Validación externa de las ecuaciones europea y americana para el cálculo del riesgo cardiovascular en población laboral española / Validación externa de las ecuaciones europea y americana para el cálculo del riesgo cardiovascular en población laboral española External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population

Objetivo Validar externamente los modelos europeo y norteamericano de cálculo de riesgo cardiovascular en prevención primaria. Métodos Estudio transversal de una cohorte nacional de población laboralmente activa. Se incluyeron trabajadores sin antecedentes de enfermedad cardiovascular que acudieron a una revisión laboral entre los años 2004 y 2007, y se siguieron hasta 2017. Resultados Participaron 244.236 sujetos. El 24,5% eran mujeres, la edad media se situó en 48,10 años (DE 6,26). El riesgo medio según el modelo europeo SCORE fue de 1,70 (DE 1,81) para hombres y de 0,37 (DE 0,53) para mujeres. Según el modelo norteamericano PCE, el riesgo medio fue de 6,98 (DE 5,66) para hombres y de 1,97 (DE 1,96) para mujeres. Se registró un total de 1.177 eventos (0,51%) considerados en la calculadora SCORE, y un total de 2.330 eventos (1%) considerados según las PCE. El estadístico C de Harrell fue de 0,746 (SCORE) y 0,725 (PCE). La sensibilidad y especificidad para el punto de corte del 5% en SCORE fue del 17,59% (IC95% 15,52-19,87%) y 95,68% (IC95% 95,59-95,76%) y para el punto de corte del 20% de las PCE de 9,06% (IC95% 7,96-10,29%) y 97,55% (IC95% 97,48-97,61%), respectivamente. Conclusiones Las tablas europeas del SCORE y americanas de las PCE sobreestiman el riesgo en nuestra población, manteniendo una discriminación aceptable. SCORE mostró mejores índices de validez que las PCE. El perfil de riesgo de las poblaciones va cambiando, por lo que es necesario ir actualizando las ecuaciones que incluyan información de poblaciones más contemporáneas (AU)

Objective This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. Methods This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until 2017. Results A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1,177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. Conclusions The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations (AU)

Prevalencia de la miocardiopatía hipertrófica en una amplia muestra de la población laboral española / Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population

Antecedentes y objetivo En España no existen estudios que hayan evaluado la prevalencia de la miocardiopatía hipertrófica en la población general. El objetivo de este trabajo fue evaluar la prevalencia de la miocardiopatía hipertrófica en una muestra amplia de la población laboral española. Materiales y métodos Se incluyó a 13.179 trabajadores (73% varones, con una edad media de 40 años) de 5 regiones españolas a los que, entre mayo de 2008 y noviembre de 2010, se les realizó un reconocimiento médico con un electrocardiograma. Se derivó a los trabajadores con alteraciones sugestivas en el electrocardiograma o con antecedentes médicos predisponentes (síncope de esfuerzo o muerte súbita en familiar menor de 50 años) para una evaluación ecocardiográfica. Se definió miocardiopatía hipertrófica a la presencia de un grosor parietal igual o mayor a 13mm en cualquier segmento del ventrículo izquierdo. Se estimó la prevalencia de la miocardiopatía hipertrófica en toda la muestra y en los trabajadores no hipertensos. Resultados Se seleccionó a 1.008 trabajadores para el ecocardiograma, aunque solo 496 (49,2% de los seleccionados) acudieron a la prueba. Tras el ecocardiograma se detectaron 16 casos de miocardiopatía hipertrófica y se estimó una prevalencia del 0,24% en el total de la muestra. En el subgrupo de trabajadores no hipertensos se objetivaron 10 casos de miocardiopatía hipertrófica, que se corresponden con una prevalencia estimada del 0,19%. Conclusiones En nuestra muestra de la población laboral española la prevalencia estimada de miocardiopatía hipertrófica fue del 0,24%. En el subgrupo de pacientes no hipertensos la prevalencia estimada fue del 0,19% (AU)

Background and objectives To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. Materials and methods The study included 13,179 workers (73% men; mean age, 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. Results A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. Conclusions In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19% (AU)

External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population.

