Enteric calicivirus and rotavirus infections in domestic pigs.

We report the prevalence of rotavirus and calicivirus infections, along with their respective association with diarrhoea in the porcine population of the region of northern Spain. A total of 221 samples were collected at random from different farms in the region and from the main slaughterhouse facility in the city of Zaragoza. Faecal samples were scored as diarrhoeic or normal and grouped into five groups to match general farm management and age criteria: group I (suckling 0-4 weeks), group II (weaning >4-8 weeks), group III (transition >8-16 weeks), group IV (fattening >16-24 weeks) and group V (adults >24 weeks). Group A rotavirus detection and caliciviruses were investigated by reverse transcription-polymerase chain reaction (RT-PCR). Conventional RT-PCR was performed using primers designed to detect rotavirus group A, caliciviruses and/or human noroviruses. A real-time RT-PCR was carried out using TaqMan probes for genogroups GI and GII of noroviruses. Rotaviruses and caliciviruses were detected with an overall prevalence of 16.7% and 12.2%, respectively. Rotavirus detection in faecal samples was associated with both age and faecal consistency, being more frequent in piglets aged <8 weeks with odds ratios (ORs) equal to 4.3 and 4.9, respectively. Calicivirus shedding in faecal samples was homogenously distributed in all ages, showing no significant association with age or faecal consistency (OR 0.87 and 0.99, respectively). A selection of rotavirus-positive stools were genotyped by multiplex nested PCR. G10, P[6], G12 P[8], G9 [p8] and G4 P[23] genotype combinations were found. Three isolates showed a G3 genotype, but their VP4 gene could not be amplified. It should be noted that the G9 genotype was the major G genotype circulating during that period in Spain. None of the porcine samples was positive for norovirus by real-time RT-PCR, despite the ability of this technique to detect at least 18 human norovirus genotypes. Our data indicate that human noroviruses are unlikely to be circulating in the porcine population; however, sapoviruses have been found. Contrary to rotavirus infection, Calicivirus infection is asymptomatic. Specific primers to detect porcine noroviruses are needed.

Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk.

OBJECTIVES: To determine the prevalence of ankle-brachial index (ABI)<0.9 and symptomatic peripheral arterial disease (PAD), association with cardiovascular risk factors (CVRF), and impact of adding ABI measurement to coronary heart disease (CHD) risk screening. DESIGN: Population-based cross-sectional survey of 6262 participants aged 35-79 in Girona, Spain. METHODS: Standardized measurements (CVRF, ABI, 10-year CHD risk) and history of intermittent claudication (IC), CHD, and stroke were recorded. ABI<0.9 was considered equivalent to moderate-to-high CHD risk (> or =10%). RESULTS: ABI<0.9 prevalence was 4.5%. Only 0.62% presented low ABI and IC. Age, current smoker, cardiovascular disease, and uncontrolled hypertension independently associated with ABI<0.9 in both sexes; IC was also associated in men and diabetes in women. Among participants 35-74 free of cardiovascular disease, 6.1% showed moderate-to-high 10-year CHD risk; adding ABI measurement yielded 8.7%. Conversely, the risk function identified 16.8% of these participants as having 10-year CHD risk>10%. In participants 75-79 free of cardiovascular disease, the prevalence of ABI<0.9 (i.e., CHD risk> or =10%) was 11.9%. CONCLUSIONS: ABI<0.9 is relatively frequent in those 35-79, particularly over 74. However, IC and CHD risk> or =10% indicators are often missing. Adding ABI measurement to CHD-risk screening better identifies moderate-to-high cardiovascular risk patients.

Six-month outcome in patients with myocardial infarction initially admitted to tertiary and nontertiary hospitals. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

