Austerity Policies and Mortality in Spain After the Financial Crisis of 2008.

OBJECTIVES: To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS: We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS: During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS: The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.

Association between glycemic index, glycemic load, and fructose with insulin resistance: the CDC of the Canary Islands study.

BACKGROUND: The involvement of carbohydrates in triggering insulin resistance (IR) remains a source of controversy. AIM OF THE STUDY: To study the relation between glycemic index (GI), glycemic load (GL), and fructose with insulin resistance in a predominantly rural population in the Canary Islands. METHODS: Cross-sectional study carried out in 668 nondiabetic people aged 18-75. IR was estimated with serum glucose and C-peptide (HOMA2-IR). Nutrient intakes were obtained from a validated food frequency questionnaire. ANOVA was used to analyze nutrient distribution across quartiles of HOMA2-IR. Four multivariate nutrient density models (dependent variable: log-transformed HOMA2-IR) which differed only in the kinds of carbohydrates included were tested (Model 1: carbohydrates; Model 2: GI and then GL; Model 3: free fructose, other simple sugars and starch; Model 4: total fructose, remaining sugars and starch). RESULTS: There was no association between GI and IR. There was a direct association between GL (P < 0.001), fructose (free [P = 0.001], total [P = 0.013]), energy intake (P < 0.001), fruit fiber (<0.001), and glucose (P = 0.003) with IR. There was an inverse association between cereal (P = 0.008) and vegetable fiber (P < 0.001) and IR. Multivariate models corroborated the association of carbohydrates, GL, fructose, vegetable fiber, and energy intake with IR. The association between GL and IR disappeared when Model 2 was adjusted by total fructose intake. CONCLUSIONS: There was a direct association between fructose intake and IR. There was no relationship between GI and IR. Although a direct association of GL with IR was detected, it was attributable to the consumption of fructose.

[The waist to height ratio as an index of cardiovascular risk and diabetes]. / El cociente perímetro abdominal/estatura como índice antropométrico de riesgo cardiovascular y de diabetes.

BACKGROUND AND OBJECTIVES: To identify the anthropometric index that best detects cardiovascular risk (CVR) and type 2 diabetes (DM2) in the adult Spanish population and to determine its cut-off point. SUBJECTS AND METHODS: Cross-sectional study in the general population (n=6279). Sensitivity and specificity were estimated for the anthropometric indexes: abdominal waist, body mass index, waist to hip ratio and waist to height ratio (WtHR). The areas of these indexes under ROC curve (AUC) were obtained for the following CVR factors: high coronary risk computed with Framingham model, Hypertension, Hyperlipemia, DM2, Metabolic Syndrome (MS) and Impaired Fasting Glucose (IFG). The odds ratio, with 95% confidence interval (CI(95%)), was calculated. RESULTS: WtHR was the index showing the highest AUC for DM2 and the remaining CVR factors, varying between 0.65 (CI(95%)=0.63-0.68) for IFG in men and 0.87 (CI(95%)=0.86-0.89) for MS in women. RA/E reached the maximum sensitivity (0.91) and specificity (0.70) in SM and its optimal cut-off point was 0.55, which displayed the highest risks amongst indexes, varying from 2.30 (1.96-2.70) in IFG to 16'20 (13.68-19.20) in MS. CONCLUSIONS: RA/E is the index presenting the best ability to detect DM2 and CVR in this population, and it shows the stronger association with them. Its cut-off point, 0.55, confirms the convenience of keeping the abdominal waist to less than half the height.

[Framingham function estimates the risk of cardio vascular mortality more effectively than SCORE function in the population of the Canary Islands (Spain)]. / En la población Canaria, la función de Framingham estima mejor el riesgo de mortalidad cardiovascular que la función SCORE.

