[Anisakiasis as differential diagnosis of acute abdominal pain at the emergencydepartment]. / Anisakiasis como diagnóstico diferencial de dolor abdominal agudo enurgencias.

Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.

Anisakiasis como diagnóstico diferencial de dolor abdominal agudo en urgencias / Anisakiasis as differential diagnosis of acute abdominal pain at the emergency department

La anisakiasis es una zoonosis cada vez más prevalente especialmente en países europeos, causada por la ingesta del nemátodo del género Anisakis en su tercer estadio larvario tras el consumo de pescado crudo o poco cocido. Puede producir una afectación gastrointestinal y también una reacción de hipersensibilidad a las proteínas del parasito. Presentamos un caso de anisakiasis gástrica acompañada de hipersensibilidad (forma gastroalérgica) tras la ingesta de pescado crudo.

Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.

Microbiome and Allergic Diseases.

Allergic diseases, such as respiratory, cutaneous, and food allergy, have dramatically increased in prevalence over the last few decades. Recent research points to a central role of the microbiome, which is highly influenced by multiple environmental and dietary factors. It is well established that the microbiome can modulate the immune response, from cellular development to organ and tissue formation exerting its effects through multiple interactions with both the innate and acquired branches of the immune system. It has been described at some extent changes in environment and nutrition produce dysbiosis in the gut but also in the skin, and lung microbiome, inducing qualitative and quantitative changes in composition and metabolic activity. Here, we review the potential role of the skin, respiratory, and gastrointestinal tract (GIT) microbiomes in allergic diseases. In the GIT, the microbiome has been proven to be important in developing either effector or tolerant responses to different antigens by balancing the activities of Th1 and Th2 cells. In the lung, the microbiome may play a role in driving asthma endotype polarization, by adjusting the balance between Th2 and Th17 patterns. Bacterial dysbiosis is associated with chronic inflammatory disorders of the skin, such as atopic dermatitis and psoriasis. Thus, the microbiome can be considered a therapeutical target for treating inflammatory diseases, such as allergy. Despite some limitations, interventions with probiotics, prebiotics, and/or synbiotics seem promising for the development of a preventive therapy by restoring altered microbiome functionality, or as an adjuvant in specific immunotherapy.

Las características personales y los valores sociales de una poblacion urbana relacionados con la participación social / Personal characteristics and social values of urban population related to social participation

Este estudio tuvo por objetivo identificar las características personales (ontosistema) y los valores sociales (macrosistema) que se relacionan con la participación social. Se encuesto a 113 habitantes de una ciudad en el noroeste de México. Se emplearon ecuaciones estructurales para identificar el modelo integrado por el factor características personales (ontosistema) con las variables autoconcepto positivo, autoconcepto negativo y autoestima positiva; el factor valores sociales (macrosistema) con las variables prosocialidad, responsabilidad y justicia-igualdad y el factor participación social con las variables organización social, acciones comunitarias y toma de decisiones. El modelo propuesto corresponde con el teórico, por lo que el factor características personales (ontosistema) y el factor valores (macrosistema) explican el diez por ciento de la varianza para el factor participación social. Se concluyó que tanto el factor características personales (ontosistema) como el factor valores (macrosistema) influyen directamente a la participación social.

The aim of this work was to identify personal characteristics (onto-system) and values (macro-system) which are related with social participation. A sample of 113 inhabitants of a Northeast city of Mexico was studied using a survey. Structural equations were used for identifying a social participation model integrated by personal characteristics factor (onto-system) with positive self-concept, negative self-concept and positive self-esteem. The values factor (macro-system) with sociality, responsibility and justice-equality values and social participation factor was integrated with the variables called social organization, communities actions and making decisions. The model found matches with theoretical model. Accordingly personal characteristics factor (onto-system) and values factor (macro-system) explain ten percent of social participation factor's variance. This study showed personal characteristics factor (onto-system) and values factor (macro-system) influence the social participation factor.

[Objective KONTROL study: therapeutic inertia in hypertensive patients attended in primary care of Spain]. / Inercia terapéutica en pacientes hipertensos asistidos en atención primaria en España. Estudio Objetivo Kontrol.

