Genetic Variants at the 9p21.3 Locus Are Associated with Risk for Non-Compressible Artery Disease: Results from the ARTPER Study.

Peripheral artery disease (PAD) and non-compressible artery disease (NCAD) constitute predictors of subclinical atherosclerosis easily assessed through the ankle brachial index (ABI). Although both diseases show substantial genetic influences, few genetic association studies have focused on the ABI and PAD, and none have focused on NCAD. To overcome these limitations, we assessed the role of several candidate genes on the ABI, both in its continuous distribution and in the clinical manifestations associated to its extreme values: PAD and NCAD. We examined 13 candidate genomic regions in 1606 participants from the ARTPER study, a prospective population-based cohort, with the ABI assessed through ultrasonography. Association analyses were conducted independently for individuals with PAD (ABI < 0.9) or with NCAD (ABI > 1.4) vs. healthy participants. After including potential covariates and correction for multiple testing, minor alleles in the genetic markers rs10757278 and rs1333049, both in the 9p21.3 region, were significantly associated with a decreased risk of NCAD. Associations with the ABI showed limited support to these results. No significant associations were detected for PAD. The locus 9p21.3 constitutes the first genetic locus associated with NCAD, an assessment of subclinical atherosclerosis feasible for implementation in primary healthcare settings that has been systematically neglected from genetic studies.

Automated Systems for Calculating Arteriovenous Ratio in Retinographies: A Scoping Review.

There is evidence of an association between hypertension and retinal arteriolar narrowing. Manual measurement of retinal vessels comes with additional variability, which can be eliminated using automated software. This scoping review aims to summarize research on automated retinal vessel analysis systems. Searches were performed on Medline, Scopus, and Cochrane to find studies examining automated systems for the diagnosis of retinal vascular alterations caused by hypertension using the following keywords: diagnosis; diagnostic screening programs; image processing, computer-assisted; artificial intelligence; electronic data processing; hypertensive retinopathy; hypertension; retinal vessels; arteriovenous ratio and retinal image analysis. The searches generated 433 articles. Of these, 25 articles published from 2010 to 2022 were included in the review. The retinographies analyzed were extracted from international databases and real scenarios. Automated systems to detect alterations in the retinal vasculature are being introduced into clinical practice for diagnosis in ophthalmology and other medical specialties due to the association of such changes with various diseases. These systems make the classification of hypertensive retinopathy and cardiovascular risk more reliable. They also make it possible for diagnosis to be performed in primary care, thus optimizing ophthalmological visits.

Relación entre la actividad física en el tiempo libre y la progresión del índice tobillo-brazo / Relationship between physical activity during leisure time and progression of ankle-brachial index

Objetivo: Estudiar la relación entre la actividad física en el tiempo libre y la progresión del índice tobillo-brazo (ITB) en población general española. Método: Estudio de cohortes prospectivo y multicéntrico, con 1941 sujetos mayores de 49 años, libres de arteriopatía periférica en el momento del reclutamiento. La variable actividad física en el tiempo libre se obtuvo mediante el cuestionario VREM ((Versión Reducida en Espãnol del Cuestionario de Actividad Física en el Tiempo Libre de Minnesota). Se consideró arteriopatía periférica un ITB <0,9. Para evaluar la asociación independiente entre la actividad física en el tiempo libre y el ITB se utilizaron modelos de regresión logística multivariante. Resultados: La edad media era de 63,4 años y el 54,6% eran mujeres. En el análisis multivariante hubo una relación positiva entre la actividad física en el tiempo libre y el ITB en pacientes con un gasto energético de más de 5000 metabolic energy turnover (MET) en 14 días (odds ratio: 0,37; intervalo de confianza del 95%: 0,18-0,80). Por actividades específicas, mostraron un efecto protector hacer deporte o bailar, ir a comprar a pie y limpiar la casa más de 1 hora al día. En el grupo de personas que mantenían a largo plazo la realización de actividad física en el tiempo libre se observó un efecto protector en la actividad física en general (MET) y en ir a comprar a pie. Conclusiones: En nuestro estudio, en una muestra de población general española muy activa, la actividad física en el tiempo libre se asoció favorablemente con el ITB. (AU)

Objective: To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population. Method: Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI) <0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI. Results: The mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot. Conclusions: In our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk. (AU)

[Relationship between physical activity during leisure time and progression of ankle-brachial index]. / Relación entre la actividad física en el tiempo libre y la progresión del índice tobillo-brazo.

