Agentes terapéuticos utilizados en 238 pacientes hospitalizados por COVID-19 y su relación con la mortalidad / Therapeutic agents tested in 238 COVID-19 hospitalized patients and their relationship with mortality

ANTECEDENTES Y OBJETIVO: En los últimos meses se han realizado grandes esfuerzos para evaluar las terapias más eficaces en el manejo de pacientes con COVID-19. Actualmente ninguna combinación ha demostrado de manera consistente una relación clara con la mortalidad. Nuestro objetivo fue valorar el patrón de asociaciones observado entre los distintos tratamientos intrahospitalarios administrados a 238 pacientes ingresados por COVID-19 y la mortalidad. MATERIALES Y MÉTODOS: Se analizaron las historias clínicas electrónicas de aquellos pacientes dados de alta o que fallecieron por COVID-19 entre el 16 de marzo y el 10 de abril de 2020 en el Hospital Universitario San Cecilio (Granada, España). Se obtuvo información sobre sexo, edad, comorbilidades al ingreso, parámetros clínicos, analíticos, pruebas de imagen y tratamientos empíricos empleados. La variable de desenlace fue la mortalidad intrahospitalaria. Para estimar las asociaciones entre los diferentes tratamientos y el riesgo de mortalidad se estimaron, mediante modelos de regresión de Cox, hazard ratio ajustadas por edad, sexo, patologías previas y gravedad al ingreso. RESULTADOS: La combinación de fármacos más frecuentemente empleada fue la formada por heparina de bajo peso molecular (HBPM), hidroxicloroquina y ritonavir/lopinavir. Ninguno de los tratamientos utilizados mostró una asociación independiente con la mortalidad. Los fármacos que mostraron una asociación inversa de mayor magnitud fueron el tocilizumab y los corticoides. CONCLUSIONES: El patrón se asociaciones obtenido es consistente con lo reportado en la bibliografía. Parece oportuno diseñar ensayos aleatorizados que valoren el posible efecto protector de los corticoides y el tocilizumab sobre el riesgo de muerte en algunos subgrupos de pacientes hospitalizados por COVID-19

BACKGROUND AND OBJECTIVES: In the last months great efforts have been developed to evaluate the more efficient therapeutic agents in the management of patients with COVID-19. Currently, no specific drug combination has consistently demonstrated an association with mortality. The aim of this study was to assess the pattern of associations observed between the different in-hospital treatments administered to a series of 238 patients admitted for COVID-19 and their relationship with mortality. METHODS: The electronic medical records of patients that discharged or died from COVID-19 in the Hospital Universitario San Cecilio (Granada, Spain) between March 16 and April 10, 2020 were analysed. From these records, information was obtained on sex, age, comorbidities at admission, clinical information, analytical parameters, imaging tests and empirical treatments used. The outcome variable was the in-hospital mortality. To estimate the associations between the different therapeutic alternatives and the risk of mortality, hazard ratios adjusted for age, sex, previous pathologies and severity at discharge were estimated using Cox regression models. RESULTS: The most frequently used combination of drugs was low molecular weight heparins, hydroxychloroquine, and ritonavir/lopinavir. None of the analysed treatments showed independent association with mortality. The drugs that showed a greater inverse association with mortality were tocilizumab and corticoids. CONCLUSIONS: The observed association patterns are consistent with previous literature. It seems necessary to design randomized controlled clinical trials that evaluate the possible protector effect of tocilizumab and corticoids in the risk of mortality for some subgroups of COVID-19 hospitalized patients

Therapeutic agents tested in 238 COVID-19 hospitalized patients and their relationship with mortality.