OBJECTIVES: To determine the level of therapeutic inertia (TI), and the factors associated to the patient, doctor and the health organisation, in hypertensive patients treated in Primary Care (PC). DESIGN: Cross-sectional, multicentre study. SETTING: A sample of PC Teams from all over Spain. PARTICIPANTS: The study was conducted among PC doctors using a questionnaire and clinical records of 4 patients. MAIN MEASUREMENTS: The TI was calculated for each patient (TIp) as the proportion of visits in which there was no change in medication when this was indicated. RESULTS: A total of 543 PC doctors provided data on 2,032 patients, who fulfilled the indication of a change in requirement. There was TI In 77.8% of cases. The TIp observed was non-existent or low for 17.1% of the patients, intermediate for 42% and high for 40.8%. For the patients, the factors most associated with TIp were, age (P<.001), diabetes (P<.001), stroke (P<.01), obesity (P<.01) and a low education level (P<.001). To be female, be less than 40 years or more than 55 years, to be a family doctor with a training program other than MIR and to work in the public sector increased the probability of TIp (P<.001 for all the assumptions). CONCLUSIONS: The results of the study indicate that there is TI in 7 out every 10 visits made by hypertensive patients in Primary care. There are significant differences as regards the clinical characteristics of the patients and of the doctors.

Different prognostic value of silent peripheral artery disease in type 2 diabetic and non-diabetic subjects with stable cardiovascular disease.

OBJECTIVE: ABI is a good predictor of morbidity and mortality in diabetic subjects with no known cardiovascular disease. However, its prognostic value in diabetic patients with prior coronary or cerebrovascular disease has not previously been evaluated. METHODS: Multicenter, prospective study of 1 year of follow-up, in 1096 patients (73.6 years, 65% males, 45.4% with diabetes) with cardiovascular disease and without known peripheral arterial disease. The main outcome measure was the first occurrence of a major cardiovascular event (non-fatal acute coronary syndrome, non-fatal stroke, revascularization procedure, or cardiovascular death). Secondary endpoints included major cardiovascular events, cardiovascular death and death from any cause. RESULTS: Prevalence of an abnormal ABI (<0.9 or >1.4) was 38.2% in diabetic and 26.8% in non-diabetic subjects. There were 150 major cardiovascular events (38.3/1000 person-years in diabetics vs. 30.6/1000 person-years in non-diabetics subjects, p=0.012) and 60 cardiovascular deaths (11.8/1000 person-years in diabetics vs. 10.7/1000 person-years in non-diabetics subjects, p=0.156). Patients with abnormal ABI had a higher rate of vascular complications. There was a significant interaction between ABI and diabetes. In non-diabetic patients, an abnormal ABI was associated with an increase risk of the primary endpoint (HR 2.71; 95% CI 1.54-4.76), cardiovascular mortality (HR 4.62; 95% CI 1.47-14.52) and total mortality (HR 2.80; 95% CI 1.08-7.27). These associations were not observed in patients with diabetes. CONCLUSION: In patients with cardiovascular disease, ABI is a good predictor of risk of recurrent cardiovascular events and death, only in non-diabetic subjects.

Factors associated with therapeutic inertia in hypertension: validation of a predictive model.

OBJECTIVE: To study factors associated with therapeutic inertia in treating hypertension and to develop a predictive model to estimate the probability of therapeutic inertia in a given medical consultation, based on variables related to the consultation, patient, physician, clinical characteristics, and level of care. METHODS: National, multicentre, observational, cross-sectional study in primary care and specialist (hospital) physicians who each completed a questionnaire on therapeutic inertia, provided professional data and collected clinical data on four patients. Therapeutic inertia was defined as a consultation in which treatment change was indicated (i.e., SBP >or= 140 or DBP >or= 90 mmHg in all patients; SBP >or= 130 or DBP >or= 80 in patients with diabetes or stroke), but did not occur. A predictive model was constructed and validated according to the factors associated with therapeutic inertia. RESULTS: Data were collected on 2595 patients and 13,792 visits. Therapeutic inertia occurred in 7546 (75%) of the 10,041 consultations in which treatment change was indicated. Factors associated with therapeutic inertia were primary care setting, male sex, older age, SPB and/or DBP values close to normal, treatment with more than one antihypertensive drug, treatment with an ARB II, and more than six visits/year. Physician characteristics did not weigh heavily in the association. The predictive model was valid internally and externally, with acceptable calibration, discrimination and reproducibility, and explained one-third of the variability in therapeutic inertia. CONCLUSION: Although therapeutic inertia is frequent in the management of hypertension, the factors explaining it are not completely clear. Whereas some aspects of the consultations were associated with therapeutic inertia, physician characteristics were not a decisive factor.

Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease.

OBJECTIVES: To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD). DESIGN: Cross sectional, observational study conducted at 96 internal medicine services. MATERIALS AND METHODS: 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9. RESULTS: Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%. CONCLUSIONS: Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.

Factors associated with the discontinuation of evidence-based cardiovascular therapies in patients with stable coronary artery disease: a primary care perspective.

BACKGROUND: To identify factors associated with the discontinuation of evidence-based cardiovascular therapies after hospital discharge for a coronary event. DESIGN: Cross-sectional study carried out between June and October 2004 in 1799 primary care centers throughout Spain. PATIENTS AND METHODS: Eight thousand eight hundred and seventeen patients (73.7% males; 65.4 years) admitted for coronary disease causes in the past 6 months to 10 years and attending primary care postdischarge from hospital. Current medications, those prescribed at hospital discharge, and the development of adverse events, new risk factors, and comorbidities during follow-up, were collected from clinical records. RESULTS: After a median follow-up of 37.4 months, discontinuation rate of lipid-lowering agents, angiotensin renin system blockers, antiplatelet drugs, and beta-blockers were 7.2, 9.1, 10, and 20%, respectively. Of these, 10.8, 16.5, 9.9, and 20.1%, respectively, were because of adverse events. Factors associated with the discontinuation of lipid-lowering agents were the development of hypertension and diabetes during the follow-up. Discontinuation of antiplatelet drug was associated with an earlier history, or with de-novo occurrence, of atrial fibrillation. Discontinuation of angiotensin renin system blockers was associated with the development of atrial fibrillation, diabetes and hypercholesterolemia, and discontinuation of beta-blockers with de-novo appearance of peripheral artery disease, cerebrovascular disease, and heart failure. CONCLUSION: In patients followed-up in primary care, the discontinuation rate of cardiovascular disease medications was low and was mainly related to the development of adverse events together with new risk factors and comorbidities arising after hospital discharge.

Gender differences in evidence-based pharmacological therapy for patients with stable coronary heart disease.

BACKGROUND: Women have a higher morbidity and mortality than men after an acute coronary event. We analyzed the prescription rates of evidence-based pharmacological therapies for patients with stable coronary heart disease and whether there were any differences with respect to gender. DESIGN: This cross-sectional study evaluated 8817 patients, 26.3% women, receiving attention from 1799 family doctors in primary care centers (PCC) throughout Spain, and who had had a coronary event requiring hospitalization in the previous 6 months to 10 years. RESULTS: Mean age was 65.4 years and a mean time-lapse since hospitalization of 37.4 months. In the overall population, prescription medications were: antiplatelet drugs in 80.5% of patients, 79% statins, 66% blockers of the angiotensin-renin system (BARS) and 47% beta-blockers. Males received less cardiovascular disease medications than females (4.3+/-1.5 versus 4.6+/-1.6, respectively; p<0.001), but when adjusted for risk factors the significance was lost (p=0.231). Following adjustment for risk factors and for co-morbidities, the use of diuretics was significantly higher in women while beta-blockers and statins were higher in men. The triple combination of antithrombotics, beta-blockers and statins was used in 41.4% (43.8% males versus 34.6% females; p<0.001) while 24.3% used this triple combination plus a BARS; without significant difference between the genders. CONCLUSIONS: An important percentage of patients with stable coronary disease, particularly women, attended-to in primary care do not receive medications that have been shown to decrease the morbido-mortality of cardiovascular disease.

[Prevalence of asymptomatic peripheral artery disease detected by the ankle-brachial index in patients with cardiovascular disease. MERITO II study]. / Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II.

