ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008-2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

Infección por SARS-CoV-2 en el embarazo y posibilidad de transmisión al neonato: una revisión sistemática / Infection by SARS-CoV-2 in pregnancy and possibility of transmission to neonates: a systematic revision

En este trabajo se revisan los artículos publicados sobre COVID-19, embarazo y afectación del neonato hasta el 30 de abril de 2020. Se han encontrado un total de 33 publicaciones que se refieren a 553 gestantes y 456 partos. Los síntomas más frecuentes en la embarazada fueron fiebre, tos y disnea. Cerca de tercios de los partos se realizaron por cesárea; el 5,9% de las mujeres requirieron ingreso en la UCI y el 4% requirieron ventilación mecánica. No se produjo ninguna muerte materna. Hubo prematuridad en el 22,3% de los partos y el neonato requirió ingreso en la UCI en el 38,3%. Solo se informó de una muerte neonatal (0,4%) y de 13 casos de COVID-19 neonatal (3,4%). La información disponible no permite asegurar que la transmisión se produjera por vía transplacentaria

Studies published on COVID-19, pregnancy and neonate disease until 30 April 2020 are revised. We found 33 articles including 553 pregnant women and 456 deliveries. The more frequent symptoms in the pregnant women were fever, cough and dyspnoea. About two thirds deliveries were carried out via Caesarean rate; 5.9% women were admitted in the ICU and 4% required mechanic ventilation. No maternal death was reported. Prematurity occurred in 22.3% deliveries and 38.3% neonates required admission in the ICU. Only one neonatal death was reported (0.4%) and 13 neonates (3.4%) suffered COVID-19. The available information does not allow to state whether transmission to neonates occurred transplacentarily

[Infection by SARS-CoV-2 in pregnancy and possibility of transmission to neonates: A systematic revision]. / Infección por SARS-CoV-2 en el embarazo y posibilidad de transmisión al neonato: una revisión sistemática.

Studies published on COVID-19, pregnancy and neonate disease until 30 April 2020 are revised. We found 33 articles including 553 pregnant women and 456 deliveries. The more frequent symptoms in the pregnant women were fever, cough and dyspnoea. About two thirds deliveries were carried out via Caesarean rate; 5.9% women were admitted in the ICU and 4% required mechanic ventilation. No maternal death was reported. Prematurity occurred in 22.3% deliveries and 38.3% neonates required admission in the ICU. Only one neonatal death was reported (0.4%) and 13 neonates (3.4%) suffered COVID-19. The available information does not allow to state whether transmission to neonates occurred transplacentarily.

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. / Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Resultados preliminares del estudio ADENI-UCI: análisis de las decisiones de no ingreso en unidades de cuidados intensivos como medida de limitación de los tratamientos de soporte vital; estudio multicéntrico, prospectivo y observacional / Preliminary results of the ADENI-ICU trial: Analysis of decisions of refuse admission in intensive care units as a limitation of life support treatments; multi-center, prospective, observational study

No disponible

Compositional analysis of dietary patterns.

Instead of looking at individual nutrients or foods, dietary pattern analysis has emerged as a promising approach to examine the relationship between diet and health outcomes. Despite dietary patterns being compositional (i.e. usually a higher intake of some foods implies that less of other foods are being consumed), compositional data analysis has not yet been applied in this setting. We describe three compositional data analysis approaches (compositional principal component analysis, balances and principal balances) that enable the extraction of dietary patterns by using control subjects from the Spanish multicase-control (MCC-Spain) study. In particular, principal balances overcome the limitations of purely data-driven or investigator-driven methods and present dietary patterns as trade-offs between eating more of some foods and less of others.

Correlation between two biomarkers of atherosclerosis, osteopontin and angiopoietin-2, in non-diabetic ankylosing spondylitis patients undergoing TNF-α antagonist therapy.