BACKGROUND AND OBJECTIVES: In the last months great efforts have been developed to evaluate the more efficient therapeutic agents in the management of patients with COVID-19. Currently, no specific drug combination has consistently demonstrated an association with mortality. The aim of this study was to assess the pattern of associations observed between the different in-hospital treatments administered to a series of 238 patients admitted for COVID-19 and their relationship with mortality. METHODS: The electronic medical records of patients that discharged or died from COVID-19 in the Hospital Universitario San Cecilio (Granada, Spain) between March 16 and April 10, 2020 were analysed. From these records, information was obtained on sex, age, comorbidities at admission, clinical information, analytical parameters, imaging tests and empirical treatments used. The outcome variable was the in-hospital mortality. To estimate the associations between the different therapeutic alternatives and the risk of mortality, Hazard Ratios adjusted for age, sex, previous pathologies and severity at discharge were estimated using Cox Regression models. RESULTS: The most frequently used combination of drugs was low molecular weight heparins, hydroxychloroquine, and ritonavir/lopinavir. None of the analysed treatments showed independent association with mortality. The drugs that showed a greater inverse association with mortality were tocilizumab and corticoids. CONCLUSIONS: The observed association patterns are consistent with previous literature. It seems necessary to design randomized controlled clinical trials that evaluate the possible protector effect of tocilizumab and corticoids in the risk of mortality for some subgroups of COVID-19 hospitalized patients.

ANTECEDENTES Y OBJETIVO: En los últimos meses se han realizado grandes esfuerzos para evaluar las terapias más eficaces en el manejo de pacientes con COVID-19. Actualmente ninguna combinación ha demostrado de manera consistente una relación clara con la mortalidad. Nuestro objetivo fue valorar el patrón de asociaciones observado entre los distintos tratamientos intrahospitalarios administrados a 238 pacientes ingresados por COVID-19 y la mortalidad. MATERIALES Y MÉTODOS: Se analizaron las historias clínicas electrónicas de aquellos pacientes dados de alta o que fallecieron por COVID-19 entre el 16 de marzo y el 10 de abril de 2020 en el Hospital Universitario San Cecilio (Granada, España). Se obtuvo información sobre sexo, edad, comorbilidades al ingreso, parámetros clínicos, analíticos, pruebas de imagen y tratamientos empíricos empleados. La variable de desenlace fue la mortalidad intrahospitalaria. Para estimar las asociaciones entre los diferentes tratamientos y el riesgo de mortalidad se estimaron, mediante modelos de regresión de Cox, hazard ratio ajustadas por edad, sexo, patologías previas y gravedad al ingreso. RESULTADOS: La combinación de fármacos más frecuentemente empleada fue la formada por heparinade bajo peso molecular (HBPM), hidroxicloroquina y ritonavir/lopinavir. Ninguno de los tratamientos utilizados mostró una asociación independiente con la mortalidad. Los fármacos que mostraron una asociación inversa de mayor magnitud fueron el tocilizumab y los corticoides. CONCLUSIONES: El patrón se asociaciones obtenido es consistente con lo reportado en la bibliografía. Parece oportuno diseñar ensayos aleatorizados que valoren el posible efecto protector de los corticoides y el tocilizumab sobre el riesgo de muerte en algunos subgrupos de pacientes hospitalizados por COVID-19.

[Therapeutic agents tested in 238 COVID-19 hospitalized patients and their relationship with mortality]. / Agentes terapéuticos utilizados en 238 pacientes hospitalizados por COVID-19 y su relación con la mortalidad.

BACKGROUND AND OBJECTIVES: In the last months great efforts have been developed to evaluate the more efficient therapeutic agents in the management of patients with COVID-19. Currently, no specific drug combination has consistently demonstrated an association with mortality. The aim of this study was to assess the pattern of associations observed between the different in-hospital treatments administered to a series of 238 patients admitted for COVID-19 and their relationship with mortality. METHODS: The electronic medical records of patients that discharged or died from COVID-19 in the Hospital Universitario San Cecilio (Granada, Spain) between March 16 and April 10, 2020 were analysed. From these records, information was obtained on sex, age, comorbidities at admission, clinical information, analytical parameters, imaging tests and empirical treatments used. The outcome variable was the in-hospital mortality. To estimate the associations between the different therapeutic alternatives and the risk of mortality, hazard ratios adjusted for age, sex, previous pathologies and severity at discharge were estimated using Cox regression models. RESULTS: The most frequently used combination of drugs was low molecular weight heparins, hydroxychloroquine, and ritonavir/lopinavir. None of the analysed treatments showed independent association with mortality. The drugs that showed a greater inverse association with mortality were tocilizumab and corticoids. CONCLUSIONS: The observed association patterns are consistent with previous literature. It seems necessary to design randomized controlled clinical trials that evaluate the possible protector effect of tocilizumab and corticoids in the risk of mortality for some subgroups of COVID-19 hospitalized patients.