OBJECTIVE: To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population. METHOD: Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI) <0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI. RESULTS: The mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot. CONCLUSIONS: In our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk.

Relationship between Retinal Microvasculature, Cardiovascular Risk and Silent Brain Infarction in Hypertensive Patients.

OBJECTIVE: The aims of this study are to analyze the role of artery-vein ratio AVR assessment using VesselMap 2 software (Imedos Systems) and cardiovascular risk evaluation by means of REGICOR in the prediction of silent brain infarction (SBI) in middle-age hypertensive patients from the ISSYS study. MATERIAL AND METHODS: A cross-sectional study with 695 patients with hypertension aged 50 to 70 years who participated in the project Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study (ISSYS), was conducted in two Primary Care Centres of Barcelona. Participants agreed to a retinography and an MRI to detect silent brain infarction (SBI). The IMEDOS software was used for the semiautomatic caliber measurement of retinal arteries and veins, and the AVR was considered abnormal when <0.66. The REGICOR score was calculated for all patients. RESULTS: Multivariate logistic regression analysis was used to evaluate the impact of AVR and REGICOR scores on SBI. The OR (odds ratio) for a high REGICOR score and an abnormal AVR were 3.16 and 4.45, respectively. When analysing the interaction of both factors, the OR of an abnormal AVR and moderate REGICOR score was 3.27, whereas with a high REGICOR score it reached 13.07. CONCLUSIONS: The measurement of AVR in patients with hypertension and with a high REGICOR score can contribute to the detection of silent brain infarction.

Fiabilidad de la retinografía para la detección de retinopatía hipertensiva en Atención Primaria / Reliability of retinography for the detection of hypertensive retinopathy in Primary Care

OBJETIVO: La hipertensión arterial es una de las enfermedades más prevalentes en la población general adulta. Su importancia reside en las complicaciones que ocasiona en el lecho vascular de órganos diana como riñón, corazón, cerebro y ojo. El objetivo de este trabajo es evaluar la concordancia en la lectura e interpretación de retinografías de pacientes hipertensos realizadas por médicos de familia y por oftalmólogos. MATERIAL Y MÉTODOS: Es un estudio transversal multicéntrico que contó con 976 pacientes hipertensos de 50 a 70 años, participantes del proyecto «Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study» (ISSYS) realizado en centros de Atención Primaria de Barcelona y que accedieron a realizarse una retinografía. Seis médicos de familia y 2 oftalmólogos valoraron la presencia de lesiones en la retina mediante los criterios de Keith-Wagener-Barker. RESULTADOS: Se analizó la concordancia Kappa inter- e intraobservador de las lecturas. La valoración de las retinografías en condiciones habituales de práctica clínica obtuvo un alto componente subjetivo, con valores de concordancia inter- e intraobservador pobres-bajos en los criterios de Keith-Wagener-Barker. Solo la valoración de los microaneurismas presentó una concordancia moderada; la ratio arteria/vena fue la menos concordante. Se recomienda la utilización de sistemas de lectura objetivos en la valoración de retinografías en pacientes hipertensos. CONCLUSIONES: La valoración de las retinografías en condiciones habituales de práctica clínica tiene un alto componente subjetivo que se refleja en unos valores de concordancia inter- e intraobservador pobres o bajos. Se recomienda la utilización de sistemas de lectura objetivos en la valoración de retinografías en pacientes hipertensos

OBJECTIVE: High blood pressure is one of the most prevalent diseases in general adult population. Its importance lies in the complications it causes in target organs such as kidney, heart, brain and eye. The aim of this work is to evaluate the agreement in the evaluation and interpretation of retinographies of hypertensive patients by family doctors and ophthalmologists. MATERIAL AND METHODS: This is a multicentric cross-sectional study in which 976 hypertensive patients from 50 to 70 years old were involved. They were participants of the «Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study» (ISSYS project) carried out in primary care centers of Barcelona and who agreed to undergo retinography. Six family physicians and 2 ophthalmologists evaluated the presence of retinal lesions through the Keith-Wagener-Barker criteria. RESULTS: The inter/intra-observer Kappa concordance of the evaluations was analyzed. The evaluation of the retinographies under the usual conditions of clinical practice obtained a high subjective component with slight and fair intra-observer concordance values in the Keith-Wagener-Barker criteria. Only the assessment of the microaneurysms showed a moderate concordance and the ratio artery/vein was the worst concordant. CONCLUSIONS: The evaluation of the retinographies in habitual conditions of clinical practice has a high subjective component that is reflected in slight and fair inter-intraobserver concordance values. The use of objective reading systems in the assessment of retinography in hypertensive patients would be useful

[Reliability of retinography for the detection of hypertensive retinopathy in Primary Care]. / Fiabilidad de la retinografía para la detección de retinopatía hipertensiva en Atención Primaria.