INTRODUCTION AND OBJECTIVE: This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. METHODS: This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until December 2017. RESULTS: A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. CONCLUSIONS: The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations.

Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population.

BACKGROUND AND OBJECTIVES: To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. MATERIALS AND METHODS: The study included 13,179 workers (73% men; mean age: 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. RESULTS: A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. CONCLUSIONS: In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19%.

Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population. / Prevalencia de la miocardiopatía hipertrófica en una amplia muestra de la población laboral española.

BACKGROUND AND OBJECTIVES: To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. MATERIALS AND METHODS: The study included 13,179 workers (73% men; mean age, 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. RESULTS: A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. CONCLUSIONS: In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19%.

Estimating the impact of obesity and metabolic phenotype on sickness absence. Results from the ICARIA study.

BACKGROUND AND AIMS: To assess the impact of obesity and being overweight on sickness absence (SA) as a function of healthy/unhealthy metabolic phenotype. METHODS AND RESULTS: A total of 173 120 healthy workers who underwent a routine check-up, consisting of a structured interview, anthropometric measurements and blood pressure and fasting blood analysis, were included as the study sample (67.1% males; 49.2% manual workers; mean age 40.6 ± 21.9 years). Workers were classified according to their body mass index (BMI) and metabolic phenotype. A metabolically unhealthy phenotype was defined as the presence of three or more of the following criteria: glycaemia ≥110 mg/dL or previously diagnosed type I/II diabetes or treatment for diabetes; triglycerides ≥150 mg/dL or lipid-lowering therapy; HDL <40/50 mg/dL M/F; blood pressure ≥130/85 mmHg or previously diagnosed hypertension or antihypertensive therapy; waist circumference >102/88 cm M/F. A one-year follow-up was conducted to evaluate the incidence of work-related and non-work-related SA (WRSA/NWRSA). The association of BMI with SA was tested using Poisson regression (standard error correction), segmenting on the basis of metabolic phenotype. The overall percentages of workers who were overweight, obese and/or had a metabolically unhealthy phenotype were 37.7%, 16.3% and 8.8%, respectively. BMI was associated with increased incidence of NWRSA in both phenotypes. It was also associated with WRSA in subjects with a BMI in the range of 35-39.99 kg/m2 and in metabolically healthy individuals. WRSA was lower in subjects with a BMI ≥40 kg/m2 and among metabolically unhealthy individuals. CONCLUSION: Obesity is associated with health problems that have a significant impact on SA.

Root caries analysis in working population of 35-44 years of age (Spain).

BACKGROUND: The aim of this study was to analyse the influence of socio-demographic variables, toothbrushing frequency, frequency of snacking between meals, and tobacco and alcohol consumption, in root caries in the Spanish working population of Valencia and Murcia regions. MATERIAL AND METHODS: Cross sectional study of 458 workers 35-44 years of age, who underwent a routine work-related check-up, from June 2009 to April 2010, and were also examined, following the WHO methodology, by a calibrated dentist. Stratified random sampling. Participants fulfilled a questionnaire comprising demographic data, toothbrushing frequency, snacking frequency and tobacco and alcohol consumption. RESULTS: The DFS index (root caries) in the employed population of 35-44 years was 0.45 ± 1.3, with a root caries prevalence of 18.6% and an active root caries prevalence of 13.5%. Higher root caries prevalence and active root caries prevalence were associated with male gender, manual occupations, foreign country of origin, lower levels of education and income, lower brushing frequency and higher frequency of snacking between meals. The DFS index was associated with all studied socio-demographic variables, but gender, and it was also associated with brushing frequency. The mean number of root decayed teeth was associated with all socio-demographic variables, but country of origin, and it was also associated with brushing frequency. CONCLUSIONS: Adult workers 35-44 years of age showed worse root condition in regard to caries than general population of this age cohort. In this study, the frequency of toothbrushing and snacking between meals were the variables that influenced more in root caries.

