Effect of an intensive intervention on the increase of physical activity and the decrease of sedentary lifestyle in inactive postmenopausal.

BACKGROUND: During the transition to menopause, women experience different psychological, hormonal, and physical alterations that can affect their health. Physical activity is considered an important strategy in the prevention and control of such changes. AIM: To evaluate the short-term effect of an intensive intervention, based on a combined exercise programme using a Smartband, on the increase of physical activity and the decrease of sedentary lifestyle in postmenopausal and inactive women. DESIGN: Randomized clinical trial with two parallel groups. METHODS: In total, 100 postmenopausal and inactive women aged 45-70 years will be randomized to a control group or an intervention group. Both groups will be given a standardized advice about physical activity. The intervention group will carry out a supervised 12-week programme of aerobic and muscle strengthening exercise; moreover, the women in this group will receive a Smartband to assist them in the intervention. The main result will be the increase of physical activity and the decrease of sedentary lifestyle, measured with an accelerometer for 1 week. This programme will be conducted by a nurse and a physiotherapist of the health centre. The study was approved by the Drug Research Ethics Committee of the Salamanca Health Service on 15 February 2019. The project was funded by the Autonomous Government of Castile and Leon and by the Carlos III Health Institute. DISCUSSION: Physical activity is an important strategy to consider when addressing the changes caused by menopause, although the current evidence shows that further studies should be carried out with longer intervention periods and new technologies. IMPACT: This study will allow determining the effectiveness of the intensive intervention based on a combined programme of physical activity using a Smartband in postmenopausal and inactive women. TRIALS REGISTRATION: ClinicalTrials.gov with identifying code NCT03872258.

Prevalence of coronary atherosclerosis and reclassification of cardiovascular risk in Spanish population by coronary computed tomography angiography: EVA study.

BACKGROUND: A more complete assessment of coronary artery disease (CAD) can be performed by coronary computed tomography angiography (CCTA). The aim was to assess the prevalence, distribution and characteristics of coronary artery disease (CAD) and the reclassification of cardiovascular risk by CCTA in an asymptomatic Spanish population. DESIGN: We included, in a cross-sectional study, 501 random subjects from asymptomatic population, aged 35 and 75. Risk factors, target organ damage and cardiovascular risk were assessed. CCTA was offered to measure the coronary artery calcium score(CACS), segment involvement score(SIS) and segment stenosis score(SSS). The offer was accepted by 220 subjects (44%), with a mean age of 58 ± 14 years, 56% of them male. RESULTS: The mean CACS was 119.6 ± 381.7 (median (IQR) (0 (0-61.55))), with higher scores in males (191.9 ± 493.1) than females (26.1 ± 73.3; P < .01). CCTA revealed coronary atherosclerosis in 89 cases, 40% (CI95%:34%-46%) in global, 51% in male and 25% in female, of which 13 had obstructive lesions (5.9%). Mean SIS was 1.5 ± 2.5 and SSS 1.2 ± 3.1. When the CACS was included in the CAD risk scale, there was a reclassification of 24%, and when using the SIS percentile, it was 38%, with a 9% increase in risk in both cases. CONCLUSIONS: The prevalence of CAD in asymptomatic Spanish population was 40%, with greater proportion among males. The incorporation of CACS and SIS in the assessment of cardiovascular risk allows reclassifying subjects who are at low or moderate risk and thus identify those with high cardiovascular risk and also the other way.

Postprandial effects of breakfast glycaemic index on cognitive performance among young, healthy adults: A crossover clinical trial.

Objective: To evaluate the postprandial effects of high and low glycaemic index (GI) breakfasts on cognitive performance in young, healthy adults.Methods: A crossover clinical trial including 40 young, healthy adults (aged 20-40 years, 50% females) recruited from primary healthcare centres in Salamanca, Spain. Verbal memory, phonological fluency, attention, and executive functions were examined 0, 60, and 120 minutes after consuming a low GI (LGI), high GI (HGI), or water breakfast. Every subject tried each breakfast variant, in a randomized order, separated by a washout period of 7 days, for a total of 3 weeks.Results: A significant interaction between the type of breakfast consumed and immediate verbal memory was identified (P<.05). We observed a trend towards better performance in verbal memory (delayed and immediate), attention, and phonological fluency following an LGI breakfast.Discussion: Cognitive performance during the postprandial phase in young, healthy adults was minimally affected by the GI of breakfast. The potential for breakfast's GI modulation to improve short- and long-term cognitive functioning requires further research.

