Physical activity and metabolic syndrome severity among older adults at cardiovascular risk: 1-Year trends.

BACKGROUND AND AIMS: Modifiable lifestyle factors, such as physical activity (PA) and Mediterranean diet (MD), decrease metabolic syndrome (MetS). The aim was to assess 1-year changes of leisure-time physical activity (LTPA), sedentary behavior, and diet quality according to MetS severity in older population at high cardiovascular risk. METHODS AND RESULTS: Prospective analysis of 55-75-year-old 4359 overweight/obese participants with MetS (PREDIMED-Plus trial) categorized in tertiles according to 1-year changes of a validated MetS severity score (MetSSS). Anthropometrics, visceral adiposity index, triglycerides and glucose index, dietary nutrient intake, biochemical marker levels, dietary inflammatory index, and depression symptoms were measured. Diet quality was assessed by 17-item MD questionnaire. PAs were self-reported using the Minnesota-REGICOR Short Physical Activity Questionnaire and 30-s chair stand test. Sedentary behaviors were measured using the Spanish version of the Nurses' Health Study questionnaire. After 1-year follow-up, decreasing MetSSS was associated with an anti-inflammatory dietary pattern, high intake of vegetables, fruits, legumes, nuts, whole grain cereals, white fish, and bluefish and low intake of refined cereals, red and processed meat, cookies/sweets, and snacks/ready-to-eat-meals. It resulted in high intake of polyunsaturated fatty acids, omega-3 fatty acids, protein, fiber, vitamins B1, B6, B9, C, D, potassium, magnesium, and phosphorus and low glycemic index and saturated fatty acid, trans fatty acid, and carbohydrates intake. Regarding PA and sedentary behavior, decreasing MetSSS was associated with increased moderate-to-vigorous LTPA, chair stand test, and decreased sedentary and TV-viewing time. CONCLUSION: Decreasing MetSSS was associated with an anti-inflammatory dietary pattern, high LTPA, high MD adherence, low sedentary time, and low depression risk.

[PERSIRIS study: observational study, postmarketing, prospective, to evaluate the persistence to treatment with monthly risedronate in women with osteoporosis]. / Estudio PERSIRIS: estudio observacional, postautorización, prospectivo, para evaluar la persistencia al tratamiento con risedronato mensual en mujeres con osteoporosis.

OBJECTIVE: To assess the persistence of treatment with monthly risedronate and know the reasons of persistence and nontherapeutic persistence and the profile of the non-persistent patients. DESING: Observational, postmarketin and prospective study. LOCATION: Primary care, traumatology, rheumatology, gynecology and geriatrics of Catalonia. PARTICIPANTS: Women with osteoporosis treated with monthly risedronate that previously had abandoned weekly bisphosphonate therapy. MAIN MEASUREMENTS: Percentage of patients on persistent monthly risedronate year of their prescription, reasons for persistent and non persistent and profile of non persistent patients in relation to biodemographic data, clinical data and risk factors for fracture. RESULTS: 289 evaluable patients with a mean age of 68.3. At 12 months of initiation with monthly risedronate, 58.1% of patients remained on treatment. Most frequent reasons for leaving: fear of having side effects and belief that the disease is typical of the age. Reasons remarkable persistence: comfort/ease and dosage. Significant differences were observed between persistent and non-persistent patients relative to: employment status, number of concomitant therapy and height; however the results of possible associated factors must be contextualized within the study characteristics and the difference in size does not seem clinically relevant. CONCLUSIONS: The administration of therapeutic patterns more comfortable as monthly risedronate in osteoporosis, could facilitate persistence in patients improving the effectiveness of the drug. However in that persistence can also influence biodemographic and clinical variables and diverse of various kinds.

Dietary Quality Changes According to the Preceding Maximum Weight: A Longitudinal Analysis in the PREDIMED-Plus Randomized Trial.

One-year dietary quality change according to the preceding maximum weight in a lifestyle intervention program (PREDIMED-Plus trial, 55-75-year-old overweight or obese adults; n = 5695) was assessed. A validated food frequency questionnaire was used to assess dietary intake. A total of 3 groups were made according to the difference between baseline measured weight and lifetime maximum reported weight: (a) participants entering the study at their maximum weight, (b) moderate weight loss maintainers (WLM), and (c) large WLM. Data were analyzed by General Linear Model. All participants improved average lifestyle. Participants entering the study at their maximum weight were the most susceptible to improve significantly their dietary quality, assessed by adherence to Mediterranean diet, DII and both healthful and unhealthful provegetarian patterns. People at maximum weight are the most benefitted in the short term by a weight management program. Long term weight loss efforts may also reduce the effect of a weight management program.

[Cardiovascular disease epidemiology and risk factors in primary care]. / Epidemiología de las enfermedades cardiovasculares y factores de riesgo en atención primaria.

