Ten-year fatal and non-fatal myocardial infarction incidence in elderly populations in Spain: the EPICARDIAN cohort study.

BACKGROUND: In Spain, more than 85% of coronary heart disease deaths occur in adults older than 65 years. However, coronary heart disease incidence and mortality in the Spanish elderly have been poorly described. The aim of this study is to estimate the ten-year incidence and mortality rates of myocardial infarction in a population-based large cohort of Spanish elders. METHODS: A population-based cohort of 3729 people older than 64 years old, free of previous myocardial infarction, was established in 1995 in three geographical areas of Spain. Any case of fatal and non-fatal myocardial infarction was investigated until December 2004 using the "cold pursuit method", previously used and validated by the the WHO-MONICA project. RESULTS: Men showed a significantly (p < 0.001) higher cumulative incidence of myocardial infarction (7.2%; 95%CI: 5.94-8.54) than women (3.8%; 95%CI: 3.06-4.74). Although cumulative incidence increased with age (p < 0.05), gender-differences tended to narrow. Adjusted incidence rates were higher in men (957 per 100 000 person-years) than in women (546 per 100 000 person-years) (p < 0.001) and increased with age (p < 0.001). The increase was progressive in women but not in men. Adjusted mortality rates were also higher in men than in women (p < 0.001), being three times higher in the age group of > or = 85 years old than in the age group of 65-74 years old (p < 0.001). CONCLUSION: Incidence of fatal and non-fatal myocardial infarction is high in the Spanish elderly population. Men show higher rates than women, but gender differences diminish with age.

[Ten-year incidence of fatal and non-fatal myocardial infarction in the elderly population of Madrid]. / Incidencia a diez años de infarto de miocardio fatal y no fatal en la población anciana de Madrid.

INTRODUCTION AND OBJECTIVES: To determine the incidence of and mortality due to myocardial infarction and coronary heart disease in the elderly population of Madrid, Spain. METHODS: The study involved a population-based cohort of 1297 individuals aged over 64 years without cardiovascular disease who were recruited in 1995. All cases of fatal and non-fatal myocardial infarction recorded up until December 2004 were investigated and classified using WHO-MONICA (World Health Organization-Multinational MONItoring of trends and determinants in CArdiovascular disease) criteria. RESULTS: Men had a significantly higher cumulative incidence of ischemic events (P< .001) and sudden death (P< .001), and a non-significantly higher risk of myocardial infarction (6.30%; 95% confidence interval [CI], 4.33%-8.76%) than women (4.90%; 95% CI, 3.54%-6.70%; P=.181). While the risk of myocardial infarction increased with age (P< .05), gender differences tended to narrow. The incidence was higher in men (889/100 000 person-years) than women (610/100,000 person-years; P< .001) and increased with age (P< .01). This increase was progressive in women but not in men. The mortality rate was also higher in men (472/100,000 person-years; 95% CI, 248-697) than women (328/100,000 person-years; 95% CI, 188-469; P< .001), and was six times higher in the 385-year-old age group than in those aged 65-74 years (P< .001). CONCLUSIONS: The incidence of fatal and non-fatal myocardial infarction was very high in the elderly population of Madrid. Both incidence and mortality rates increased dramatically with age after 64 years. Rates were higher in men than women at all ages, though gender differences decreased with age.

Incidencia a diez años de infarto de miocardio fatal y no fatal en la población anciana de Madrid / Ten-year incidence of fatal and non-fatal myocardial infarction in the elderly population of Madrid