OBJECTIVE: High blood pressure is one of the most prevalent diseases in general adult population. Its importance lies in the complications it causes in target organs such as kidney, heart, brain and eye. The aim of this work is to evaluate the agreement in the evaluation and interpretation of retinographies of hypertensive patients by family doctors and ophthalmologists. MATERIAL AND METHODS: This is a multicentric cross-sectional study in which 976 hypertensive patients from 50 to 70 years old were involved. They were participants of the «Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study¼ (ISSYS project) carried out in primary care centers of Barcelona and who agreed to undergo retinography. Six family physicians and 2 ophthalmologists evaluated the presence of retinal lesions through the Keith-Wagener-Barker criteria. RESULTS: The inter/intra-observer Kappa concordance of the evaluations was analyzed. The evaluation of the retinographies under the usual conditions of clinical practice obtained a high subjective component with slight and fair intra-observer concordance values in the Keith-Wagener-Barker criteria. Only the assessment of the microaneurysms showed a moderate concordance and the ratio artery/vein was the worst concordant. CONCLUSIONS: The evaluation of the retinographies in habitual conditions of clinical practice has a high subjective component that is reflected in slight and fair inter-intraobserver concordance values. The use of objective reading systems in the assessment of retinography in hypertensive patients would be useful.

Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol.

INTRODUCTION: Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses. METHODS: One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention. RESULTS: Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample. DISCUSSION: Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900.

Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database.

BACKGROUND: Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. METHODS: Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009-2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). RESULTS: Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. CONCLUSIONS: Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients.

Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up.

BACKGROUND: To know the epidemiology (prevalence, incidence, progression and morbidity and mortality associated) of peripheral artery disease in general population and the factors associated with this progression is essential to know the evolution of atherosclerosis and develop preventive strategies. The aim of the study was to determine the incidence of PAD after 5 years of follow-up population-based cohort ARTPER, and the evolution of Ankle brachial Index (ABI) in this period. METHODS: Peripheral artery disease incidence analysis after 5 years of follow-up of 3786 subjects > 50 years old. Peripheral artery disease incident when the second cross section Ankle brachial Index was <0.9 in any of the lower limbs, with normal baseline (0.9 to 1.4). RESULTS: Between 2012 and 2013 2762 individuals (77% participation) were re-examined . Finally analyzed 2256 subjects (after excluding pathological Ankle brachial Index) followed for 4.9 years (range 3.8 to 5.8 years), totalling 11,106 person-years. Peripheral artery disease 95 new cases were detected, representing an incidence of 4.3% at 5 years and 8.6 per 1000 person-years (95% CI 6.9 to 10.5) being higher in men (10.2, 95% CI 7.4 to 13.5) than in women (7.5, 95% CI 5.5 to 9.9). Linear correlation between the baseline Ankle brachial Index and the second cross section was low (r = 0.23). CONCLUSIONS: The incidence of peripheral artery disease in ARTPER cohort was 8.6 cases per 1000 person-years, being higher in men, especially <65 years. The correlation between two measures Ankle brachial Index after 5 years of follow-up was low. One might consider whether Ankle brachial Index repeated measures could improve the correlation.

Relación entre actividad física en el tiempo libre y el índice tobillo-brazo en población general española: estudio ARTPER / The relationship between physical activity in leasure time and the ankle-brachial index in a general Spanish population: The ARTPER study