The effect of multimorbidity on sickness absence by specific diagnoses.

BACKGROUND: As the world's population ages, the prevalence of multiple chronic and non-chronic health-related conditions is increasing. Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly involved patient and older populations. Its effect in working populations, presumably younger and healthier, is not well known but could conceivably affect sickness absence (SA) and ability to return to work. AIMS: To examine the effect of multimorbidity on the incidence and duration of SA episodes by frequent diagnostic groups. METHODS: A prospective study (in 2006-2008) of workers in Spain. Information on health-related conditions was gathered with a standardized questionnaire and used to construct a sex-specific multidimensional multimorbidity score (MDMS). In order to estimate the effect of MDMS on incidence and duration of SA episodes due to cardiovascular diseases (CVD), musculoskeletal disorders (MSD) and mental health disorders (MHD), we fitted Cox models adjusted by age, occupational social class and number of prior SA episodes for both sexes. RESULTS: The study population was 372370. Men with high MDMS showed a trend towards higher incidence risk for SA due to CVD and MSD [adjusted hazard ratio (aHR) = 2.03; 95% confidence interval (CI) 1.48-2.78 and aHR = 1.20; 95% CI 1.01-1.43, respectively]. Women showed a similar trend for MSD, but MHD had the strongest association (aHR = 4.78; 95% CI 1.97-11.62) for high MDMS. In both sexes, the effect of MDMS was strongest among those without a prior SA. No consistent associations with SA duration were observed. CONCLUSIONS: Multimorbidity increased the risk of incident musculoskeletal, mental and cardiovascular SA episodes but not their duration.

Variación estacional del peso en población trabajadora / Seasonal variation in weight in a working population

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Promoción de la salud desde el lugar de trabajo / Health promotion at the workplace

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The impact of poor psychosocial work environment on non-work-related sickness absence.

PURPOSE: We aimed to analyse the impact of psychosocial work environment on non-work-related sickness absence (NWRSA) among a prospective cohort study, stratified using a random sampling technique. METHODS: Psychosocial variables were assessed among 15,643 healthy workers using a brief version of the Spanish adaptation of Copenhagen Psychosocial Questionnaire. A one year follow-up assessed the total count of NWRSA days. Zero-inflated negative binomial regression was used for multivariate analyses. RESULTS: After adjusting for covariates, low levels of job control and possibilities for development (Odds Ratio [OR]: 1.17; 95% CI: 1.01-1.36 [men]; OR: 1.39 95% CI: 1.09-1.77 [women]), poor social support and quality of leadership (OR: 1.29; 95% CI: 1.11-1.50 [men]; OR: 1.28; 95% CI: 1.01-1.63 [women]), and poor rewards (OR: 1.34; 95% CI: 1.14-1.57 [men]; OR: 1.30; 95% CI: 1.01-1.66 [women]) predicted a total count of sickness absence greater than zero, in both men and women. Double presence was also significantly associated with NWRSA different than 0, but only among women (OR: 1.40; 95% CI: 1.08-1.81). Analyses found no association between psychosocial risk factors at work and the total count (i.e., number of days) of sickness absences. CONCLUSIONS: The results suggest that work-related psychosocial factors may increase the likelihood of initiating an NWRSA episode, but were not associated with the length of the sickness absence episode. Among our large cohort we observed that some associations were gender-dependent, suggesting that future research should consider gender when designing psychosocial interventions aimed at decreasing sickness absences.

Prevalence of atherogenic dyslipidemia: association with risk factors and cardiovascular risk in Spanish working population. "ICARIA" study.