OBJECTIVES: To determine whether circulating osteopontin (OPN) levels in patients with ankylosing spondylitis (AS) undergoing TNF-α antagonist-infliximab-therapy are increased compared with controls and to establish whether disease activity, systemic inflammation, metabolic syndrome, adipokines and biomarkers of atherosclerosis are potential determinants of circulating OPN levels in these patients. METHODS: We assessed OPN serum concentrations in a series of 30 non-diabetic AS patients without cardiovascular disease undergoing TNF-α antagonist-infliximab therapy and 48 matched controls. OPN levels were measured immediately before and after an infliximab infusion, at time 0 and at time 120 minutes respectively. Correlations of OPN serum levels with clinical features, disease activity, systemic inflammation, metabolic syndrome and several biomarkers of atherosclerosis were assessed. Potential changes in OPN concentration following an infusion of anti-TNF-α monoclonal antibody-infliximab were also analysed. RESULTS: At the time of the study AS patients undergoing anti-TNF-α therapy had low disease activity (mean BASDAI 2.94) and they showed similar OPN serum levels to healthy controls. No differences in OPN levels according to the specific clinical features of the disease were seen. Also, no correlation between OPN concentration and insulin resistance and adipokines was observed. However, a positive correlation between OPN and angiopoietin-2 (Angpt-2) serum levels was found (r=0.397; p=0.04). In addition, a single infliximab infusion led to a marginal statistically significant reduction in OPN levels (24112.19±14608.73 pg/ml at time 0 versus 21806.62±11390.83 pg/ml at time 120'; p=0.05). CONCLUSIONS: OPN and Angpt-2 serum levels are correlated in non-diabetic AS patients undergoing TNF-α antagonist therapy.

Gelsolin levels are decreased in ankylosing spondylitis patients undergoing anti-TNF-alpha therapy.

OBJECTIVES: To determine whether circulating gelsolin (GSN) levels in patients with ankylosing spondylitis (AS) undergoing TNF-α antagonist-infliximab-therapy are altered compared with controls and to establish whether disease activity, systemic inflammation and metabolic syndrome are potential determinants of circulating GSN levels in these patients. METHODS: We assessed GSN serum concentrations in a series of 30 non-diabetic AS patients without cardiovascular (CV) disease undergoing TNF-α antagonist-infliximab therapy and 48 matched controls. GSN levels were measured immediately before and after an infliximab infusion. Correlations of GSN serum levels with disease activity, systemic inflammation and metabolic syndrome were assessed. Potential changes in GSN concentration following an infusion of anti-TNF-α monoclonal antibody-infliximab were also analysed. RESULTS: Although at the time of the study AS patients undergoing anti-TNF-α therapy had adequate control of the disease (mean BASDAI 2.94), they showed lower GSN serum levels than healthy controls (mean±SD: 38660.42±23624.6 ng/ml versus 68975.43±31246.79 ng/ml; p<0.0001). When AS patients were stratified according to sex, we observed that GSN levels were significantly lower in men than in women (p=0.032). However, no differences in GSN levels according to the specific clinical features of the disease were seen. No association was found between GSN concentration and adipokines or biomarkers of endothelial cell activation. However, correlation between basal GSN levels and insulin resistance was observed. A single infliximab infusion did not lead to significant changes in GSN levels. CONCLUSIONS: GSN concentration is reduced in AS patients undergoing periodical anti-TNF-α therapy and low disease activity. Potential association with some metabolic syndrome features seems to exist.

Evaluación de los conocimientos paternos sobre asma con el Newcastle Asthma Knowledge Questionnaire / Assessment of parental asthma knowledge with the Newcastle Asthma Knowledge Questionnaire

Objetivo: determinar el grado de conocimiento sobre asma de los padres de niños/as asmáticos seguidos en una consulta de Neumología infantil. Material y método: estudio descriptivo y transversal, mediante encuestas autocumplimentadas. Los conocimientos sobre asma se evaluaron usando el Newcastle Asthma Knowledge Questionnaire (NAQK). Se realizó el cuestionario a padres y otros familiares de niños asmáticos atendidos en la consulta de Neumología infantil de un hospital terciario. Las encuestas fueron realizadas entre septiembre y noviembre de 2009. Resultados: la muestra quedó conformada por 344 cuestionarios. Un 72,7% fue contestado por la madre del paciente, un 14,9% por el padre, en un 6,7% fueron ambos progenitores los que rellenaron el cuestionario y en un 5,8% fue otra persona diferente. Los pacientes fueron 203 niños (59%) y 141 niñas (41%) con una edad media de 8±4 años. La puntuación media fue de 18,5±3,7 sobre 31. Conclusiones: nuestros encuestados han obtenido mayor puntuación media en comparación con muestras similares en otros estudios. A pesar de ello, consideramos que una intervención educativa puede mejorar los conocimientos sobre asma y contribuir a disminuir la morbilidad de esta enfermedad crónica (AU)