BACKGROUND AND OBJECTIVE: Patients with polyvascular disease have an increased rate of cardiovascular events and death. Their identification would define a subgroup of the population at very high risk, who would be candidates to intensified preventive measures. The objective of the present study was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previous diagnosis of vascular disease in other territories. PATIENTS AND METHOD: Subjects with a coronary or a cerebrovascular event between 3 months and 5 years, and who were attended at internal medicine outpatient clinics from Spain were included in the study. All patients had a clinical history, a physical examination, a blood and urine analysis, and a measurement of the ankle-brachial index (ABI). RESULTS: A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. A previous coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%, and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was 33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associated with a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic blood pressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both, the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low. CONCLUSIONS: Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovascular disease, particularly if there are clinical manifestations in both territories.

[Occult chronic kidney disease in patients with stable coronary heart disease]. / Insuficiencia renal crónica oculta en pacientes con enfermedad coronaria estable.

BACKGROUND AND OBJECTIVE: Chronic kidney disease (CKD) increases cardiovascular risk mainly in subjects with coronary heart disease. The aim of this study was to evaluate the prevalence of occult CKD (OCKD) in stable coronary heart disease patients and to study the factors associated in order to improve its detection. PATIENTS AND METHOD: Cross sectional study of 7,884 patients who had had a coronary event requiring hospitalization in the previous 6 months to 10 years. Glomerular filtration rate was estimated by means of the Modification of Diet in Renal Disease (MDRD) study equation. CKD was defined as a glomerular filtration rate lower than 60 ml/min/1.73 m(2), and OCKD when, in addition, serum creatinine was < 133 mmol/l in men and < 124 mmol/l in women. RESULTS: The mean age was 65.3 years, 73.7% male and 22.4% had CKD, 68.3% of them with normal serum creatinine. In subjects with OCKD the prevalence of risk factors and cardiovascular diseases associated was intermediate between subjects without CKD and subjects with CKD and high serum creatinine. Age, female sex, hypertension, diabetes, heart failure, cerebrovascular disease and peripheral artery disease were significantly and independently associated with OCKD in the multivariate analysis. CONCLUSIONS: Almost one in 4 subjects with stable coronary heart disease had CKD, most of them with normal serum creatinine, mainly women and older patients.

Sub-clinical vascular disease in type 2 diabetic subjects: relationship with chronic complications of diabetes and the presence of cardiovascular disease risk factors.

BACKGROUND: We evaluated the association between a low ankle-brachial index (ABI), chronic complications of diabetes, and the presence of traditional cardiovascular disease risk factors in subjects with type 2 diabetes but without known cardiovascular disease. METHODS: We included diabetic subjects (n=923; 52% male; age range 50-85 years) without clinical evidence of coronary, cerebrovascular, or peripheral artery disease (PAD). A history of nephropathy, retinopathy, or neuropathy was collected from the medical records. A 12-lead electrocardiogram and ABI measurements were conducted on all study participants. RESULTS: The mean duration of diabetes was 9.6 years. Prevalence of a low ABI (<0.9) was 26.2%. Multivariate analysis indicated that factors significantly associated with a low ABI were age (OR: 1.06; 95%CI: 1.033-1.084; p<0.001), plasma triglyceride concentration (OR: 1.002; 95%CI: 1.001-1.004; p=0.006), duration of diabetes (OR: 1.029; 95%CI: 1.008-1.051; p=0.007), and smoking habit (OR: 1.755; 95%CI: 1.053-2.925; p=0.03). The presence of nephropathy, neuropathy, retinopathy, left ventricular hypertrophy, left bundle branch block, and atrial fibrillation were all associated with a low ABI, but only renal disease remained significant after adjusting for age, duration of diabetes, and cardiovascular risk factors. CONCLUSION: A low ABI is highly prevalent in subjects with diabetes and is related to age, duration of diabetes, smoking habit, and hypertriglyceridemia. Although chronic complications are frequently associated with a low ABI, only renal damage is independently associated with peripheral artery disease.

Achievement of therapeutic goals and utilization of evidence-based cardiovascular therapies in coronary heart disease patients with chronic kidney disease.