Fundamento y objetivo: Niveles elevados de actividad física durante la vida diaria se asocian con un menor deterioro funcional en las personas con arteriopatía periférica (AP) y positivamente con el índice tobillo-brazo (ITB) en sujetos libres de esta enfermedad. El objetivo de este estudio es examinar la relación entre la actividad física en el tiempo libre (AFTL) y el ITB en población general. Material y método: Se analizaron los datos basales de la cohorte ARTPER correspondientes a 2.840 sujetos mayores de 49 años de Barcelona. La AFTL se obtuvo mediante la versión reducida validada en español del Cuestionario de actividad física en el tiempo libre de Minnesota. Se consideró AP un ITB < 0,9. Para evaluar la asociación independiente entre AFTL y AP se utilizaron modelos de regresión logística multivariante. Resultados: Los sujetos que realizaban más AFTL eran más jóvenes, mujeres, menos fumadores y tenían menos AP. La actividad total medida en metabolic energy turnover (MET) y el cómputo de horas totales de AFTL fue significativamente superior en sujetos sanos (p < 0,001). Existía una relación inversa entre la AFTL total y el riesgo de padecer AP (odds ratio 0,56, intervalo de confianza del 95% 0,38-0,81 para los que gastaban 2.700 o más MET en 14 días) ajustando por factores de confusión. Conclusiones: La AFTL se relacionó positivamente con el ITB en nuestro estudio, siendo los sujetos con AP los que menos AFTL realizaban (AU)

Background and objective: High levels of daily physical activity have been shown to be linked to decreased functional impairment in peripheral artery disease (PAD) patients and positively related to the ankle brachial index (ABI) in subjects without PAD. The aim of this study was to examine the relationship between leisure time physical activity (LTPA) and the ABI in a general population. Material and method: Baseline data from the ARTPER study cohort corresponding to 2,840 subjects > 49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI < 0.9 was taken to indicate PAD. Multivariate logistic regression analysis was performed to evaluate the independent association between LTPA and PAD. Results: Subjects with more LTPA were younger, female, less smokers, and suffered fewer PAD. Total activity, measured in metabolic energy turnover (MET) and the LTPA hours, was significantly higher in subjects without PAD (P < .001). There was an inverse relationship between LTPA and the risk of suffering PAD (odds ratio 0.56, 95% confidence interval 0.38-0.81 for those who expended 2,700 METs or more in 14 days) adjusting for confounding factors. Conclusions: In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA (AU)

[The relationship between physical activity in leasure time and the ankle-brachial index in a general Spanish population: The ARTPER study]. / Relación entre actividad física en el tiempo libre y el índice tobillo-brazo en población general española: estudio ARTPER.

BACKGROUND AND OBJECTIVE: High levels of daily physical activity have been shown to be linked to decreased functional impairment in peripheral artery disease (PAD) patients and positively related to the ankle brachial index (ABI) in subjects without PAD. The aim of this study was to examine the relationship between leisure time physical activity (LTPA) and the ABI in a general population. MATERIAL AND METHOD: Baseline data from the ARTPER study cohort corresponding to 2,840 subjects>49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI<0.9 was taken to indicate PAD. Multivariate logistic regression analysis was performed to evaluate the independent association between LTPA and PAD. RESULTS: Subjects with more LTPA were younger, female, less smokers, and suffered fewer PAD. Total activity, measured in metabolic energy turnover (MET) and the LTPA hours, was significantly higher in subjects without PAD (P<.001). There was an inverse relationship between LTPA and the risk of suffering PAD (odds ratio 0.56, 95% confidence interval 0.38-0.81 for those who expended 2,700 METs or more in 14 days) adjusting for confounding factors. CONCLUSIONS: In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA.

Concordancia entre 3 métodos de medición del índice tobillo-brazo para el diagnóstico de arteriopatía periférica / Concordance between 3 methods of measurement the ankle-brachial index to diagnose peripheral artery disease

Fundamento y objetivos: Determinar la concordancia del índice tobillo-brazo (ITB) determinado mediante esfigmógrafo automático Omron y la medición automatizada mediante triple toma respecto al método de referencia doppler, así como su sensibilidad y especificidad. Pacientes y métodos: Pacientes de la cohorte poblacional ARTPER, clasificados como arteriopatía periférica (AP) si ITB < 0,9, calcificados si ITB ≥ 1,4, y sanos. Se calculó el índice kappa para ver la concordancia entre los 3 métodos con estas categorías y el coeficiente de correlación intraclase (CCI) para ver la concordancia del valor continuo de ITB. Resultados: Se incluyeron 88 participantes, un 52% mujeres, con una edad comprendida entre 57 y 87 años. Fue posible calcular el ITB en el 100% con doppler, en el 97% con Omron y en el 95% con triple toma. Las medias (desviación estándar) de ITB con los 3 métodos fueron: doppler 1,089 (0,236), Omron 1,082 (0,110), triple toma 1,146 (0,134), con pobre concordancia (CCI doppler/Omron = 0,27, doppler/triple toma = 0,13 y triple toma/Omron = 0,39). Categorizando el ITB en AP-sano-calcificación presentaron ITB < 0,9 un 13,6% (mediante doppler), 6,8% (Omron) y 3,4% (triple toma), e ITB ≥ 1,4 un 9,1% (mediante doppler), 1,1% (Omron) y 9,1% (triple toma), obteniendo índices kappa débiles (doppler/Omron = 0,22, doppler/triple toma = 0,01, triple toma/Omron = 0,17). Tanto Omron como triple toma fueron muy específicos (97%), pero muy poco sensibles (8 y 33%, respectivamente) con respecto a doppler. Conclusiones: Ni Omron ni triple toma tienen una buena concordancia con doppler, por lo que los primeros no parecen adecuados para el cribado de AP en las consultas de atención primaria (AU)

