The health status: the ignored risk factor in dementia incidence. NEDICES cohort.

BACKGROUND: The causes of the dementia decrease in affluent countries are not well known but health amelioration could probably play a major role. Nevertheless, although many vascular and systemic disorders in adult life are well-known risk factors (RF) for dementia and Alzheimer disease (AD), health status is rarely considered as a single RF. AIM: To analyse whether the health status and the self-perceived health (SPH) could be RF for dementia and AD and to discuss its biological basis. METHODS: We analysed different objective health measures and SPH as RF for dementia and AD incidence in 4569 participants of the NEDICES cohort by means of Cox-regression models. The mean follow-up period was 3.2 (range: 0.03-6.6) years. RESULTS: Ageing, low education, history of stroke, and "poor" SPH were the main RF for dementia and AD incidence, whereas physical activity was protective. "Poor" SPH had a hazard ratio = 1.66 (95% CI 1.17-2.46; p = 0.012) after controlling for different confounders. DISCUSSION: According to data from NEDICES cohort, SPH is a better predictor of dementia and AD than other more objective health status proxies. SPH should be considered a holistic and biologically rooted indicator of health status, which can predict future development of dementia and AD in older adults. CONCLUSIONS: Our data indicate that it is worthwhile to include the SPH status as a RF in the studies of dementia and AD incidence and to explore the effect of its improvement in the evolution of this incidence.

[Pulmonary hypertension during exercise in toxic oil syndrome]. / Hipertensión pulmonar con el ejercicio en el síndrome del aceite tóxico.

BACKGROUND AND OBJECTIVE: Toxic oil syndrome is a risk factor for pulmonary arterial hypertension (PAH) and new cases of this entity are emerging after more than 20 years since the initial toxic oil epidemic. Abnormal elevation of pulmonary systolic pressure with exercise may be considered an early marker of PAH in populations at risk. We aimed to analyze the pulmonary systolic pressure with exercise echocardiography in toxic oil syndrome patients. PATIENTS AND METHOD: 50 toxic oil syndrome patients (cases), and 20 healthy control subjects were submitted to rest and peak exercise echocardiography (semi supine cycloergometer) measuring pulmonary systolic pressure. In toxic oil syndrome patients, pulmonary carbon monoxide diffusion capacity was also analyzed. RESULTS: Peak exercise pulmonary systolic pressure was statistically similar in cases and controls. Nevertheless, 8% of cases reached a pulmonary systolic pressure > or = 80 mmHg and this fact was associated with mild pulmonary arterial hypertension, reduced right ventricular function and abnormal pulmonary diffusion capacity in the rest study. A rest pulmonary systolic pressure cut-off value > or = 27 mmHg had a 100% sensitivity and 71% specificity to predict a peak exercise systolic pulmonary pressure > or = 80 mmHg. CONCLUSIONS: A minority of toxic oil syndrome patients develop severe pulmonary arterial hypertension during exercise. This abnormal response is associated with other markers of pulmonary vasculopathy. Further studies are needed to elucidate the relation between these findings and the likelihood to develop pulmonary arterial hypertension in the future.

[Prevalence of cardiovascular risk factors in a cohort of affected by the toxic oil syndrome]. / Prevalencia de factores de riesgo cardiovascular en una cohorte de afectados por el síndrome del aceite tóxico.

BACKGROUND AND OBJECTIVE: During the first stages of the toxic oil syndrome (TOS), elevations of the blood pressure as well as increases in the cholesterol, glucose and triglycerides levels were reported. Here we analyze these cardiovascular risk factors in the chronic phase of the illness and their distribution according to the severity of the illness. We also compare them with those found in the general population. PATIENTS AND METHOD: We studied a sample of 1,862 individuals aged between 35 and 65 years. A medical examination was performed in each and blood pressure, weight, height, tobacco consumption, cholesterol, glucose and triglycerides levels were measured. RESULTS: The prevalence of high blood pressure (>140/90 mmHg) was 46.1% and the prevalence of diabetes mellitus (>126 mg/dl) was 9.1%. The prevalence of obesity (BMI>30) was 24.9%. 11.8% of patients had hypertriglyceridemia (>200 mg/dl) and 19.8% had hypercholesterolemia (>250 mg/dl). 37.9% were smokers. The standardized prevalence rate (SPR) of high blood pressure was 1.35 (95% CI, 1.28-1.44); tobacco consumption SPR=1.27 (95% CI, 1.20-1.36); hypercholesterolemia SPR=1.10 (95% CI, 1.01-1.21). The prevalence of risk factors was higher among the most seriously affected subjects. CONCLUSIONS: The chronic phase of TOS is characterized by a high prevalence of cardiovascular risk factors, which was significantly higher than that expected in the general population.

Prevalencia de factores de riesgo cardiovascular en una cohorte de afectados por el síndrome del aceite tóxico / Prevalence of cardiovascular risk factors in a cohort of affected by the toxic oil syndrome

FUNDAMENTO Y OBJETIVO: En las primeras fases del síndrome del aceite tóxico (SAT) se ha descrito la elevación de las cifras de la presión arterial, de la concentración de colesterol, de la glucemia y de los triglicéridos. Hoy las enfermedades cardiovasculares son su principal causa de muerte. Pretendemos describir los factores de riesgo cardiovascular en la fase crónica de la enfermedad y su distribución según gravedad de la enfermedad, y compararlos con la población general. PACIENTES Y MÉTODO: Se ha estudiado a 1.862 sujetos con edades comprendidas entre 35 y 65 años. Se les realizó una exploración médica y se midieron las variables presión arterial, peso, talla, tabaquismo, colesterol, glucemia y triglicéridos. RESULTADOS: La prevalencia de hipertensión arterial (definida por presión arterial superior a 140/90 mmHg) fue del 46,1 por ciento, y la de diabetes mellitus (definida por glucemia mayor de 126 mg/dl), del 9,1 por ciento. La prevalencia de obesidad (índice de masa corporal superior a 30 kg/m2) fue del 24,9 por ciento; la de hipertrigliceridemia (concentración de triglicéridos superior a 200 mg/dl), del 11,8 por ciento, y la de hipercolesterolemia (concentración de colesterol mayor de 250 mg/dl), del 19,8 por ciento. El porcentaje de fumadores fue del 37,9 por ciento. La razón de prevalencia estandarizada para hipertensión fue de 1,35 (intervalo de confianza [IC] del 95 por ciento, 1,28-1,44), para tabaquismo de 1,27 (IC del 95 por ciento, 1,20-1,36) y para hipercolesterolemia de 1,10 (IC del 95 por ciento, 1,01-1,21).La prevalencia de factores de riesgo fue mayor en los enfermos graves. CONCLUSIONES: La fase crónica del SAT se caracteriza por una elevada prevalencia de factores de riesgo cardiovascular, mayor de lo esperado para la población general (AU)