Acute effect of healthy walking on arterial stiffness in patients with type 2 diabetes and differences by age and sex: a pre-post intervention study.

BACKGROUND: Daily aerobic exercise such as healthy walking could have an immediate effect on parameters of arterial stiffness; however, there is little evidence in the diabetic population. Our aim, therefore, is to evaluate the association between healthy walking and acute effects on the parameters of arterial stiffness in subjects with type 2 diabetes. METHODS: The Effectiveness of a multifactorial intervention in diabetics study (EMID), is a study based on an application for smartphones, healthy walking and a nutritional workshop in patients with type 2 diabetes in primary care, is a randomized controlled trial of two parallel groups. This is a subanalysis of the intervention group to evaluate the response to the healthy walking according to age and sex, in 89 subjects with type 2 diabetes, aged between 40 and 70 years. The intervention was a 4 km of a healthy walking at low-moderate intensity. To value our aim, the main study variables were measured before and after it. RESULTS: The study population had an average age of 65.0 years (61.2-68.1). After the healthy walking, there was a decrease in the parameters of arterial stiffness: Cardio ankle vascular index (CAVI) of - 0.2 (95%CI:-0.4 to - 0.1) and pulse pressure (PP) of the lower extremities of - 3.9 mmHg (95%CI: -5.9 to - 2.0). Furthermore, in the lower extremities there was a decrease in systolic blood pressure of - 5.3 mmHg (95% CI: -7.3 mmHg to - 3.3 mmHg), in diastolic blood pressure of - 1.5 mmHg (95% CI: -2.6 mmHg to - 0.4 mmHg) (p < 0.05 for all). It is observed that males have an OR of 2.981 (IC = 95% 1.095 to 8.119) to achieve a reduction in the CAVI (p < 0.05) and an OR of 2.433 (95%CI: 0.871 to 6.794) in the ankle PP (p > 0.05), compared with females. CONCLUSIONS: The findings of this study suggest that daily aerobic exercise at a low to moderate intensity, such as healthy walking, has an immediate beneficial effect on the cardio-ankle vascular index, especially in males. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02991079 .

Effectiveness of an intensive intervention to improve lifestyles in people with intermediate cardiovascular risk (DATE study): Study protocol for a randomized controlled trial.

AIM: The aim of this study was to evaluate the effectiveness of an intensive intervention led by primary care nurses for lifestyle modification among people with intermediate cardiovascular risk. BACKGROUND: Cardiovascular diseases may be prevented by adopting healthy lifestyles. Interventions focused on populations at risk are more efficient than those aimed at the general population. More than 50 per cent of cardiovascular events occur in people with intermediate cardiovascular risk, but only a few studies have targeted this population. DESIGN: A randomized controlled trial approved in January 2017. METHODS: We will recruit 208 participants aged 35-74 years who have intermediate cardiovascular risk. They will be selected by consecutive sampling and will be randomized into a control group or intervention group. Individual standardized brief counselling on healthy lifestyles will be provided to both groups. Additionally, individuals from the intervention group will receive four weekly group sessions focusing on cardiovascular risk, healthy diet, moderation in alcohol consumption, daily physical activity, stress management and smoking cessation and two motivational follow-up calls. The primary outcome will be the lifestyle modification measured by total steps recorded by a pedometer, total score on the Mediterranean Diet Adherence Screener and percentage of current smokers. DISCUSSION: This study will allow us to investigate whether an intensive intervention based on a multifactorial group approach is more effective in lifestyle modification than individual standardized brief counseling among adults with intermediate cardiovascular risk. Our results could lead to the establishment of new strategies for cardiovascular risk management.