Introducción y objetivos. Estimar las tasas de incidencia y mortalidad por infarto de miocardio (IM) y enfermedad coronaria (EC) en la población anciana de Madrid. Métodos. En 1995 se estableció una cohorte de base poblacional formada por 1.297 individuos de edad superior a 64 años y sin enfermedades cardiovasculares. Se investigaron todos los casos de infarto de miocardio mortales y no mortales hasta diciembre de 2004 y se clasificaron según los criterios OMS-MONICA. Resultados. Los varones presentaron incidencias acumulativas significativamente superiores de episodios isquémicos (p < 0,001) y de muerte súbita (p < 0,001), así como un riesgo de infarto de miocardio superior, aunque no significativamente (6,3%; intervalo de confianza [IC] del 95%, 4,33%-8,76%), a los de las mujeres (4,9%; IC del 95%, 3,54%-6,7%) (p = 0,181). Aunque el riesgo de infarto de miocardio aumentaba con la edad (p < 0,05), las diferencias entre los dos sexos tendían a reducirse. Las tasas de incidencia fueron mayores en los varones (889/100.000 personas-años) que en las mujeres (610/100.000 personas-años) (p < 0,001) y con la edad más avanzada (p < 0,01). Este aumento era progresivo en las mujeres, pero no en los varones. Las tasas de mortalidad fueron también más altas entre los varones (472; IC del 95%, 248-697) que entre las mujeres (328; IC del 95%, 188-469) (p < 0,001), con unos valores en el grupo de edad 3 85 años 6 veces superiores a los del grupo de edad de 65-74 años (p < 0,001). Conclusiones. La incidencia de infarto de miocardio mortal y no mortal es muy alta en la población anciana de Madrid. Las tasas de incidencia y de mortalidad aumentan de manera muy notable con la edad a partir de los 64 años. Los varones presentan unas tasas más altas que las mujeres de cualquier edad, pero las diferencias entre los sexos disminuyen con la edad (AU)

Introduction and objectives. To determine the incidence of and mortality due to myocardial infarction and coronary heart disease in the elderly population of Madrid, Spain. Methods. The study involved a population-based cohort of 1297 individuals aged over 64 years without cardiovascular disease who were recruited in 1995. All cases of fatal and non-fatal myocardial infarction recorded up until December 2004 were investigated and classified using WHO-MONICA (World Health Organization-Multinational MONItoring of trends and determinants in CArdiovascular disease) criteria. Results. Men had a significantly higher cumulative incidence of ischemic events (P<.001) and sudden death (P<.001), and a non-significantly higher risk of myocardial infarction (6.30%; 95% confidence interval [CI], 4.33-8.76) than women (4.90%; 95% CI, 3.54-6.70; P=.181). While the risk of myocardial infarction increased with age (P<.05), gender differences tended to narrow. The incidence was higher in men (889/100 000 person-years) than women (610/100 000 person-years; P<.001) and increased with age (P<.01). This increase was progressive in women but not in men. The mortality rate was also higher in men (472/100 000 person-years; 95% CI, 248-697) than women (328/100 000 person-years; 95% CI, 188-469; P<.001), and was 6 times higher in the ≥85-year-old age group than in those aged 65-74 years (P<.001). Conclusions. The incidence of fatal and non-fatal myocardial infarction was very high in the elderly population of Madrid. Both incidence and mortality rates increased dramatically with age after 64 years. Rates were higher in men than women at all ages, though gender differences decreased with age (AU)

Prevalencia, distribución y variabilidad geográfica de los principales factores de riesgo cardiovascular en España. Análisis agrupado de datos individuales de estudios epidemiológicos poblacionales: estudio ERICE / Prevalence, geographic distribution and geographic variability of major cardiovascular risk factors in Spain. Pooled analysis of data from population-based epidemiological studies: the ERICE study

