Incidencia de cardiopatía isquémica en el estudio HERMEX y su asociación con los factores de riesgo cardiovascular clásicos / Incidence of ischemic heart disease in the HERMEX study and its association with classical cardiovascular risk factors

Objetivos: El conocimiento sobre la incidencia de enfermedad coronaria en nuestro país es escaso y sus fuentes poco comparables. Fue nuestro objetivo determinar la incidencia de cardiopatía isquémica en una cohorte poblacional con un seguimiento de 7 años y el riesgo asociado a los factores de riesgo cardiovascular clásicos. Métodos: Estudio de cohortes prospectivo en una muestra poblacional de 2833 sujetos, seleccionada por método aleatorio simple entre ciudadanos de 25 a 79 años del Área de Salud Don Benito – Villanueva de la Serena (Badajoz), tasa de respuesta 80,5%. Se recogieron todos los episodios de angina de pecho, infarto de miocardio letal y no letal en individuos sin antecedentes previos de enfermedad cardiovascular. Se calcularon las incidencias acumuladas y las tasas de incidencia ajustadas por 100.000 personas-año por sexo y global. Resultados: De los 2833 participantes iniciales, se excluyeron 103 por antecedentes de enfermedad cardiovascular y 61 por pérdidas, completando el seguimiento 2669 (94,2%). La mediana de seguimiento fue de 6,9 años (RI 6,5 - 7,5), 56,4% mujeres; se registraron 59 eventos. La tasa de incidencia global de cardiopatía isquémica fue 327 casos/100.000 personas-año correspondiendo 470 casos/100.000 al sexo masculino y 211 casos/100.000 personas-año al femenino. Los factores de riesgo cardiovascular clásicos que se asociaron con mayor riesgo de presentar eventos en el seguimiento fueron la dislipemia y la HTA, además del sexo masculino y la edad. Conclusiones: La incidencia de cardiopatía isquémica en la población urbano-rural de Extremadura, es elevada. Los factores de riesgo cardiovascular clásicos más fuertemente asociados a su aparición fueron la dislipemia, y la hipertensión arterial (AU)

Objectives: Knowledge about the incidence of coronary heart disease in our country is scarce and its sources are not comparable. Our aim was to determine the incidence of ischemic heart disease in a population cohort in a 7 years of follow-up, as well as the risk associated with the different classical cardiovascular risk factors. Methods: Cohort study with a population sample of 2833 subjects, selected by the simple random method in a population between 25 and 79, from the Don Benito – Villanueva de la Serena (Badajoz) health area, response rate was 80.5%. All episodes of angina pectoris, lethal and non-lethal myocardial infarction were collected in individuals with no previous history of cardiovascular disease. Cumulative incidences and incidence rates adjusted per 100,000 person-years by sex and overall were calculated. Results: From 2833 initial cohort participants, 103 were excluded due to a history of cardiovascular disease and 61 for losses, 2669 completed the follow-up (94.2%). The median follow-up was 6.9 years (IR 6.5–7.5), 56.4% women; 59 events were recorded. The overall incidence rate of ischemic heart disease was 327 cases/100,000 person-years, corresponding to 470 cases/100,000 for men and 211 cases/100,000 people-years for women. The classical cardiovascular risk factors that were associated with a higher risk of presenting events in the follow-up were dyslipidemia and arterial hypertension, in addition to male sex and age. Conclusions: The incidence of ischemic heart disease in the urban–rural population of Extremadura is high. The classical cardiovascular risk factors most strongly associated with events were dyslipidemia, and arterial hypertension (AU)

[Incidence of ischemic heart disease in the HERMEX study and its association with classical cardiovascular risk factors]. / Incidencia de cardiopatía isquémica en el estudio HERMEX y su asociación con los factores de riesgo cardiovascular clásicos.