OBJECTIVES: The aim of the present study was to ascertain whether the degree of accessibility to coronary angiography and revascularization results in differing usages or outcomes, or both, in the setting of a high coverage national health system. BACKGROUND: The selective use of coronary angiography and revascularization procedures in the management of acute myocardial infarction (MI) remains controversial. METHODS: A cohort of 1,460 consecutive patients with a first MI admitted to four referral teaching hospitals (one with tertiary facilities) were followed up for 6 months after admission. Only patients initially admitted to each of the study hospitals were retained for analysis in the original hospital's cohort. End points were 6-month mortality and readmission for reinfarction, unstable angina, heart failure or severe ventricular arrhythmia. RESULTS: Patients admitted to the tertiary hospital were more likely to undergo coronary angiography (adjusted relative risk 4.22, 95% confidence interval [CI] 3.37 to 5.45) than those admitted to the nontertiary sites (use rate: 22.1% for nontertiary care, 55.5% for tertiary care). Revascularization procedures were performed in 21.2% of patients in the tertiary hospital and in 8.3% in the nontertiary hospitals (p < 0.0001). Median delay for emergency coronary angiography was shorter in the tertiary hospital (within 1 vs. 2 days, p < 0.0001). Six-month mortality or readmission rates were similar (23.7% and 24.7% for tertiary and nontertiary care, respectively). After adjustment for comorbidity and disease severity, the relative risk of death or readmission for the tertiary hospital was 1.03 (95% CI 0.69 to 1.53) times that of the nontertiary hospitals. CONCLUSIONS: Selective use of coronary angiography and revascularization procedures may be as effective as less restricted use in the management of acute MI.

Six-month outcome in unstable angina patients without previous myocardial infarction according to the use of tertiary cardiologic resources. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

OBJECTIVES: The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes. BACKGROUND: The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established. METHODS: A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias. RESULTS: Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p < 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67). CONCLUSIONS: The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.

New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease.

BACKGROUND: Anti-tumour necrosis factor α (anti-TNF) agents have been implicated in drug-induced liver injury. There is minimal data on this occurrence in inflammatory bowel disease (IBD) patients. AIM: To identify the characteristics of liver enzyme elevations following anti-TNF therapy initiation in IBD. METHODS: A retrospective cohort of patients initiating anti-TNF therapy were analysed for new onset alanine transaminase (ALT) elevation (≥60 U/L). We collected data on natural history, outcomes and patient characteristics compared with controls with persistent normal liver enzymes. Likelihood of causal association was assessed using the RUCAM score. RESULTS: From 1753 patients initiating an anti-TNF (1170 infliximab, 575 adalimumab, 8 certolizumab), 102 (6%) developed new onset ALT elevation. In 54 (53%), this could be linked to an alternate aetiology. Among those with idiopathic ALT elevations, the median time to ALT elevation from anti-TNF initiation was 18 weeks and median peak ALT was 96 U/L. Six underwent liver biopsy, all demonstrating hepatitis with autoimmune features. Compared to controls, cases were on a lower dose of infliximab (5.7 vs. 6.7 mg/kg, P = 0.02) but were otherwise similar in body mass index, sex and age. On follow-up, 34 continued the anti-TNF, 14 stopped therapy and 4 initiated steroids. Most (85%) normalised their LFTs after a median of 17 weeks including 28 (82%) of those who continued anti-TNF therapy. Ten patients were transitioned to a second anti-TNF without recurrence. CONCLUSIONS: ALT elevations occurred in 6% of IBD patients initiating anti-TNF therapy. Most idiopathic elevations were mild, transient and resolved despite therapy continuation.

Relationship of abdominal adiposity and dyslipemic status in women with a common mutation in the lipoprotein lipase gene. The REGICOR investigators.

Abdominal obesity constitutes an important risk factor for cardiovascular disease. Hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterol concentration constitute the major lipid alterations observed in obesity. A common variant of the lipoprotein lipase (LPL) gene, the HindIII polymorphism, has been found to be associated with changes in triglyceride and HDL-cholesterol levels. We have investigated the impact of the LPL HindIII polymorphism on the relationship between abdominal adiposity and lipoprotein concentrations in 156 randomly selected women in a cross-sectional study conducted in the province of Gerona, in the northeast of Spain. The waist-to-hip ratio was used as an estimate of regional fat distribution. Serum lipid and lipoprotein measurements as well as lipoprotein lipase-HindIII genotypes were determined. Percentile 50 of waist-to-hip ratio (WHR) (0.81) was used as a cutoff to define low or high WHR groups, which significantly differed in blood pressure and lipid trait concentrations. Serum triglyceride concentrations and mean log triglyceride-to-HDL-cholesterol ratio were significantly higher in H+ homozygous women compared with H- carriers. Whereas no statistically-significant differences were observed in HDL-cholesterol concentration and log triglyceride-to-HDL-cholesterol ratio of H- carriers between WHR groups, H+ homozygous women showed significant differences in these lipid traits. It is noteworthy that high-WHR H- carrier women showed a mean HDL-cholesterol value similar to those of both genotypes in the low WHR group. A statistically significant interaction between WHR and genotype was observed for HDL-cholesterol concentration (P=0. 027) and log triglyceride-to-HDL-cholesterol ratio (P=0.040). These results stress the compensating effects that weight loss may have on women with adverse genetic factors. From a complementary viewpoint, the presence of the H- allele seems to confer a protective lipid profile, even when an adverse anthropometric factor such as abdominal adiposity is present.