The EVIDENT diet quality index is associated with cardiovascular risk and arterial stiffness in adults.

BACKGROUND: We aimed to simplify information from food frequency questionnaires (FFQs) in a single parameter that allows for rapid identification of quality of patient diet and its relationship to cardiovascular risk and pulse wave velocity (PWV). METHODS: The sample from the EVIDENT study, consisting of 1553 subjects (aged 20-80 years) with no cardiovascular disease selected by random sampling among those attending primary care clinics, was used. The EVIDENT diet index (range 0-100) was calculated based on the results of a FFQ. Evaluation of dietary habits also included adherence to the Mediterranean diet (MD). Cardiovascular risk was estimated, and carotid-femoral pulse wave velocity was measured. RESULTS: Mean subject age was 54.9 ± 13.8 years, and 60.3% of subjects were female. The mean value of the EVIDENT diet index was 52.1 ± 3.2 points. Subjects in the third tertile (the highest score) had the greatest adherence to MD and the highest energy intake, with greater amounts of carbohydrates, protein, and fiber. The best cut-off point of the EVIDENT diet index for predicting good adherence to the MD is 52.3 (0.71 sensitivity, 0.61 specificity). In a multiple regression analysis, after a complete adjustment, it was estimated that for each one-point increase in the EVIDENT diet index, cardiovascular risk (CVR), blood-pressure, waist circumference, and PWV decreased by 0.14, 0.43, 0.24, and 0.09 respectively (p < 0.05, all). CONCLUSIONS: The diet quality index developed is associated to CVR and its components, and also with arterial stiffness, as measured with PWV. This index is also a good predictor of adherence to MD.

Diet and physical activity in people with intermediate cardiovascular risk and their relationship with the health-related quality of life: results from the MARK study.

BACKGROUND: To analyze the interplay between diet, physical activity and health-related quality of life in a Spanish randomly selected sample of individuals attended in general practitioners offices with intermediate cardiovascular risk. METHODS: This study analyzed 314 subjects, aged 35-74 years (50.6% women), from the MARK study, conducted in Spain. Health related quality of life was measured by the SF-12 questionnaire. The assessment of the lifestyles included the diet quality index, the adherence to the Mediterranean diet and the leisure time physical activity practice. RESULTS: The highest values of health related quality of life were obtained in the area of vitality (51.05 ± 11.13), while the lowest were found in the general health (39.89 ± 8.85). In the multiple linear regression analysis, after adjustment for age, gender and other confounders, for each point of increase in the Mediterranean diet adherence score, there was an increase of 1.177 points in the mental component value (p < 0.01). Similarly, for each point of increase in the Diet Quality Index Score, there was an increase in the mental component of 0.553 (p < 0.05). Likewise, the physical activity was positively associated with the physical function and vitality (ß = 0.090 and 0.087, (p < 0.01 and p < 0.05), respectively). CONCLUSIONS: In people with intermediate cardiovascular risk, better food habits and greater adherence to the Mediterranean diet are associated with higher scores on the mental component of quality of life. Likewise, increased physical activity is related with positive scores on the physical function.

Dietary glycemic index and retinal microvasculature in adults: a cross-sectional study.

OBJECTIVE: To analyze the relationship between dietary glycemic index (GI) and retinal microvasculature in adults. METHODS: This was a cross-sectional study of 300 subjects from the EVIDENT II study. Dietary GI was calculated using a validated, semi-quantitative food frequency questionnaire. Retinal photographs were digitized, temporal vessels were measured in an area 0.5-1 disc diameter from the optic disc and arteriolar-venular index (AVI) was estimated with semi-automated software. RESULTS: AVI showed a significant difference between the tertiles of GI, after adjusting for potential confounders. The lowest AVI values were observed among subjects in the highest tertile of GI, whereas the greatest were found among those in the lowest tertile (estimated marginal mean of 0.738 vs. 0.768, p = 0.014). CONCLUSIONS: In adults, high dietary GI implies lowering AVI values regardless of age, gender and other confounding variables. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT02016014 . Registered 9 December 2013.