OBJECTIVES: Knowledge about the incidence of coronary heart disease in our country is scarce and its sources are not comparable. Our aim was to determine the incidence of ischemic heart disease in a population cohort in a 7 years of follow-up, as well as the risk associated with the different classical cardiovascular risk factors. METHODS: Cohort study with a population sample of 2833 subjects, selected by the simple random method in a population between 25 and 79, from the Don Benito - Villanueva de la Serena (Badajoz) health area, response rate was 80.5%. All episodes of angina pectoris, lethal and non-lethal myocardial infarction were collected in individuals with no previous history of cardiovascular disease. Cumulative incidences and incidence rates adjusted per 100,000 person-years by sex and overall were calculated. RESULTS: From 2833 initial cohort participants, 103 were excluded due to a history of cardiovascular disease and 61 for losses, 2669 completed the follow-up (94.2%). The median follow-up was 6.9 years (IR 6.5-7.5), 56.4% women; 59 events were recorded. The overall incidence rate of ischemic heart disease was 327 cases/100,000 person-years, corresponding to 470 cases/100,000 for men and 211 cases/100,000 people-years for women. The classical cardiovascular risk factors that were associated with a higher risk of presenting events in the follow-up were dyslipidemia and arterial hypertension, in addition to male sex and age. CONCLUSIONS: The incidence of ischemic heart disease in the urban-rural population of Extremadura is high. The classical cardiovascular risk factors most strongly associated with events were dyslipidemia, and arterial hypertension.

Tendencias en las tasas de hospitalización por ictus en Extremadura en el periodo 2002-2014. Cambiando la idea del ictus como una enfermedad propia de la senectud / Trends in stroke hospitalisation rates in Extremadura between 2002 and 2014: Changing the notion of stroke as a disease of the elderly

INTRODUCCIÓN: La incidencia del ictus en nuestro medio ha sido evaluada en diferentes estudios con amplia variabilidad y no comparables. Tampoco hay estudios que analicen los cambios epidemiológicos en pacientes más jóvenes. MÉTODO: Estudio retrospectivo observacional. Conjunto Mínimo Básico de Datos. Se seleccionó a todos los pacientes mayores de 19 años hospitalizados por ictus (códigos ICD-9-CM 434.01, 434.11, 434.91, 430, 431, 432.9, 436 y 435) en el periodo 2002-2013. Análisis mediante el método de regresión lineal segmentada. RESULTADOS: Un total de 39.321 casos fueron identificados. El 47,25% mujeres. Un 3,73% tenía entre 20-44 años, el 6,29% entre 45-54, el 11,49% entre 55-64, el 23,89% entre 65-74 y un 54,60% más de 74 años. Se demuestra un incremento significativo en la tasa de hospitalización por ictus isquémico en varones de 45-54 años, +6,7% (IC del 95%: 3,3-10,2) y en mujeres de 20-44 y 45-54 años, +6,1% (IC del 95%: 0,8-11,7) y +5.7% (IC del 95%: 3,0-8,4), respectivamente. También se observa un incremento significativo de la tasa de hospitalización de ictus isquémico en varones mayores de 74 años, +4,2% (IC del 95%: 1,3-7,2). El análisis para los ataques isquémicos transitorios reproduce lo que ocurre en el ictus isquémico. El mismo análisis para el caso de la hemorragia confirma una estabilización en las tasas de hospitalización en el tiempo. CONCLUSIONES: Este estudio demuestra de una forma indirecta los cambios epidemiológicos que se están produciendo en el ictus. Existe suficiente evidencia que indica un cambio epidemiológico al aumentar la tasa de hospitalizaciones en adultos jóvenes

BACKGROUND: The incidence of stroke in Spain has been evaluated in several studies, whose results are highly variable and not comparable. No studies of stroke have analysed epidemiological changes in younger patients. METHOD: We conducted a retrospective observational study using the Spanish health system's Minimum Data Set and included all patients older than 19 hospitalised due to stroke (ICD-9-CM codes 434.01, 434.11, 434.91, 430, 431, 432.9, 436, and 435) between 2002 and 2013. The analysis was performed using joinpoint regression. RESULTS: A total of 39,321 patients were identified (47.25% were women); 3.73% were aged 20-44, 6.29% were 45-54, 11.49% were 55-64, 23.89% were 65-74, and 54.60% were > 74 years. The hospitalisation rate due to ischaemic stroke has increased significantly in men aged 45-54 (+6.7%; 95% CI, 3.3-10.2) and in women aged 20-44 and 45-54 (+6.1%; 95% CI, 0.8-11.7 and +5.7%; 95% CI, 3.0-8.4, respectively). We also observed a significant increase in the rate of hospitalisation due to ischaemic stroke in men aged over 74 (+4.2%; 95% CI, 1.3-7.2). The rate of hospitalisations due to transient ischaemic attack has also increased significantly whereas the rate of hospitalisations due to brain haemorrhage has stabilised over time. CONCLUSIONS: Our results provide indirect evidence that the epidemiological profile of stroke is changing based on the increase in hospitalisation rates in young adults

Trends in stroke hospitalisation rates in Extremadura between 2002 and 2014: Changing the notion of stroke as a disease of the elderly. / Tendencias en las tasas de hospitalización por ictus en Extremadura en el periodo 2002-2014. Cambiando la idea del ictus como una enfermedad propia de la senectud.

