Gender differences in obesity related cardiovascular risk factors in Spain.

BACKGROUND: Obesity and overweight are increasing progressively leading to an increase in cardiovascular risk factors and cardiovascular events. METHODS: The MESYAS Registry (Metabolic Syndrome in Active Subjects) recruited active workers from their annual health examinations in Spain through 2003. Body mass index was used to diagnose overweight and obesity. Metabolic syndrome (MS) and risk factors were assessed according to the ATP-III definitions. RESULTS: 19,041 subjects were included (80% males), mean age 42.2 (10.7). The prevalence of overweight was 44.6% (44.0-45.2), obesity 17.3% (17.0-17.5) and MS 12.0% (11.8-12.2). Women had lower prevalence of all cardiovascular risk factors. Multivariate analysis showed independent associations between overweight (OR: 2.4; 95% CI 2.2-2.6) or obesity (OR: 5.3; 95% CI 4.7-5.9) and any other two MS criteria. Overweight and obesity were independently associated with all cardiovascular risk factors, except low high-density lipoproteins in women. Significantly higher association was found in women between obesity and diabetes (OR: 13.6; 95% CI 3.8-48.6), MS (OR: 10.6; 7.6-14.8), hypertriglyceridemia (OR: 8.6; 95% CI 5.6-13.1), and impaired fasting glucose (OR: 3.7; 95% CI 2.7-5.3). CONCLUSIONS: Overweight and obesity are strongly related to classical cardiovascular risk factors, atherogenic dyslipidaemia and MS. Obesity has higher association to insulin-resistance related risk factors in women.

Comparison of serum lipid values in subjects with and without the metabolic syndrome.

Insulin resistance is supposed to be the basis of metabolic syndrome (MS), although it is difficult to measure. The ratio of triglyceride (TG) to high-density lipoprotein (HDL) has been proposed as a surrogate marker of insulin resistance in overweight subjects. The aim of the present study was to assess the accuracy of the TG/HDL ratio for the diagnosis of MS. Data of 18,778 active workers (77.6% men) enrolled in 3 insurance companies in Spain were collected from their annual health examinations. Mean age was 42.2 +/- 10.7 years. MS was assessed according to modified Adult Treatment Panel III criteria. Prevalences of MS were 18.8% in men and 6.1% in women. Mean value of the TG/HDL ratio was 2.50 +/- 2.2 and increased in parallel to the number of MS components present. Subjects with MS had a ratio that was 2 times higher compared with those without (5.10 vs 2.03, p <0.001). Receiver operating characteristic curves were performed to assess the capability of the TG/HDL ratio to contribute to a diagnosis of MS and 80% sensitivity and 78% specificity were obtained for values >2.75 in men and >1.65 in women. In conclusion, the TG/HDL ratio is a feasible and accurate measurement for assessment of MS in healthy subjects. We propose cut-off values of 2.75 for men and 1.65 for women for a diagnosis of MS.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: CEIPC 2008 Spanish adaptation]. / Guía europea de prevención cardiovascular en la práctica clínica: Adaptación española del CEIPC 2008.

We present the Spanish adaptation from the CEIPC of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure <140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be <200 mg/dl and cLDL <130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by BMI -body mass index- and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

The gap between dyslipidemia control perceived by physicians and objective control patterns in Spain.

OBJECTIVE: It is well-known that adequate control of dyslipidemia is low. But little is known about how well physicians perceive the control of their dyslipidemic patients. This study examines physicians' subjective perception of dyslipidemia control, and compares it with control determined objectively with published guidelines. METHODS: A total of 33,913 patients were studied cross-sectionally in 164 Spanish outpatients' clinics. Of these patients, 5583 were evaluable patients with a documented diagnosis of dyslipidemia. Control of dyslipidemia was evaluated by two methods: the physician's opinion on their patient's lipid levels (adequate control or inadequate control), and the proportion of patients who objectively reach the LDL-cholesterol goals of the National Cholesterol Education Program (NCEP/ATPIII). RESULTS: Physicians perceived that 44% (95% CI 42.7-45.3%) of their patients had an adequate control of their dyslipidemia, but only 32.8% (95% CI 31.6-34.0%) were objectively controlled. Subjective control hardly changed across the NCEP cardiovascular risk groups, but objective control was lower in the 2372 coronary heart disease patients (15.1%) and in the 1407 moderately high-risk patients (29.6%) than in the 1804 lower risk patients (58.5%). Physicians' perception of control was significantly and independently associated with objective control (P<0.001). CONCLUSIONS: Physicians overestimate dyslipidemia control in the majority of their patients. Misperception of control by physicians may contribute to the low achievement of objective control.

Prehypertension is associated with insulin resistance state and not with an initial renal function impairment. A Metabolic Syndrome in Active Subjects in Spain (MESYAS) Registry substudy.