Relationship of age-related myocardial infarction risk and Gln/Arg 192 variants of the human paraoxonase1 gene: the REGICOR study.

Paraoxonase1 (PON1) seems to exert a major antioxidant effect by removing lipid-peroxidation products. A common polymorphism of the PON1 gene, the PON1-192 genetic polymorphism, modulates PON1 activity and has been related in some studies to coronary heart disease. Oxidized LDL is believed to play a crucial role in the pathogenesis of atherosclerosis and there are studies providing support for the oxidative stress theory of aging. We have conducted a case-control study to determine whether PON1 activity and PON1-192 genetic variants have a different impact on myocardial infarction (MI) risk among individuals stratified by tertiles of age distribution. PON1-192 genotypes and PON1 activity were determined in 280 consecutive MI patients and 396 control subjects. Serum PON1 activity levels were significantly higher in controls than in MI patients [226 U/l (159-351) vs. 216 U/l (146-298), median (interquartile range), P=0.005]. A decline of PON1 activity levels with advancing age in subjects carrying the low-activity QQ genotype was observed, particularly in MI patients. PON1 activity and age negatively correlated in MI patients but not in controls. In the entire population, middle-aged and older subjects showed MI risks of 1.89 (P=0.012) and 2.69 (P<0.001) respectively, compared with young subjects. These risks increased to 2.41 (P=0.016) and 4.39 (P<0.001), respectively, in QQ homozygotes in comparison with younger QQ homozygotes, decreased to 1.53 (P=0.314) and 2.08 (P=0.112), respectively, in QR heterozygotes, and also lowered to 1.95 (P=0.410) and 0.51 (P=0.508) in RR homozygotes who were middle-aged and older, respectively, compared with younger RR carriers. The effect of PON1-192 genotypes on the association of the older age-category and MI risk was gene-dosage related. PON1 activity decreases as a function of age in subjects homozygous for the Q allele. Age may also act on MI risk as a function of PON1-192 alleles. The risk of MI increases with advancing age, principally among subjects carrying the low-activity QQ genotype.

Usefulness of hospital admission risk stratification for predicting nonfatal acute myocardial infarction or death six months later in unstable angina pectoris. RESCATE Study Group. Resources Used in Acute Coronary Syndromes and Delays in Treatment.

The aim of this study was to assess the clinical course of unstable angina and the prognostic value of clinical and electrocardiographic variables measured during admission in a prospective, multicenter cohort study with 6-month follow-up. The population corresponds to 4 general teaching hospitals in Catalonia, Spain. The clinical course was analyzed in 839 consecutive patients aged up to 80 years with primary unstable angina, without myocardial infarction or previous coronary bypass. The main outcome measures were cardiac mortality and nonfatal myocardial infarction. Patients involved in the present analysis belonged to the Resources Used in Acute Coronary Syndromes and Delays in Treatment (RESCATE) study. Six-month overall mortality, cardiac mortality, and nonfatal myocardial infarction rates were 4.6%, 4.1%, and 3.9%, respectively. Six-month cardiac mortality or myocardial infarction rate did not differ among clinical forms of presentation. Peripheral artery disease (RR 3.5, 95% confidence interval [CI] 1.88 to 6.50, p = 0.0001), ST-T-wave electrocardiographic changes on admission (RR 2.22, 95% CI 1.13 to 4.36, p = 0.0203), and age >65 years (RR 1.74, 95% CI 1.04 to 2.91, p = 0.0356) independently predicted 6-month cardiac mortality or nonfatal myocardial infarction. Their positive predictive values were 21%, 10%, and 11%, respectively, whereas their negative predictive value was > or = 93% in all cases. Prevalences were 9%, 70%, and 41%, respectively. In this prospective study, patients with unstable angina without prior myocardial infarction have a relatively low, although not negligible, 6-month severe complication rate. Stratification risk can easily be established with clinical and electrocardiographic characteristics measured during admission. Their absence almost rules out future adverse events, while their presence does not necessarily imply bad prognosis.

