Long-term risk of cardiovascular events after detecting silent coronary atheromatosis using computed tomography.

BACKGROUND: Coronary calcium score (CCS) and coronary computed tomography angiography (CTA) assessments using multidetector computed tomography are invaluable for atheromatosis screening. We studied their usefulness in cardiovascular risk assessments, and compared evaluations using the Systematic COronary Risk Evaluation (SCORE) algorithm with those from CTA and CSS assessments in terms of their ability to predict cardiovascular events in Mediterranean patients. PATIENTS AND METHODS: Two hundred and sixty-six asymptomatic patients whose mean age was 55.4 years, 89.5% of whom were men, were evaluated using CTA and CCS and followed for more than 10 years. The CTA and CCS risk predictions were compared with those determined using the SCORE algorithm designed for low-risk populations. RESULTS: Coronary lesions were present in 140 (53.4%) patients. Of the lesions, 17% were noncalcified, 17% were mixed, and 66% were calcified; in addition, 24.2% of the patients who had lesions had cardiovascular events during follow-up (P<0.00001), but just 2.9% of the patients without lesions. Detection of atheromatosis using computed tomography was associated with an increased risk of cardiovascular disease events at more than 10 years [odds ratio (OR): 6.828; 95% confidence interval (CI): 2.001-23.305; P=0.002]. This OR was higher than that obtained for intermediate-risk individuals (OR: 4.818; 95% CI: 1.360-17.075; P=0.015) and lower than that determined for high-risk individuals (OR: 9.395; 95% CI: 2.489-35.460; P=0.001) using the SCORE algorithm, and higher that that determined for CCS assessments (OR: 3.916; 95% CI: 1.572-9.751; P=0.03). More cardiovascular events were associated with higher amounts of calcium. CONCLUSION: The detection of atheromatosis using the CCS and CTA was associated with an increased risk of cardiovascular events at more than 10 years. CTA and CCS assessments had a higher OR than that associated with assessments of patients at intermediate risk using the SCORE algorithm.

Housing Policies and Health Inequalities.

A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed. Housing conditions related to fuel poverty are associated with poorer health and are unevenly distributed across Europe. We found possible positive effects of façade insulation interventions on cold-related mortality in women living in social housing; but not in men. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most vulnerable groups and be adaptable to their needs.

Changes in Health Following Housing Improvement in a Vulnerable Population in Spain: A Follow-up Study.

The objective of this study is to compare changes in health among a sample of families living in substandard dwellings or with housing affordability problems assisted by Caritas Diocesana de Barcelona, according to the improvement of their socioeconomic and housing situation during the study period. A quasi-experimental study was performed, including 232 families assisted by Caritas who were interviewed in 2012 and one year later. Participants could have received a set of interventions, including relocation and different types of economic subsidies. Regression models were fitted to identify the association of participants' changes in self-rated general health and mental health between baseline and follow-up with improvements across three dimensions: socioeconomic situation and housing affordability, physical housing characteristics, and neighborhood. An improvement in self-reported health status was associated with having found a job and reporting fewer problems in meeting monthly housing costs. Mental health improved among participants with an increased household income, with a reduction in the perceived risk of losing their house, and with reduced housing-related material deprivations. The study shows that health gains can derive from improvements in housing conditions, especially those related to housing affordability.