Background and objectives: To determine the concordance of the ankle-brachial index (ABI) determined by automatic measurements (sphygmomanometer Omron and the triple cuff device) using doppler as the gold-standard, computing as well as sensitivity and specificity. Patients and methods: ARTPER population cohort subjects, classified as peripheral arterial disease (PAD) if ABI < 0.9, calcified ifABI 1.4 and healthy otherwise. To asses concordance we used kappa index using the 3 categories and the intraclass correlation coefficient (ICC) for ABI continuous values. Results: Eighty-eight participants, 52% women, 57-87 years. It was possible to calculate the ABI using doppler for100%,97%usingOmronand95%using triple.ABImeans (standarddeviation)were:doppler1.089 (0.236),Omron1.082 (0.110),triple1.146(0.134), withpoor agreement(ICCdoppler/Omron = 0.27,doppler/ triple = 0.13, and triple/Omron = 0.39). Categorizing ABI as PAD-healthy-calcified 13.6% (doppler), 6.8% (Omron) and 3.4% (triple) were PAD and 9.1% (doppler), 1.1% (Omron) and 9.1% (triple) were calcified. Kappa indexes were weak (doppler/Omron = 0.22, doppler/triple = 0.01, triple/Omron = 0.17). Both triple andOmronwerehighly specific (97%)buthadvery lowsensitivity (8 and33%, respectively) comparedtodoppler. Conclusions: Concordance of ABI automatic measurements as Omron and triple with doppler was poor, and they do not seem suitable for screening for PAD in primary care consultations (AU)

[Concordance between 3 methods of measurement the ankle-brachial index to diagnose peripheral artery disease]. / Concordancia entre 3 métodos de medición del índice tobillo-brazo para el diagnóstico de arteriopatía periférica.

BACKGROUND AND OBJECTIVES: To determine the concordance of the ankle-brachial index (ABI) determined by automatic measurements (sphygmomanometer Omron and the triple cuff device) using doppler as the gold-standard, computing as well as sensitivity and specificity. PATIENTS AND METHODS: ARTPER population cohort subjects, classified as peripheral arterial disease (PAD) if ABI<0.9, calcified if ABI≥1.4 and healthy otherwise. To asses concordance we used kappa index using the 3 categories and the intraclass correlation coefficient (ICC) for ABI continuous values. RESULTS: Eighty-eight participants, 52% women, 57-87 years. It was possible to calculate the ABI using doppler for 100%, 97% using Omron and 95% using triple. ABI means (standard deviation) were: doppler 1.089 (0.236), Omron 1.082 (0.110), triple 1.146 (0.134), with poor agreement (ICC doppler/Omron=0.27, doppler/triple=0.13, and triple/Omron=0.39). Categorizing ABI as PAD-healthy-calcified 13.6% (doppler), 6.8% (Omron) and 3.4% (triple) were PAD and 9.1% (doppler), 1.1% (Omron) and 9.1% (triple) were calcified. Kappa indexes were weak (doppler/Omron=0.22, doppler/triple=0.01, triple/Omron=0.17). Both triple and Omron were highly specific (97%) but had very low sensitivity (8 and 33%, respectively) compared to doppler. CONCLUSIONS: Concordance of ABI automatic measurements as Omron and triple with doppler was poor, and they do not seem suitable for screening for PAD in primary care consultations.

Ankle-brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort.