Effect and usability of the use of twitter as a complementary teaching tool in different subjects of nursing studies: Educational intervention study.

BACKGROUND: Some social networks, such as Twitter (now known as X), have proven to be very useful for sharing and discussing multiple aspects related to the healthcare field. However, the use of Twitter as a method of communication and knowledge transfer to nursing students has been limited. OBJECTIVES: To evaluate the usability and effect of an educational intervention for monitoring additional content, through the social network Twitter, of various subjects of nursing studies (clinical nursing, community nursing, and nursing fundamentals). DESIGN: An exploratory experimental study was carried out through an educational intervention during the 2020-2021 and 2021-2022 academic years. SETTINGS: Faculty of Nursing at the University of Salamanca, Spain. Participants were 308 students. METHODS: Students used Twitter to receive tweets about news or links to subject-related content. They also completed a pre-post questionnaire. RESULTS: A high degree of visualization and interaction of the study's Twitter account stands out, mainly in the subject clinical nursing. In relation to usability, the participants stated that they strongly agreed with aspects such as "thinking that it was easy to use the account" (59.4 %) as well as "imagining that the majority of colleagues would learn very quickly to use said account" (46.5 %). Students who used the account at least once a day obtained higher scores on the post-study knowledge questionnaire than those who used it less than once a day (p < 0.05), or those who used it 2 or 3 times during the study (p = 0.010). CONCLUSIONS: The group of participants who used the Twitter account at least once a day stated that using the account was easy and that they would like to use it more frequently. Likewise, greater use of this tool was associated with a better score on a post-study knowledge questionnaire.

Analysis of the determinants of sleep quality in a Spanish population: a study protocol for a cross-sectional study.

INTRODUCTION: Sleep problems are a growing public health concern being related, among others, to an increased risk of cardiovascular diseases or worse cognitive functioning. In addition, they can affect aspects related to personal motivation and quality of life. However, very few studies have analysed the possible determinants of sleep quality in the adult population as a whole, establishing patterns based on these determinants.The objectives are to evaluate the determinants of sleep quality in a representative sample of the general adult population between 25 and 65 years old, and to establish patterns of sleep quality based on lifestyles, psychological factors, morbidities, sociodemographic variables, biological markers and other possible determinants. METHODS AND ANALYSIS: Descriptive observational cross-sectional study. The study population will include a representative sample of 500 people between 25 and 65 years old from the cities of Salamanca and Ávila (Spain) selected by random sampling stratified by age groups and sex. A 90-minute visit will be performed, during which sleep quality will be assessed. The variables collected will be: morbidity, lifestyles (physical activity, diet, toxic habits), psychological factors (depression, stress, occupational stress and anxiety), socioeconomic and work-related variables, habitability conditions of the habitual residence and rest area, screen time, relaxation techniques and melatonin as a biological marker related to sleep quality. DISCUSSION: With the results of this work, improved interventions for behaviour modification could be designed, as well as intervention and education programmes or other research aimed at improving sleep quality. ETHICS AND DISSEMINATION: This study has a favourable opinion from the Ethics Committee for Drug Research of the Health Areas of Salamanca and Ávila (CEim Code: PI 2021 07 815). The results of this study will be published in international impact journals of different specialties. TRIAL REGISTRATION NUMBER: NCT05324267.

Sedentary Behaviour and Its Relationship with Early Vascular Ageing in the General Spanish Population: A Cross-Sectional Study.

