Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Efecto de la variante Ómicron sobre la incidencia y la letalidad durante la 6 onda epidémica COVID-19 en España / Effect of the Omicron variant on cumulative incidence of infection and lethality during the sixth wave of the COVID-19 epidemic in Spain

La pandemia COVID-19 ha puesto a prueba los sistemas sanitarios a nivel mundial. Las sucesivas ondas epidémicas han mostrado características diferentes. La variante Ómicron del SARS-CoV-2 modificó el comportamiento epidémico que habían seguido las variantes previas. El objetivo de este análisis fue determinar las características epidemiológicas de la COVID-19 durante la 6.ª onda epidémica y sus diferencias según predominara las variantes Delta u Ómicron. Se analizaron los datos epidemiológicos correspondientes a la 6.ª onda epidémica publicados por los organismos oficiales, y se analizaron la incidencia acumulada de infección (IA-I) y las tasas de letalidad (TL), tanto del conjunto de España como de las diferentes Comunidades Autónomas, en el conjunto de la población y por grupos etarios. Los resultados mostraron que la IA-I era mayor con la variante Ómicron (10,89 vs. 0,75% con Delta) mientras que la TL lo era con la variante Delta (4,2 vs. 1,3‰ con Ómicron), así como una mayor tasa de hospitalización e ingreso en UCI con la variante Delta.(AU)

The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2‰ vs 1.3‰ with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.(AU)

Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

[Effect of the Omicron variant on cumulative incidence of infection and lethality during the sixth wave of the COVID-19 epidemic in Spain]. / Efecto de la variante Ómicron sobre la incidencia y la letalidad durante la 6.ª onda epidémica COVID-19 en España.

The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2‰ vs 1.3‰ with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.

Intensive Weight-Loss Lifestyle Intervention Using Mediterranean Diet and COVID-19 Risk in Older Adults: Secondary Analysis of PREDIMED-Plus Trial.

OBJECTIVES: We tested the effects of a weight-loss intervention encouraging energy-reduced MedDiet and physical activity (PA) in comparison to ad libitum MedDiet on COVID-19 incidence in older adults. DESIGN: Secondary analysis of PREDIMED-Plus, a prospective, ongoing, multicentre randomized controlled trial. SETTING: Community-dwelling, free-living participants in PREDIMED-Plus trial. PARTICIPANTS: 6,874 Spanish older adults (55-75 years, 49% women) with overweight/obesity and metabolic syndrome. INTERVENTION: Participants were randomised to Intervention (IG) or Control (CG) Group. IG received intensive behavioural intervention for weight loss with an energy-reduced MedDiet intervention and PA promotion. CG was encouraged to consume ad libitum MedDiet without PA recommendations. MEASUREMENTS: COVID-19 was ascertained by an independent Event Committee until December 31, 2021. COX regression models compared the effect of PREDIMED-Plus interventions on COVID-19 risk. RESULTS: Overall, 653 COVID-19 incident cases were documented (IG:317; CG:336) over a median (IQR) follow-up of 5.8 (1.3) years (inclusive of 4.0 (1.2) years before community transmission of COVID-19) in both groups. A significantly lowered risk of COVID-19 incidence was not evident in IG, compared to CG (fully-adjusted HR (95% CI): 0.96 (0.81,1.12)). CONCLUSIONS: There was no evidence to show that an intensive weight-loss intervention encouraging energy-reduced MedDiet and PA significantly lowered COVID-19 risk in older adults with overweight/obesity and metabolic syndrome in comparison to ad libitum MedDiet. Recommendations to improve adherence to MedDiet provided with or without lifestyle modification suggestions for weight loss may have similar effects in protecting against COVID-19 risk in older adults with high cardiovascular risks.

