by follow-up assessment. This translated into an increased cost, estimated at €5 801 464.18 per year. Furthermore, pharmacological treatment for hypertension or hyperlipidaemia was significantly associated with longer SL duration. CONCLUSION Moderate-to-high CVR in asymptomatic subjects was significantly associated with the duration and cost of CV and non-CV SL. These results constitute the first body of evidence that the SCORE charts can be used to identify people with a non-established CV disease, which might ultimately translate into more lost workdays and therefore increased cost for society.

Atorvastatin in dyslipidaemia of the nephrotic syndrome

SUMMARY:  The combined dyslipidaemia that accompanies the nephrotic syndrome increases the cardiovascular risk and appears to worsen long‐term renal function. Our aim was to determine the efficacy and safety of 10 mg atorvastatin in the control of dyslipidaemia in these patients. We carried out a prospective, open, 6 month study of 10 patients with primary or secondary nephrotic syndrome (proteinuria >3.5 g/day, hypoalbuminaemia, oedema and hyperlipidaemia). The changes in lipids and plasma lipoproteins were measured, as well as the safety profile (transaminases, creatine phosphokinase, fibrinogen and antithrombin III activity) and parameters of renal function. The addition of 10 mg atorvastatin daily for 6 months resulted in a 41% reduction in low density lipoprotein (LDL) cholesterol and 31% in triglycerides (both P < 0.05), and a 15% increase in high density lipoprotein (HDL) cholesterol (NS). The drug was well tolerated and there was no change in the safety profile or deterioration in renal function. In fact, the levels of proteinuria fell in all but one patient (6.2 ± 2.6 vs 4.8 ± 2.5 g/24 h; P < 0.05). Atorvastatin, at the above dose, and for the time used proved to be a safe drug that effectively reduced dyslipidaemia in patients with nephrotic syndrome.

Factors influencing return-to-work after cerebrovascular disease: the importance of previous cardiovascular risk

Background The role of prior cardiovascular risk (CVR) in the multifactorial process of returning to work after a cerebrovascular event has not been adequately investigated. Therefore, the objective of the present study was to analyse the association between previous CVR level, cardiovascular risk factors (CVRFs) and return-to-work (RTW) following cerebrovascular disease. Design This was a prospective observational study. Methods We analysed a cohort of 348 patients who had experienced an episode of cerebrovascular disease-related work absence. These individuals were selected from the ICARIA study (Ibermutuamur CArdiovascular RIsk Assessment). Global CVR was assessed using the SCORE system. We investigated the association between demographics, work-related variables, CVRFs and RTW following a cerebrovascular event. Results We found that a total of 254 individuals (73.0%; 95% CI: 68.3–77.7) returned to work after cerebrovascular disease. Also, we observed a median loss of 12 working years due to disability. Moreover, adjusting for potential confounders revealed that low CVR level and the absence of the following CVRFs was associated with a higher likelihood of RTW: low vs moderate-to-high CVR level (OR: 2.55; 95% CI: 1.42–4.57), no hypertension before stroke (OR: 1.95; 95% CI: 1.11–3.41), non-smoker status (OR: 2.26; 95% CI: 1.30–3.93) and no previous diabetes (OR: 2.46; 95% CI: 1.26–4.79). Conclusions Low CVR, along with the absence of several CVRFs, can be used to predict RTW rates following cerebrovascular events. Therefore, controlling hypertension, tobacco consumption and diabetes might contribute to the effectiveness of multidisciplinary rehabilitation and/or secondary/tertiary prevention programs for cerebrovascular disease.

High risk of subclinical atherosclerosis in COPD exacerbator phenotype

It is not known whether COPD exacerbations contribute to an increased vascular risk already associated with the disease. For this reason, we prospectively evaluated 127 patients referred for a monographic COPD consultation. We classify as exacerbators those who had experienced two or more moderate exacerbations in the previous year, or who had had a hospital admission. All underwent a blood analysis, respiratory function tests, global cardiovascular and coronary risk estimates (with four of the most frequently used scores, and the Chronic Obstructive Pulmonary Disease Coronaropathy Risk (COPDCoRi) score, respectively); and an EcoDoppler to measure carotid intima-media thickness and the ankle-brachial index. Finally, we included 50 patients with exacerbator phenotypes and 57 with non-exacerbator phenotypes, ranging from 63 ± 7 years old, 74% of whom were male. The exacerbator phenotype increased the risk of carotid intima-media thickness above the 75th percentile range by a factor of almost three, independently of the severity of COPD and global cardiovascular risk. The association between the exacerbator phenotype and high c-IMT was more evident in patients under 65. In conclusion, the presence of subclinical atherosclerosis is independently associated with the exacerbator phenotype, with more pronounced differences in younger patient; which suggests that we should intensify control of vascular risk factors in these groups of patients.