BACKGROUND: Peripheral arterial disease (PAD) of the lower limbs is a cardiovascular disease highly prevalent particularly in the asymptomatic form. Its prevalence starts to be a concern in low coronary risk countries like Spain. Few studies have analyzed the relationship between ankle-brachial index (ABI) and cardiovascular morbi-mortality in low cardiovascular risk countries like Spain where we observe significant low incidence of ischemic heart diseases together with high prevalence of cardiovascular risk factors. The objective of this study is to determine the relationship between pathological ABI and incidence of cardiovascular events (coronary disease, cerebrovascular disease, symptomatic aneurism of abdominal aorta, vascular surgery) and death in the >49 year population-based cohort in Spain (ARTPER). METHODS: Baseline ABI was measured in 3,786 randomly selected patients from 28 Primary Health Centers in Barcelona, distributed as: ABI<0.9 peripheral arterial disease (PAD), ABI ≥1.4 arterial calcification (AC), ABI 0.9-1.4 healthy; and followed during 4 years. RESULTS: 3,307 subjects were included after excluding those with previous vascular events. Subjects with abnormal ABI were older with higher proportion of men, smokers and diabetics. 260 people presented cardiovascular events (incidence 2,117/100,000 person-years) and 124 died from any cause (incidence 978/100,000 person-years). PAD had two-fold greater risk of coronary disease (adjusted hazard ratio (HR) = 2.0, 95% confidence interval (CI) 1.3-3.2) and increased risk of vascular surgery (HR = 5.6, 95%CI 2.8-11.5) and mortality (HR = 1.8, 95%CI 1.4-2.5). AC increased twice risk of cerebrovascular events (HR = 1.9, 95%CI 1.0-3.5) with no relationship with ischemic heart disease. CONCLUSIONS: PAD increases coronary disease risk and AC cerebrovascular disease risk in low cardiovascular risk Mediterranean population. ABI could be a useful tool to detect patients at risk in Primary Health Care.

[Validation of a Spanish Short Version of the Minnesota Leisure Time Physical Activity Questionnaire (VREM)]. / Validación de una versión reducida en español del cuestionario de actividad física en el tiempo libre de Minnesota (VREM).

BACKGROUND: The aim of this study is to develop and validate a shorter version (VREM) of the Spanish version of the Minnesota leisure time Physical Activity Questionnaire (CAFM), in order to have a shorter physical activity questionnaire to be used in Primary Care. METHODS: Descriptive study of validation of a new physical activity measurement questionnaire. 200 patients older than 50, who visited one of 5 primary care centers in Barcelona for any reason were selected, with age-sex Catalonia's distribution. Two phases: first, VREM construction through items reduction. Second, validity of VREM against CAFM (gold standard) and test-retest reliability of VREM were analyzed, using kappa index and the intraclass correlation coefficient (ICC). RESULTS: 6 items were included in the VREM: Walking, Gardening, Sport/dancing, Climbing stairs, Shopping walking and Cleaning house. The interview using VREM lasted 5 minutes (standard deviation 2). Agreement between both questionnaires, using 4 levels of physical activity, was 95.5% (kappa=0.93). Test-retest reliability of the questionnaire was 92.5% (kappa=0.88). Using a continuous outcome in metabolic energy turnover (MET), VREM also proved to be valid and reliable (ICC=0.95 and ICC=0.96 respectively). CONCLUSION: This short version of CAFM has shown good validity and reliability in people ≥50 years.

Validación de una versión reducida en español del Cuestionario de Actividad Física en el tiempo libre de Minnesota (VREM) / Validation of a Spanish Short Version of the Minnesota Leisure Time Physical Activity Questionnaire (VREM)

Fundamentos: con el fin de disponer de una versión breve y en españoldel Cuestionario de Actividad Física en el tiempo libre de Minnesota (CAFM) para poder utilizarlo en atención primaria, el objetivo de este trabajo es presentar la elaboración de la versión reducida (VREM) y su validación. Métodos: Estudio descriptivo de validación del cuestionario, realizada en cinco centros de Atención Primaria de Barcelona. Se seleccionaron 200 sujetos igual o mayores de 50 años que consultaron por cualquier motivo, con una distribución por edad y sexo similar a la de la población de Cataluña . Dos fases: primera, se construyó el VREM mediante reducción del número de ítems. Segunda, se evaluó su validez de criterio respecto al CAFM (referencia) y la fiabilidad test-retest mediante el índice kappa y el coeficiente de correlación intraclase (CCI). Resultados: Los 6 ítems incluidos en el VREM fueron: caminar, trabajar el huerto, hacer deporte o bailar, subir escaleras, ir a comprar a pie y limpiar la casa. La duración de la entrevista mediante el VREM fue de 5 minutos (desviación estándar 2). La validez de criterio entre ambos cuestionarios, usando 4 categorías de actividad física, fue del 95,5% (kappa=0,93). La fiabilidad test-retest del cuestionario fue del 92,5% (kappa=0,88). Usando un resultado continuo en forma de metabolic energy turnover (MET) el VREM también mostró una alta validez y fiabilidad (CCI=0,95 y CCI=0,96 respectivamente). Conclusiones: La versión reducida del CAFM es válida y fiable en población mayor o igual a 50 años(AU)