Sedentary behaviour is associated with a greater predisposition to developing cardiovascular diseases. The aim of the study was to analyse the relationship between sedentary time and early vascular ageing. A total of 501 participants (49.70% men) were recruited through random sampling stratified by age group and sex. Vascular ageing was evaluated considering three criteria: (1) the vascular ageing index (VAI); (2) the carotid−femoral pulse wave velocity (cfPWV) 10th and 90th percentiles of the reference values in the European population by age; and (3) the Framingham's heart age. The carotid intima−media thickness was measured using a Sonosite Micromaxx ultrasound, the presence of peripheral artery disease was assessed by calculating the ankle−brachial index using a VaSera VS-1500, and the cfPWV was measured with a SphygmoCor® device. Weekly sedentary hours were evaluated through a sitting time questionnaire. The average age of the population was 55.90 ± 14.24 years. The men spent more hours sitting per week (47.6 ± 16.6 vs. 36.8 ± 17.3 h/W), at work (16.7 ± 16.2 vs. 9.73 ± 14.9 h/W), and watching TV (21.6 ± 12.5 vs. 18.7 ± 11.9 h/W). In the logistic regression analysis, the individuals with early vascular aging (EVA), with respect to those with healthy vascular aging (HVA), spent more hours sitting per week (OR = 1.03 vs. OR = 1.02; p < 0.05) and watching TV (OR = 1.03 vs. OR = 1.03; p < 0.05), using the criteria of the European guideline and VAI, and more hours sitting when commuting (OR = 1.04; p < 0.05), using Framingham's heart age to define EVA. The results of this study indicate that sedentary time is associated with early vascular ageing. Therefore, reducing sedentary time would improve vascular health.

Relationship of Different Anthropometric Indices with Vascular Ageing in an Adult Population without Cardiovascular Disease-EVA Study.

The objectives of this study were to analyse the capacity of different anthropometric indices to predict vascular ageing and this association in Spanish adult population without cardiovascular disease. A total of 501 individuals without cardiovascular disease residing in the capital of Salamanca (Spain) were selected (mean age: 55.9 years, 50.3% women), through stratified random sampling by age and sex. Starting from anthropometric measurements such as weight, height, and waist circumference, hip circumference, or biochemical parameters, we could estimate different indices that reflected general obesity, abdominal obesity, and body fat distribution. Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (cf-PWV) using a SphygmoCor® device. Vascular ageing was defined in three steps: Step 1: the participants with vascular injury were classified as early vascular ageing (EVA); Step 2: classification of the participants using the 10 and 90 percentiles of cf-PWV in the study population by age and sex in EVA, healthy vascular ageing (HVA) and normal vascular ageing (NVA); Step 3: re-classification of participants with arterial hypertension or type 2 diabetes mellitus included in HVA as NVA. The total prevalence of HVA and EVA was 8.4% and 21.4%, respectively. All the analysed anthropometric indices, except waist/hip ratio (WHpR), were associated with vascular ageing. Thus, as the values of the different anthropometric indices increase, the probability of being classified with NVA and as EVA increases. The capacity of the anthropometric indices to identify people with HVA showed values of area under the curve (AUC) ≥ 0.60. The capacity to identify people with EVA, in total, showed values of AUC between 0.55 and 0.60. In conclusion, as the values of the anthropometric indices increased, the probability that the subjects presented EVA increased. However, the relationship of the new anthropometric indices with vascular ageing was not stronger than that of traditional parameters. Therefore, BMI and WC can be considered to be the most useful indices in clinical practice to identify people with vascular ageing in the general population.

Association between measurements of arterial stiffness and target organ damage in a general Spanish population.

INTRODUCTION: Little is known about the relationship between arterial stiffness and cardiovascular target organ damage (TOD) in the general population. The aim was to analyse the relationship between different measurements of arterial stiffness and TOD, in a general Spanish population without a history of cardiovascular event. MATERIALS AND METHODS: Transversal descriptive study. Through stratified random sampling, a total of 501 individuals were included. Carotid-femoral pulse wave velocity (cf-PWV) was measured using a SphygmoCor System®, the cardio-ankle vascular index (CAVI) was determined with aVasera VS-1500® and brachial-ankle pulse wave velocity (ba-PWV)was calculated through a validated equation. RESULTS: The average age was 55.84 ± 14.26.The percentage of vascular TOD, left ventricular hypertrophy (LVH) and renal TOD was higher in men (p < .001). A positive correlation was obtained between carotid intima-media thickness (c-IMT) and the measurements of vascular function. In the model 1 of the logistic regression analysis, cf-PWV was associated with vascular TOD (OR = 1.15, p = .040), ba-PWV was associated with vascular TOD (OR = 1.20, p = .010) and LVH (OR = 1.12, p = .047). CONCLUSIONS: The different measurements of arterial stiffness are highly associated with each other. Moreover, cf-PWV and ba-PWV were associated with vascular TOD, and ba-PWV with LVH, although they disappear when adjusting for cardiovascular risk factors. Key Messages There is a strong correlation between the different measurements of vascular structure and function. Carotid-femoral and brachial-ankle pulse wave velocity were positively associated with vascular target organ damage, the latter was also positively associated with left ventricular hypertrophy. This associations disappear when adjusting for cardiovascular risk factors.