Objective: to determine the level of asthma knowledge in parents of asthmatic children followed in a pediatric respiratory ward. Material and methods: descriptive and cross-sectional study. Asthma Knowledge was assessed using the Newcastle Asthma Knowledge Questionnaire (NAQK). We performed a questionnaire to parents and other relatives of asthmatic children treated in the pediatric pulmonary ward of a tertiary hospital. The surveys were conducted between September and November 2009. Results: the sample consisted of 344 questionnaires. The mothers answered 72.7%, the fathers14.9%, both parents filled the questionnaire in 6.7% and 5.8% were filled by a different person. Patients were 203 boys (59%) and 141 girls (41%) with a mean age of 8 ± 4 years. The average score was 18.5 ± 3.7 points out of 31. Conclusions: our respondents have obtained higher mean score compared to similar samples in other studies. Nevertheless we believe that an educational intervention can improve asthma knowledge and help decrease the morbidity of this chronic disease (AU)

Cold-related mortality due to cardiovascular diseases, respiratory diseases and cancer: a case-crossover study.

OBJECTIVES: The aim of this study was to identify the relationship between low temperatures in winter and mortality due to cancer, cardiovascular diseases and respiratory diseases. STUDY DESIGN: Case-crossover study. METHODS: A case-crossover study was performed in Cantabria (northern Spain) in the years 2004-2005; 3948 deaths were included. Odds ratios were estimated using conditional logistic regression, stratified by age, sex, and delay of exposure to low temperatures. RESULTS: There was an inverse dose-response relationship between temperature and mortality in the three causes of death studied; this result was consistent across genders and age groups. The higher OR for cancer mortality was seen on the first day of exposure (OR = 4.91; 95% CI: 1.65-13.07 in the whole population), and it decreased when exposure over several days in a row was considered; people aged 75 years or more were especially susceptible to cold temperatures (OR = 17.9; 95% CI: 2.38-134.8). Cardiovascular (OR = 2.63; 95% CI: 1.88-3.67) and respiratory mortality (OR = 2.72; 95% CI: 1.46-5.08) showed a weaker effect. CONCLUSION: There is a striking association between the extreme cold temperatures and mortality from cancer, not previously reported, which is more remarkable in the elderly. These results could be explained by a harvesting effect in which the cold acts as a trigger of death in terminally ill patients at high risk of dying a few days or weeks later.

Topiramate in the treatment of alcohol dependence: a meta-analysis.

UNLABELLED: Several controlled clinical trials have studied the efficacy of topiramate in the treatment of alcoholism. In this paper, we have performed a meta-analysis of those trials in which topiramate was compared with placebo and then we reviewed its efficacy in trials in which it was compared with other drugs. METHOD: A quantitative synthesis of data was per-formed using inverse variance weighting in a random effects model. RESULTS: Based on three placebo-controlled trials, topiramate is more efficacious than placebo in reducing the percentage of heavy drinking days (23.2%, 95% confidence interval [CI]: 15.7 to 34.4), increasing the number of days of abstinence (mean difference: 2.9 days, 95% CI: 2.5 to 3.3),and lowering the logarithm of g-GT levels (mean difference:0.075 95% CI: 0.048 to 0.118). Two trials suggested that topiramate is also more efficacious than naltrexone, and one open-label study reported better results for disulfiram than for topiramate. CONCLUSION: Topiramate can be used in alcohol dependence. Adverse effects such as paresthesia or insomnia should be taken into account when prescribing topiramate.Its optimal dosage requires further research.

Effect of cold temperatures on mortality in Cantabria (Northern Spain): a case-crossover study.

OBJECTIVES: To determine the impact of low temperatures on mortality in a Spanish region that includes both rural and urban areas. STUDY DESIGN: Case-crossover study. METHODS: A case-crossover study was conducted on the impact of cold temperatures on mortality in Cantabria, a Spanish region which includes both rural and urban areas, in 2004-2005. Odds ratios for several cold weather indicators were estimated using conditional logistic regression, adjusting for humidity and wind speed. Zero- to 6-day lags in the temperature effect were considered. RESULTS: Temperatures lower than the 5th percentile were strongly associated with mortality compared with temperatures above the 5th percentile (OR 3.40, 95% confidence interval 2.95-3.93 for 6-day lag). All temperature indices show a negative association with mortality; for instance, the maximum temperature had ORs of 0.71, 0.58, 0.32 and 0.16 for Quintiles 2-5 (reference: Quintile 1). This effect was common to all age groups. CONCLUSION: Cold weather is strongly associated with mortality in small cities and rural areas.