BACKGROUND: The incidence of stroke in Spain has been evaluated in several studies, whose results are highly variable and not comparable. No studies of stroke have analysed epidemiological changes in younger patients. METHOD: We conducted a retrospective observational study using the Spanish health system's Minimum Data Set and included all patients older than 19 hospitalised due to stroke (ICD-9-CM codes 434.01, 434.11, 434.91, 430, 431, 432.9, 436, and 435) between 2002 and 2013. The analysis was performed using joinpoint regression. RESULTS: A total of 39,321 patients were identified (47.25% were women); 3.73% were aged 20-44, 6.29% were 45-54, 11.49% were 55-64, 23.89% were 65-74, and 54.60% were > 74 years. The hospitalisation rate due to ischaemic stroke has increased significantly in men aged 45-54 (+6.7%; 95% CI, 3.3-10.2) and in women aged 20-44 and 45-54 (+6.1%; 95% CI, 0.8-11.7 and +5.7%; 95% CI, 3.0-8.4, respectively). We also observed a significant increase in the rate of hospitalisation due to ischaemic stroke in men aged over 74 (+4.2%; 95% CI, 1.3-7.2). The rate of hospitalisations due to transient ischaemic attack has also increased significantly whereas the rate of hospitalisations due to brain haemorrhage has stabilised over time. CONCLUSIONS: Our results provide indirect evidence that the epidemiological profile of stroke is changing based on the increase in hospitalisation rates in young adults.

Infarto de miocardio en mayores de 75 años: una población en aumento. Estudio CASTUO / Myocardial infarction in older than 75 years: An increasing population. CASTUO Study

Objetivos: Los ancianos con infarto agudo de miocardio constituyen una población que no está adecuadamente representada en ensayos clínicos ni en registros médicos. Nuestro objetivo fue comparar, entre pacientes menores y mayores de 75 años, las características clínicas, los tratamientos administrados y la mortalidad. Material y métodos: Estudio observacional y retrospectivo de pacientes ingresados por infarto agudo de miocardio en la década 2000-09. Se construyeron modelos multivariados para estimar mortalidad hospitalaria y tardía (mediana 4,6 años; RI 25-75: 2,1-7,3). Resultados: Se incluyeron 2.177 pacientes (hombres 995 [79%]) con una edad media de 70,8 años (DE: 12,6). Un total de 917 (42,0%) tenían 75 años o más. Estos enfermos comparados con los menores de 75 años presentaron mayor prevalencia de diabetes (38,3 vs. 32,5%; p<0,002), enfermedad pulmonar obstructiva crónica (15,6 vs. 11,2%; p<0,002), ictus (14,3 vs. 7,3%; p<0,001), insuficiencia renal crónica (11 vs. 3,9%; p<0,001), fibrilación auricular (15,9 vs. 6,9%; p<0,001), insuficiencia cardiaca (28 vs. 23,4%; p<0,008). Recibieron menos betabloqueantes (55,9 vs.71,2%; p<0,001) y estatinas (44,3 vs. 62,3%; p<0,001), se les realizaron menos coronariografías (17,9 vs. 48,5%; p<0,001) y angioplastias (10,8 vs. 29,1; p<0,001). Los mayores de 75 años mostraron una menor supervivencia (mortalidad 44,5 vs. 18,9%), HR 1,89 (IC 95%: 1,57-2,29), asociándose inversamente con la mortalidad tardía: betabloqueantes (HR=0,74; IC 95%: 0,62-0,89), estatinas (HR: 0,73; IC 95%: 0,58-0,91) y angioplastias (HR=0,42; IC 95%: 0,30-0,57). Conclusiones: Los pacientes mayores de 75 años con infarto agudo de miocardio tuvieron menor supervivencia y recibieron menos betabloqueantes, estatinas y angioplastias, indicaciones que se asocian a una menor mortalidad (AU)