Reference values of central blood pressure and central haemodynamic parameters and their relationship with cardiovascular risk factors in a Spanish population: early vascular ageing study.

OBJECTIVES: Central blood pressure (BP) predicts mortality independent of office brachial BP. The aim was to describe reference values for central blood pressure and pulsatile hemodynamic parameters, and their relationship with cardiovascular risk factors in an adult Spanish population without cardiovascular disease. METHODS: Cross-sectional study. We included 501 participants stratified by age and sex by random sampling, with a mean age of 56 years (50.3% women). The SphygmoCor System device's pulse wave analysis software was used to perform the measurements. RESULTS: The following values were obtained: central blood pressure median (109/76 mmHg), central pulse pressure (33 mmHg), pulse pressure amplification (8.5 mmHg), ejection duration (130 ms) and subendocardial viability ratio (163%). All parameters were greater in men, except heart rate and ejection duration. In the logistic regression analysis, controlled for age, sex and taking antihypertensive drugs, being hypertensive was associated with cSBP (OR = 1.265), cDBP (OR = 1.307), cPP (OR = 1.067), pulse wave amplification (OR = 1.034) and SEVR (OR = 0.982); being diabetic was associated with SEVR (OR = 0.982); being obese was associated with cSBP (OR = 1.028) and cDBP (OR = 1.058) and being a smoker was associated with ejection duration (OR = 0.980) and SEVR (OR = 0.984). CONCLUSION: This study provides reference values for central blood pressure and parameters derived from the pulse wave analysis in a random sample of the Spanish population. The only risk factor that is not associated with any of the parameters analysed is dyslipidaemia. TRIAL REGISTRATION NUMBER: https://clinicaltrials.gov/ct2/show/NCT02623894.

Relationship of healthy vascular aging with lifestyle and metabolic syndrome in the general Spanish population. The EVA study.

INTRODUCTION AND OBJECTIVES: Our objective was to study the relationship of healthy vascular aging (HVA) with lifestyle and the components of metabolic syndrome. We also analyzed the differences between chronological age and heart age (HA) and vascular age (VA) in the Spanish adult population without cardiovascular disease. METHODS: This descriptive cross-sectional study selected 501 individuals without cardiovascular disease (mean age, 55.9 years; 50.3% women) via random sampling stratified by age and sex. HA was estimated with the Framingham equation, whereas VA was estimated with the VaSera VS-1500 device. HVA was defined as a <5-year difference between the chronological age and the HA or VA and the absence of a vascular lesion, hypertension, and diabetes mellitus. RESULTS: Compared with the chronological age, the mean HA and VA were 2.98±10.13 and 3.08±10.15 years lower, respectively. Smoking (OR, 0.23), blood pressure ≥ 130/85mmHg (OR, 0.11), altered baseline blood glucose (OR, 0.45), abdominal obesity (OR, 0.58), triglycerides ≥ 150mg/dL (OR, 0.17), and metabolic syndrome (OR, 0.13) decreased the probability of HVA estimated by HA; an active lifestyle (OR, 1.84) and elevated high-density lipoprotein-cholesterol (OR, 3.26) increased the probability of HVA estimated by HA. Smoking (OR, 0.45), blood pressure ≥ 130/85mmHg (OR, 0.26), altered baseline blood glucose (OR, 0.42), and metabolic syndrome (OR, 0.40) decreased the probability of HVA estimated by VA; abdominal obesity (OR, 1.81) had the opposite effect. CONCLUSIONS: HA and VA were 3 years lower than the chronological age. HA was associated with tobacco consumption, physical activity, and the components of metabolic syndrome. Meanwhile, VA was associated with tobacco consumption, blood pressure, waist circumference, and altered baseline glycemia. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Identifier: NCT02623894.