Topiramato en el tratamiento de la dependencia etílica: un metaanálisis / Topiramate in the treatment of alcohol dependence: a meta-analysis

Introducción. Algunos ensayos clínicos controlados han estudiado la eficacia del topiramato para el tratamiento del alcoholismo. En este artículo, primero realizamos un meta análisis de los ensayos donde el topiramato era comparado con el placebo, y después revisamos la eficacia en los ensayos donde era comparado con otros fármacos. Método. Una síntesis cuantitativa de los datos se llevó acabo ponderando por el inverso de la varianza en un modelo de efectos aleatorios. Resultados. En base a tres ensayos clínicos controlados, el topiramato es más eficaz que el placebo en: reducción del porcentaje de los días de consumo elevado (23,2%, intervalo de confianza [IC] del 95%: 15,7 a 34,4), incremento del número de días de abstinencia (diferencia media: 2,9 días, IC del 95%: 2,5 a 3,3) y descenso del logaritmo de los niveles de epsilon-GT (diferencia media: 0,075, IC del 95%: 0,048 a 0,118).Dos ensayos sugirieron que el topiramato es también más eficaz que la naltrexona y un estudio abierto refirió mejores resultados para el disulfirán que para el topiramato. Conclusiones. El topiramato puede ser utilizado para el tratamiento en la dependencia etílica; los efectos adversos tales como las parestesias o el insomnio deben ser tenidos en cuenta cuando se prescribe topiramato. La dosis óptima precisa investigación adicional (AU)

Introduction. Several controlled clinical trials have studied the efficacy of topiramate in the treatment of alcohol dependence: a metaanalysis Introduction. Several controlled clinical trials have studied the efficacy of topiramate in the treatment of alcoholism. In this paper, we have performed a metaanalysis of those trials in which topiramate was compared with placebo and then we reviewed its efficacy in trials in which it was compared with other drugs. Method. A quantitative synthesis of data was performed using inverse variance weighting in a random effects model. Results. Based on three placebo-controlled trials, topiramate is more efficacious than placebo in reducing the percentage of heavy drinking days (23.2%, 95% confidence interval [CI]: 15.7 to 34.4), increasing the number of days of abstinence (mean difference: 2.9 days, 95%CI: 2.5 to 3.3), and lowering the logarithm of g-GT levels(mean difference: 0.075 95% CI: 0.048 to 0.118). Two trials suggested that topiramate is also more efficacious than naltrexone, and one open-label study reported better results for disulfiram than for topiramate. Conclusion. Topiramate can be used in alcohol dependence. Adverse effects such as paresthesia or insomnia should be taken into account when prescribing topiramate. Its optimal dosage requires further research (AU)

Factores que determinan la alta satisfacción del usuario con la asistencia hospitalaria / Factors associated with patient satisfaction with hospital care

Objetivo. Identificar la influencia sobre la alta satisfacciónde factores sociodemográficos, asistenciales y decomunicación.Material y Métodos. Estudio de corte transversal medianteencuesta telefónica a pacientes dados de alta duranteel mes de septiembre de 2006. Instrumento de medida:cuestionario SERQVHOS. Como medida de fuerza de asociaciónse ha utilizado la odds ratio (OR) y su intervalode confianza (IC) al 95%. Para el ajuste por factores deconfusión se ha utilizado el análisis de regresión logística.Resultados. La tasa de respuesta fue del 80,9%. Al evaluarla influencia de características sociodemográficas, se observaque los usuarios con nacionalidad no pertenecientea la Unión Europea mostraron mayor satisfacción que losespañoles (OR=3,01 IC 95%: 1,40-3,51), y los entrevistadoscon estudios primarios resultaron más satisfechos que losuniversitarios (OR=2,85 IC 95% [1,88-4,35]). En cuanto afactores asistenciales, en los pacientes con reingresos porla misma categoría diagnóstica mayor se observó una menorprevalencia de alta satisfacción, con una OR de 0,67 ysignificación limítrofe. Por último, respecto a la comunicación,los tres aspectos más asociados a la alta satisfacciónfueron la identificación correcta del personal (OR: 6,22 IC95% [3,52-10,97]), recibir información suficiente sobre elestado de salud (OR: 3,83 IC 95% [1,94-7,57]) y recibir informaciónsobre el lugar y horario de información médica(OR: 2,60 IC95% [1,60-4,22]).Conclusiones. La comunicación incide favorablementeen la percepción final de la asistencia lo que justificaque se continúe trabajando en su mejora en los centrossanitarios de nuestra comunidad(AU)