INTRODUCTION AND OBJECTIVES: To study the prevalence of and risk factors for cardiovascular disease in primary care. PATIENTS AND METHOD: A cross-sectional study was carried out at an urban health center in Barcelona, Spain. In total, 2248 patients > or =15 years old were selected randomly from medical records. The study investigated cardiovascular diseases such as ischemic heart disease, cerebrovascular disease and peripheral arterial disease, and cardiovascular risk factors such as age, sex, smoking, high blood pressure, hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus. RESULTS: The patients' mean age was 49.1 (18.9) years and 53.5% were male. Cardiovascular risk factor prevalences were: smoking, 35.2%; high blood pressure, 33.7%; hypercholesterolemia, 21.9%; hypertriglyceridemia,12.7%; and diabetes mellitus, 15.8%. Overall, 57.9% of patients had at least 1 cardiovascular risk factor. Significantly more males presented with each risk factor (P<.05), apart from high blood pressure. The prevalence of all risk factors, except smoking, increased with age until 74 years and then stabilized, except high blood pressure, which continued to increase. Around 10% had cardiovascular disease, with myocardial ischemia in 5.5%, cerebrovascular disease in 3.7%, and peripheral arterial disease in 2.4%. All except cerebrovascular disease were significantly more common in males (P<.05). The prevalence of cardiovascular disease was low in individuals <55 years old, particularly women, and increased with age for all forms of disease. Some 68.3% were > or =65 years old. CONCLUSIONS: The high prevalence of cardiovascular risk factors was confirmed. Cardiovascular disease was more common in males and the elderly.

[Association between clustering of cardiovascular risk factors and the risk of cardiovascular disease]. / Asociación entre la agrupación (clustering) de factores de riesgo cardiovascular y el riesgo de enfermedad cardiovascular.

BACKGROUND: Cardiovascular diseases are the main cause of mortality in Spain. The aim of this work was to study the association between clustering of cardiovascular risk factors and the risk of suffering major cardiovascular events: ischemic cardiopathy, cerebrovascular disease and peripheral arteriopathy of the lower limbs. METHOD: A descriptive transversal study was carried out in a city health centre, with a total of 2248 patients selected by simple random sampling of the clinical records with a mean age of 15 years. The data were obtained by examining the clinical records and estimating Odds Ratios (OR) for any cardiovascular event (n = 224), ischemic cardiopathy (n = 123), cerebrovascular disease (n = 84) and peripheral arteriopathy (n = 55) in relation to the number of cardiovascular risk factors. The cardiovascular risk factors included in the study were smoking, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes and obesity. The OR was adjusted for age and sex. RESULTS: The percentage of patients with 0, 1, 2, 3 and 4-6 cardiovascular risk factors was 39.1, 32.8, 17.5, 6.9 and 3.7 respectively. The OR for experiencing a cardiovascular event associated to 1, 2, 3 and 4-6 cardiovascular risk factors was 1.6 (CI95%: 0.9-2.7), 2.8 (CI95%: 1.7-4.7), 3.6 (CI95%: 1.9-6.5) and 5.6 (CI95%: 2.9-10.8), respectively. The OR for ischemic cardiopathy associated to the same risk levels were 2.3 (CI95%: 1.1-4.6), 2.5 (CI95%: 1.2-5.2), 5.3 (CI95%: 2.4-11.5) and 6.2 (CI95%: 2.7-14.3), respectively. For cardiovascular disease, the OR were 1.1 (CI95%: 0.5-2.5), 2.3 (CI95%: 1.2-5.3), 2.4 (CI95%: 1.0-5.9) and 5.6 (CI95%: 2.2-14.1), respectively. The OR for peripheral arteriopathy were 2.1 (CI95%: 0.8-5.9), 3.7 (CI95%: 1.3-10.5), 3.3 (CI95%: 1.0-11.1) and 6.1 (CI95%: 1.8-20.3), respectively. CONCLUSIONS: The addition of cardiovascular risk factors is associated with an increased risk of cardiovascular events. This finding emphasises the need for prevention of cardiovascular risk factors in primary care.

Estudio PERSIRIS: estudio observacional, postautorización, prospectivo, para evaluar la persistencia al tratamiento con risedronato mensual en mujeres con osteoporosis / PERSIRIS study: observational study, postmarketing, prospective, to evaluate the persistence to treatment with monthly risedronate in women with osteoporosis