INTRODUCTION: To compare the performance of the Framingham and SCORE functions to estimate fatal cardiovascular events. In addition, we explored the ability of both functions to detect the risk contributed by factors not included in their equations: sedentariness, obesity, abdominal circumference, abdomen/height razón, abdomen/pelvis ratio, and excessive alcohol consumption. METHODS: We performed a cross-sectional study of 5,289 individuals aged 30 to 69 years old, recruited by random sampling of the general population of the Canary Islands. We calibrated the Framingham and SCORE functions and estimated their concordance. The cardiovascular mortality rate for the population in this age range was compared with the risk predicted by the two functions. RESULTS: Among males, the mortality rate per 100,000 inhabitants was 67.4, while the Framingham, SCORE-low and SCORE-high estimations were 80, 140, and 270, respectively. Among females, the mortality rate was 19.3 while the estimations were 30, 50, and 70, respectively. Both functions detected the increased risk contributed by the factors studied, except for sedentariness among females with SCORE, and excessive alcohol consumption with both functions. Among males, taking cut points of > or = 12%, > or = 15%, and > or = 20% for Framingham, the concordance with SCORE-low yielded Kappa values of 0.6, 0.7, and 0.5, respectively. CONCLUSIONS: The Framingham function yielded the best estimate of cardiovascular mortality rates. Only Framingham detected the cardiovascular risk contributed by sedentariness in both genders. We recommend the use of the calibrated Framingham function for this population.

Hospital Mortality in 415 798 AMI Patients: 4 Years Earlier in the Canary Islands Than in the Rest of Spain.

INTRODUCTION AND OBJECTIVES: The Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes. METHODS: Cross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set. RESULTS: A total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. CONCLUSIONS: Mortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.

[Presentation of the "CDC de Canarias" cohort: objectives, design and preliminary results]. / Presentación de la cohorte "CDC de Canarias": objetivos, diseño y resultados preliminares.

BACKGROUND: The Canary Islands rank first in Spain with respect to the ischaemic heart disease and diabetes mortality rates. The Islands female population leads the country in deaths from breast cancer. The "CDC de Canarias" is a general population cohort study in order to analyse the prevalence and incidence of these diseases and the exposure to their risk factors (RF) in the adult population of the archipelago. METHODS: Prospective study with a random sampling of the general population, in which 6,729 individuals participated between 2000 and 2005 (aged 18-75). Anthropometric measurements were taken, and blood was drawn for the storage of serum and genetic samples. The following information was gathered through a questionnaire: eating habits, physical activity, personal and family medical history, exposure to occupational or environmental risk factors, smoking, etc. RESULTS: The prevalence of obesity is close to 30%, without differences between sexes, however, more male subjects were overweight than women (45 vs. 33%; p <0.001) and also presented a greater prevalence of diabetes (12 vs. 10%; p =0.005), high blood pressure (43 vs. 33%; p <0.001), excessive intake of alcohol (13 vs. 2%; p <0.001) and lack of sun protection (46 vs. 18%; p <0.001). Exposure to low levels of HDL cholesterol is more frequent in women (37 vs. 30%; p <0.001) as is also the case with a sedentary life style (71 vs. 55%; p <0.001). The exposure to the risk factors studied, including poverty, is greater in advanced age groups, except for smoking (26%) which is greater in the younger subjects. The estimate of relative risks of exposure to cardiovascular and cancer risk factors is higher in low-income social classes. CONCLUSIONS: The current adult population of the Canaries presents a high prevalence of exposure to risk factors for cardiovascular disease, diabetes and cancer, among which overweight, obesity and lack of exercise stand out particularly.

Validation of DIABSCORE in screening for Type 2 Diabetes and prediabetes in Tunisian population.

AIMS: To perform a validation of DIABSCORE in a sample of Tunisian adults and find out the optimal cut-off point for screening of Type 2 diabetes (T2D) and prediabetes. METHODS: 225 adults 18-75 years and a subgroup of 138 adults (18-54 years), with undiagnosed T2D from the region of Cap-Bon, Tunisia were included in the present study. The DIABSCORE was calculated based on: age, waist/height ratio, family history of T2D and gestational diabetes. Receiver operating characteristics (ROC) curves and areas under curve (AUC) were obtained. The T2D and prediabetes prevalences odds ratios (OR) between patients exposed and not exposed to DIABSCORE≥90 and DIABSCORE≥80, respectively were calculated in both age ranges. RESULTS: For screening of T2D the best value was DIABSCORE = 90 with a highest sensitivity (Se), negative predictive value (NPV) and lower negative likelihood ratio in participants aged 18-75 yr (Se = 97%; NPV = 97%) when compared to participants aged 18-54 yr (Se = 95%; NPV = 97%); for prediabetes, the best Se and NPV were for DIABSCORE = 80 in both age groups, but it showed a disbalanced sensitivity-specificity. The ROC curves for T2D showed a similar AUC in both age ranges (AUC = 0.62 and AUC = 0.61 respectively). The ROC curves for prediabetes showed a highest AUC in those aged 18-54 years than the older ones (AUC = 0.62 and AUC = 0.57, respectively). The prevalences OR of T2D for DIABSCORE≥90 was higher than for DIABSCORE≥80 in both age ranges. Nevertheless, the prevalences OR of prediabetes for DIABSCORE≥90 was half of the detected for DIABSCORE≥80 in both age ranges. CONCLUSION: The DIABSCORE is a simple clinical tool and accurate method in screening for T2D and prediabetes in the adult Tunisian population.

Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care.

AIMS: To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients. METHODS: Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c ≥6.5%) between patients exposed and not exposed to DIABSCORE ≥100, and to fasting blood glucose ≥126mg/dL were calculated. The opinions of both the professionals and the patients concerning DIABSCORE were collected, and a cost-effectiveness analysis was performed. RESULTS: In both regions, the valid cut-off point for diabetes (DIABSCORE=100), showed an area under the curve >0.80. The prevalences odds ratio of diabetes for DIABSCORE ≥100 was 9.5 (3.7-31.5) in Canarian and 18.3 (8.0-51.1) in Valencian; and for glucose ≥126mg/dL it was, respectively, 123.0 (58.8-259.2) and 303.1 (162.5-583.8). However, glucose ≥126mg/dL showed a low sensitivity (below 48% in both communities) as opposed to DIABSCORE ≥100 (above 90% in both regions). Professionals (100%) and patients (75%) satisfaction was greater when using DIABSCORE rather than glucose measurement for diabetes screening. The cost of each case of diabetes identified was lower with DIABSCORE ≥100 (7.6 € in Canarian and 8.3 € in Valencian) than glucose ≥126mg/dL (10.8 € and 10.5 €, respectively). CONCLUSIONS: DIABSCORE is an applicable and cost-effective screening method for type 2 diabetes in primary care.

Inverse association of resistin with physical activity in the general population.

AIM: Resistin is a cytokine related with inflammation and ischemic heart disease. Physical activity (PA) prevents chronic inflammation and ischemic heart disease. We studied the relationship of serum concentration of resistin with HDL cholesterol, a known biomarker of PA, and with different measures of PA, in a large sample of the general adult population in the Canary Islands. METHODS: Cross-sectional study of 6636 adults recruited randomly. We analyzed the correlation of resistin and HDL cholesterol with PA (as metabolic equivalent level [MET]), and fitted the results with linear and logistic regression models using adjustment for age, alcohol consumption and smoking. RESULTS: Mean resistin level was higher in women (p<0.001), correlated inversely with age, HDL cholesterol (p<0.001) and alcohol consumption (p<0.001 in men), and correlated directly with smoking (p<0.001). Resistin correlated inversely with the duration of leisure time PA (p<0.001), leisure time MET (p<0.001) and moderate leisure time PA (p<0.001), with some differences between sexes. Men (OR = 0.78 [0.61-0.99; p<0.05]) and women (OR = 0.75 [0.61-0.92; p<0.01]) in the upper quintile of leisure time PA had a lower risk of elevated resistin. In contrast, a high degree of sedentarism was associated with an increased risk elevated resistin in women (OR = 1.24 [1.04-1.47; p<0.05] and in men (OR = 1.40 [1.01-1.82; p<0.05]). CONCLUSIONS: In our sample of the general population, resistin was inversely associated with measures and levels of PA and HDL cholesterol. The association of resistin with PA was stronger than the association of HDL cholesterol with PA, making resistin a potentially useful biomarker of PA.

Leptin, estrogens and cancer.

Obesity is a state of leptin resistance in which the membrane leptin receptor and the JAK-STAT pathway are blocked. This leads to increased intracellular concentrations of lipid metabolites, increased non-oxidative metabolism by adipocytes, and stimulation of the cell estrogen cycle. These factors are potentially oncogenic via the shared mitogen-activated protein kinase (MAPK), mitogen/extracellular signal-regulated kinase (MEK) and extracellular signal-regulated kinase (ERK) cellular pathways.

[Coronary risk in the population of the Canary Islands, Spain, using the Framingham function]. / Estimación del riesgo coronario en la población de Canarias aplicando la ecuación de Framingham.