Influence of gender in acute and long-term cardiac mortality after a first myocardial infarction. REGICOR Investigators.

The effect of gender and other clinical variables on short-term and long-term cardiac mortality after a first transmural myocardial infarction (MI) was assessed in a population-based hospital register. A cohort of 1216 consecutive patients (1023 men and 193 women), 25-74 years old admitted to the only reference hospital with a coronary care unit at Girona, Northeastern Spain, were recruited for 1978 to 1988 and followed-up for a mean period of almost 5 years (3-12 years). Compared with men, women had a relative risk (RR) of 1.56 (95% confidence interval (CI) of 0.99-2.48) of dying in the acute phase of MI after adjusting for age, MI location, presence of severe arrhythmias, diabetes and hypertension. However, when additionally adjusting for severity (Killip class), women presented a RR of 1.11. Age and hypertension were independent risk factors for acute mortality. Women surviving the acute period of MI showed a RR of 1.37 (CI 0.97-1.92) for long-term mortality, that was only slightly modified by Killip class during hospital stay (RR = 1.27). Age and diabetes were independent risk factors for long term mortality. It is concluded that women have a 56% excess risk for early mortality after a first transmural MI than men mainly explained by a higher severity.

Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in Gerona, Spain, 1990-1992. REGICOR Investigators.

BACKGROUND: Community-based registries provide the best approach to assessing the impact of myocardial infarction (MI) in a population. The objective of the present study was to determine MI mortality, incidence, attack rate and 28-day case fatality in the province of Gerona, Spain from 1990 to 1992. METHODS: Standardized methods were used to find, register and classify MI cases in that population (509628 inhabitants) as definite, possible and insufficient-data MI. RESULTS: Of the 1456 cases fulfilling eligibility criteria, 850 (58.4%) were classified as definite MI, 162 (11.1%) as fatal possible MI, 232 (15.9%) as no MI and 160 (11.0%) as fatal insufficient data. The 1990-1992 age-standardized incidence rates (first MI cases only) for definite and fatal possible MI were 140.8 per 100000 men and 20.4 per 100000 women, all aged 35-64 years; attack rates (first and recurrent MI cases) were 182.9 and 24.5, and mortality rates 46.4 and 5.8, respectively. Case fatality at 28 days was 27.4% and 19.9% in men and women, respectively, but women died later over that period. With respect to men, the age-adjusted risk among women of dying within 28 days post-MI was 1.26 (95% confidence interval [CI]: 0.94-1.69). CONCLUSIONS: Myocardial infarction, incidence, mortality rates and case fatality in Gerona are among the lowest in the world. Age-adjusted case fatality within 28 days is only marginally higher in women than in men, but fatal cases occur later within this period in women.

Interaction between the Gln-Arg 192 variants of the paraoxonase gene and oleic acid intake as a determinant of high-density lipoprotein cholesterol and paraoxonase activity.

Olive oil, rich in oleic acid, could play a particular beneficial role in the anti-atherogenic effects attributed to the Mediterranean diet. Paraoxonase (PON1) has emerged as the component of high-density lipoproteins (HDL) most likely to explain its ability to attenuate the oxidation of low-density lipoproteins. We hypothesised that oleic acid intake might be associated with changes in PON1-HDL associated particles, and investigated the impact, if any, on this association of the PON1-192 polymorphism, a common polymorphism that strongly modulates PON1 activity. Six hundred and fifty-four men randomly selected from the census were studied. Oleic acid intake was calculated from a 72-h recall questionnaire with specific software. Oleic acid intake groups (low vs. high) were created by stratifying the population according the median value as a cut-point. After adjusting for confounding variables, high oleic acid intake was associated with increased HDL cholesterol levels and PON1 activity only in subjects with the QR and the RR genotypes, respectively. Analyses of the variance showed a statistically significant interaction between PON1-192 genotypes and oleic acid intake for log PON1 activity (P=0.005) and a marginally significant interaction for HDL cholesterol (P=0.066). These results suggest that the beneficial effect of increasing oleic acid intake on HDL and PON1 activity at population level is especially observed in subjects carrying the R allele of the PON1-192 polymorphism.

Platelet glycoprotein IIb/IIIa genetic polymorphism is associated with plasma fibrinogen levels in myocardial infarction patients. The REGICOR Investigators.