To evaluate whether the presence of chronic kidney disease (CKD) influenced the rate of prescription of evidence-based cardiovascular preventive therapies and attainment of therapeutic goals in patients with stable coronary heart disease, 7,884 patients (mean age 65.4 years; 81.7% men; 22.4% with CKD) attended to in 1,799 primary-care centers and who had had a coronary event requiring hospitalization in the previous 6 months to 10 years were recruited. Glomerular filtration rate (GFR) was estimated using the MDRD Study equation. Results indicated that patients with CKD received more diuretics (47.6% vs 32.8%; p = 0.034), calcium channel blockers (29.3% vs 23.2%, p = 0.027); and blockers of the angiotensin-renin system (76.4% vs 65.3%; p <0.001). The lower prescription rate of antiaggregants, beta blockers, and statins in subjects with CKD did not reach statistical significance in multivariate analysis. A lower percentage of subjects with CKD achieved good control of blood pressure (39.2% vs 65.4%; p <0.001) and glycosylated hemoglobin (43.9% vs 53.4%; p <0.001) relative to patients without CKD. Only 11.8% of patients with CKD had optimum control of all risk factors. Using multivariate analysis, the presence of CKD was inversely related to the degree of risk-factor control, especially in groups with low GFR. In conclusion, patients with stable coronary heart disease and CKD attended to in primary-care centers had poorer control of coronary heart disease risk factors than those with normal GFR despite receiving a similar rate of prescription of evidence-based cardiovascular disease preventive therapies.

[Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study]. / Modificación de la estratificación del riesgo vascular tras la determinación del índice tobillo-brazo en pacientes sin enfermedad arterial conocida. Estudio MERITO.

BACKGROUND AND OBJECTIVES: Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index < 0.9), and its potential clinical-therapeutic impact, in patients without known atherotrombotic disease from internal medicine practices. PATIENTS AND METHOD: It was a multicenter, cross-sectional, observational study. Outpatients aged 50 through 80 years, with either diabetes or a SCORE risk estimation of at least 3%, were enrolled. RESULTS: A total of 1,519 subjects (58% men) were evaluated, 917 with diabetes (61%). The mean age (standard deviation) was 66.2 (8.3) years. The prevalence of an ankle-brachial index < 0.9 was 26.19%. In multiple logistic regressions the risk factors associated to an ankle-brachial index < 0.9 were age, sedentary lifestyle, smoking, macroalbuminuria, and heart rate. There was a significant relationship between the ankle-brachial index and the SCORE risk estimation. With respect to the therapeutic aims of the patients with an ankle-brachial index < 0.9, only 21% were taking antiplatelet drugs, 26% showed low density lipoproteins-cholesterol values < 100 mg/dl (53% < 130 mg/dl), and 16% displayed recommended blood pressure levels. CONCLUSIONS: Measurement of ankle-brachial is useful to reclassify as high risk a significant proportion of patients without known previous atherotrombotic disease. The ankle-brachial index should be incorporated into routine cardiovascular evaluation, particularly in subjects with diabetes or a score risk assessment > or = 3%.

[Cardiovascular risk profile of uncontrolled hypertensive patients. The Control-Project study]. / Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project.

BACKGROUND AND OBJECTIVE: To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP]>or=140/90 mmHg or>or=130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem. PATIENTS AND METHOD: Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients. RESULTS: Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3+/-11.4 years; 56.7% women). Normal BP values (<140/90 mmHg) were exhibited by 0.2%, high-normal BP (120-139/80-89 mmHg) were exhibited by 2.8%, grade 1 hypertension (140-159/90-99 mmHg) by 49.9%, grade 2 hypertension (160-179/100-109 mmHg) by 39.3%, and grade 3 hypertension (>or=180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI=94.7-97.2%), target organ damage in 34.5% (95% CI=31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI=33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI=31.5-38.2%) were at very-high risk; 29.4% (95% CI=26.4-32.8%) at high risk; 30.4% (95% CI=27.2-33.7%) at moderate risk and 5.4% (95% CI=3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI=28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs. CONCLUSIONS: Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies.

Evidence-based cardiovascular therapies and achievement of therapeutic goals in diabetic patients with coronary heart disease attended in primary care.