BACKGROUND AND OBJECTIVE: Although ischemic cardiopathy mortality in the Canary Islands is among the highest in Spain, the specific coronary risk for its population has not been estimated. This study presents the first cardiovascular risk charts for the Canarian adult population and compares them with those previously published on Gerona, Spain. SUBJECTS AND METHOD: A cross-sectional study of 4915 subjects, aged 25-74, that had been enrolled in the cohort study CDC of the Canary Islands. The standardized prevalence of obesity, overweight, smoking, hypertension and diabetes were estimated with the information obtained from personnel interviews, physical exams and blood samples. Those prevalences were used to calibrate the Framingham coronary function and to elaborate coronary risk charts. RESULTS: The crude prevalence of obesity was 30% (95% confidence interval [CI], 28.7-31.3), overweight 39% (95% CI, 37.6-40.4), smoking 26% (95% CI, 24.8-27.2), hypertension 40% (95% CI, 38.6-41.4) and diabetes 12% (95% CI, 11.1-12.9). In most of the factors, these prevalences were higher than Gerona's population in every age group and gender. On average, the estimated coronary risk of the islanders was 89% higher than Gerona's risk (94% higher in males and 87% in females), which is concordant with the distance between both populations in the national mortality statistics. CONCLUSIONS: The high prevalence of obesity and other factors in the Canarian population implies important coronary risks and it explains the position of the Canary Islands in the Spanish statistics of ischemic cardiopathy mortality. The use of these calibrated risk charts would be helpful to intensify the prevention of cardiovascular diseases.

Lipid and inflammatory biomarker profiles in early insulin resistance.

AIMS: To analyze the serum lipid and inflammatory biomarker profile in the early insulin resistance (e-IR). METHODS: Cross-sectional study of 5943 adults without diabetes, stratified into no IR group (C-peptide

Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome.

OBJECTIVES: To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis. METHODS: Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable. RESULTS: The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1-10.5), but these patients accounted for 56.6% (95% CI = 47.4-65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9-36.0) for in-hospital death, and 51.4% (95% CI = 44.8-58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3-53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8-31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9-8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2-18.1) for in-hospital death at the highest severity level. CONCLUSIONS: The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.

Social class and metabolic syndrome in populations from Tunisia and Spain.

BACKGROUND: There is an increasing prevalence of obesity and metabolic syndrome (MS) in developing countries. It has been shown the relationship between social class and MS in developed countries. The objective of our study was to compare the association of social class with the prevalence of MS in a developing country (Tunisia, region of Cap-Bon) and a developed one (Spain, Canary Islands). METHODS: Cross-sectional study of 6729 Canarian and 393 Tunisian individuals. Social class was measured with the income, crowding and education (ICE) model, which includes family income, household crowding and education level. Logistic regression models adjusted by age estimated the risk by odds ratio (OR) and confidence interval (CI 95 %) of MS according to social class. RESULTS: MS prevalence was higher in Tunisian (50 %) than in Canarian women (29 %; p = 0.002), with no significant differences between men. For Canarian women, being in the highest social class was a protective factor against MS (OR = 0.39; CI 95 % 0.29-0.53) and all its components. The Canarian population and the Tunisian women, showed a significant linear trend (p < 0.001) of MS to decrease when social class increased. CONCLUSION: High social class is a protective factor from MS and its components within the Canarian population and the Tunisian women. Our results suggest that the socioeconomic transition in a developing country like Tunisia can improve the population health in a sex-specific manner.

C-peptide as a risk factor of coronary artery disease in the general population.

OBJECTIVE: To analyse the association between serum C-peptide and coronary artery disease in the general population. METHODS: Follow-up study of 6630 adults from the general population. They were stratified into group 1 (no insulin resistance: C-peptide < third tercile and glycaemia < 100 mg/dL), group 2 (initial insulin resistance: C-peptide ⩾ third tercile and glycaemia < 100 mg/dL) and group 3 (advanced insulin resistance: glycaemia ⩾ 100 mg/dL). RESULTS: After 3.5 years of follow-up, group 2 had a higher incidence of myocardial infarction (relative risk (RR) = 4.2, 95% confidence interval (CI) = 1.7-10.6) and coronary artery disease (RR = 3.5, 95% CI = 1.9-6.6) than group 1. Group 3 also had increased incidences of both diseases. In multivariable analysis of the entire population, groups 2 and 3 showed significant risks of myocardial infarction and coronary artery disease (RR > 3 and RR > 2, respectively). However, when people with diabetes were excluded, the increased risks were corroborated only in group 2 for myocardial infarction (RR = 2.8, 95% CI = 1.1-6.9; p = 0.025) and coronary artery disease (RR = 2.4, 95% CI = 1.3-4.6; p = 0.007). CONCLUSION: Elevated C-peptide is associated with the incidence of myocardial infarction and coronary artery disease in the general population. It can be an earlier predictor of coronary events than impaired fasting glucose.