OBJECTIVE: The aim of this study was to assess the prevalence of atherogenic dyslipidemia (AD) and the lipid triad (LT) in the working population in Spain, their associated variables and how far they are linked to cardiovascular risk (CVR). METHODS: Observational cross-sectional study of 70,609 workers (71.5% male (M), 28.5% female (F), mean age 39.2 ± 10), who attended medical checkups and agreed to participate. Plasma samples were analysed in a central laboratory. AD definition used was: triglycerides ≥150 mg/dl and HDL cholesterol <40 mg/dl (M)/<50 mg/dl (F) and LT when LDL cholesterol > 160 mg/dl is further added. Univariate comparisons in the absence and presence of AD and LT and the probability of AD according to different parameters and their possible association with CVR were assessed. CVR was stratified following the European SCORE model for low risk-population. RESULTS: 5.7% (95% CI 4.7-6.9) of the working population have AD and 1.1% (95% CI 1.0-1.2) LT. In univariate analysis, workers with AD and LT had a higher prevalence of obesity, hypertension, smoking and diabetes than those who had not (p < 0.001). In multivariate analysis, BMI, sex, age 40-49, diabetes, tobacco, uric acid, LDL or blood pressure significantly influenced the risk of AD. AD was significantly associated with CVR after adjusting for alcohol and obesity. However, most of the AD subjects (91.8%) were classified as low risk. CONCLUSIONS: About 6% of the working population in Spain meets AD criteria. Assuming that these subjects have increased CVR, AD allows to identify additional 5% of subjects with increased CVR to that one the SCORE model detects, helping to improve cardiovascular risk stratification.

Long-term sickness absence due to adjustment disorder.

BACKGROUND: Although adjustment disorder is frequently reported in clinical settings, scientific evidence is scarce regarding its impact on sickness absence and the variables associated with sickness absence duration. AIMS: To report sickness absence duration and to identify predictors of long-term sickness absence in patients with adjustment disorder. METHODS: This observational, prospective study included subjects with non-work-related sickness absence (>15 days) after a diagnosis of adjustment disorder. A stepwise logistic regression analysis was conducted to identify the best predictors of long-term sickness absence (≥ 6 months). RESULTS: There were 1182 subjects in the final analysis. The median duration of sickness absence due to adjustment disorder was 91 days. Twenty-two per cent of the subjects reported long-term sickness absence. After multivariate analysis, comorbidity (OR = 2.23, 95% CI 1.43-3.49), age (25-34 years old versus <25 years old: OR = 2.78, 95% CI 1.27-6.07; 35-44 years old versus <25 years old: OR = 3.70, 95% CI 1.71-7.99; 45-54 years old versus <25 years old: OR = 3.58, 95% CI 1.60-8.02; ≥ 55 years old versus <25 years old: OR = 6.35, 95% CI 2.64-15.31) and occupational level (blue collar versus white collar: OR = 1.52, 95% CI 1.10-2.09) remained significantly associated with long-term sickness absence. Comorbidity was the strongest predictor. CONCLUSIONS: It is possible to predict long-term sickness absence due to adjustment disorder on the basis of demographic, work-related and clinical information available during the basic assessment of the patient.

Variables moduladoras de la discapacidad asociada al trastorno depresivo / Modulating variables of work disability in depressive disorders

Objetivos. Describir la duración de la incapacidad temporal asociada a los trastornos depresivos unipolares y determinar su asociación con variables demográficas laborales y clínicas. Métodos. Estudio observacional prospectivo. Selección secuencial sistemática de una muestra de 1.292 sujetos con diagnóstico de trastorno depresivo (CIE-9-MC) en situación de incapacidad temporal en una mutua de accidentes de trabajo y enfermedades profesionales. Se realizó un análisis descriptivo de la duración de la incapacidad temporal y análisis bivariados (contraste de la mediana) y multivariados (regresión logística) para encontrar asociaciones con variables demográficas, laborales y clínicas. Resultados. La mediana de duración de la incapacidad temporal por trastorno depresivo fue de 120 días. Ser mujer (p<0,01), una mayor edad (p<0,01), menor nivel educativo (p<0,01), las modalidades de pago directo durante la baja (trabajadores autónomos y que quedaran en desempleo durante la misma) (p<0,01) y la derivación conjunta a un psiquiatra y un psicólogo (p<0,01) se asociaron con un riesgo mayor de cronicidad en el análisis multivariante. Conclusiones. Los resultados confirman el papel de la depresión como importante generador de incapacidad laboral y señalan la necesidad de introducir mejoras en la evaluación y promoción de la capacidad funcional del enfermo, en el tratamiento del trastorno, así como en el itinerario asistencial del paciente depresivo(AU)

