Susana Monereo

Tablas de evaluación del riesgo coronario adaptadas a la población española. Estudio DORICA

Fundamento y objetivo Los factores de riesgo independientes (consumo de tabaco, hipertensionarterial, hipercolesterolemia ydiabetes mellitus) son causa directa de cardiopatia isquemica y son frecuentes en la poblacion.Resulta mas apropiado estimar el riesgo global considerando la presencia de los diferentes factores de riesgo. El objetivo de este trabajo es presentar unas ta-blas de riesgo coronario confeccionadas a partir de la ecuacion de Framingham adaptada a la prevalencia de factores de riesgo en Espana Sujetos y metodo Se ha estimado la prevalencia de factores de riesgo en la poblacion espanola a partir del analisis de un conjunto de estudios poblacionales transversales. Se ha sustituido enla ecuacion de Framingham los datos estimados de prevalencia y la tasa de incidencia de acon-tecimientos coronarios. Se ha calculado la probabilidad de riesgo a 10 anos y se ha confeccio-nado una tablas que clasifican el riesgo con un codigo de colores Resultados La fraccion atribuible (FA) estimada para la hipertension arterial en la poblacionespanola es del 26,7% en varones y el 22,9% en mujeres, y para la hipercolesterolemia es del 15,7% en varones y el 12,7% en mujeres. El tabaquismo se situa en tercer lugar en orden de importancia en los varones (FA, 13,13%) y en cuarto en las mujeres (FA, 3,71%). Se estimouna prevalencia de obesidad del 13,2% en varones y el 17,5% en mujeres.En varones la FA a la obesidad es del 4% y en mujeres del 5% Conclusiones La adaptacion de la ecuacion de Framingham calibrada segun la prevalencia de los factores de riesgo independientes en la poblacion espanola y a la incidencia de aconteci-mientos coronarios en esta poblacion permiteconfeccionar herramientas utiles para estimar el riesgo coronario a 10 anos mientras no se disponga de estimaciones basadas en una ecuacionpropia a partir de un estudio de cohortes

Independent impact of obesity and fat distribution in hypertension prevalence and control in the elderly

Background Studies on the impact of weight excess and fat distribution on blood pressure are usually limited to young and middle-aged population, and data on the elderly are scarce. Methods and results We performed an analysis of the Prevencion de Riesgo de Ictus, a population-based study on individuals aged 60 years or more in Spain, to assess the impact of weight excess, stratified by body mass index (normal <25; overweight 25–29.9; obesity ≥30 kg/m2), and waist circumference [increased if ≥88 cm (women) or ≥102 (men)] on the prevalence on hypertension and lack of blood pressure control. In 6263 individuals (mean age 71.9 years old, 53.3% women; 73.0% with diagnosed hypertension), prevalence of obesity was 35.0%, and 65.6% showed an increased waist circumference. Body mass index and waist circumference showed an independent impact on the prevalence and absence of hypertension control. In a multivariate model including age, sex, body mass index, and waist circumference, prevalence of hypertension was higher in the overweight and obesity groups (odds ratio 1.41 and 1.96, respectively, compared to normal weight), and in those with increased waist circumference (odds ratio 1.25) compared with normal waist circumference. After further adjustment for antihypertensive therapy, overweight, and obesity (odds ratio 1.40 and 1.59, respectively) as well as increased waist circumference (odds ratio 1.39) were independently related to absence of blood pressure control. The impact of waist circumference on hypertension and blood pressure control was shown in each category of body mass index. Conclusion In this cross-sectional study in an elderly population, body mass index and waist circumference showed an independent and direct impact on the prevalence of hypertension and on the absence of blood pressure control.

Recomendaciones y algoritmo de tratamiento del sobrepeso y la obesidad en personas adultas

Entre 1996 y 1999 se publicaron las primeras revisiones sistemáticas sobre la eficacia de diferentes intervenciones para el tratamiento del exceso de peso (sobrepeso y obesidad), momento en el que también se publicaron, en lengua inglesa, las 2 guías de práctica clínica (GPC) existentes para el abordaje clínico basado en la evidencia del sobrepeso y de la obesidad1,2. La GPC más reciente data de 1998, fue elaborada por el Panel de Expertos del Instituto Nacional del Corazón, el Pulmón y la Sangre de EE.UU. y alcanzó una gran difusión3. Desde entonces se ha acumulado gran cantidad de información científica, especialmente en aspectos relacionados con el tratamiento farmacológico y con el tratamiento quirúrgico para la reducción y el mantenimiento del peso corporal, información que posibilita la elaboración de una GPC actualizada sobre diagnóstico, valoración clínica y tratamiento del sobrepeso y de la obesidad en personas adultas.

