Mikel Basterretxea

Adherence to the Mediterranean Diet and Risk of Coronary Heart Disease in the Spanish EPIC Cohort Study

No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29-69 years, recruited in 1992-1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.

Incidence of acute myocardial infarction in the Spanish epic cohort

BACKGROUND There is some evidence that Mediterranean diet reduces risk of ischemic heart disease, and this is to be investigated in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). In this paper we present the incidence of acute myocardial infarction (AMI) in four EPIC Spanish cohorts. METHOD Incidence cases were ascertained in EPIC cohort during the follow up period (from recruitment to the end of 2004), by means of self-report questionnaires, hospital morbidity and mortality registries, and population AMI registries. Analysis was restricted to aged 45 to 74. The present study included data from 13,704 women and 19,410 men, after excluding a priori participants with prevalent AMI. Age standardized incidence rate for each cohort was estimated and compared with the available population rates. RESULTS The Median duration of follow-up was 9.3 years, yielding a total of 297,704 person-years. 391 men and 99 women presented AMI in the four cohorts studied. Age standardized AMI rates in men of the EPIC cohorts go from the lowest 302 (CI: 268-335) per 100.000 person-year of Gipuzkoa to the highest 330 (CI: 293-367) of Navarra. Women in Navarra presented the lowest AMI incidence with 60 (CI: 43-77) per 100,000 and the highest was observed in Murcia (114, CI: 91-137). The AMI incidence in all EPIC centres are close to the population incidence rates and in any case these are within the EPIC 95% CI. CONCLUSIONS The comparison of incidence in EPIC with population rates shows very good agreement for acute myocardial infarction.

Socioeconomic differences in incidence and relative survival after a first acute myocardial infarction in the Basque Country, Spain

OBJECTIVE To estimate the incidence and 28-day and 5-year survival rates after a first acute myocardial infarction (AMI) in relation to socioeconomic status in the Basque Country (Spain) between 1999 and 2000. METHODS Data from a population-based registry of AMI were used. The study included 3,619 patients to calculate age-standardized incidence by the direct method and 2,003 patients (out-of-hospital deaths were excluded) to calculate observed and relative survival using the Kaplan-Meier and Hakulinen methods, respectively. Socioeconomic status was quantified using a deprivation index ecologically assigned to each patient according to the census tract of residence at diagnosis of AMI and was categorized into quintiles. RESULTS Among men, the risk of AMI was higher in the lowest socioeconomic group than in the highest socioeconomic group (RR=1.17; 95%CI: 1.02-1.34). In men, a higher risk of death was observed in the middle (Q3; HR=1.60; 95%CI: 1.02-2.51) and low (Q5; HR=1.65; 95%CI: 1.02-2.69) quintiles compared with the least deprived group for age-adjusted survival during the acute phase. In the fully adjusted model, this effect was attenuated and no significant differences were observed in long-term survival. Among women, no significant differences were observed either in incidence or in short- and long-term survival. CONCLUSIONS Socioeconomic inequalities were only observed in men in incidence and in survival during the acute phase after an AMI.

Diferencias por sexo en la supervivencia relativa y los factores pronósticos de pacientes con un primer infarto agudo de miocardio en Guipúzcoa

Introduccion y objetivos Estimar la supervivencia a los 28 dias y a los 5 anos y los factores pronosticos asociados en personas que han sufrido un primer infarto agudo de miocardio. Metodos Se estudio a 1.677 pacientes con un primer infarto agudo de miocardio que accedieron a un hospital de Guipuzcoa entre 1997 y 2000. Resultados Las mujeres eran unos 10 anos mayores, presentaron mas diabetes mellitus e hipertension y un cuadro clinico mas desfavorable y recibieron menos recursos terapeuticos, aunque eran menos fumadoras que los varones. La supervivencia fue superior entre los varones mayores de 60 anos a los 28 dias y a los 5 anos. En el periodo de 29 dias a 5 anos, los varones de todos los grupos de edad presentaron una supervivencia relativa mas larga. Los factores relacionados con la supervivencia a corto y largo plazo difirieron entre uno y otro sexo. La gravedad de la enfermedad en la fase aguda y la edad en la fase tardia fueron factores relacionados con la supervivencia de varones y mujeres y en el resto de las variables el comportamiento fue distinto entre uno y otro sexo. Conclusiones El infarto es una enfermedad con una elevada mortalidad en la fase aguda. Existe una interaccion entre el sexo y la edad que afecta a la supervivencia tras un infarto agudo de miocardio. Varios factores se asocian a un peor pronostico precoz y tardio en ambos sexos.

Sex Differences in Relative Survival and Prognostic Factors in Patients With a First Acute Myocardial Infarction in Guipuzcoa, Spain

INTRODUCTION AND OBJECTIVES To determine 28-day and 5-year survival rates in patients who have experienced a first acute myocardial infarction and to identify prognostic factors for survival. METHODS This study involved 1,677 patients with a first acute myocardial infarction who were treated at a hospital in Guipuzcoa, Spain between 1997 and 2000. RESULTS Women were approximately 10 years older than men, presented more often with diabetes and hypertension, were in a less favorable clinical condition, and consumed fewer medical resources, but were less likely to smoke. Survival rates at 28 days and 5 years were higher in men over 60 years of age. In the period from 29 days to 5 years, the relative survival rate was higher in men from all age groups. Factors associated with short- and long-term survival varied between the sexes. Disease severity in the acute phase and, later on, age were associated with survival in both men and women, whereas the effect of other variables differed between the sexes. CONCLUSIONS Myocardial infarction is a condition associated with high mortality in the acute phase. There is an interaction between sex and age that affects survival after an acute myocardial infarction. A number of factors are associated with poor short- and long-term prognoses in both sexes.