Sociodemographic, clinical and laboratory factors on admission associated with COVID-19 mortality in hospitalized patients: A retrospective observational study.

BACKGROUND: To identify and quantify associations between baseline characteristics on hospital admission and mortality in patients with COVID-19 at a tertiary hospital in Spain. METHODS AND FINDINGS: This retrospective case series included 238 patients hospitalized for COVID-19 at Hospital Universitario Clínico San Cecilio (Granada, Spain) who were discharged or who died. Electronic medical records were reviewed to obtain information on sex, age, personal antecedents, clinical features, findings on physical examination, and laboratory results for each patient. Associations between mortality and baseline characteristics were estimated as hazard ratios (HR) calculated with Cox regression models. Series mortality was 25.6%. Among patients with dependence for basic activities of daily living, 78.7% died, and among patients residing in retirement homes, 80.8% died. The variables most clearly associated with a greater hazard of death were age (3% HR increase per 1-year increase in age; 95%CI 1-6), diabetes mellitus (HR 2.42, 95%CI 1.43-4.09), SatO2/FiO2 ratio (43% HR reduction per 1-point increase; 95%CI 23-57), SOFA score (19% HR increase per 1-point increase, 95%CI 5-34) and CURB-65 score (76% HR increase per 1-point increase, 95%CI 23-143). CONCLUSIONS: The patients residing in retirement homes showed great vulnerability. The main baseline factors that were independently associated with mortality in patients hospitalized for COVID-19 were older age, diabetes mellitus, low SatO2/FiO2 ratio, and high SOFA and CURB-65 scores.

[Prevalence of Hypothyroidism in Andalusia, Spain, Determined by Thyroid Hormone Comsumption]. / Prevalencia de hipotiroidismo en Andalucía según el consumo de hormona tiroidea en 2014.

OBJECTIVE: Hypothyroidism is the most common condition linked to a hormone deficiency, nevertheless data on its prevalence are scarce in Spain. For that reason, we have estimated its prevalence through the registration of patients who had used thyroid hormones in Andalusia (South Spain). METHODS: Data of patients who had withdrawn levothyroxine under the public system during 2014 from the base of the Andalusian Health Service were considered. Prevalence were calculated with confidence intervals of 95% for each management area, stratified by sex and age groups, and differences between them were evaluated. RESULTS: 321,368 people (98% older than 18 years and 83% female) were identified as levothyroxine users and a prevalence of hypothyroidism of 3.95% (95%CI:3.94-3.96) was estimated for the general population. The condition was more common in females, in the older 18 years 7.81% (95%CI:7.80 to 7.82) compared to males 1.75% (95%CI:1.73-1.77) with a ratio of 4.5-fold. It increases in the population of women older than 45 years, 10.32% (95%CI:10.30-0.32) and in the over 60 years 11.37% (95%CI: 11.35-11.40). The prevalence in adult women in the western provinces is 7.38% (95%CI:7.36-7.40), in the eastern provinces 8.59% (95%CI:8.57-8.62) and in coastal areas 6.70% (95%CI: 6.68-6.72) compared to the mountainous ones, which is 8.91% (95%CI:8.88-8.94). CONCLUSIONS: The results denote a high prevalence of hypothyroidism in the adult population of Andalusia compared to the nearby countries, with a clear increased associated with females and age. Furthermore, the prevalence of the illness presents also a geographically-related variability.

Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain.

OBJECTIVES: To estimate the prevalence of known and undiagnosed depression in patients with type 2 diabetes attended in primary care setting in Spain, and to determine the factors associated with the presence of depression. METHODS: This was a cross-sectional and multicenter study performed in a random sample of patients with type 2 diabetes attended in 21 primary care centers. Depressive symptoms were measured with the self-administered Patient Health Questionnaire (PHQ-9). RESULTS: A total of 411 patients were analyzed (mean age 70.8 (SD 10.3) years; 53.8% women). 29.2% of patients met the diagnostic criteria of depression, of whom 17% had known depression and 12.2% undiagnosed depression (PHQ-9 score ≥10, without a previous diagnosis of depression). Depression was more common in women (43.4%; 95% confidence interval [CI] 34.5-52.3%), widow (33.3%; 95% CI 27.9-38.7%), and hypothyroidism (12.5%; 95% CI 8.7-16.3%). Cardiovascular risk factors, the degree of control, complications related to diabetes, antidiabetic therapy and the number of drugs were not associated with the presence of depression. CONCLUSIONS: The prevalence of depression was high in patients with type 2 diabetes. However, in approximately 40% of patients depression was undiagnosed. The complications related to diabetes and antidiabetic therapy were not associated with the presence of depression.