Prevalencia de sobrepeso y obesidad en población española de 60 años o más y factores relacionados.: Estudio PREV-ICTUS

BACKGROUND AND OBJECTIVE Data on the prevalence of obesity in elderly population in Spain are scarce. The objective of this work was to describe the prevalence of obesity and the related factors in a random sample of Spanish population aged 60 years-old or more, stratified by autonomous communities. SUBJECTS AND METHOD We analyzed the PREV-ICTUS study, a population-based study carried out between September and December 2005 in a random sample stratified by autonomous communities according to the census of inhabitants and the habitat in each community. Subjects were classified as with normal weight (body mass index [BMI] < 25 kg), overweight (BMI 25-29.9) and obesity (BMI > or = 30 kg). RESULTS In 6,843 subjects -mean age (standard deviation): 71.9 (7.1) years-old; 53.3% women-, prevalence of obesity was 34.5% (95% confidence interval [CI], 33.3-35.5%), higher in women (38.4%; 95% CI, 36.8-39.9%) than in men (30.0%; 95% CI, 28.4-31.6%; p < 0.001), with a tendency to decrease in the older population. In total, 81.7% of the population showed overweight (BMI > or = 25). Prevalence differed among communities from 46.4% to 20.7% (p < 0.001). In the multivariate analysis, obesity was inversely related to age (odds ratio [OR] = 0.98 per each year increment), and directly to female gender (OR = 1.25), rural (OR = 1.50) or semi-urban habitat (OR = 1.38), sedentary lifestyle (OR = 1.86) and non-smoking history (OR = 1.19). CONCLUSIONS Obesity was present in one out of 3 individuals of this reasonably representative sample of the Spanish population in an age range, 60 years-old or more, which concentrates a high cardiovascular risk. Differences in the prevalence among autonomus communities were detected.

Posicionamiento de las sociedades SEEN-SECO-SEEDO-SED sobre la cirugía metabólica en la diabetes mellitus tipo-2

There is increasing interest in Spain on the possibility of using gastrointestinal surgery as a treatment able to reverse or improve type 2 diabetes mellitus (T2DM). However, because of the lack of a duly established consensus including this option in treatment algorithms, some professional groups have shown great interest in positioning metabolic surgery as a universal procedure useful in a high number of diabetic patients. Representatives of the scientific bodies signing this manuscript therefore decided, at the beginning of 2013, to write a position statement clearly reflecting the indications for surgery in T2DM in our environment, thus laying the foundations for a subsequent consensus document. Metabolic surgery consists of the application of surgical procedures aimed at the treatment of T2DM and improvable cardiometabolic risk factors. It is indicated mainly in

Obesity as a risk factor in cancer: A national consensus of the Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology

Abstract In the last few years, many prospective studies have demonstrated a clear association between obesity and cancers of the colon and rectum, breast in post-menopausal women, endometrium, kidney, oesophagus and pancreas. Obesity is also associated with a high risk of recurrence and cancer-related death. The pathophysiology of obesity involves various changes that may be implicated in the relationship between obesity and cancer, such as excess inflammatory cytokines and chronic inflammation, hyperinsulinaemia, insulin resistance, and raised leptin and oestrogens. The Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology have signed a cooperation agreement to work together towards reducing the impact of obesity in cancer. Preventing obesity prevents cancer.

Effects of Orlistat on Visceral Fat After Liposuction

BACKGROUND Liposuction can aggravate metabolic complications associated with obesity. It has been shown that the recovery of weight lost through these interventions is associated with body fat redistribution toward the visceral cavity, increasing metabolic risk factors for coronary heart disease such as insulin resistance and high triglyceride levels. OBJECTIVES The aim of this study was to evaluate the consequences of liposuction on body mass redistribution and metabolic parameters 6 months after surgery and to evaluate the use of orlistat treatment (tetrahydrolipstatin) in controlling these parameters. METHODS A population of 31 women with a mean body mass index of 26.17±3.9 kg/m2 and undergoing liposuction of more than 1,000 cm3, was studied. Twelve of them were treated postsurgery with 120 mg of orlistat every 8 hours for the following 6 months. Anthropometric, analytical, and radiological (computed tomography) tests were performed to quantify visceral fat area before surgery and 6 months after surgery. RESULTS Despite weight loss after liposuction, visceral fat was not modified. Patients treated with orlistat showed a greater reduction in visceral fat, although not statistically significant. Orlistat use induced a reduction in low‐density lipoprotein cholesterol values of 20.0±22.5 mg/dL, compared with an increase of 8.46±20.1 mg/dL in controls (p=.07). CONCLUSIONS Visceral fat does not decrease despite weight loss after liposuction. Orlistat use postliposuction might be a useful tool because it shows a tendency to reduce visceral fat and improve blood lipids profile. The authors have indicated no significant interest with commercial supporters.