Adherence to the Mediterranean Diet in Spanish Population and Its Relationship with Early Vascular Aging according to Sex and Age: EVA Study.

The objective of this study is to analyze the influence of adherence to the Mediterranean diet (MDA) and its components on early vascular aging (EVA) in a Spanish population sample free of cardiovascular disease and to analyze the differences by sex. METHODS: We recruited 501 individuals aged 35-75 without cardiovascular disease by random sampling (55.90 ± 14.24 years, 49.70% men). EVA was defined in two steps: Step 1: subjects with vascular damage in carotid arteries or peripheral artery disease were classified as EVA. Step 2: subjects at the percentile of the combined Vascular Aging Index (VAI) were classified; ≥ p90 was considered EVA and < p90 was considered normal vascular aging (NVA), estimated using the following formula (VAI = (log (1.09) × 10 cIMT + log (1.14) cfPWV) × 39.1 + 4.76 by age and sex. Carotid-femoral pulse wave velocity (cfPWV) was measured by SphigmoCor System® and carotid intima-media thickness by Sonosite Micromax® ultrasound and classified thus: values ≥ Percentile 90 were considered EVA and those < Percentile 90 as NVA, with population percentiles analyzed. The principal result variable was assessed using the 14-item MEDAS questionnaire, developed and validated by the PREDIMED group, comprising 12 questions about the frequency of food consumption and two questions regarding the Spanish population's typical eating habits. RESULTS: MDA was observed by 25% (17% men and 34% women). EVA was present in 17% (29% men and 4% women). The adjusted logistic regression models showed that an increase in MDA decreases the probability of EVA in the global analysis (OR = 0.36; 95% CI: 0.16-0.82). In the analysis by sex, this association was only seen in men (OR = 0.33; 95% CI: 0.12-0.86), but not in women (OR = 0.31; 95% CI: 0.04-2.50). CONCLUSION: The results of this study suggest that a greater adherence to the Mediterranean diet decreases the probability of presenting EVA. In the analysis by sex, this association applies only to men.

Multivariate Analysis of Influence of Vitamin Intake on Vascular Function Parameters by Sex in the General Spanish Population: EVA Study.

The influence of vitamin intake on vascular function parameters in the Spanish general population has not been studied. The main objective of this study is to analyze the influence of vitamin intake on vascular function and as a secondary objective the adequacy of vitamin intake in a sample of the Spanish population without previous cardiovascular disease and analyze the differences according to sex. Methods: We included 501 individuals obtained by simple random sampling with replacement (reference population 43,946). The average age was 55.90 ± 14.24 years, 49.70% men. Participants recorded the intake of vitamins using the EVIDENT app, previously validated, during a period of 3 days. Vascular function was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) with the SphygmoCor device, cardio-ankle vascular index (CAVI) with the VaSera device and brachial-ankle pulse wave velocity (baPWV) by using a validated equation. Results: The vitamins with the least adequate intake was vitamin D, less than 5%, and vitamin B9, less than 35%. Vitamins with an adequate intake percentage, close to 100%, were B12 and B6. The multiple regression analysis showed a negative association between cfPWV and vitamin B2 in both sexes, and a positive one with retinol in men and B3 in women. baPWV was negatively associated with vitamins B1 and B12 in women and B9 in men, while being positively linked with B6 in men. CAVI presented a negative association with vitamin D in women. The results were similar in the canonical correspondence analysis. In conclusion, the results of this study suggest that the influence of vitamins on vascular function is not homogeneous and varies according to the parameter analyzed. Thus, in men, vitamins B2 and retinol were associated with cfPWV and vitamins B6 and B9 with baPWV. In women, vitamins B2 and B3 were related cfPWV, vitamins B1 and B12 with cfPWV and vitamin D with CAVI.