Prevalencia de hipotiroidismo en Andalucía según el consumo de hormona tiroidea en 2014 / Prevalence of hypothyroidism in Andalusia, Sapin, determined by thyroid hormone comsumption

Fundamento: El hipotiroidismo es la condición más común ligada a un déficit hormonal. A pesar de ello existe una escasez de datos en España sobre su su prevalencia. El objetivo fue estimar la prevalencia en Andalucía a través del registro de pacientes que consumieron hormona tiroidea durante el año 2014. Método: Se recuperaron los datos de las personas que habían retirado de la farmacia levotiroxina con cargo al sistema público durante 2014 de la base de datos del Servicio Andaluz de Salud. Se calcularon las prevalencias con sus intervalos de confianza del 95% para cada Área de Gestión, estratificadas por sexo y grupos etarios. Resultados: Se identificaron 321.368 personas (98% mayores de 18 años y 83% mujeres) consumidoras de levotiroxina y se estimó una prevalencia de hipotiroidismo del 3,95% (IC95%: 3,943,96) para población general. La condición era más común en la mujer, en mayores de 18 años un 7,81% (IC95 7,80 a 7,82) comparada con el hombre 1,75% (IC95 1,73 a 1,77) con una razón de 4,5. Aumenta en la población de mujeres mayores de 45 años, 10,32% (IC95 10,30 a 10,32) y más en las mayores de 60 años 11,37% (IC95%: 11,35 a 11,40). La prevalencia en mujer adulta de las provincias occidentales fue 7,38% (IC95%: 7,36-7,40), en las orientales de 8,59% (IC95%: 8,57-8,62) y en las áreas costeras fue de 6,70% (IC95%: 6,68-6,72) frente a las montañosas que fue 8,91% (IC95%: 8,88-8,94). Conclusión: Los resultados indican una elevada prevalencia de hipotiroidismo en la población adulta de Andalucía, con un claro predominio de la mujer y un incremento con la edad. Además, la prevalencia de la enfermedad también presenta una importante variabilidad geográfica (AU)

Background: Hypothyroidism is the most common condition linked to a hormone deficiency, nevertheless data on its prevalence are scarce in Spain. For that reason, we have estimated its prevalence through the registration of patients who had used thyroid hormones in Andalusia (South Spain). Method: data of patients who had withdrawn levothyroxine under the public system during 2014 from the base of the Andalusian Health Service were considered. Prevalence were calculated with confidence intervals of 95% for each management area, stratified by sex and age groups, and differences between them were evaluated. Results: 321,368 people (98% older than 18 years and 83% female) were identified as levothyroxine users and a prevalence of hypothyroidism of 3.95% (95%CI:3.94-3.96) was estimated for the general population. The condition was more common in females, in the older 18 years 7.81% (95%CI:7.80 to 7.82) compared to males 1.75% (95%CI:1.73-1.77) with a ratio of 4.5-fold. It increases in the population of women older than 45 years, 10.32% (95%CI:10.30- 0.32) and in the over 60 years 11.37% (95%CI: 11.35-11.40). The prevalence in adult women in the western provinces is 7.38% (95%CI:7.36-7.40), in the eastern provinces 8.59% (95%CI:8.57-8.62) and in coastal areas 6.70% (95%CI: 6.68-6.72) compared to the mountainous ones, which is 8.91% (95%CI:8.88- 8.94). Conclusion: The results denote a high prevalence of hypothyroidism in the adult population of Andalusia compared to the nearby countries, with a clear increased associated with females and age. Furthermore, the prevalence of the illness presents also a geographically-related variability (AU)

Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus.