Fibrinogen is the major ligand of platelet glycoprotein IIb/IIIa platelet receptor. Genes coding for platelet fibrinogen receptor glycoprotein IIb/IIIa are polymorphic. The PLA alloantigen has two antigenic determinants, PLA1 and PLA2, located in a 17-23 kD fragment of glycoprotein IIIa. We analyzed whether PLA genotype has any effect on plasma fibrinogen concentration and investigated if the effect has different magnitude in myocardial infarction patients compared with subjects free of angina or myocardial infarction. One hundred sixteen consecutive patients who suffered a myocardial infarction and 136 subjects recruited by random sampling from the local census were included in the study. PLA genotype distribution and allele frequencies in patients did not significantly differ from those in the control group. Mean fibrinogen concentration tended to be higher in controls with genotype PLA1PLA1 than in those with genotype PLA1PLA2 or PLA2PLA2, and in patients this difference reached statistical significance (p < 0.001). We conclude that the PLA polymorphism may be in linkage disequilibrium with another functional mutation in or near the promoter area of the fibrinogen gene or even in another gene, which controls the production or the clearance of fibrinogen.

Role of age and sex in short-term and long term mortality after a first Q wave myocardial infarction.

STUDY OBJECTIVE: The objective of this study was to analyse whether the risk of death within 28 days and three years after a first Q wave myocardial infarction was higher in hospitalised women than in men. DESIGN: Follow up study. PATIENTS AND SETTING: All consecutive first Q wave myocardial infarction patients aged 25 to 74 years (447 women and 2322 men) admitted to a tertiary hospital in Gerona, Spain, from 1978 to 1997 were registered and followed up for three years. MAIN RESULTS: Women were older, presented more comorbidity and developed more severe myocardial infarctions than men. A significant interaction was found between sex and age. Women aged 65-74 had higher early mortality risk than men of the same age (OR 1.62; 95% CI 1.01, 2.66) after adjusting for age, comorbidity and acute complications including heart failure. Women under 65 tended to be at lower risk of early mortality than men (0.45 (95% CI 0.19, 1.04). Three year mortality of 28 day survivors did not differ between sexes. CONCLUSIONS: These data support the idea that the higher 28 day mortality in hospitalised women with a first Q wave myocardial infarction is mainly attributable to the large number of patients aged 65 to 74 years in whom the risk is higher than that in men. Women under 65 with myocardial infarction do not seem to be a special group of risk.

High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGICOR Investigators.

STUDY OBJECTIVE: To establish the prevalence of main cardiovascular risk factors in the province of Gerona, where the incidence of myocardial infarction is known to be low. DESIGN: This was a cross sectional study of prevalence of cardiovascular risk factors conducted on a large random population sample. SETTING: The province of Gerona, Spain. PARTICIPANTS: Two thousand four hundred and four eligible inhabitants of Gerona aged between 25 and 74 years were randomly selected for a multi-stage sample stratified by age and sex. The following were standardly measured: lipids (total cholesterol, high density, low density, lipoprotein (a) and triglycerides), fibrinogen, basal glycaemia, arterial pressure, anthropometric variables, smoking, history of angina (Rose questionnaire), and a medical history questionnaire. Population measurements were standardised for the world population of 24 to 74 years of age. RESULTS: The participation rate was 72.7% (1748). Total mean cholesterol was 5.69 mmol/l in men and 5.61 mmol/l in women and mean high density cholesterol was 1.22 mmol/l and 1.47 mmol/l, respectively. Median lipoprotein (a) was 0.22 g/l. These three lipids increased significantly with age. Mean fibrinogen was 2.92 g/l in men and 3.09 g/l in women, and was higher in smokers. The prevalence of hypertension (systolic arterial tension > or = 140 mm Hg or diastolic > or = 90 mm Hg or drug treatment) was 31.3% in men and 27.7% in women. The proportion of male smokers was 33.8% and female smokers 22.7%. The proportion of female smokers in the 25-34 year age group exceeded that of the remaining age groups for both men and women. CONCLUSIONS: The prevalence of cardiovascular risk factors in Gerona is relatively high for the low myocardial infarction incidence typical of the area, although similar to that of other Spanish areas. The factors that confer sufficient protection to compensate for the effect of the prevalence of these risk factors remain to be elucidated.

Short-term mortality of myocardial infarction patients with diabetes or hyperglycaemia during admission.