Concentración de trihalometanos y de ácidos haloacéticos en el agua de consumo y estimación de su ingesta durante el embarazo en la cohorte INMA-Guipúzcoa (España)

OBJECTIVES To report trihalomethane (THM) and haloacetic acid (HAA) concentrations in drinking water, assess variations in these concentrations depending on source and over time, and estimate individual intake during pregnancy. METHODS Water taken from 33 representative points of the water supply network of the 25 municipalities in the study area was analyzed from 2006-2008. Water drinking habits were recorded using a questionnaire. RESULTS Mean total THM concentrations were 16.9 μg/L (standard deviation, 7.9), while the mean value for the sum of concentrations of five HAA (monochloroacetic, dichloroacetic, tricholoroacetic, monobromoacetic, and dicromoacetic acids) was 10.9 μg/L (standard deviation, 4.9). Concentrations were lower in spring waters, which were only chlorinated, compared with dam waters, which were subject to a complete purification treatment: 8.8 μg/L vs 19.1 μg/L (p<0.01) and 8.2 μg/L vs 11.7 μg/L (p<0.01). Concentrations significantly increased with the number of deposits in the network and with their rechlorination and were higher in the summer and fall. Mean intakes of total THM and of the five HAA were lower in women supplied with spring water. Intakes differed depending on supply reservoir. CONCLUSIONS Disinfection by-products in water are affected by water source, supply network structure, and annual season. The mean intake of these products varies depending on the source of drinking water. Mean intakes of all products were much lower than values recommended by the World Health Organization.

«Esa corporeidad mortal y rosa»: análisis del tiempo libre de enfermedad del cáncer de mama en Gipuzkoa en presencia de riesgos competitivos

OBJECTIVE To analyze time of disease-free survival and relative survival in women diagnosed with breast cancer in the province of Gipuzkoa within the context of competing risks by assessing differences between the direct use of the Kaplan-Meier estimator and the multiple decrement method on the one hand, and relative survival on the other. METHODS All registered breast cancer cases in Gipuzkoa in 1995 and 1996 with stages other than stage IV were included. An 8-year follow-up for recurrence and a 10-year follow-up for survival were performed. Time of disease-free survival was studied by the multiple decrement model. Observed survival and survival corrected by the expected mortality in the population (relative survival) were also studied. RESULTS Estimation of the probability of recurrence at 8 years with the multiple decrement method was 8.8% lower than that obtained with the Kaplan-Meier method. The difference between the observed and relative survival rates at 10 years was 10.8%. Both results show how, in this case, the Kaplan-Meier estimator overestimates both the probability of recurrence and that of mortality from the disease. CONCLUSIONS Two issues are often overlooked when performing survival analyses: firstly, because of the lack of independence between survival time and censoring time, the results obtained by the Kaplan-Meier estimator are uninterpretable; secondly, it is an incontrovertible fact that one way or another, everyone causes failures. In this approach, survival analyses must take into account the probability of failure in the general population of reference. The results obtained in this study show that superficial use of the Kaplan Meier estimator overestimates both the probability of recurrence and that of mortality caused by the disease.

Diferencias socioeconómicas en la incidencia y supervivencia relativa del infarto agudo de miocardio en el País Vasco

Objetivo Estimar la incidencia y la supervivencia a 28 dias y 5 anos tras un primer infarto agudo de miocardio (IAM) segun la posicion socioeconomica en el Pais Vasco entre 1999 y 2000. Metodos Utilizando datos de un registro poblacional de IAM se incluyeron 3.619 pacientes para estimar la incidencia ajustada por edad por el metodo directo, y 2003 (excluidas las muertes extrahopitalarias) para la supervivencia observada y relativa con el metodo de Kaplan-Meier y el de Hakulinen, respectivamente. El nivel socioeconomico se definio por un indice de privacion ecologicamente asignado a cada paciente segun la seccion censal de residencia al diagnostico del IAM, y se categorizo en quintiles. Resultados Los hombres del nivel socioeconomico mas bajo tuvieron un mayor riesgo de IAM que los del mas alto (RR=1,17; IC95%: 1,02-1,34). En la supervivencia en la fase aguda ajustada por edad, los hombres de los quintiles medio (Q3; HR=1,60; IC95%: 1,02-2,51) y bajo (Q5; HR=1,65; IC95%: 1,02-2,69) presentaron un mayor riesgo de muerte en comparacion con el grupo mas favorecido. Este efecto se vio atenuado en los modelos completamente ajustados, y no hubo diferencias significativas en la supervivencia a largo plazo. En la mujeres no se hallaron diferencias significativas en la incidencia ni en la supervivencia a corto y largo plazo. Conclusiones Solo se han observado desigualdades socioeconomicas en los hombres en la incidencia y la supervivencia durante la fase aguda.