Objective. To identify the influence of sociodemographic,care and communication factors on patient satisfaction.Methods. Cross-sectional study by means of a telephonicsurvey of patients discharged during September,2006. Instrument for measuring satisfaction: SERQVHOSquestionnaire. Statistical analysis: we used odds ratio(OR) and its 95% confidence interval (CI); adjustmentfor confusion factors was performed using multiple logisticregression.Results. Response rate was 80.9%. On evaluating the influenceof sociodemographic characteristics, we observedthat patients whose nationality did not correspondto the European Union were more satisfied than Spanishpatients (OR=3.01; 95% CI: 1.40-3.51); subjects who hadonly completed primary studies were more satisfiedthan those with university studies (OR = 2.85, 95% CI:1.88-4.35). With respect to care factors, patients readmittedbecause of the same major diagnostic category hadlower satisfaction (OR=0.67, bordering statistical significance).Finally, with regard to communication factors,the three aspects most associated with patient satisfactionwere: correct health-care personnel identification(OR: 6.22 95% CI: 3.52-10.97), receiving enough informationabout his/her state of health (OR: 3.83 95% CI: 1.94-7.57), and being informed about the place and schedulefor medical information (OR: 2.60, 95% CI: 1.60-4.22).Conclusions. Communication favourably affects thefinal perception of care, which justifies the continuityof its improvement in the health centres of our region(AU)

Influence of nitric oxide synthase gene polymorphisms on the risk of cardiovascular events in rheumatoid arthritis.

OBJECTIVE: Complex interactions between environmental and genetic determinants in both the host immune system and the vasculature may operate modifying the vascular risk in rheumatoid arthritis (RA). An increased incidence of cardiovascular (CV) events in RA patients carrying HLA-DRB1 shared epitope alleles, in particular HLA-DRB1*0404, has recently been found. In the present study we have assessed the potential contribution of inducible and endothelial nitric oxide synthase (NOS2A and NOS3) gene polymorphisms to CV events in a cohort of patients with rheumatoid arthritis (RA). Also, interactions between NOS2A or NOS3 gene polymorphisms and HLA-DRB1 alleles for the risk of developing CV events were assessed. PATIENTS AND METHODS: One hundred and eighty-two consecutive patients fulfilling the 1987 American College of Rheumatology classification criteria for RA seen at the Rheumatology outpatient clinic of Hospital Xeral Calde, Lugo, Northwest Spain, between March and September 1996 were included. Patients were genotyped by PCR based techniques for a multiallelic (CCTTT)n repeat in the promoter region of the NOS2A gene and for a T/C polymorphism at position -786 in the promoter region and a polymorphism in exon 7 (298Glu/Asp or 5557G/T) of the NOS3 gene. They were prospectively followed and clinical records were examined until patient's death or September 1, 2005. At the end of the study 39 (21%) patients had experienced CV events. RESULTS: No significant differences in allele or genotype frequencies for the NOS2A promoter CCTTT repeat microsatellite and NOS3 gene polymorphisms between RA patients with or without CV events were found. However, an increased frequency of CV events was observed in RA patients who carried the HLA-DRB1*0404 allele and were homozygous for the NOS3 (-786) TT genotype (OR: 9.06 [95% CI: 1.29-63.37]; p= 0.03) or for the presence of long NOS2A alleles (OR: 11.7 [95% CI: 1.53-88.4]); p= 0.02). CONCLUSIONS: Our results show that NOS2A or NOS3 gene polymorphisms do not infer a direct risk for CV events in RA. However, some interactions between NOS gene polymorphisms and HLA-DRB1 alleles confer and increased risk of developing CV events in patients with RA.