Metabolic syndrome and coronary heart disease among Spanish male workers: a case-control study of MESYAS.

BACKGROUND AND AIMS: In Spain, the incidence of coronary heart disease is below that expected based on the burden of classic cardiovascular risk factors present in the population. Whether the risk associated with metabolic syndrome is lower in Spain deserves to be investigated. This study evaluates the association of incident clinical coronary heart disease with metabolic syndrome and each of its individual defining components in a sample of Spanish working males. METHODS AND RESULTS: Among the workers of a factory (MESYAS registry), 208 incident cases of coronary heart disease (between 1981 and 2005) were age-matched with 2080 healthy workers visited in 2004-2005. Metabolic syndrome was characterized using modified criteria of the joint consensus definition (2009). Metabolic syndrome was strongly associated with coronary heart disease (OR = 4.03; 95% CI: 2.98, 5.45) and the risk seemed to be fully explained by metabolic syndrome components (OR = 0.84, p = 0.54 after adjustment). Odds ratios for the independent effects of the diagnostic criteria were: hypertriglyceridemia (OR = 3.39, p < 0.001), hyperglycemia (OR = 2.70, p < 0.001), low HDL cholesterol (OR = 2.35, p < 0.001), hypertension (OR = 1.49, p = 0.016) and overweight (OR = 1.07, p = 0.678). Young workers showed a higher risk associated with metabolic syndrome. CONCLUSION: The risk associated with metabolic syndrome is fully explained by its components considered independently. The risk of coronary heart disease in a Spanish male working population is considerably increased among those with metabolic syndrome, by a factor similar to that described for other countries. Public health measures to prevent a rise in the prevalence of metabolic syndrome are advisable to minimize cardiovascular disease rate in Spain.

[Obesity and arterial hypertension]. / Obesidad e hipertensión arterial.

Obesity constitutes an important problem of public health in developed countries because of its high prevalence (affecting nearly one third of the population) and the reduction of life expectancy in this population. Every day new physiopathologic implications are discovered concerning obesity and other cardiovascular risk factors such as diabetes, hypertension and dyslipemia. We present the mechanisms that explain the physiopathology of obesity from the point of view of hemodynamic modifications, neurohormonal alterations (sympathetic nervous system, renin-angiotensin-aldosterone system, vasopressin, endothelin), and alterations in the glucidic metabolism (insulin-resistance and hyperinsulinism), the lipidic metabolism and the endothelium. The treatment of obese hypertensive patients is based on two principles: the correction of overweight and the treatment of hypertension, bearing ind mind the peculiarities in these patients.

[The pathogenesis of the evolution of the atheroma plaque]. / Patogenia de la evolución de la placa de ateroma.

The different theories on the pathogenesis of the atherosclerotic plaque may be integrated into a single multifactorial one. According to this, the atherosclerotic risk factors produce impairement of the endothelial cell function as well as the release of growing factors leading to smooth muscle cells and macrophage activation and subsequent collagen synthesis and foam cells formation, the two main components of the atheroma plaque. The arterial thrombosis is another important factor for the atherosclerotic plaque growth and for the occlusive complications that leads to acute ischemic syndromes. The same etiologic risk factor that initiate the atherosclerotic process are implicated in its progression. Most coronary acute syndromes show the same pathologic syndrome of a fissured atherosclerotic plaque with a superimposed thrombus. The lipid rich plaques with a thin fibrous cap and the presence of monocyte/macrophages are unstable and prone to fissuring more than the old fibrous plaques. The arterial stress can be an important precipitating factor for the plaque disruption. The possibility of slowing human atherosclerosis and even inducing its regression is one of the present therapeutic goals. One of the most useful approaches is the lipid lowering therapy in hyperlipidemic patients with atherosclerosis. These treatments have demonstrated its efficacy in decreasing the arterial occlusive complications even before showing the atherosclerotic plaque regression. Another approach would be the use of aspirin and other antiplatelet and antithrombotic agents that may partially prevent the progression of the atherosclerotic process.

[Control of cholesterolemia in Spain, 2000. A tool for cardiovascular prevention]. / Control de la colesterolemia en España, 2000. Un instrumento para la prevención cardiovascular.

The document "Cholesterolemia Control in Spain, 2000: A Tool for Cardiovascular Disease Prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

[Changes in lipid profile of young persons after substitution of sunflower oil by olive oil in the diet]. / Cambios en el perfil lipídico de individuos jóvenes tras la sustitución del aceite de girasol de su dieta por aceite de oliva.

BACKGROUND AND OBJECTIVES: There is controversy in determining the effects of olive oil in the lipidic metabolism. We studied the changes produced in the lipid profile after substituting sunflower dietetic oil with virgin olive oil. POPULATION AND METHODS: We studied 154 cadets of Academia General Militar de Zaragoza (AGEMZA), analyzing their smoking habits, anthropometric measures and dietetic intake. Hematologic, biochemical and lipidic parameters were determined in venous blood samples. All sunflower dietetic oil was substituted with olive oil, without making any other qualitative-quantitative variation in the diet 10 weeks after which the morphometric and analytical evaluation was repeated, comparing both measurements. RESULTS: 87% of cadets took part in the study. 34.3% of them were smokers. There were no significant anthropometric changes. After the interventional period, there was a decrease of 12.2% in total cholesterol (166.6 vs 146.2 mg/dl; p < 0.0001), 13.5% in LDL-cholesterol (99.7 vs 86.2 mg/dl; p < 0.0001), 12.2% in triglycerides (71.1 vs 62.4 mg/dl; p < 0.0001), 9.9% in HDL-cholesterol (52.6 vs 47.4 mg/dl; p < 0.001), despite which total-cholesterol/HDL-cholesterol ratio increased 3.1% (3.2 +/- 0.7 vs 3.1 +/- 0.7; p < 0.001). There were no changes in Lp(a) plasmatic concentrations or hematologic or biochemical parameters. CONCLUSION: The improvement of the lipidic parameters can only be explained by the use of olive oil in the diet of the AGEMZA cadets.

[Recommendations for the control of cholesterolemia in Spain]. / Recomendaciones para el control de la colesterolemia en España.

A number of recommendations are provided regarding the detection, assessment and management in primary and secondary prevention, approaching hypercholesterolaemia from a multifactorial standpoint based on cardiovascular risk. Cardiovascular diseases are the leading cause of death in Spain. The major risks involved are coronary heart disease and cerebrovascular disease. The demographic, health-related and social impact thereof will be increasing over the coming decades. Controlling hypercholesterolaemia, in conjunction with eradicating the smoking habit and controlling hypertension, diabetes, obesity and physical inactivity comprise one of the main strategies for preventing cardiovascular diseases. Breaking down the risk of individuals based on the major cardiovascular risk factors is essential, given that these factors condition the frequency with which these individuals must be monitored and the type and degree of treatment entailed. Based on this breakdown, the priorities have been set for taking steps to prevent cardiovascular disease. In primary prevention, the therapeutic objective in high-risk persons (20% risk or higher or those persons involving two or more risk factors) has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol (130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Those patients having coronary heart disease must be included in secondary prevention programs that will ensure good, constant clinical and risk factor-related control.

[Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention]. / Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular.

The document "Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.