Genetic Variants at the 9p21.3 Locus Are Associated with Risk for Non-Compressible Artery Disease: Results from the ARTPER Study.

Peripheral artery disease (PAD) and non-compressible artery disease (NCAD) constitute predictors of subclinical atherosclerosis easily assessed through the ankle brachial index (ABI). Although both diseases show substantial genetic influences, few genetic association studies have focused on the ABI and PAD, and none have focused on NCAD. To overcome these limitations, we assessed the role of several candidate genes on the ABI, both in its continuous distribution and in the clinical manifestations associated to its extreme values: PAD and NCAD. We examined 13 candidate genomic regions in 1606 participants from the ARTPER study, a prospective population-based cohort, with the ABI assessed through ultrasonography. Association analyses were conducted independently for individuals with PAD (ABI < 0.9) or with NCAD (ABI > 1.4) vs. healthy participants. After including potential covariates and correction for multiple testing, minor alleles in the genetic markers rs10757278 and rs1333049, both in the 9p21.3 region, were significantly associated with a decreased risk of NCAD. Associations with the ABI showed limited support to these results. No significant associations were detected for PAD. The locus 9p21.3 constitutes the first genetic locus associated with NCAD, an assessment of subclinical atherosclerosis feasible for implementation in primary healthcare settings that has been systematically neglected from genetic studies.

[PAPPS update on older people 2022]. / Actividades preventivas en el mayor. Actualización PAPPS 2022.

This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.

[Deprescription in old people: It's time to take action]. / Deprescripción en personas mayores: es el momento de pasar a la acción.

The use of drugs has undeniable benefits to the elderly, but it is not exempt from undesirable effects. Deprescription is the process of systematic medication review with the target of achieving the best risk-benefit ratio based on the best available evidence. This process is especially important for polymedicated elderly patients as well as those overtreated, frail, terminally ill and at the end of life. The deprescription must be done in stages, establishing a close follow-up in case problems appear after withdrawal. In the decision-making process, it is very important to consider the patient and caregivers opinion, assessing the objectives of the treatment according to the clinical, functional and social situation of the patient. There are multiple tools to make it easier for clinicians to select which drugs to deprescribe (Beers criteria, STOPP-START…). The most susceptible to intervention pharmacological groups are: antihypertensives, antidiabetics, statins, benzodiazepines, antidepressants, anticholinergics, anticholinesterase agents, and neuroleptics.

[Relationship between physical activity during leisure time and progression of ankle-brachial index]. / Relación entre la actividad física en el tiempo libre y la progresión del índice tobillo-brazo.

OBJECTIVE: To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population. METHOD: Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI) <0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI. RESULTS: The mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot. CONCLUSIONS: In our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk.

Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2.

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Type 2 Diabetes Mellitus and Cancer: Epidemiology, Physiopathology and Prevention.

Individuals with type 2 diabetes mellitus are at greater risk of developing cancer and of dying from it. Both diseases are age-related, contributing to the impact of population aging on the long-term sustainability of health care systems in European Union countries. The purpose of this narrative review was to describe, from epidemiological, pathophysiological and preventive perspectives, the links between type 2 diabetes mellitus and the most prevalent cancers in these patients. Multiple metabolic abnormalities that may occur in type 2 diabetes mellitus, particularly obesity, could explain the increased cancer risk. In addition, the effectiveness of drugs commonly used to treat type 2 diabetes mellitus (e.g., metformin and thiazolidinediones) has been broadly evaluated in cancer prevention. Thus, a better understanding of the links between type 2 diabetes mellitus and cancer will help to identify the contributing factors and the pathophysiological pathways and to design personalized preventive strategies. The final goal is to facilitate healthy aging and the prevention of cancer and other diseases related with type 2 diabetes mellitus, which are among the main sources of disability and death in the European Union and worldwide.

Incidence of SARS-CoV-2 infection in close contacs. Telephone follow-up in Primary Care.

OBJECTIVE: To study the incidence of infection in close contacts with patiens with SARS-CoV-2 infection using a telephone monitoring protocol after the recommendation of isolation and quarantine at home. PATIENTS AND METHODS: Cohort study, with 124 patients older than 15 years, included consecutively, asymptomatic at the time of the consultation, who had had close contact (<2 m) with confirmed or possible cases of SARS-CoV-2 infection. The intervention consisted of 2 weeks of home isolation and quarantine, contacting by phone on days, 2, 4, 7 and 14 after the contact. The event of interest was the appereance of symptoms compatible with SARS-CoV-2 infection. RESULTS: The average age was 45.1 years (55.6% women); 328 phone calls were made (average 2.6 calls for patient). After 2 weeks of follow-up, 6 patients developed symptoms, confirming serologically or by PCR in 3 of them (2.4%, CI 95%: 0.8-6.9). CONCLUSIONS: The incidence of SARS-CoV-2 infection in close contacts is low 2 weeks after home isolation and quarantine at home.