Objectives: Elderly patients with acute myocardial infarction constitute a population that is not adequately represented in clinical trials or medical registries. Our objective was to compare the clinical characteristics, treatments administered and mortality among patients younger and older than 75 years. Material and methods: Observational retrospective study of patients hospitalized for acute myocardial infarction in the decade 2000-2009. Multivariate models were constructed to determine hospital and late mortality (median, 4.6 years; IQR 25-75: 2.1-7.3). Results: We included 2,177 patients (995 men [79%]), with a mean age of 70.8 years (SD, 12.6). A total of 917 (42.0%) of the patients were 75 years of age or older. When compared with the patients younger than 75 years, the older patients had a greater prevalence of diabetes (38.3% vs. 32.5%; P<.002), chronic obstructive pulmonary disease (15.6% vs. 11.2%; P<.002), stroke (14.3% vs. 7.3%; P<.001), chronic renal failure (11.0% vs. 3.9%; P<.001), atrial fibrillation (15.9% vs. 6.9%; P<.001), heart failure (28.0% vs. 23.4%; P<.008). The older patients were treated with fewer beta-blockers (55.9% vs. 71.2%; P<.001), statins (44.3% vs. 62.3%; P<.001), coronary angiographies (17.9% vs. 48.5%; P<.001) and angioplasties (10.8% vs. 29.1%; P<.001). The patients older than 75 years had lower survival (mortality, 44.5% vs. 18.9%; HR 1.89; 95% CI 1.57-2.29). The use of beta-blockers (HR, 0.74; 95% CI 0.62-0.89), statins (HR 0.73; 95% CI 0.58-0.91) and angioplasty (HR, 0.42; 95% CI 0.30-0.57) was inversely correlated with mortality. Conclusions: Patients older than 75 years with acute myocardial infarction had lower survival and were treated with fewer beta-blockers, statins and angioplasty, indications that are associated with lower mortality (AU)

Myocardial infarction in older than 75 years: An increasing population. CASTUO Study. / Infarto de miocardio en mayores de 75 años: una población en aumento. Estudio CASTUO.

OBJECTIVES: Elderly patients with acute myocardial infarction constitute a population that is not adequately represented in clinical trials or medical registries. Our objective was to compare the clinical characteristics, treatments administered and mortality among patients younger and older than 75 years. MATERIAL AND METHODS: Observational retrospective study of patients hospitalized for acute myocardial infarction in the decade 2000-2009. Multivariate models were constructed to determine hospital and late mortality (median, 4.6 years; IQR 25-75: 2.1-7.3). RESULTS: We included 2,177 patients (995 men [79%]), with a mean age of 70.8 years (SD, 12.6). A total of 917 (42.0%) of the patients were 75 years of age or older. When compared with the patients younger than 75 years, the older patients had a greater prevalence of diabetes (38.3% vs. 32.5%; P<.002), chronic obstructive pulmonary disease (15.6% vs. 11.2%; P<.002), stroke (14.3% vs. 7.3%; P<.001), chronic renal failure (11.0% vs. 3.9%; P<.001), atrial fibrillation (15.9% vs. 6.9%; P<.001), heart failure (28.0% vs. 23.4%; P<.008). The older patients were treated with fewer beta-blockers (55.9% vs. 71.2%; P<.001), statins (44.3% vs. 62.3%; P<.001), coronary angiographies (17.9% vs. 48.5%; P<.001) and angioplasties (10.8% vs. 29.1%; P<.001). The patients older than 75 years had lower survival (mortality, 44.5% vs. 18.9%; HR 1.89; 95% CI 1.57-2.29). The use of beta-blockers (HR, 0.74; 95% CI 0.62-0.89), statins (HR 0.73; 95% CI 0.58-0.91) and angioplasty (HR, 0.42; 95% CI 0.30-0.57) was inversely correlated with mortality. CONCLUSIONS: Patients older than 75 years with acute myocardial infarction had lower survival and were treated with fewer beta-blockers, statins and angioplasty, indications that are associated with lower mortality.