AIMS: To evaluate the degree of glycemic control and its relationship with disease characteristics and antidiabetic treatment in patients with type 2 diabetes mellitus (DM), as well as the frequency of A1c use. METHODS: For this purpose, an observational, cross-sectorial, and multicenter study was performed. A total of 443 patients were monitored in 17 Spanish primary healthcare centers. Demographic and clinical variables were recorded from the clinical history of patients. RESULTS: Mean age was 68.9±12.0 years. Time of evolution of DM was 9.2±6.4 years. Mean A1c was 7.38±1.34% and 45% of patients achieved A1c <7%. There was a no significant relationship between the degree of control and time of evolution of DM. In 16% of patients no A1c determination was performed in the previous twelve months. In those patients in whom A1c was determined, 95% received pharmacologic treatment, and 31% insulin therapy. 66% of patients on monotherapy attained A1C <7%, compared with 39% and 23% of those receiving double- and triple-oral therapy, respectively (p<0.001). Only 21% of patients on insulin therapy achieved A1c <7%. The worst-controlled patients were those receiving oral antidiabetic agents and insulin (24% had A1c levels ≥9%). CONCLUSIONS: A large proportion of patients are poorly controlled. Poor control increases according to complexity of treatment. A1c is underdetermined in many patients, likely related to clinical inertia.

Evaluación de la realización del cribado del pie diabético en Atención Primaria / Evaluation of diabetic foot screening in Primary Care

OBJETIVO: Conocer si se realiza el cribado del pie diabético en pacientes con diabetes tipo 2 atendidos en Atención Primaria y analizar qué factores relacionados con el paciente y el centro de salud se asocian a la cumplimentación de dicho cribado. MATERIAL Y MÉTODO: Estudio epidemiológico, transversal y multicéntrico. Se revisaron las historias clínicas de una muestra representativa (n = 443) de pacientes con diabetes tipo 2 que habían sido seguidos en Atención Primaria como mínimo en los 12 meses previos. Se registraron variables demográficas, de proceso asistencial y características del centro. RESULTADOS: El 51,2% de los pacientes recibieron educación sanitaria sobre el autocuidado del pie, al 56,4% se le realizó inspección de los pies, el 39,5% fueron explorados con monofilamento, y en el 45,8 y 10,1% se realizó palpación de pulsos periféricos e índice tobillo-brazo, respectivamente. El cribado del pie diabético (inspección, exploración de sensibilidad con monofilamento y palpación de pulsos periféricos) fue efectuado al 37% de los pacientes estudiados, y la estratificación del riesgo de úlceras se determinó en el 12,4% de los casos. Existe asociación entre realización del cribado y presencia de deformidades en el pie (p < 0,001), antecedentes de neuropatía (p = 0,005) y arteriopatía periférica (p < 0,05). También se asocia a algunas características del centro: recibir información sobre consecución de objetivos (p < 0,001), y percepción de incentivos económicos por cumplimiento de los mismos (p < 0,001). CONCLUSIONES: Se constata una deficiente atención a las personas con diabetes tipo 2 respecto a la prevención del pie diabético, pues no se realiza de forma rutinaria cribado y estratificación de riesgo

AIM: To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. MATERIAL AND METHODS: A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. RESULTS: In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P < .001), history of neuropathy (P = .005), and history of peripheral artery disease (P < .05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P < .001) and economic incentives for goal attainment (P < .001). CONCLUSIONS: Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor

Evaluation of diabetic foot screening in Primary Care.

AIM: To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. MATERIAL AND METHODS: A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. RESULTS: In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P<.001), history of neuropathy (P=.005), and history of peripheral artery disease (P<.05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P<.001) and economic incentives for goal attainment (P<.001). CONCLUSIONS: Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor.

Association of HbA1c and cardiovascular and renal disease in an adult Mediterranean population.