OBJETIVO: Estudiar mediante un protocolo de seguimiento telefónico la incidencia de infección en los contactos estrechos de pacientes con infección por SARS-CoV-2 tras la recomendación de aislamiento y cuarentena en el domicilio. PACIENTES Y MÉTODOS: Estudio de cohortes, con 124 pacientes mayores de 15 años, incluidos consecutivamente, asintomáticos en el momento de la visita, con contacto estrecho (<2 metros) con casos confirmados o posibles de infección por SARS-CoV-2. La intervención consistió en aislamiento y cuarentena en domicilio durante 2 semanas, contactando telefónicamente los días 2, 4, 7 y 14 tras el contacto. El evento de interés fue la aparición de clínica compatible con infección por SARS-CoV-2. RESULTADOS: La edad media fue de 45,1 años (55,6% mujeres). Se realizaron 328 llamadas telefónicas (media de 2,6 llamadas por paciente). Tras 2 semanas de seguimiento desarrollaron síntomas 6 pacientes, confirmados serológicamente o por PCR en 3 de ellos (2,4%; IC 95%: 0,8­6,9). CONCLUSIONES: La incidencia de infección por SARS-CoV-2 en los contactos estrechos es baja a las 2 semanas tras el aislamiento y cuarentena domiciliarios.

[Incidence of SARS-CoV-2 infection in close contacs. Telephone follow-up in Primary Care]. / Incidencia de infección por SARS-CoV-2 en contactos estrechos. Seguimiento telefónico en Atención Primaria.

OBJECTIVE: To study the incidence of infection in close contacts with patiens with SARS-CoV-2 infection using a telephone monitoring protocol after the recommendation of isolation and quarantine at home. PATIENTS AND METHODS: Cohort study, with 124 patients older than 15 years, included consecutively, asymptomatic at the time of the consultation, who had had close contact (<2 meters) with confirmed or possible cases of SARS-CoV-2 infection. The intervention consisted of 2 weeks of home isolation and quarantine, contacting by phone on days, 2, 4, 7 and 14 after the contact. The event of interest was the appereance of symptoms compatible with SARS-CoV-2 infection. RESULTS: The average age was 45.1 years (55.6% women); 328 phone calls were made (average 2.6 calls for patient). After 2 weeks of follow-up, 6 patients developed symptoms, confirming serologically or by PCR in 3 of them (2.4%, CI 95%: 0.8-6.9). CONCLUSIONS: The incidence of SARS-CoV-2 infection in close contacts is low 2 weeks after home isolation and quarantine at home.

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort.

BACKGROUND: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). METHODS: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. RESULTS: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. CONCLUSIONS: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.

Impact of COVID-19 outbreak by income: hitting hardest the most deprived.

BACKGROUND: The impact of the 2019 coronavirus disease (COVID-19) has many facets. This ecological study analysed age-standardized incidence rates by economic level in Barcelona. METHODS: We evaluated confirmed cases of COVID-19 in Barcelona (Spain) between 26 February 2020 and 19 April 2020. Districts were classified according to most recent (2017) mean income data. The reference for estimating age-standardized cumulative incidence rates was the 2018 European population. The association between incidence rate and mean income by district was estimated with the Spearman rho. RESULTS: The lower the mean income, the higher the COVID-19 incidence (Spearman rho = 0.83; P value = 0.003). Districts with the lowest mean income had the highest incidence of COVID-19 per 10 000 inhabitants; in contrast, those with the highest income had the lowest incidence. Specifically, the district with the lowest income had 2.5 times greater incidence of the disease, compared with the highest-income district [70 (95% confidence interval 66-73) versus 28 (25-31), respectively]. CONCLUSIONS: The incidence of COVID-19 showed an inverse socioeconomic gradient by mean income in the 10 districts of the city of Barcelona. Beyond healthcare for people with the disease, attention must focus on a health strategy for the whole population, particularly in the most deprived areas.

[Prognostic importance of diagnosticated peripheral arterial disease through the ankle brachial index in spanish general population]. / Importancia pronóstica de la enfermedad arterial periférica diagnosticada mediante el índice tobillo-brazo en población general española.

OBJECTIVE: The objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain. DESIGN: Population-based cohort study LOCATION: A health area of the province of Badajoz (Spain) PARTICIPANTS: 2,833 subjects, representative of residents, between 25 and 79 years old, MEASUREMENTS: The ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated. RESULTS: 2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2). CONCLUSIONS: Low ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified.