Introducción y objetivos. La insuficiencia cardiaca congestiva (ICC) tiene elevadas incidencia, morbilidad y mortalidad y una gran prevalencia. Sin embargo, no hay datos directos sobre este aspecto en nuestro país. El objetivo de nuestro estudio es evaluar la prevalencia de ICC en España. Métodos. Se diseñó un estudio poblacional en el que participaron 15 centros repartidos por toda España. Se seleccionó de forma aleatoria una muestra de la población de 45 o más años de edad atendida en cada área de salud, que fue estudiada por sus médicos de atención primaria. Se utilizaron los criterios de Framingham para el diagnóstico. Las personas con criterios de ICC fueron remitidas a una consulta de cardiología para confirmación diagnóstica y realización de ecocardiograma. Resultados. Se evaluó a 1.776 personas, con una media ± desviación estándar (intervalo) de edad de 64 ± 12 (45-100) años; eran varones el 44%. Se remitió a cardiología a 242 pacientes. La prevalencia ponderada de ICC fue del 6,8% (intervalo de confianza [IC] del 95%, 4%-8,7%). La prevalencia fue similar en varones (6,5%; IC del 95%, 4,7%-8,4%) y en mujeres (7%; IC del 95%, 4,4%-9,6%). Por edades, la prevalencia fue del 1,3% (0,4%-2,1%) entre los 45 y 54 años; el 5,5% (2,4%-8,5%) entre 55 y 64 años; el 8% (4,2%-11,8%) entre 65 y 74 años, y el 16,1% (11%-21,1%) en personas de 75 o más años. Conclusiones. La prevalencia de ICC en España es alta, en torno a un 7-8%. La prevalencia es similar en varones y mujeres, y parece aumentar con la edad (AU)

Introduction and objectives. Congestive heart failure is associated with substantial morbidity and mortality and both its incidence and prevalence are high. Nevertheless, comprehensive data on this condition in Spain are lacking. The aim of this study was to determine the prevalence of congestive heart failure in Spain. Methods. A demographic study which involved the participation of 15 healthcare centers throughout Spain was carried out. In each health area, a random sample was taken of the population aged 45 years or more. These individuals were examined by their primary care physicians, who made their diagnoses using Framingham criteria. Individuals who satisfied criteria for congestive heart failure were referred to a cardiologist for confirmation of the diagnosis and for echocardiography. Results. Overall, 1776 individuals were evaluated. Their mean age was 64±12 years (range, 45-100 years) and 44% were male. Of these, 242 were referred to a cardiologist. The weighted prevalence of congestive heart failure was 6.8% (95% confidence interval [CI] 4-8.7). The prevalence was similar in men (6.5%, 95% CI 4.7-8.4) and women (7%, 95% CI 4.4-9.6). When analyzed by age, the prevalence was 1.3% (0.4%-2.1%) in those aged 45-54 years, 5.5% (2.4%-8.5%) in those aged 55-64 years, 8% (4.2%-11.8%) in those aged 65-74 years, and 16.1% (11%-21.1%) in those aged over 74 years. Conclusions. Prevalence of congestive heart failure in Spain is high, at about 7%-8%. The prevalence was similar in males and females, and appeared to increase with age (AU)

Prevalence, geographic distribution and geographic variability of major cardiovascular risk factors in Spain. Pooled analysis of data from population-based epidemiological studies: the ERICE Study.

INTRODUCTION AND OBJECTIVES: To determine the prevalence and geographic distribution of major cardiovascular risk factors in the Spanish population. To investigate whether geographic variability exists. METHODS: Data were pooled from eight cross-sectional epidemiologic studies carried out in Spain between 1992 and 2001 whose methodological quality satisfied predefined criteria. Individual data were reassessed and analyzed by age group (20-44 years, 45-64 years, and 365 years), sex and geographic area. The study population included 19,729 individuals. Mean values and unadjusted and adjusted prevalence rates were derived for various risk factors. RESULTS: The most common cardiovascular risk factors in the Spanish population were, in descending order: hypercholesterolemia (i.e., total cholesterol >200 mg/dL) in 46.7%, hypertension in 37.6%, smoking in 32.2%, obesity in 22.8%, and diabetes mellitus in 6.2%. The mean values for blood pressure, body mass index, high-density lipoprotein cholesterol and glycemia varied considerably with age, sex and geographic area. The highest levels of cardiovascular risk factors were observed in Mediterranean and south-eastern areas of the country and the lowest, in northern and central areas. CONCLUSIONS: The prevalence of major cardiovascular risk factors in Spain was high. Their distribution varied considerably with geographic area.