BACKGROUND: Increasing evidence suggests a mechanistic link between the glycemic environment and renal and cardiovascular events, even below the threshold for diabetes. We aimed to assess the association between HbA1c and chronic kidney disease (CKD) and cardiovascular disease (CVD). METHODS: A cross-sectional study involving a random representative sample of 2270 adults from southern Spain (Malaga) was undertaken. We measured HbA1c, serum creatinine and albuminuria in fasting blood and urine samples. RESULTS: Individuals without diabetes in the upper HbA1c tertile had an unfavorable cardiovascular and renal profile and shared certain clinical characteristics with the patients with diabetes. Overall, a higher HbA1c concentration was strongly associated with CKD or CVD after adjustment for traditional risk factors. The patients with known diabetes had a 2-fold higher odds of CKD or CVD. However, when both parameters were introduced in the same model, the HbA1c concentration was only significantly associated with clinical endpoints (OR: 1.4, 95% CI, 1.1-1.6, P = 0.002). An increase in HbA1c of one percentage point was associated with a 30% to 40% increase in the rate of CKD or CVD. This relationship was apparent in persons with and without known diabetes. ROC curves illustrated that a HbA1c of 37 mmol/mol (5.5%) was the optimal value in terms of sensitivity and specificity for predicting endpoints in this population. CONCLUSION: HbA1c levels were associated with a higher prevalence of CKD and CVD cross-sectionally, regardless of diabetes status. These data support the value of HbA1c as a marker of cardiovascular and renal disease in the general population.

Prevalence of metabolically discordant phenotypes in a mediterranean population-The IMAP study.

OBJECTIVE: To study the prevalence and correlates of body size phenotypes in an adult Spanish population. METHODS: We undertook a cross-sectional analysis in a random sample of 2,270 individuals. We defined six body size phenotypes based on body mass index category (normal-weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; obese, ≥30.0 kg/m2) and the presence of ≤1 (metabolically healthy) or ≥2 (metabolically abnormal) cardiometabolic abnormalities: metabolically healthy normal-weight (MHNW), metabolically abnormal normal-weight (MANW), metabolically healthy overweight (MHOW), metabolically abnormal overweight (MAOW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). We considered four cardiometabolic abnormalities: systolic and/or diastolic blood pressure ≥130/85 mm Hg, triglycerides ≥150 mg/dL, high-density-lipoprotein cholesterol levels <40/<50 mg/dL in men/women, and elevated glucose (fasting plasma glucose ≥100 mg/dL or previous diabetes). RESULTS: The prevalence of the MHO, MHOW, and MANW phenotypes was 2.2, 13.9, and 7.9%, respectively. Whereas 9.6% of obese and 32.6% of overweight individuals were metabolically healthy, 21.3% of the normal-weight subjects were metabolically abnormal. A multivariate regression model (adjusted for age, sex, and waist circumference) showed that age >40 years, male sex, and higher waist circumference were independently associated with the metabolically abnormal phenotype MANW, whereas younger age, female sex, and lower waist circumference were independently associated with the metabolically healthy phenotypes. CONCLUSION: The prevalence of MHO in our population is low and is more common in women and younger people. In contrast, a high proportion of normal-weight individuals (mainly over 40 years of age) in our population show cardiometabolic abnormalities.

Educational inequalities and cardiovascular risk factors. A cross-sectional population-based study in southern Spain.

OBJECTIVES: To determine the prevalence and distribution of modifiable cardiovascular risk factors focused on educational level differences, in an adult population in Southern Spain. DESIGN AND SAMPLE: Cross-sectional population-based study. Random sample from the adult population assigned to a Primary Health Care Centre in Málaga (Southern Spain), which attends 38,625 inhabitants. MEASURES: Level of education, physical activity, blood pressure, waist perimeter, body mass index, lipid profile, fasting plasma glucose, among others, were assessed. RESULTS: Final sample included 2,270 subjects with a mean age of 43.65 (SD: 16.65), 49.74% male and 50.26% female. 57.6% had none or only primary studies. Overweight was present in 55.8%, smokers were 27.6% and sedentary people 51.9%. Once adjusted by sex and age, all modifiable factors were lower in people with higher education. The highest risks were sedentarism (OR 1.95; 95% CI: 1.16-3.29) and hypertension (OR: 2.07 95% CI: 1.49-2.80) for those with lower education. CONCLUSIONS: There is a clear inverse gradient of cardiovascular risk factors and educational level in the study population. Public health and community nurses should develop strong interventions for this challenge and extend their influence to public policies focused on educational inequalities and health.