AIM: The hypothesis that patients with hyperglycaemia during admission, regardless of previous diagnosis of diabetes, have worse prognosis than those with normal glucose values is controversial. The objective was to assess the role of hyperglycaemia on short-term mortality after myocardial infarction (MI). METHODS AND RESULTS: A cohort study nested in a prospective registry of MI patients in the reference hospital of Gerona, Spain was performed. All consecutive MI patients under 75 were registered between 1993 and 1996. Patient and clinical characteristics, including previous diagnosis of diabetes, glycaemia on admission and in the next four days, were recorded. Patients with glycaemia on admission or four day mean glycaemia >6.67 mmol/l were considered hyperglycaemic. The main outcome measure was mortality at 28 days. Of 662 patients with MI included, 195 (29.7%) had previously known diabetes mellitus, but 457 (69.0%) had glycaemia >6.67 mmol/l on admission. Patients with hyperglycaemia on admission were older, more often female, more frequently had a previous diagnosis of diabetes, developed more complications, and had higher 28 day mortality. The effect of admission glycaemia >6.67 mmol/l on 28 day mortality was independent of major confounding factors, particularly previous diagnosis of diabetes (OR=4.20, 95% confidence intervals 1.18 to 14.96). CONCLUSIONS: Higher 28 day mortality was observed among MI patients with glycaemia on admission >6.67 mmol/l compared with patients with lower levels, independently of major confounding variables and, particularly, previous diagnosis of diabetes. This early, simple, and inexpensive marker of bad prognosis after MI should prompt the application of more aggressive treatment of MI and risk factors and, probably, of glycaemia during admission.

An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas.

AIM: To determine whether the Framingham function accurately predicts the 10 year risk of coronary disease and to adapt this predictive method to the characteristics of a Spanish population. METHOD AND RESULTS: A Framingham function for predicting 10 year coronary deaths and non-fatal myocardial infarction was applied to the population of the province of Gerona, Spain, where the cumulated incidence rate of myocardial infarction has been determined since 1988 by a specific registry. The prevalence of cardiovascular risk factors in this region of Spain was established in 1995 by a cross sectional study on a representative sample of 1748 people. The number of cases estimated by the Framingham function for 10 year coronary deaths and non-fatal myocardial infarction was compared with that observed. The Framingham function estimated 2425 coronary heart disease cases in women and 1181 were observed. In men, 9919 were estimated and 3706 were observed. Recalibrating the Framingham equations to the event rate and the prevalence of the risk factors in Gerona led to estimates very close to the number of cases observed in Gerona men and women. CONCLUSIONS: The Framingham function estimates more than doubled the actual risk of coronary disease observed in north east Spain. After calibration, the Framingham function became an effective method of estimating the risk in this region with low coronary heart disease incidence.

Use of a three-day estimated food record, a 72-hour recall and a food-frequency questionnaire for dietary assessment in a Mediterranean Spanish population.

AIM: To assess the validity and the short-term reproducibility of a semi-quantitative, self-administrated food frequency questionnaire and a structured 72-hour recall in a Mediterranean Spanish population. METHODS: 44 free-living volunteers participated in the study. Macronutrient, vitamin and mineral intake, recorded on the food frequency questionnaire and the structured 72-h recall were compared with intakes derived from a three-day food record (reference method). Validity of the dietary assessment methods was further assessed by comparing urinary nitrogen, plasma vitamin C, plasma beta-carotene and whole blood glutathione peroxidase activity levels with the corresponding nutrient intakes from the questionnaires. The food frequency questionnaire and the 72-h recall were administered twice to assess the short term reproducibility. RESULTS: Pearson's correlation coefficients between urinary nitrogen, plasma vitamin C, plasma beta-carotene and whole blood glutathione peroxidase activity levels and the reported nitrogen, vitamin C, beta-carotene and selenium intakes were 0.26, 0.53, 0.17, 0.26 for the food frequency questionnaire; 0.41, 0.09, 0.34, 0.42 for the structured 72-h recall and 0.50, 0.54, 0.44, 0.38 for the three-day food record, respectively. The short term reproducibility of analysed nutrient intake showed average intra-class correlation coefficients of 0.91 and 0.69 for the food frequency questionnaire and the structured 72-h recall irrespectively. CONCLUSION: The food frequency questionnaire and the structured 72-h recall provide valid estimates of nutrient intake and could be used for dietary assessments.

Population dietary habits and physical activity modification with age.