Background: The aim of this study is to develop and validate a shorter version (VREM) of the Spanish version of theMinnesota leisure time PhysicalActivity Questionnaire (CAFM), in order to have a shorter physical activity questionnaire to be used in Primary Care. Methods: Descriptive study of validation of a new physical activity measurement questionnaire. 200 patients older than 50, who visited one of 5 primary care centers in Barcelona for any reason were selected, with age-sex Catalonia’s distribution. Two phases: first, VREM construction through items reduction. Second, validity of VREM against CAFM (gold standard) and test-retest reliability of VREMwere analyzed, using kappa index and the intraclass correlation coefficient (ICC). Results: 6 items were included in the VREM:Walking, Gardening, Sport/dancing, Climbing stairs, Shopping walking and Cleaning house. The interview using VREM lasted 5 minutes (standard deviation 2). Agreement between both questionnaires, using 4 levels of physical activity, was 95.5% (kappa=0.93). Test-retest reliability of the questionnaire was 92.5% (kappa=0.88). Using a continuous outcome in metabolic energy turnover (MET), VREM also proved to be valid and reliable (ICC=0.95 and ICC=0.96 respectively). Conclusion: This short version of CAFM has shown good validity and reliability in people >=50 years(AU)

Ischemic stroke incidence in Santa Coloma de Gramenet (ISISCOG), Spain. A community-based study.

BACKGROUND: In Spain, stroke is one of the major causes of death and the main cause of severe disability in people over 65 years. We analyzed the incidence of ischemic stroke, stroke subtypes, case fatality and disability at 90 days after the event in a Spanish population. METHODS: A prospective community-based register of ischemic strokes was established in Santa Coloma de Gramenet (Barcelona) [116,220 inhabitants of all ages, according to the municipal census of December 31,2001], from January 1 to December 31, 2003. Standard definitions and case finding methods were used to identify all cases in all age groups. Every patient underwent a complete clinical evaluation and systematic tests including neuroimaging (CT/MRI) and vascular studies (carotid duplex ultrasound intra and extracranial and MR angiography). RESULTS: Over a one year period, 196 ischemic strokes were registered [107 men; median age = 76 years (range 39-98)], being the first event in 159 patients (81.1%) and a recurrent stroke in 37 (18.9%). After age-adjustment to the European population, the incidence of ischemic stroke per 100,000 inhabitants was 172 (95% CI, 148-196); 219 (176-261) in men and 133 (105-160) in women, with an annual incidence for first ischemic stroke of 139 (118-161); 165 (128-201) in men and 115 (89-140) in women. The incidence of stroke increased with age. Stroke subtypes (TOAST classification criteria) were lacunar in 28.8%, atherothrombotic in 18.6%, cardioembolic in 26.6% and undetermined in 26.0% of patients. At 90 days, the case-fatality was 12%, and among survivors, moderate-to-severe disability was present in 45 % at 3 months. CONCLUSION: This prospective community-based study shows one of the lowest incidences of stroke in Europe, as well as one of the lowest case fatality and disability rates at 90 days after stroke.

Peripheral Arterial Disease study (PERART): prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality.

BACKGROUND: The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study). METHODS/DESIGN: This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality. From September 2006 to June 2007, a total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain). The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.90, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluted every 6 months by telephone interview and the clnical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infartction, symptomatic abdominal aneurysm and vascular mortality. DISCUSSION: In this study we hope to determine the prevalence of peripheral arterial disease, especially the silent forms, in the general population and establish its relationship with cardiovascular morbimortality. A low AAI may be a better marker of arterial disease than the classical cardiovascular risk factors and may, therefore, contribute to improving the predictive value of the equations of cardiovascular risk and thereby allowing optimisation of multifactorial treatment of atherosclerotic disease.