OBJETIVO: Evaluar la persistencia del tratamiento con risedronato mensual y conocer los motivos de persistencia y no persistencia terapéutica y el perfil de las pacientes no persistentes. DISEÑO: Estudio observacional, postautorización y prospectivo. Emplazamiento: Consultas de atención primaria, traumatología, reumatología, ginecología y geriatría de Cataluña. PARTICIPANTES: Mujeres con osteoporosis en tratamiento con risedronato mensual que previamente hubiesen abandonado el tratamiento con bifosfonato semanal. MEDICIONES PRINCIPALES: Porcentaje de pacientes bajo risedronato mensual persistentes al año de su prescripción, motivos de persistencia y no persistencia y perfil de pacientes no persistentes en relación a datos biodemográficos, datos clínicos y factores de riesgo de fractura. RESULTADOS: Doscientos ochenta y nueve pacientes valorables con una edad media de 68,3. A los 12 meses de inicio de risedronato mensual, un 58,1% de las pacientes persistía con el tratamiento. Motivos más frecuentes de abandono: miedo a tener efectos secundarios y creencia de que la enfermedad es propia de la edad. Motivos de persistencia destacables: comodidad/facilidad y posología. Se observaron diferencias significativas entre pacientes persistentes y no persistentes en relación a: situación laboral, número de tratamientos concomitantes y talla; sin embargo los resultados de posibles factores asociados deben contextualizarse dentro de las características del estudio y la diferencia de talla no parece clínicamente relevante. CONCLUSIONES: La administración de pautas terapéuticas más cómodas, como risedronato mensual en la osteoporosis, podría facilitar la persistencia en los pacientes mejorando la efectividad del fármaco. Sin embargo, en dicha persistencia pueden influir también variables biodemográficas y clínicas de diversa índole

OBJECTIVE: To assess the persistence of treatment with monthly risedronate and know the reasons of persistence and nontherapeutic persistence and the profile of the non-persistent patients. Desing: Observational, postmarketin and prospective study. LOCATION: Primary care, traumatology, rheumatology, gynecology and geriatrics of Catalonia. PARTICIPANTS: Women with osteoporosis treated with monthly risedronate that previously had abandoned weekly bisphosphonate therapy. MAIN MEASUREMENTS: Percentage of patients on persistent monthly risedronate year of their prescription, reasons for persistent and non persistent and profile of non persistent patients in relation to biodemographic data, clinical data and risk factors for fracture. RESULTS: 289 evaluable patients with a mean age of 68.3. At 12 months of initiation with monthly risedronate, 58.1% of patients remained on treatment. Most frequent reasons for leaving: fear of having side effects and belief that the disease is typical of the age. Reasons remarkable persistence: comfort/ease and dosage. Significant differences were observed between persistent and non-persistent patients relative to: employment status, number of concomitant therapy and height; however the results of possible associated factors must be contextualized within the study characteristics and the difference in size does not seem clinically relevant. CONCLUSIONS: The administration of therapeutic patterns more comfortable as monthly risedronate in osteoporosis, could facilitate persistence in patients improving the effectiveness of the drug. However in that persistence can also influence biodemographic and clinical variables and diverse of various kinds

Asociación entre la agrupación (clustering) de factores de riesgo cardiovascular y el riesgo de enfermedad cardiovascular / Association between Clustering of Cardiovascular Risk Factors and the Risk of Cardiovascular Disease

Fundamento: Las enfermedades cardiovasculares constituyen la principal causa de mortalidad en España. El objetivo del estudio es estudiar la asociación entre la agrupación (clustering) de factores de riesgo cardiovascular y el riesgo de padecer eventos cardiovasculares mayores: cardiopatía isquémica, enfermedad cerebrovascular y arteriopatía periférica de extremidades inferiores.Método: Se realizó un estudio descriptivo transversal, rea lizado en un centro de salud urbano. Se estudiaron 2.248 historias clínicas de personas con edad igual o superior a 15 años, seleccionadas mediante muestreo aleatorio simple. Los datos se obtuvieron por revisión de las historias clínicas, estimando la odds ratio (OR) para padecer algún evento cardiovascular (n = 224), cardiopatía isquémica (n = 123), enfermedad cerebrovascular (n = 84) y arteriopatía periférica (n = 55) respecto al número de factores de riesgo cardiovascular. Se incluyeron los factores de riesgo cardiovascular tabaquismo, hipertensión arterial, hipercolesterolemia, hipertrigliceridemia, diabetes y obesidad. La OR fue ajustada por edad y sexo.Resultados: El porcentaje de pacientes con 0,1, 2, 3 y 4-6 factores de riesgo cardiovascular fue de 39,1, 32,8, 17,5, 6,9 y 3,7 respectivamente. Las OR para el riesgo de tener algún evento cardiovascular asociada a 1, 2, 3 y 4-6 factores de riesgo cardiovascular fueron de 1,6 (IC95 per cent: 0,9-2,7), 2,8 (IC95 per cent: 1,7-4,7), 3,6 (IC95 per cent: 1,9-6,5) y 5,6 (IC95 per cent: 2,9-10,8), respectivamente. Las OR para la cardiopatía isquémica, asociada a los mismos niveles de riesgo, fueron de 2,3 (IC95 per cent: 1,1-4,6), 2,5 (IC95 per cent: 1,2-5,2), 5,3 (IC95 per cent: 2,4-11,5) y 6,2 (IC95 per cent: 2,7-14,3), respectivamente. Para la enfermedad cerebrovascular las OR fueron 1,1 (IC95 per cent: 0,5-2,5), 2,3 (IC95 per cent: 1,2-5,3), 2,4 (IC95 per cent: 1,0-5,9) y 5,6 (IC95 per cent: 2,2-14,1), respectivamente. Las OR para la arteriopatía periférica fueron 2,1 (IC95 per cent: 0,8-5,9 ), 3,7 (IC95 per cent: 1,3-10,5), 3,3 (IC95 per cent: 1,0-11,1) y 6,1 (IC95 per cent: 1,8-20,3), respectivamente.Conclusiones: La adición de factores de riesgo cardiovascular se asocia a un aumento del riesgo de eventos cardiovasculares. Este hecho refuerza la necesidad de realizar una prevención primaria de los factores de riesgo cardiovascular (AU)