Riesgo vascular, diabetes e índice tobillo-brazo / Vascular risk, diabetes and the ankle-brachial index

No disponible

Why not use the HbA1c as a criterion of dysglycemia in the new definition of the metabolic syndrome? Impact of the new criteria in the prevalence of the metabolic syndrome in a Mediterranean urban population from Southern Europe (IMAP study. Multidisciplinary intervention in primary care).

We analysed the prevalence of metabolic syndrome (MS) of the new diagnostic criteria and the HbA1c to diagnose dysglycemia. We studied 2006 adults without cardiovascular disease or diabetes. The use of the new criteria and the HbA1c resulted in an increase in the population prevalence of MS.

Prevalencia de sobrepeso y obesidad en población adulta de un área de Salud Urbana / Prevalence of overweight and obesity in adults in an urban health area

Objetivo. Estimar la prevalencia de sobrepeso y obesidad en adultos de un área de salud urbana e identificar a grupos de alto riesgo cardiovascular (diabéticos e hipertensos) que puedan beneficiarse de una intervención enfermera sobre modificación de estilos de vida para reducir el peso. Método. Estudio transversal analítico realizado con una muestra aleatoria de 2.270 individuos obtenida a partir de la población adulta (18–80 años) perteneciente a un centro de salud. A todos los participantes se les realizó una historia clínica (incluyendo datos sociodemográficos), una exploración física y determinaciones analíticas. Resultados. El índice de masa corporal (IMC) medio se encontraba en el rango del sobrepeso (26,9±5,1kg/m2) y fue superior en varones. El 38% de la muestra tenía sobrepeso y el 22% obesidad. No se encontraron diferencias entre sexos en la prevalencia de obesidad, aunque las mujeres presentaron una mayor prevalencia de obesidad grados ii y iii. El sobrepeso fue más frecuente en los varones. La prevalencia de sobrepeso y obesidad aumenta con la edad. El 7% de la muestra (156 personas) presentaron diabetes, el 31% (707) tenían hipertensión arterial y en el 5% (111 personas) coincidían ambas patologías. El IMC fue significativamente mayor (p<0,001) en los pacientes con diabetes e hipertensión (31,4±5,3), hipertensión (29,7±5,2) y diabetes (28,5±4,6) que en aquellos que no tenían estas patologías (25,4±4,3). Conclusiones. En nuestra población existe una alta prevalencia de sobrepeso y obesidad siendo más elevada en pacientes con diabetes e hipertensión (AU)

Objective. To estimate prevalence of overweight and obesity in adults and to identify those individuals at high cardiovascular risk (subjects with type 2 diabetes or hypertension) in whom a nurse intervention might be beneficial in terms of life-style changes and reduction in body weight. Method. A cross-sectional study on 2270 adults (18–80 years-old) from an urban Primary Health Care Centre. Medical history, social and demographic data, physical examination and blood tests were collected. Results. The mean body mass index was 26.9±5.1kg/m2 and was found to be higher in men. Thirty-eight percent of subjects were overweight and 22% were obese. Although the prevalence of obesity was identical in both sexes, women had higher prevalences of type ii and iii obesity than men, but overweight was more frequent in men. Among those older than fifty years-old, 84% were overweight or obese. One-hundred and fifty-six (7%) subjects had type 2 diabetes and 707 (31%) had hypertension, and 111 (5%) subjects with both diabetes and hypertension. BMI was higher (P<0.001) in patients who suffered from, hypertension (29.7±5.2), diabetes (28.5±4.6), and diabetes and hypertension (31.4±5.3), than in those who did not suffer from these diseases (25.4±4.3). Conclusions. Obesity and overweight is highly prevalent in the population studied and is higher in patients with diabetes and hypertension (AU)

[Prevalence of overweight and obesity in adults in an urban health area]. / Prevalencia de sobrepeso y obesidad en población adulta de un área de Salud Urbana.