BACKGROUND: Diabetic patients have a higher rate of recurrent cardiovascular events and death than nondiabetic individuals. Although partially attributable to lower use of evidence-based preventive therapies, studies are lacking on the prescription rate during the stable phase of the disease. METHODS: Between June 1 and October 19, 2004, we obtained, from 1799 primary care centers throughout Spain, data on 8817 subjects (mean age 65.4 years, 73.7% male, 32.7% with diabetes) who had had a coronary event requiring hospitalization in the previous 6 months to 10 years. RESULTS: After adjustment for confounding variables, the diabetic patients received more frequent treatment with angiotensin-renin system blockers (73.5% vs 61%, P < .001), calcium channel blockers (29.8% vs 21.9%, P < .001), nitrates (58% vs 47.5%, P < .001), digoxin (6.6% vs 3.9%, P < .001), and diuretics (46.2% vs 32.2%, P < .001), but it is similar with respect to lipid-lowering drugs (81.1% vs 80.3%), antiplatelet drugs (80.2% vs 80.2%), or beta-blockers (45.4% vs 47.7%). The percentage of diabetic subjects attaining objectives for smoking habit, low-density lipoprotein cholesterol, blood pressure, and glycated hemoglobin were 90.7%, 29%, 38.2%, and 49.7%, respectively. Only 7% had optimum control of all their risk factors. The parameters most closely related to optimum treatment and risk-factor control were the specialist follow-up and the attending physician's awareness of appropriate treatment objectives. CONCLUSIONS: A significant percentage of diabetic patients with stable coronary disease receive evidence-based preventive medications in primary care. However, the percentage achieving adequate control of their risk factors is low and is related to the level of physician awareness of appropriate therapeutic targets.

Prevalence of renal insufficiency in individuals with hypertension and obesity/overweight: the FATH study.

Overweight and obesity are associated with increased cardiovascular risk. Some studies have demonstrated that they also can result in renal damage. The aim of this study was to assess the prevalence of renal insufficiency (RI), defined as a GFR <60 ml/min per 1.73 m2, in a cohort of 4585 patients who attended primary care with essential hypertension and a body mass index > or =25 kg/m2. The patients were classified as overweight and obese according to body mass index (25 to 29.9 and > or =30 kg/m2, respectively). Abdominal obesity was defined as a waist circumference > or =88 and 102 cm in women and men, respectively. Both groups had a high prevalence of metabolic syndrome (Adult Treatment Panel III). The prevalence of RI was high in both the overweight group (22.7%; 95% confidence interval [CI] 20.6 to 24.9) and in the obese group (22.8%; 95% CI 21.0 to 24.7). The presence of diabetes increased the risk for RI (odds ratio 1.83; 95% CI 1.55 to 2.16). The prevalence of RI was greater in patients with abdominal obesity (23 versus 17%; P < 0.001). In the presence of abdominal obesity, cardiovascular risk factors and components of the metabolic syndrome also were more prevalent. The higher risk for RI with abdominal obesity persisted even after adjustment for dyslipidemia, elevated blood glucose levels, and other variables that are associated with RI (adjusted odds ratio 1.40; 95% CI 0.84 to 2.33). It was concluded that patients who have hypertension and visceral obesity and attend primary care present a higher prevalence of metabolic syndrome and RI.

Relationship between ankle-brachial index and chronic kidney disease in hypertensive patients with no known cardiovascular disease.

Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n = 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m2, and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P = 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03 to 1.08; P < 0.0001), triglyceride concentration (OR 1.003; 95% CI 1.001 to 1.005; P = 0.001), presence of albuminuria (OR 1.61; 95% CI 1.18 to 2.20; P = 0.003), smoking habit (OR 1.72; 95% CI 1.13 to 2.63; P = 0.012), and a GFR <60 ml/min per 1.73 m2 (OR 1.47; 95% CI 1.01 to 2.17; P = 0.049). In patients with hypertension and without known vascular disease, reduced GFR and albuminuria are associated independently with an ABI <0.9. Their combined presence characterizes a subgroup of the population who have an elevated prevalence of peripheral artery disease and could benefit from early diagnosis and treatment.