Weight-Related Quality of Life in Spanish Obese Subjects Suitable for Bariatric Surgery is Lower Than in Their North American Counterparts: a Case–Control Study

BackgroundObesity impairs quality of life, but the perception of the impairment could be different from one country to another. The purpose was to compare weight-related quality of life (QOL) between cohorts from Spain and North America.MethodsA cross-sectional case–control study was performed between two populations. Four hundred Spanish and 400 North American obese subjects suitable for bariatric surgery closely matched for race, gender, age, and body mass index (BMI) were included. Two non-obese control groups matched for gender, age, and BMI from each population were also evaluated (n = 400 in each group). The participants completed the Impact of Weight on Quality of Life—Lite (IWQOL—Lite) questionnaire, a measure of weight-related QOL.ResultsSpanish morbidly obese patients showed poorer QOL than their North American counterparts in physical function, sexual life, work, and total score. By contrast, Spanish non-obese control subjects reported better QOL in all domains than their North American counterparts. Women, both in Spain and North America, reported reduced QOL compared to men on the domain of self-esteem. In addition, North American women reported reduced QOL on the sexual life domain compared to men. BMI correlated negatively with all domains of QOL except for self-esteem in both national groups.ConclusionsSpanish obese subjects suitable for bariatric surgery report poorer weight-related quality of life than their North American counterparts, and obese women, regardless of nationality, perceive a reduced quality of life compared to men.

Parámetros antropométricos asociados al riesgo cardiovascular en España. Estudio DORICA

Introduccion El riesgo cardiovascular de cualquier poblacion esta directamente relacionado con la prevalencia de los distintos factores de riesgo y con el impacto que cada uno de ellos pueda tener en la morbimortalidad por enfermedades cardiovasculares. Estas singularidades poblacionales son las que obligan a tener en consideracion los datos extraidos de la propia poblacion a la hora de sacar consecuencias para la valoracion del riesgo cardiovascular individual. Objetivos El objetivo del presente trabajo ha sido conocer, a partir de amplios estudios poblacionales, cuales son las caracteristicas antropometricas que en la poblacion espanola se asocian con los distintos factores de riesgo, a fin de establecer–si fuera possible–puntos de corte de parametros antropometricos relacionados con un mayor riesgo cardiovascular. Metodos Los datos han sido extraidos del estudio DORICA, llevado a cabo con datos de casi 15.000 individuos procedentes de 9 comunidades autonomas. Se analiza la prevalencia de los diferentes factores de riesgo, y se establecen los resultados de los puntos de corte para la poblacion espanola que permiten establecer ciertos marcadores antropometricos asociados al riesgo cardiovascular. En este sentido, el indice de masa corporal (IMC) se situa en 27 kg/m 2 para las mujeres y en 30 kg/m 2 para los varones. El perimetro de la cintura, que en la poblacion espanola se acompana de agrupacion de factores de riesgo metabolicos, resulto ser, en la mujer, de 80 y 90 cm, y en el varon, de 88 cm y 98 cm para un IMC de 25 y 30, respectivamente. Conclusiones Estos datos sugieren que, tal y como se propone, los parametros antropometricos sugerentes de riesgo cardiovascular elevados deben adaptarse a las caracteristicas poblaciones, lo que tiene una enorme trascendencia a la hora de establecer criterios diagnosticos para procesos con riesgo elevado.

Insuficiencia suprarrenal y su tratamiento sustitutivo. Su realidad en España

Adrenal insufficiency (AI) is a rare endocrine disease, associated to increased mortality if left untreated. It can be due to a primary failure of the adrenal glands (primary AI) or malfunctioning of the hypothalamic-pituitary-adrenal axis (HPA) (secondary AI). The lack of data on incidence/prevalence of adrenal insufficiency in Spain complicates any evaluation of the magnitude of the problem in our country. Initial symptoms are non-specific, so often there is a delay in diagnosis. Current therapy with available glucocorticoids is associated with decreased quality of life in patients with treated AI, as well as with increased mortality and morbidity, probably related to both over-treatment and lack of hydrocortisone, associated with non-physiological peaks and troughs of the drug over the 24 hours. The availability of a new drug with a modified dual release (immediate and retarded), that requires one only daily dose, improves and simplifies the treatment, increases compliance as well as quality of life, morbidity and possibly mortality. This revision deals with the knowledge on the situation both globally and in Spain, prior to the availability of this new drug.