Características clínicas y mortalidad de la insuficiencia cardiaca. Estudio INCAex / Clinical characteristics and mortality of heart failure. INCAex study

Antecedentes y objetivos. La insuficiencia cardiaca es la causante del mayor gasto sanitario en hospitalización y la tercera causa de mortalidad cardiovascular. Fue nuestro objetivo determinar la evolución de las características clínicas, y los factores relacionados con el pronóstico en pacientes ingresados por insuficiencia cardiaca en un área de salud de Extremadura durante 10 años. Pacientes y métodos. Estudio observacional, retrospectivo y unicéntrico en pacientes consecutivos ingresados por insuficiencia cardiaca descompensada en un Hospital General de la provincia de Badajoz en el período 2000/2009. Resultados. Se incluyeron 2.220 pacientes con una edad media de 76,3 (DE±10,1) años, 54% mujeres. Estratificados en 4 períodos de 30 meses, se observó: un significativo incremento de los pacientes mayores de 75 años (55 al 71%; p<0,001) y al alta una mayor prescripción de bloqueadores beta (12 al 34%; p<0,001), estatinas (8 al 31%; p<0,001), y anticoagulantes orales (13 al 25%; p<0,001). La mortalidad intrahospitalaria disminuyó del 13 al 8% (p<0,01) y al año del 30 al 23% (p<0,01). Fueron predictores independientes de mortalidad al año la edad (HR=1,04 [IC del 95%: 1,02-1,05]), la diabetes (HR=1,35 [IC del 95%: 1,11-1,66]) y la insuficiencia renal (HR=1,49 [IC del 95%: 1,18-1,87]). Conclusiones. La mortalidad ha disminuido significativamente en la década a pesar del incremento de la edad. La edad, la diabetes y la insuficiencia renal crónica resultaron predictores independientes de mortalidad al año. La anticoagulación resultó protectora(AU)

Background and objectives. Heart failure is responsible for a major part of hospital health expenditure and the third cause of cardiovascular death. To describe the evolution of clinical features, and factors related to prognosis of patients admitted due to decompensated heart failure in a region of Extremadura during a period 10 years. Patients and methods. Observational, retrospective and single centre study of consecutive patients admitted due to decompensated heart failure in a general hospital in the province of Badajoz, during the period 2000/2009. Results. A total of 2220 patients with mean age of 76.3 (SD±10.1), being 54% female were included in the study. Stratified into four periods (30 months each), a significant increase in patients over 75 years was observed (55 vs. 71%; P<.001), as well as an increase in the prescription of beta blockers at discharge (12 vs. 34%, P<.001), statins (8 vs. 31%; P<.001), and oral anticoagulants (13 vs. 25%; P<.001). Hospital mortality significantly decreased from 13 to 8% (P<.01), and from 30 to 23% (P<.01) at one year follow-up. Age (HR per year=1.04 [95% CI: 1.02 to 1.05]), diabetes (HR=1.35 [95% CI: 1.11 to 1.66]) and chronic renal failure (HR=1.49 [95% CI: 1.18 to 1.87]) were identified as independent predictors of all-cause mortality at one year of follow-up. Conclusions. Total mortality in patients with decompensated heart failure has declined significantly over the last decade, despite the increasing age. Age, diabetes and chronic renal failure were independent predictors of total mortality at one year. Oral anticoagulation was a protective factor(AU)

Clinical characteristics and mortality of heart failure. INCAex study.

BACKGROUND AND OBJECTIVES: Heart failure is responsible for a major part of hospital health expenditure and the third cause of cardiovascular death. To describe the evolution of clinical features, and factors related to prognosis of patients admitted due to decompensated heart failure in a region of Extremadura during a period 10 years. PATIENTS AND METHODS: Observational, retrospective and single centre study of consecutive patients admitted due to decompensated heart failure in a general hospital in the province of Badajoz, during the period 2000/2009. RESULTS: A total of 2220 patients with mean age of 76.3 (SD±10.1), being 54% female were included in the study. Stratified into four periods (30 months each), a significant increase in patients over 75 years was observed (55 vs. 71%; P<.001), as well as an increase in the prescription of beta blockers at discharge (12 vs. 34%, P<.001), statins (8 vs. 31%; P<.001), and oral anticoagulants (13 vs. 25%; P<.001). Hospital mortality significantly decreased from 13 to 8% (P<.01), and from 30 to 23% (P<.01) at one year follow-up. Age (HR per year=1.04 [95% CI: 1.02 to 1.05]), diabetes (HR=1.35 [95% CI: 1.11 to 1.66]) and chronic renal failure (HR=1.49 [95% CI: 1.18 to 1.87]) were identified as independent predictors of all-cause mortality at one year of follow-up. CONCLUSIONS: Total mortality in patients with decompensated heart failure has declined significantly over the last decade, despite the increasing age. Age, diabetes and chronic renal failure were independent predictors of total mortality at one year. Oral anticoagulation was a protective factor.