OBJECTIVE: To estimate prevalence of overweight and obesity in adults and to identify those individuals at high cardiovascular risk (subjects with type 2 diabetes or hypertension) in whom a nurse intervention might be beneficial in terms of life-style changes and reduction in body weight. METHOD: A cross-sectional study on 2270 adults (18-80 years-old) from an urban Primary Health Care Centre. Medical history, social and demographic data, physical examination and blood tests were collected. RESULTS: The mean body mass index was 26.9±5.1kg/m(2) and was found to be higher in men. Thirty-eight percent of subjects were overweight and 22% were obese. Although the prevalence of obesity was identical in both sexes, women had higher prevalences of type ii and iii obesity than men, but overweight was more frequent in men. Among those older than fifty years-old, 84% were overweight or obese. One-hundred and fifty-six (7%) subjects had type 2 diabetes and 707 (31%) had hypertension, and 111 (5%) subjects with both diabetes and hypertension. BMI was higher (P<0.001) in patients who suffered from, hypertension (29.7±5.2), diabetes (28.5±4.6), and diabetes and hypertension (31.4±5.3), than in those who did not suffer from these diseases (25.4±4.3). CONCLUSIONS: Obesity and overweight is highly prevalent in the population studied and is higher in patients with diabetes and hypertension.

Enfermedad arterial periférica oculta en población diabética seguida en atención primaria / Occult peripheral arterial disease in patients with type 2 diabetes in primary care

Introducción El objetivo del estudio fue estimar la prevalencia de enfermedad arterial periférica (EAP) no diagnosticada, mediante el índice tobillo-brazo (ITB), en pacientes diabéticos tipo 2 de una zona urbana seguidos en Atención Primaria (AP) y los factores asociados a la misma. Métodos Estudio descriptivo transversal (de prevalencia). Muestreo aleatorio sistemático de pacientes diabéticos tipo 2, entre 50–80 años, seguidos en AP. Nuestra variable dependiente fue la presencia de EAP diagnosticada mediante un ITB<0,9. Variables independientes: demográficas, clínicas y de laboratorio. Para determinar las variables asociadas a un ITB patológico se utilizó la regresión logística binaria por pasos hacia adelante. Resultados Muestra de 456 pacientes, de los que 243 (53%) eran hombres, con una edad media de 61±6 años. Presentaron ITB<0,9: 126 pacientes (27,6%), ITB entre 0,9 y 1,3: 310 pacientes (68%) y un ITB>1,3: 20 pacientes (4,4%). Mediante análisis multivariante las variables relacionadas con un ITB<0,9 fueron el ser o haber sido fumador, los años de evolución de la diabetes, el número de plaquetas y la hipertrigliceridemia, mientras que con un ITB>1,3 fueron el perímetro de cintura y las complicaciones microvasculares. Conclusiones La prevalencia de enfermedad arterial periférica es elevada en diabéticos tipo 2, consistente con lo publicado. Esta alta prevalencia de ITB alterado refuerza la recomendación de realizar el índice tobillo-brazo a todos los diabéticos tipo 2 mayores de 50 años valorados y seguidos en AP (AU)

Introduction The aim of our study was to estimate the prevalence and associated factors of occult peripheral arterial disease (PAD) assessed by the ankle-brachial index (ABI) in subjects with type 2 diabetes mellitus followed up in a single urban Primary Care Center. Methods This is a cross-sectional study involving subjects who were sampled randomly from patients with type 2 diabetes and aged 50 to 80 years-old. The dependent variable was the presence of PAD, assessed by an ABI below 0.9. Demographic, clinical and laboratory parameters were also recorded. A forward, stepwise, logistic binary regression was built in order to examine variables associated with abnormal ABI.ResultsFour-hundred and fifty-six patients were included; they were 61±6 years-old, of which 243 (53%) were men. An ABI<0.9 was found in 126 patients (27.6%), 310 (68%) patients had an ABI 0.9–1.3 and only 20 patients (4.4%) had and ABI higher than 1.3. Using multivariate analyses, past or present smoking, duration of diabetes, platelet count and hypertriglyceridemia, were independently associated to PAD; on the contrary, only waist cincumference and the presence of microvascular disease were associated to an ABI higher than 1.3.Conclusion The prevalence of PAD was high and consistent with the literature, thus reinforcing the measurement of ABI for all patients with type 2 diabetes followed up in primary care. Smoking, duration of diabetes, platelet count and hypertriglyceridemia were independently associated to a low ABI (AU)