BACKGROUND: The aim of this study was to assess the prevalence of metabolic syndrome (MS) and other surrogate markers of insulin resistance, and whether these markers are better for defining the prehypertensive state than is renal dysfunction. METHODS: Data from 19,041 healthy active workers, mean age 42.2 (10.7) years, from three health insurance companies, were prospectively collected. Presence of MS, assessed according to the modified criteria of the National Cholesterol Education Program Third Adult Treatment Panel, and the ratio of triglycerides to high-density lipoprotein were considered as surrogate markers of insulin resistance. Renal function was assessed by the Modification of Diet in Renal Disease Study equation. Blood pressure was classified as normotension (NT), prehypertension (PHT), or hypertension (HT) according to the guidelines of the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. RESULTS: The global presence of MS was 11.8% The higher prevalence was found in subjects with hypertension (30%), followed by those with PHT (9.6%). The prevalence in normotensive subjects was very low (0.9%). The presence of MS and hypertension increased in parallel with age. Metabolic syndrome (odds ratio [OR] 4.3), obesity (OR 2.2), overweight (OR 1.7), impaired fasting glucose (OR 1.3), and elevated triglycerides to HDL ratio (OR 1.2), but no degree of renal dysfunction, were independent risk factors for the progression from NT to PHT. CONCLUSIONS: Prehypertension is associated with markers of insulin resistance, assessed by the presence of MS and other surrogate markers, and not with an initial renal dysfunction. In this study, MS was found to be present in almost one third of hypertensive but asymptomatic and otherwise healthy workers.

[Prevalence of dyslipidemia in outpatients of the Spanish health service: the HISPALIPID Study]. / Prevalencia de dislipemia en las consultas ambulatorias del Sistema Nacional de Salud: Estudio HISPALIPID.

BACKGROUND AND OBJECTIVE: We intended to estimate the prevalence of dyslipidemia among patients attending outpatient clinics of the Spanish health service. PATIENTS AND METHOD: HISPALIPID is a multicenter, cross-sectional study performed in 33,913 patients (55.7% women) with a mean age of 54.6 +/- 18.3 years attended in outpatient clinics across 15 of the 17 autonomous communities of Spain. 1,461 physicians (78.8% primary care physicians, and 21.2% specialists) participated in the study. Patients were considered having dyslipidemia if their doctor had established a previous diagnosis. RESULTS: A total of 8,256 patients (52.4% women, mean age 62.4 +/- 12.4 years) had been diagnosed with dyslipidemia, representing a global prevalence of 24.3% (CI95%: 23.8-24.8) (M: 26.2%; W:22.9%; P<0.001). The communities with the higher and lower prevalence were the Canary Islands (33.9%) and Cantabria (18.6%), respectively. About 87% dyslipemic patients presented an additional cardiovascular risk factor and 36.7% of dyslipemic patients had an associated cardiovascular disease. CONCLUSIONS: The prevalence of dyslipidemia is high in patients attending outpatient clinics of the Spanish health service (one out of four patients). In addition, these patients are at a high cardiovascular risk.

[Prevalence of metabolic syndrome in the Spanish working population: MESYAS registry]. / Prevalencia del síndrome metabólico en población laboral española: registro MESYAS.

INTRODUCTION AND OBJECTIVES: To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. SUBJECTS AND METHOD: Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). RESULTS: Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. CONCLUSIONS: One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile.

[Cardiovascular risk factors and metabolic syndrome associated with subclinical renal failure]. / Factores de riesgo cardiovascular y síndrome metabólico asociados a la disfunción renal subclínica: subanálisis del Registro MESYAS.

BACKGROUND AND OBJECTIVE: The objectives of this study were to describe the prevalence of subclinical renal dysfunction, assessed by glomerular filtration rate (GFR), and identify the associated cardiovascular risk factors in active working subjects of Spain. SUBJECTS AND METHOD: Data were collected in 11,582 active healthy workers (78.5% males), mean age (standard deviation) 40.2 (10.7) years, in their annual health examinations. Renal function was assessed by the GFR estimated by 3 methods: the abbreviated equation of Modification of Diet in Renal Disease (MDRD) study, the Cockroft-Gault (CG) equation and the weight/creatinine ratio. The assessment of the metabolic syndrome was done according to the modified Adult Treatment Panel III criteria. RESULTS: The 3 equations used for the estimation of GFR showed different values. GFR mean values were highest with the CG method (99.0 [25.0]) ml/min/1.73 m2, followed by the results of the MDRD and weigh/creatinine ratio (90.2 [18.5] ml/min/1.73 m2 and 81.2 [18.3] ml/min/1.73 m2, respectively). The prevalence of mild renal dysfunction (GFR: 60-89 ml/min/1.73 m2) ranged between 35.7% and 50.8% depending on the method applied, and the presence of moderate-severe (GFR < 60 ml/min/1.73 m2) ranged between 1.2% and 2.6%. All cardiovascular risk factors were more prevalent in the categories of worst renal function. Multivariant regression analysis showed that hypertriglyceridemia (odds ratio [OR] = 1.2), metabolic syndrome (OR = 1.2), overweight (OR = 1.2) and hypercholesterolemia (OR = 1.5) were associated independently with mild renal dysfunction. Hypercholesterolemia (OR = 1.6), hypertension (OR = 1.6), low HDL (OR = 2.4), and diabetes mellitus (OR = 3.2) were associated with moderate-severe renal dysfunction. CONCLUSIONS: Renal subclinical dysfunction is highly prevalent and is independently associated with classical cardiovascular risk factors and metabolic syndrome.

Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study.

INTRODUCTION AND OBJECTIVES: Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140,000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. METHODS: This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12,096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. RESULTS: Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. CONCLUSIONS: Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.

[Cardiovascular risk factors and lifestyle associated with premature myocardial infarction diagnosis]. / Factores de riesgo cardiovascular y estilo de vida asociados a la aparición prematura de infarto agudo de miocardio.

Young and old patients with acute myocardial infarction have different risk factor profiles, clinical presentation, angiographic findings and prognosis. In the present study we investigated the clinical profile of patients aged <46 years with acute myocardial infarction.

Relationship between metabolic syndrome and ischemic heart disease mortality in Spain.

Morbidity and mortality due to ischemic heart disease (IHD) is subject to wide geographic variation both between and within countries. The aim of this study was to determine whether geographic variations exist in the prevalence of metabolic syndrome in the Spanish working population or in its relationship with IHD mortality. We analyzed clinical and laboratory data obtained during health check-ups carried out in Spanish workers (n=17,837) during 2003. The prevalence of metabolic syndrome was 17% in men and 6.5% in women. However, there was a heterogeneous distribution across the different regions studied. The prevalence in southern and western regions (e.g., in men: 22.15% in Extremadura and 20.6% in Galicia) was double that observed in central and northern zones (e.g., in the Basque Country and Castile and León). This research indicates that there is a significant association between IHD mortality and the prevalence of metabolic syndrome in workers from different Spanish regions.

Usefulness of triglycerides-to-high-density lipoprotein cholesterol ratio for predicting the first coronary event in men.

Overweight and obesity potentiate the development of cardiovascular risk factors but many doubts have arisen recently regarding their role in coronary events. We evaluated the predictive value of a surrogate maker of insulin resistance, the ratio of triglyceride (TG) to high-density lipoprotein (HDL), for the incidence of a first coronary event in men workers according to body mass index (BMI). We designed a case-control study of active subjects collected from a single factory through their annual health examination and medical reports. Case subjects included those with myocardial infarction, unstable angina pectoris, or subclinical myocardial ischemia detected through electrocardiographic abnormalities. The sample was constituted by 208 case and 2,080 control subjects (mean age 49.9 years, 49.6 to 50.2). General characteristics of case and control subjects were well matched. The TG/HDL ratio was significantly higher in case subjects compared to controls. Stratification of the sample revealed an increasing prevalence of case subjects and mean TG/HDL in each category of BMI. Multivariable analysis, adjusted by smoking, demonstrated that TG/HDL increased 50% the risk of a first coronary event (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.26 to 1.71), whereas low-density lipoprotein cholesterol values indicated a more moderate increased risk (OR 1.01, 95% CI 1.005 to 1.012); metabolic syndrome (OR 1.76, 95% CI 0.94 to 3.30) and hypertension (OR 1.50, 95% CI 0.81 to 2.79) did not reach statistical significance. The TG/HDL ratio was associated with a first coronary event in all categories of BMI. In conclusion, the TG/HDL ratio has a high predictive value of a first coronary event regardless of BMI.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish Adaptation]. / Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008.

The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure<140/90mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is<130/80mmHg. Serum cholesterol should be<200mg/dl and cLDL<130mg/dl, although in patients with CVD or diabetes, the objective is<100mg/dl (80mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin<7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Comparison of cardiovascular risk factors in young Spanish men between the 1980s and after the year 2000. Data from the AGEMZA study.

INTRODUCTION AND OBJECTIVES: To investigate the cardiovascular risk profile of a sample of young Spanish men taken in the 1980s, the initial AGEMZA study cohort, and to compare the findings with those in another sample with similar characteristics taken after 2000. METHODS: The two AGEMZA study cohorts comprised young men who were resident at the Zaragoza General Military Academy, where they were studying as aspiring cadets. A descriptive study of each cohort was carried out and the participants' anthropometric characteristics, sporting and dietary habits, exposure to toxins, and biochemical and lipid profiles were analyzed. Data on the prevalence of various risk factors were obtained for each cohort and the coronary disease risk was estimated using the Framingham equation. RESULTS: Comparison of data on 248 subjects from the current cohort with data on 260 from the initial cohort showed the following significant changes: weight (+6.03 kg), body mass index (BMI) (+1.57), cholesterol (+12.46 mg/dL), low-density lipoprotein cholesterol (+15.8 mg/dL), high-density lipoprotein cholesterol (-4.11 mg/dL), triglycerides (+3.64 mg/dL), apolipoprotein B (+24.8 mg/dL), estimated coronary disease risk in the next 10 years (+1/1000 individuals) and estimated coronary disease risk up to the age of 65 years (+23/1000 individuals). There were significant correlations between increases in weight and BMI and lipid profile alterations. CONCLUSIONS: The lipid profile and BMI were worse in the current sample. These findings make it essential that preventive measures for young people should be introduced and that an increased effort should be made to develop programs aimed at either stopping the progressive rise in obesity or even preventing it altogether.