Epidemiología de las enfermedades cardiovasculares y factores de riesgo en atención primaria / Cardiovascular disease epidemiology and risk factors in primary care

Introdución y objetivos. Estudiar la prevalencia de las enfermedades cardiovasculares y sus factores de riesgo en atención primaria. Pacientes y método. Estudio descriptivo transversal realizado en un centro de salud urbano de Barcelona (España).Se incluyó a 2.248 pacientes ≥ 15 años, seleccionados mediante muestreo aleatorio simple del archivo de historias clínicas. Se estudiaron las siguientes enfermedades cardiovasculares: cardiopatía isquémica, enfermedad cerebrovascular y arteriopatía periférica de extremidades inferiores, y los siguientes factores de riesgo cardiovascular: edad, sexo, tabaquismo, hipertensión arterial, hipercolesterolemia, hipertrigliceridemia y diabetes mellitus. Resultados. La edad media fue de 49,1 ± 18,9 años y un 53,5% era mujer. La prevalencia de los factores de riesgo cardiovascular fue: tabaquismo, 35,2%; hipertensión arterial, 33,7%; hipercolesterolemia, 21,9%; hipertrigliceridemia,12,7%, y diabetes melitus, 15,8%. El 57,9%presentó al menos 1 factor de riesgo. Los varones presentaron una proporción superior (p < 0,05) excepto en la hipertensión arterial. Su prevalencia aumentó con la edad(excepto en el tabaquismo) hasta los 74 años, en que se estabilizó, excepto en la hipertensión, que siguió aumentando. Tenían alguna enfermedad cardiovascular el10,0% de los pacientes: cardiopatía isquémica el 5,5%;enfermedad cerebrovascular el 3,7% y arteriopatía periférica de extremidades inferiores el 2,4%. Fueron más frecuentes en varones (p < 0,05), excepto la enfermedad cerebrovascular. Su prevalencia fue baja en < 55 años(especialmente en mujeres) y aumentó con la edad en todas las enfermedades cardiovasculares, correspondiendo el 68,3% a pacientes de ≥ 65 años. Conclusiones. Se confirma la elevada prevalencia delos factores de riesgo cardiovascular en nuestro medio. Las enfermedades cardiovasculares son especialmente frecuentes en varones y ancianos

Introduction and objectives. To study the prevalence of and risk factors for cardiovascular disease in primary care. Patients and method. A cross-sectional study was carried out at an urban health center in Barcelona, Spain. In total, 2248 patients ≥15 years old were selected randomly from medical records. The study investigated cardiovascular diseases such as ischemic heart disease, cerebrovascular disease and peripheral arterial disease, and cardiovascular risk factors such as age, sex, smoking, high blood pressure, hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus. Results. The patients’ mean age was 49.1 (18.9) years and 53.5% were male. Cardiovascular risk factor prevalences were: smoking, 35.2%; high blood pressure, 33.7%;hypercholesterolemia, 21.9%; hypertriglyceridemia,12.7%;and diabetes mellitus, 15.8%. Overall, 57.9% of patients had at least 1 cardiovascular risk factor. Significantly more males presented with each risk factor (P<.05), apart from high blood pressure. The prevalence of all risk factors, except smoking, increased with age until 74 years and then stabilized, except high blood pressure, which continued to increase. Around 10% had cardiovascular disease, with myocardial ischemia in 5.5%, cerebrovascular disease in3.7%, and peripheral arterial disease in 2.4%. All except cerebrovascular disease were significantly more common in males (P<.05). The prevalence of cardiovascular disease was low in individuals <55 years old, particularly women, and increased with age for all forms of disease. Some 68.3% were ≥65 years old. Conclusions. The high prevalence of cardiovascular risk factors was confirmed. Cardiovascular disease was more common in males and the elderly