Vascular aging and its relationship with lifestyles and other risk factors in the general Spanish population: Early Vascular Ageing Study.

OBJECTIVES: To describe the prevalence of healthy vascular aging (HVA), normal vascular aging and early vascular aging (EVA) in a sample of Spanish population without cardiovascular disease. The relationship of vascular aging with lifestyle, cardiovascular risk factors, psychological and inflammatory risk factors is also analyzed. METHODS: A total of 501 participants were recruited (49.70% men, aged 55.90 ±â€Š14.24 years) by random sampling. Vascular aging was defined in three steps: Step 1: participants with vascular damage in carotid arteries or peripheral artery disease were classified as EVA. Step 2: with the percentiles of carotid-to-femoral pulse wave velocity (cfPWV) we used three criteria, first, the 10th and 90th cfPWV percentiles of the population studied by age and sex; second, the 10th and 90th percentiles of the European population reference values and third, the 25th and 75th cfPWV percentiles of the population studied by age and sex. Step 3: participants with hypertension or type 2 diabetes mellitus included in HVA were reclassified as normal vascular aging. Arterial stiffness was assessed with cfPWV using a Sphygmocor device. Physical activity was measured with an accelerometer. Psychological factors, lifestyle and other clinical information were obtained by standard questionnaire. RESULTS: The global prevalence of HVA was 8 and 14% (men 8 and 10%, women 9 and 18%), and 22 and 18% (men 26 and 23%, women 17 and 12%) for EVA, using criteria a and b, respectively. In the logistic regression analysis, vascular aging maintains positive associations with more sedentary time [odds ratio (OR) = 2.37 and 4.51], having triglycerides above 150 mg/dl (OR = 6.55 and 4.06), abdominal obesity (OR = 2.73 and 2.90), increased uric acid (OR = 4.63 and 2.98) and insulin resistance index homeostatic model assessment (OR = 4.05 and 6.78), and a negative association with less physical activity (OR = 0.29 and 0.28) using criteria a and b, respectively. CONCLUSION: One in 10 has HVA and one in five EVA. The prevalence of EVA is higher in men. Study results suggest that preventive strategies aimed at increasing physical activity, reducing sedentary time and decreasing obesity and insulin resistance improve vascular aging.

Effect of a multifactorial intervention on the increase in physical activity in subjects with type 2 diabetes mellitus: a randomized clinical trial (EMID Study).

BACKGROUND: Regular physical activity is essential for metabolic control in type 2 diabetes mellitus. AIMS: The aim of this study was to assess the short and long-term impact of a multifactorial intervention on physical activity and clinically relevant biochemical parameters in patients with type 2 diabetes mellitus. METHODS: This randomised, controlled clinical trial (NCT02991079) included two parallel groups aged 25-70 years from a primary care health centre in Salamanca, Spain. The subjects were assigned randomly (1:1) to control and intervention groups, using Epidat 4.0 software. Both were counselled on the importance of physical activity and maintaining a healthy diet. The intervention group also took five low-moderate intensity 4 km nurse-guided walks, received a smartphone application to promote healthy habits and attended a diet workshop. Physical activity was measured objectively using a pedometer and subjectively using a shortened international physical activity questionnaire (at baseline, 3 and 12 months). RESULTS: In total, 204 subjects were included (mean age 60.6 years, 45.6% were women). After 3 months, relative to the control group, the intervention group increased their daily number of steps by 1852, aerobic steps by 1623, distance walked by 994 m, and total metabolic equivalent minutes per week by 1297 and decreased sedentary time by 34.3 minutes per day. Differences from baseline persisted at 12 months, including mean increases of 1141 daily steps, 917 aerobic steps, and 1065 total metabolic equivalent minutes per week in the intervention group relative to the control group ( P<0.05 for all). CONCLUSIONS: The success of this multifactorial intervention should help inform future clinical approaches and application designs towards managing type 2 diabetes mellitus and improving patient outcomes.