[Effect of cardiovascular risk factors on long-term morbidity and mortality following acute myocardial infarction]. / Efecto de los factores de riesgo cardiovascular sobre la morbimortalidad a largo plazo después de un infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: Generally, cardiovascular risk factors are poorly controlled after myocardial infarction. The objective of this study was to determine the effect of these risk factors on long-term morbidity and mortality in patients experiencing a myocardial infarction. METHODS: In total, 655 acute myocardial infarction survivors recorded in the IBERICA database for the Spanish province of Albacete were followed up. Provincial healthcare center databases and the regional death registry were consulted, and semistructured interviews were carried out. Bivariate and multivariate descriptive and comparative statistical analyses were performed. RESULTS: The median follow-up period was 5.5 years. At the end of the study, 74% of patients had hypertension or hypercholesterolemia, 39% had diabetes, 36% were obese, 13% smoked, and 1% were alcoholics. Overall, 48% of patients experienced a cardiovascular event. Uncontrolled hypercholesterolemia was found to be a risk factor for angina (odds ratio [OR]=2.4, 95% confidence interval [CI], 1.1-5.1), and uncontrolled diabetes was a risk factor for reinfarction (OR=3.5, 95% CI, 1.6-7.6) and stroke (OR=10.6, 95% CI, 3.6-31.2), both of which occurred earlier in patients with uncontrolled diabetes. In total, 115 (18%) patients died, with more than 50% of deaths being due to cardiovascular causes. Uncontrolled hypertension and diabetes were the most important risk factors for both overall and early mortality, whereas controlled hypercholesterolemia appeared to be a protective factor. CONCLUSIONS: The prevalence of cardiovascular risk factors in patients who have experienced a myocardial infarction is very high. Control of these risk factors influences both cardiovascular events and long-term mortality.

Efecto de los factores de riesgo cardiovascular sobre la morbimortalidad a largo plazo después de un infarto agudo de miocardio / Effect of cardiovascular risk factors on long-term morbidity and mortality following acute myocardial infarction

Introducción y objetivos. El control de los factores de riesgo cardiovascular después de un infarto de miocardio no es apropiado. El objetivo es estudiar su efecto sobre la morbimortalidad a largo plazo en pacientes con infarto de miocardio. Métodos. Se realizó el seguimiento a 655 pacientes que sobrevivieron a la fase aguda de un infarto de miocardio (registro IBERICA Albacete) mediante la revisión de los centros sanitarios de la provincia y el boletín regional de defunciones, además de realizar una entrevista semiestructurada. El análisis estadístico fue descriptivo y comparativo, bivariable y multivariable. Resultados. La mediana de seguimiento fue de 5,5 años. Al finalizar, el 74% presentaba hipertensión arterial o hipercolesterolemia, el 39% diabetes mellitus, el 36% obesidad, el 13% tabaquismo y el 1% alcoholismo. El 48% presentó algún evento cardiovascular. La hipercolesterolemia no controlada fue el factor implicado en la aparición de angina (odds ratio [OR] = 2,4; intervalo de confianza [IC] del 95%, 1,1-5,1) y la diabetes no controlada, en la aparición de reinfarto (OR = 3,5; IC del 95%, 1,6-7,6) e ictus (OR = 10,6; IC del 95%, 3,6-31,2). Además, ambos se presentaron de forma más temprana en pacientes diabéticos no controlados. Fallecieron 115 pacientes (18%) y la etiología fue cardiovascular en más del 50%. La hipertensión arterial y la diabetes no controladas fueron los factores con un mayor riesgo de muerte y de experimentarla más tempranamente; mientras que la hipercolesterolemia controlada se comportó como un factor protector. Conclusiones. La prevalencia de los factores de riesgo en pacientes con infarto de miocardio es alta y su control está relacionado tanto con la presencia de eventos cardiovasculares como con la letalidad a largo plazo (AU)

Introduction and objectives. Generally, cardiovascular risk factors are poorly controlled after myocardial infarction. The objective of this study was to determine the effect of these risk factors on long-term morbidity and mortality in patients experiencing a myocardial infarction. Methods. In total, 655 acute myocardial infarction survivors recorded in the IBERICA database for the Spanish province of Albacete were followed up. Provincial healthcare center databases and the regional death registry were consulted, and semistructured interviews were carried out. Bivariate and multivariate descriptive and comparative statistical analyses were performed. Results. The median follow-up period was 5.5 years. At the end of the study, 74% of patients had hypertension or hypercholesterolemia, 39% had diabetes, 36% were obese, 13% smoked, and 1% were alcoholics. Overall, 48% of patients experienced a cardiovascular event. Uncontrolled hypercholesterolemia was found to be a risk factor for angina (odds ratio [OR]=2.4, 95% confidence interval [CI], 1.1-5.1), and uncontrolled diabetes was a risk factor for reinfarction (OR=3.5, 95% CI, 1.6-7.6) and stroke (OR=10.6, 95% CI, 3.6-31.2), both of which occurred earlier in patients with uncontrolled diabetes. In total, 115 (18%) patients died, with more than 50% of deaths being due to cardiovascular causes. Uncontrolled hypertension and diabetes were the most important risk factors for both overall and early mortality, whereas controlled hypercholesterolemia appeared to be a protective factor. Conclusions. The prevalence of cardiovascular risk factors in patients who have experienced a myocardial infarction is very high. Control of these risk factors influences both cardiovascular events and long-term mortality (AU)

Efficacy of two peroxygen-based disinfectants for inactivation of Cryptosporidium parvum oocysts.

Two commercial peroxygen-based disinfectants containing hydrogen peroxide plus either peracetic acid (Ox-Virin) or silver nitrate (Ox-Agua) were tested for their ability to inactivate Cryptosporidium parvum oocysts. Oocysts were obtained from naturally infected goat kids and exposed to concentrations of 2, 5, and 10% Ox-Virin or 1, 3, and 5% Ox-Agua for 30, 60, and 120 min. In vitro excystation, vital dyes (4',6'-diamidino-2-phenylindole and propidium iodide), and infectivity in neonatal BALB/c mice were used to assess the viability and infectivity of control and disinfectant-treated oocysts. Both disinfectants had a deleterious effect on the survival of C. parvum oocysts, since disinfection significantly reduced and in some cases eliminated their viability and infectivity. When in vitro assays were compared with an infectivity assay as indicators of oocyst inactivation, the excystation assay showed 98.6% inactivation after treatment with 10% Ox-Virin for 60 min, while the vital-dye assay showed 95.2% inactivation and the infectivity assay revealed 100% inactivation. Treatment with 3% Ox-Agua for 30 min completely eliminated oocyst infectivity for mice, although we were able to observe only 74.7% inactivation as measured by excystation assays and 24.3% with vital dyes (which proved to be the least reliable method for predicting C. parvum oocyst viability). These findings indicate the potential efficacy of both disinfectants for C. parvum oocysts in agricultural settings where soil, housing, or tools might be contaminated and support the argument that in comparison to the animal infectivity assay, vital-dye and excystation methods overestimate the viability of oocysts following chemical disinfection.