[PAPPS GdT Major 2020 Update]. / Actualización PAPPS GdT Mayor 2020.

In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.

Cardiovascular risk in mild to moderately decreased glomerular filtration rate, diabetes and coronary heart disease in a southern European region.

INTRODUCTION AND OBJECTIVES: Individuals with mild to moderately decreased estimated glomerular filtration rate (eGFR=30-59 mL/min/1.73 m2) are considered at high risk of cardiovascular disease (CVD). No studies have compared this risk in eGFR=30-59, diabetes mellitus (DM), and coronary heart disease (CHD) in regions with a low incidence of CHD. METHODS: We performed a retrospective cohort study of 122 443 individuals aged 60-84 years from a region with a low CHD incidence with creatinine measured between January 1, 2010 and December 31, 2011. We identified hospital admissions due to CHD (myocardial infarction, angina) or CVD (CHD, stroke, or transient ischemic attack) from electronic medical records up to December 31, 2013. We estimated incidence rates and Cox regression adjusted subdistribution hazard ratio (sHR) including competing risks in patients with eGFR=30-59, DM and CHD, or combinations, compared with individuals without these diseases. RESULTS: The median follow-up was 38.3 [IQR, 33.8-42.7] months. Adjusted sHR for CHD in individuals with eGFR=30-59, DM, eGFR=30-59 plus DM, previous CHD, CHD plus DM, and CHD plus eGFR=30-59 plus DM, were 1.34 (95%CI, 1.04-1.74), 1.61 (95%CI, 1.36-1.90), 1.96 (95%CI, 1.42-2.70), 4.33 (95%CI, 3.58-5.25), 7.05 (5.80-8.58) and 7.72 (5.72-10.41), respectively. The corresponding sHR for CVD were 1.25 (95%CI, 1.06-1.46), 1.56 (95%CI, 1.41-1.74), 1.83 (95%CI, 1.50-2.23), 2.86 (95%CI, 2.48-3.29), 4.54 (95%CI, 3.93-5.24), and 5.33 (95%CI, 4.31-6.60). CONCLUSIONS: In 60- to 84-year-olds with eGFR=30-59, similarly to DM, the likelihood of being admitted to hospital for CHD and CVD was about half that of individuals with established CHD. Thus, eGFR=30-59 does not appear to be a coronary-risk equivalent. Individuals with CHD and DM, or eGFR=30-59 plus DM, should be prioritized for more intensive risk management.

Reference ranges of glycated hemoglobin (HbA1c) in capillary blood in the Spanish population.

Cross-sectional analysis describing HbA1c reference values by sex and age in a randomly selected Mediterranean general population sample. Using two methods, Point-of-Care systems and centralized laboratory, results show that HbA1c values increase with age. Almost half of the sample aged 65 years or older had median values >5.7% (prediabetes cut-off point).

Impact of the new criteria of the ACC/AHA on the diagnostic prevalence of hypertension. / Impacto de los nuevos criterios de la ACC/AHA sobre la prevalencia diagnóstica de hipertensión arterial.

OBJECTIVE: To study the impact on the prevalence of hypertension with the criteria (2017) of the American College of Cardiology/American Heart Association (ACC/AHA). PATIENTS AND METHODS: Cross-sectional study, including 370 patients ≥18 years, randomly selected in a Health Centre, with at least one visit and a measurement of systolic (SBP) and diastolic blood pressure (DBP) recorded the last 2 years. Previous hypertension was considered if the diagnosis was confirmed or they had an SBP ≥140 or DBP ≥90mmHg and as ACC/AHA AHT criteria in any of these cases or an SBP between 130-139mmHg or DBP between 80-89mmHg. RESULTS: The average age was 52.3 years (58.6% women). Forty-one point nine percent had previous hypertension, increasing to 67.8% with the ACC/AHA criteria (p <.05). Pharmacological treatment was received by 32.2% of the population, increasing to 38.4% with the ACC/AHA criteria (p>.05). The newly diagnosed patients (p <.05) were younger (mean difference 19.6 years) and less obese (23% vs. 41.4%). CONCLUSIONS: The ACC/AHA criteria would represent an increase of 25.9% in the prevalence of hypertension, considering 2 out of 3 adults hypertensive.

Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study.

BACKGROUND: Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. AIM: To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. METHODS: A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. RESULTS: Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). CONCLUSIONS: Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.

Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up.

BACKGROUND: Guidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population. AIM: The aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk. DESIGN AND SETTING: A population-based prospective cohort study was performed in the province of Barcelona, Spain. METHOD: A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events. RESULTS: 3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI. In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes. Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI. The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py). Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02-2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment. CONCLUSION: The results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.