[Resting heart rate and cardiovascular disease]. / Frecuencia cardiaca en reposo y enfermedad cardiovascular.

Heart rate reflects autonomic nervous system activity. Numerous studies have demonstrated that an increased heart rate at rest is associated with cardiovascular morbidity and mortality as an independent risk factor. It has been shown a link between cardiac autonomic balance and inflammation. Thus, an elevated heart rate produces a micro-inflammatory response and is involved in the pathogenesis of endothelial dysfunction. In turn, decrease in heart rate produces benefits in congestive heart failure, myocardial infarction, atrial fibrillation, obesity, hyperinsulinemia, insulin resistance, and atherosclerosis. Alteration of other heart rate-related parameters, such as their variability and recovery after exercise, is associated with risk of cardiovascular events. Drugs reducing the heart rate (beta-blockers, calcium antagonists and inhibitors of If channels) have the potential to reduce cardiovascular events. Although not recommended in healthy subjects, interventions for reducing heart rate constitute a reasonable therapeutic goal in certain pathologies.

Relationships between serum resistin and fat intake, serum lipid concentrations and adiposity in the general population.

AIMS: The serum resistin level is associated with the incidence of ischemic heart disease in the general population. We analyzed the associations between serum resistin and fat intake, serum lipid concentrations and adiposity in the general population. METHODS: A cross-sectional study of 6,637 randomly recruited adults was conducted. The resistin levels were measured in thawed aliquots of serum using an enzyme immunoanalysis technique. RESULTS: The resistin level exhibited a positive nonparametric correlation with saturated fat intake(p < 0.001) and an inverse correlation with adherence to the Mediterranean diet(p < 0.001), monounsaturated fat intake(p < 0.05), total serum cholesterol(p < 0.001), non-HDL cholesterol(p < 0.001), LDL cholesterol(p < 0.001), body mass index(p < 0.001), waist circumference(p < 0.001) and the waist/height ratio(p < 0.001). An elevated resistin concentration(fifth quintile) was associated with adherence to the Mediterranean diet(OR=0.82 CI95%=0.71-0.93), saturated fat intake(OR=1.34 CI95%=1.16-1.56), monounsaturated fat intake(OR=0.88 CI95%=0.78-0.99), a total cholesterol level of ≥200 mg/dL(OR=0.81 CI95%=0.72-0.91), a low HDL cholesterol level(OR=0.84 CI95%= 0.76-0.93), a high non-HDL cholesterol level(OR=0.84 CI95%=0.72-0.99), a high LDL cholesterol level(OR=0.82 CI95%=0.70-0.97) and a waist/height ratio of ≥0.55(OR=0.76 CI95%=0.67-0.85). The multivariate models corroborated the positive associations between the resistin level and saturated fat intake(p < 0.001) and serum triglycerides(p=0.004) and the inverse associations between the resistin level and adherence to the Mediterranean diet(p=0.002), total serum cholesterol(p < 0.001) and cholesterol fractions and the waist/height ratio(p=0.02). CONCLUSIONS: In the general population, the serum resistin level is associated with fat intake: positively with saturated fat intake and inversely with monounsaturated fat intake. As a consequence, the resistin level is also inversely associated with adherence to the Mediterranean diet. In addition, the resistin level is inversely associated with the serum cholesterol level and adiposity.

The association of resistin with coronary disease in the general population.