Case-fatality rate of SARS-CoV-2 infection during the third and fifth epidemic waves in Spain: Impact of vaccination / Tasa de letalidad de la infección por SARS-CoV-2 durante la tercera y quinta oleadas epidémicas en España: impacto de la vacunación

Introduction During the first and second epidemic waves in Spain, the SARS-CoV-2 case-fatality rates (CFRs) showed significant differences between Autonomous Communities (ACs). Comparing CFRs in the third and fifth epidemic waves can provide information on the impact of the different vaccination coverages in the ACs. Objective To evaluate the impact of vaccination on COVID-19 CFRs in the third and fifth epidemic waves in Spain, according to sex, age, and AC. Methods This work is an observational, descriptive study which uses data on COVID-19 infections, deaths, and vaccinees published by the Spanish Ministry of Health and the regional Health Departments of the ACs. The third epidemic wave was defined as the period from 26th December 2020 to 19th April 2021, and the fifth wave, from 19th July to 19th September 2021. The CFRs (deaths per 1000 infected [‰]) were calculated according to sex, age group, and AC. The standardized case-fatality ratio (SCFR) was adjusted for age and sex for each wave. We estimated the correlation between CFRs and their change between the two epidemic waves with the vaccination coverages reached at the beginning of the fifth wave. Results The CFR in the fifth wave (5.7‰) was lower than in the third wave (16.5‰). In addition, the CFR in both waves was significantly higher in men than in women, and in older people than in younger ones. A decrease in the CFR between both waves was only observed in those older than 49. A strong direct and positive correlation (R2a=0.8399) was found between vaccination coverage by age group and decrease in CFR between both epidemic waves. Significant differences were seen between ACs in the two waves, as regards both CFRs and SCFRs. When comparing ACs, a direct correlation was observed between vaccination coverage and CFRs in the fifth wave, and also – although weak – between vaccination coverage and decrease in CFR between both waves (AU)

Introducción Durante la primera y segunda oleadas epidémicas en España, las tasas de letalidad (TL) por SARS-CoV-2 mostraron diferencias significativas entre comunidades autónomas (CC. AA.). La comparación de las TL en la tercera y quinta oleadas epidémicas puede aportar información sobre el impacto de las diferentes coberturas vacunales en las CC. AA. Objetivo Evaluar el impacto de la vacunación sobre las TL de COVID-19 en la tercera y quinta onda epidémica en España, según sexo, edad y CC. AA. Métodos Este trabajo es un estudio observacional, descriptivo, que utiliza los datos de infectados, fallecidos y vacunados por COVID-19 publicados por el Ministerio de Sanidad y las Consejerías de Sanidad de las CC. AA. La tercera onda epidémica se definió como el periodo comprendido entre el 26 de diciembre de 2020 y el 19 de abril de 2021, y la quinta onda, entre el 19 de julio y el 19 de septiembre de 2021. Las TL (muertes por cada 1.000 infectados [‰]) se calcularon en función del sexo, el grupo de edad y la CC. AA. La razón estandarizada de letalidad (REL) se ajustó por edad y sexo para cada oleada. Se estimó la correlación entre las TL y su cambio entre las 2 oleadas epidémicas con las coberturas de vacunación alcanzadas al inicio de la quinta oleada. Resultados La TL en la quinta onda (5,7‰) fue inferior a la de la tercera onda (16,5‰). Además, la TL en ambas oleadas fue significativamente mayor en varones que en mujeres, y en personas mayores que en jóvenes. Solo se observó una disminución de la TL entre ambas oleadas en los mayores de 49 años. Se encontró una fuerte correlación directa y positiva (R2a=0,8399) entre la cobertura de vacunación por grupo de edad y la disminución de la TL entre ambas oleadas epidémicas (AU)

Case-fatality rate of SARS-CoV-2 infection during the third and fifth epidemic waves in Spain: Impact of vaccination.