OBJECTIVE: The aim of the present study was to analyse the relation between age and both dietary habits and leisure-time physical activity, and to determine nutrient inadequacy of aged groups in our population. DESIGN: Cross-sectional study. SETTING: A random sample of the 25-74-y-old population of Gerona, Spain. SUBJECTS: A total of 838 men and 910 women were selected from among the general population according to the 1991 census. OUTCOME MEASURES: Analysis of dietary habits, including amount and type of alcohol consumption, and detailed evaluation of leisure-time physical activity. RESULTS: Nutrient densities of carbohydrates, vitamin B(1), vitamin B(12), vitamin C, vitamin E, folate, potassium, iron, magnesium, copper, and dietary fiber increased significantly (P<0.05) with age in both genders, whereas an inverse trend was observed for total fat, saturated fatty acids, cholesterol, and sodium. Multiple linear regression analysis revealed a direct association of healthy dietary habits, characterized through a composite dietary score, with age after adjusting for several confounders both in men and women (P<0.001). This score was composed of folate, vitamin C, vitamin E, beta-carotene, dietary fibre, cholesterol, saturated fatty acids, and sodium. In all, 29 and 10% of male and female subjects aged 65-74 y, respectively, reported inadequate intakes of six or more of 16 nutrients. Total leisure-time physical activity increased with age in men (P<0.002), and was not different among female age groups. CONCLUSION: Dietary behaviours and levels of physical activity spent during leisure time indicate a healthy lifestyle of the aged men and women in the present population. Nutrient inadequacy observed in some aged men and women, however, deserves particular intervention of health-care programmes for this growing part of our society.

Characteristics of Myocardial Infarction Episodes in Two Distant Communities: From the REGICOR Registry in Girona, Spain and the MITI Registry in Greater Seattle, USA.

Background: The objective of the study is to compare patient characteristics and outcome after myocardial infarction (MI) between two geographically and socially different communities. Methods/Results: The study was designed as an ecological comparison between a 1-year hospital registry of consecutive MIs in Seattle (1,400,000 inhabitants and a predominantly urban and suburban distribution) and nine hospitals in Giroma (500,000 inhabitants in a predominantly rural distribution). Hospitalization rates for MI are higher in Seattle (standardized rates of 2.5/1000 for men and 0.8/1000 for women) than in Girona (1.5/1000 for men and 0.2/1000 for women). In both registries men under age 60 accounted for 45.5% of cases. Women accounted for 25% of all MI episodes in Seattle and for only 16% in Giromi. Treatment with thrombolytic and beta-blocking drugs was twice as common in Seattle hospitals as in Girona. Hospital mortality in tertiary care hospitals was similar in both registries, but mortality in local hospitals (having no coronary care unit) in Giroma was significantly higher than other hospital mortality rates for MI. Conclusions: The higher in-hospital mortality rate may in large part be explained by the absence of a coronary care unit. However, the dispersion of Girona's population and the lack of specific programs to provide emergent specialized care to possible MI patients may also contribute to the higher in-hospital mortality rate in Girona.

[Anthropometric and dietary determinants of blood levels of HDL cholesterol in a population-based study. The REGICOR study. Researchers of the REGICOR study]. / Determinantes antropométricos y dietéticos de la concentración sérica del colesterol de las lipoproteínas de alta densidad en un estudio de base poblacional. El estudio REGICOR. Investigadores del Estudio REGICOR.

OBJECTIVES: The aim of the present study was to identify dietary and anthropometric factors influencing HDL cholesterol levels in the region of Girona. POBLATION AND METHODS: A cross-sectional study was designed with random recruitment and 798 men and 862 women were included. Anthropometric variables were collected, the energy expenditure in physical activity was calculated and a dietary questionnaire was supplied in order to obtain nutritional data. Furthermore, lipid levels and lipoprotein concentrations were determined. RESULTS: Significant differences were found in serum triglycerides, body mass index, glucose levels and alcohol intake between the upper and the lower tertils of HDL cholesterol in both men and women. In men, energy expenditure in physical activity was significantly associated with HDL cholesterol levels, as well as total fat and monounsaturated fat. In women, together with the waist-to-hip ratio and fasted glycemia, vitamin C was the dietary factor positively associated with HDL cholesterol levels. CONCLUSIONS: Moderate alcohol intake, physical activity, vitamin C consumption and optimizing body weight strongly contribute to increased HDL cholesterol levels in our region.