AIMS: To explore the association between resistin expression and the incidence of ischemic heart disease in the general population. METHODS: A follow-up study of 6636 adults recruited randomly from the general population. RESULTS: The serum resistin concentration was higher in women (6.1 ng/mL; CI95%=6.0-6.2) than in men (5.6 ng/mL; CI95%=5.5-5.7). Individuals in the 5th quintile or higher of resistin (RQ5) were younger (P＜0.001) and had a lower prevalence of arterial hypertension (P＜0.001), abdominal obesity (P＜0.001), diabetes (P＜0.001) and dyslipidemia (P＜0.001). The cardiovascular risk estimated by the Framingham function was also lower in the RQ5 subgroup (P＜0.001); however, the prevalence of smoking was higher (P＜0.001), as was the prevalence of low HDL cholesterol (P＜0.001). After 3.5 years of follow-up, the RQ5 subgroup had a higher incidence of acute myocardial infarction (AMI, RR=1.9; CI95%=1.01-3.54). In the population without diabetes, the RQ5 subgroup had a higher risk of AMI (RR=2.4; CI95%=1.10-5.17), and the risk of AMI was highest in women in this group (4.97; CI95%=1.33-18.57). The risk levels were significant in the Cox models adjusted for age, sex and smoking; and the hazard ratio was 2.5 for AMI (CI95%=1.29-4.70) in the sample of patients matched by sex and smoking status. CONCLUSIONS: Resistin may be a risk marker for ischemic heart disease in the general population. The serum resistin concentration is higher in women, and the associated increase in the risk of AMI based on the resistin level is also higher in women than in men.

Microsatellite polymorphisms in the EGFR, NOTCH4 and E2F4 genes and their association with breast cancer risk.

BACKGROUND: The sequences of many human genes that encode proteins involved in cancer contain polymorphic microsatellites. Variations in microsatellite length may constitute risk factors in several human diseases, a possibility that has been little explored in breast cancer. Among the genes that contain polymorphic microsatellites are EGFR, NOTCH4 and E2F4. The length of some of these microsatellites has been associated with breast cancer risk. PURPOSE AND METHODS: To determine whether the length of the microsatellites (CA)n in EGFR, (CTG)n in NOTCH4 and (AGC)n in E2F4 was associated with breast cancer risk, we genotyped these 3 microsatellites in 212 women with breast cancer and a control group of 308 women from the general population who did not have this disease. RESULTS AND CONCLUSIONS: The allelic distribution observed for the 3 microsatellites matched that found in other white populations, with the exception of some (AGC)n alleles in E2F4, which have not been described previously. The length of (CA)n in EGFR and (CTG)n in NOTCH4 was not associated with breast cancer (OR=0.99; 95% CI 0.59-1.37; p=0.619 and OR=1.08; 95% CI 0.71-1.65; p=0.725, respectively). Short alleles (<13 repeats) of (AGC)n in E2F4 were less frequent in women with cancer than in the control sample.

Factors associated with knowledge and control of arterial hypertension in the Canary Islands.

INTRODUCTION AND OBJECTIVES: To analyze the factors associated with knowledge and control of hypertension in the adult population of the Canary Islands (18-75 years). METHODS: We recruited a random sample of the general population aged ≥18 years. Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg or known hypertension (self-declared, or controlled hypertension <140/90 mmHg). The bivariate association of known and controlled hypertension with age, sex, anthropometry, serum lipids, medication, and lifestyle was corroborated by adjusting a multivariate logistic model. RESULTS: We included 6675 participants. The prevalence of hypertension was higher in men (40% vs 31%, P<.001), who also had a lower frequency of treated and controlled hypertension. Female sex (P<.001), age ≥55 years (P<.001), obesity (P<.001), and diabetes (P<.001) were associated with known hypertension. The modifiable factors that, in spite of treatment, increased the risk of poor control of hypertension were alcohol consumption (>30 g/day, odds ratio [OR]=2.4, P<.001; >15-≤30 g/day, OR=2, P=.009; >5-≤15, g/day, OR=1.83, P=.004), obesity (body mass index ≥30, OR=2, P=.003; >24.9-<30, OR=1.7, P=.024), serum cholesterol >250 mg/dL (OR=1.6, P=.006) and elevated heart rate (>80 bpm, OR=1.45, P=.045; >70-≤80 bpm, OR=1.36, P=.038). CONCLUSIONS: The awareness of hypertension increases with frequent use of the health system and with factors associated with known hypertension: female sex, age, underlying health problems. The modifiable factors associated with poor control of known hypertension are alcohol consumption, obesity, elevated heart rate, and hypercholesterolemia.