INTRODUCTION: During the first and second epidemic waves in Spain, the SARS-CoV-2 case-fatality rates (CFRs) showed significant differences between Autonomous Communities (ACs). Comparing CFRs in the third and fifth epidemic waves can provide information on the impact of the different vaccination coverages in the ACs. OBJECTIVE: To evaluate the impact of vaccination on COVID-19 CFRs in the third and fifth epidemic waves in Spain, according to sex, age, and AC. METHODS: This work is an observational, descriptive study which uses data on COVID-19 infections, deaths, and vaccinees published by the Spanish Ministry of Health and the regional Health Departments of the ACs. The third epidemic wave was defined as the period from 26th December 2020 to 19th April 2021, and the fifth wave, from 19th July to 19th September 2021. The CFRs (deaths per 1000 infected [‰]) were calculated according to sex, age group, and AC. The standardized case-fatality ratio (SCFR) was adjusted for age and sex for each wave. We estimated the correlation between CFRs and their change between the two epidemic waves with the vaccination coverages reached at the beginning of the fifth wave. RESULTS: The CFR in the fifth wave (5.7‰) was lower than in the third wave (16.5‰). In addition, the CFR in both waves was significantly higher in men than in women, and in older people than in younger ones. A decrease in the CFR between both waves was only observed in those older than 49. A strong direct and positive correlation (R2a=0.8399) was found between vaccination coverage by age group and decrease in CFR between both epidemic waves. Significant differences were seen between ACs in the two waves, as regards both CFRs and SCFRs. When comparing ACs, a direct correlation was observed between vaccination coverage and CFRs in the fifth wave, and also - although weak - between vaccination coverage and decrease in CFR between both waves. CONCLUSION: The CFR significantly decreased in Spain between the third and the fifth epidemic waves in population aged 50 or older, probably due to the high vaccination coverage in that age group. Differences were observed between CFRs and SCFRs between ACs that are not explained by the differences in vaccination coverage, suggesting the need for further research and evaluation.

Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes / Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study

Objetivos: Conocer el grado de control óptimo simultáneo de la diabetes (DM), hipertensión arterial (HTA) e hipercolesterolemia y determinar los factores asociados. Material y métodos: Estudio descriptivo transversal en pacientes diabéticos de 18 o más de edad, seleccionados consecutivamente en consultas de medicina de familia (MF). Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró buen control metabólico una HbA1c < 7%, buen control de la presión arterial (PA) valores < 140/80 mmHg y buen control de colesterol LDL (c-LDL) valores < 100 mg/dL. Se realizó análisis bivariante y se calcularon odds ratio (OD) en un modelo de regresión logística. El estudio fue aprobado por el CEIm del Hospital Clínico San Carlos (Madrid). Resultados: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años. El 75,9% eran hipertensos y el 69,1% dislipémicos. Los valores de HbA1c fueron de 6,9 (1,2) %, PA sistólica 135,0 (16,8) mmHg, PA diastólica 75,9 (10,6) mmHg y LDL-colesterol 93,7 (32,8) mg/dL. El buen control metabólico de la DM se alcanzó en el 63% (intervalo de confianza [IC] 95%: 60,4-65,5), el buen control de la HTA en el 42,6% (IC 95%: 40,0-45,2) y el buen control de colesterol LDL en el 61,1% (IC 95%: 58,4-63,7) de los pacientes. El buen control de los tres factores de riesgo cardiovascular (FRCV) simultáneamente se alcanzó en el 16,1% (IC 95%: 14,2-18,1). Se observó una asociación positiva e independiente (p < 0,05) entre el buen control simultáneo de los FRCV con la edad (OR: 1.017) y los antecedentes personales de enfermedad cardiovascular (OR: 1.596). Conclusiones: Los resultados de nuestro estudio indican que una proporción pequeña, menos de dos de cada 10 pacientes cumplen los objetivos de buen control recomendados por las guías de práctica clínica (AU)

Objectives: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. Material and method: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. Results: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4–65.5), good control of HTA at 42.6% (95% CI: 40.0–45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4–63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2–18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). Conclusions: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease (AU)

[Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain]. / Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España.

INTRODUCTION: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. MATERIAL AND METHODS: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. RESULTS: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%). The FRo and FRMo were significantly higher in the age group ≥ 65 years (55.4% and 72.2% respectively) than in the group <65 years (0.5% and 1.4% respectively). The Basque Country, Aragon, Andalusia and Castilla la Mancha presented SFR significantly higher than the global FR of Spain. The correlations between the prevalence of infection and the FRo were inverse. CONCLUSIONS: The case-fatality from COVID-19 during the second epidemic wave in Spain improved compared to the first wave. The case-fatality rates were higher in men and the elderly people, and varied significantly between AC. It is necessary to delve into the analysis of the causes of these differences.

[Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study]. / Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes.

OBJECTIVES: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. MATERIAL AND METHOD: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. RESULTS: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4-65.5), good control of HTA at 42.6% (95% CI: 40.0-45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4-63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2-18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). CONCLUSIONS: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease.

[Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: Final results]. / Factores asociados al riesgo cardiovascular y enfermedad cardiovascular y renal en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal): resultados definitivos.

OBJECTIVE: To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS: Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS: Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS: The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD.

Factores asociados al riesgo cardiovascular y enfermedad cardiovascular y renal en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal): resultados definitivos / Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: final results

OBJETIVO: Analizar la prevalencia en práctica clínica de los factores de riesgo cardiovascular (FRCV) y la enfermedad cardiovascular (ECV), así como su relación causal, en la visita de inclusión. MATERIAL Y MÉTODOS: Análisis transversal de la visita de inclusión de los 8.066 pacientes de 18 a 85años de edad incluidos en el estudio IBERICAN. Se analizó la información socio-demográfica, los antecedentes personales y familiares, y la prevalencia de FRCV, de ECV y de enfermedad renal. Se ha realizado un análisis multivariante, mediante regresión logística que incluía la variable comunidad autónoma como variable de efectos aleatorios, para analizar el impacto de determinadas variables en el desarrollo de cada FRCV, síndrome metabólico, lesión de orden subclínica (LOS), enfermedad renal y ECV. RESULTADOS: La dislipemia fue 2,4 veces más frecuente en diabéticos y se incrementó el riesgo un 59% en hipertensos. La hipertensión arterial fue dos veces más frecuente en diabéticos y se incrementó un 94% en hiperuricémicos y un 62,1% en dislipémicos. La diabetes mellitus fue 2,5 veces mayor en dislipémicos y 2,2 veces mayor en hipertensos. La ECV fue cuatro veces más frecuente en pacientes con antecedentes familiares, y se incrementó un 90,8% el riesgo en mujeres y un 53,8% en pacientes con enfermedad renal. CONCLUSIONES: La población española asistida en atención primaria (AP) que ha sido analizada en el estudio IBERICAN presenta una elevada prevalencia de FRCV y ECV establecida, lo que le confiere un elevado RCV. El análisis multivariante realizado muestra una estrecha relación causal entre los FRCV entre sí y con la enfermedad renal y la ECV

OBJECTIVE: To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS: Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS: Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS: The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD

Análisis de las tasas de letalidad de la infección por SARS-CoV-2 en las comunidades autónomas de España / Analysis of fatality rates case of SARS-CoV-2 infection in the Autonomous Communities of Spain

INTRODUCCIÓN: La pandemia por el virus SARS-CoV-2 ha supuesto un auténtico reto para los sistemas sanitarios. En España, la distribución heterogénea del virus y las diferentes estrategias sanitarias han condicionado la morbilidad y la letalidad. El objetivo de este estudio fue analizar la letalidad de la infección por sexo y rangos de edad en las comunidades autónomas (CC.AA.) de España. MATERIAL Y MÉTODOS: Para realizar el análisis, los datos se extrajeron del Ministerio de Sanidad, Consejerías y Departamentos de Salud Pública de las diferentes CC.AA. Se estimó la población infectada a partir de los resultados del ENE-COVID19 y de la población censada a 1 de enero de 2020 (INE) para una validez del test de anticuerpos IgG con 80% de sensibilidad y 100% de especificidad. La tasa de letalidad (TL) (fallecidos/1.000 infectados estimados) por sexo y edad (< 20 años, 20-64 y ≥ 65 años) se calculó para cada CC.AA. Se calculó la razón estandarizada de letalidad (REL) por el método exacto (EPIDAT). RESULTADOS: La prevalencia estimada de infección por SARS-CoV-2 en España fue del 6% (rango, 1,4% [Ceuta] - 14,1% [Comunidad de Madrid]). La TL para el conjunto de España fue del 9,6/1.000, oscilando entre el 1/1.000 en Melilla y el 26,6/1.000 en La Rioja, sin que se encontrara correlación entre letalidad y prevalencia de la infección. La TL fue mayor en hombres (10,2/1.000, razón 1,17 respecto de mujeres), excepto en Cataluña (razón 0,92), y especialmente elevada en los mayores de 64 años en La Rioja (143,5/1.000), Asturias (69,2/1.000) y País Vasco (46,6/1.000). Se encontró un exceso de letalidad (REL) global superior al 30% en La Rioja (2,91; IC 95%: 2,36-3,57), Asturias (1,51; IC 95%: 1,27-1,80), País Vasco (1,42; IC 95%: 1,31-1,54) y Extremadura (1,37; IC 95%: 1,20-1,57) y en los mayores de 64 años en Madrid y Canarias. CONCLUSIONES: La infección por el virus SARS-CoV-2 se ha distribuido de forma muy irregular en las diferentes CCAA, existiendo una gran diferencia en la tasa de letalidad entre comunidades, siendo especialmente elevada en La Rioja, Asturias y País Vasco. Es relevante el exceso de letalidad respecto a la media nacional en la población mayor de 64 años en las CC.AA. de Madrid y Canarias