Objectives. To describe the duration of sickness absence in unipolar depression and to determine the relationship of demographic, job-related and clinical variables with length of temporary work disability in depressive disorders. Methods. Prospective observational study. A total of 1,292 subjects with depressive disorder diagnosis (ICD-9-CM) were selected claiming sick leave in an Occupational Diseases and Accident sat Work Insurance Scheme (sampling on successive occasions). Descriptive analyses of sickness absence duration, and bivariate (median test) and multivariate analysis (logistic regression) were performed to find relationships between demographic, job-related and clinical variables. Results. Mean duration of sickness absence episodes due to a depressive disorder was 120 days. After multivariate analyses, female sex (p<0.01), higher age (p<0.01), lower educational level (p<0.01), method of payment according to whether self-employed or unemployed workers (p<0.01) and being referred to both psychiatrist and psychologist (p<0.01) remained significantly associated with sick leave length. Conclusions. These findings confirm a strong association of depression with long periods of work disability and high absenteeism, and also suggest the need for improvements in functional ability assessment and promotion, treatment and referral of depressed patients(AU)

[Modulating variables of work disability in depressive disorders]. / Variables moduladoras de la discapacidad asociada al trastorno depresivo.

OBJECTIVES: To describe the duration of sickness absence in unipolar depression and to determine the relationship of demographic, job-related and clinical variables with length of temporary work disability in depressive disorders. METHODS: Prospective observational study. A total of 1,292 subjects with depressive disorder diagnosis (ICD-9-CM) were selected claiming sick leave in an Occupational Diseases and Accident sat Work Insurance Scheme (sampling on successive occasions). Descriptive analyses of sickness absence duration, and bivariate (median test) and multivariate analysis (logistic regression) were performed to find relationships between demographic, job-related and clinical variables. RESULTS: Mean duration of sickness absence episodes due to a depressive disorder was 120 days. After multivariate analyses, female sex (p < 0.01), higher age (p < 0.01), lower educational level (p < 0.01), method of payment according to whether self-employed or unemployed workers (p < 0.01) and being referred to both psychiatrist and psychologist (p < 0.01) remained significantly associated with sick leave length. CONCLUSIONS: These findings confirm a strong association of depression with long periods of work disability and high absenteeism, and also suggest the need for improvements in functional ability assessment and promotion, treatment and referral of depressed patients.

High cardiovascular risk in Spanish workers.

BACKGROUND AND AIMS: To investigate the prevalence of high cardiovascular risk in the Spanish working population, and its distribution among different occupations and gender. METHODS AND RESULTS: Cross-sectional study of 309,955 workers (72.6% males, mean age 36.5 years, range 16-74 years), who underwent a routine medical check-up. Workers were classified as high, intermediate or low cardiovascular risk, according to the SCORE system. Workers with a relative risk greater than 4 were also considered as high-risk. The prevalence of high cardiovascular risk was 7.6% (95% CI 7.5-7.7) in males and 1.7% (95% CI 1.6-1.8) in females. After adjusting for age and gender, the prevalence of high cardiovascular risk was greater in workers from the Agriculture and Construction sectors than in those from Industry and Service sectors. The prevalence of high cardiovascular risk was higher in blue-collar than in white-collar occupations. CONCLUSIONS: A sizeable proportion of workers, especially blue-collar males, are at high cardiovascular risk. Knowledge of this risk for certain workers may serve as a basis for preventive strategies.