INTRODUCTION: The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain. MATERIAL AND METHODS: To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (< 20 years, 20-64 and ≥ 65 years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT). RESULTS: The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] - 14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64 years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95% CI: 2.36-3.57), Asturias (1.51; 95% CI: 1.27-1.80), Basque Country (1.42; 95% CI: 1.31-1.54) and Extremadura (1.37; 95% CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands. CONCLUSIONS: SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64 years of age in the ACs of Madrid and the Canary Islands

[Analysis of fatality rates case of SARS-CoV-2 infection in the Autonomous Communities of Spain]. / Análisis de las tasas de letalidad de la infección por SARS-CoV-2 en las comunidades autónomas de España.

INTRODUCTION: The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain. MATERIAL AND METHODS: To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (<20years, 20-64 and ≥65years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT). RESULTS: The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] -14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95%CI: 2.36-3.57), Asturias (1.51; 95%CI: 1.27-1.80), Basque Country (1.42; 95%CI: 1.31-1.54) and Extremadura (1.37; 95%CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands. CONCLUSIONS: SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64years of age in the ACs of Madrid and the Canary Islands.

Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN) / Description of the sample, design and methods of the study for the identification of the Spanish population at cardiovascular and renal risk (IBERICAN)

ANTECEDENTES Y OBJETIVO: Las enfermedades cardiovasculares (ECV) son la primera causa de muerte en nuestro país, y aunque las tasas de incidencia disminuyen desde hace años por las mejoras en la prevención y el tratamiento, aún hay margen para una mayor reducción. La atención primaria tiene un papel primordial en la prevención y el control de estas enfermedades. Conocer la prevalencia e incidencia de los factores de riesgo cardiovascular y de las enfermedades cardiovasculares en población adulta española asistida en atención primaria es el objetivo del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN). MATERIAL Y MÉTODOS: Estudio de cohortes prospectivas. Población asistida en centros de atención primaria entre 18 y 85 años seleccionada mediante muestreo consecutivo no probabilístico entre el 1 de abril de 2014 y el 31 de octubre de 2018. Mediante revisión de la historia clínica, analíticas y visitas médicas el médico del paciente ha recogido información sociodemográfica, antecedentes personales y familiares y prevalencia e incidencia de factores de riesgo cardiovascular y enfermedad cardiovascular y renal. Se estimarán las incidencias y factores asociados mediante modelos de riesgos proporcionales de Cox y curvas de Kaplan-Meier. RESULTADOS: Forman parte de la cohorte IBERICAN 8.066 pacientes reclutados por 531 médicos de atención primaria de todas las CC. AA. de España, con la excepción de Ceuta. La edad media de la cohorte es de 57,9 años, con un 54,5% de mujeres. La obesidad, la dislipidemia y la HTA son los factores de riesgo cardiovascular más prevalentes. El 16,3% presentaba antecedentes de ECV y el 25,5% alguna lesión de órgano subclínica. CONCLUSIÓN: El estudio IBERICAN es una cohorte de personas atendidas en atención primaria que espera aportar información relevante sobre los factores que determinan la incidencia de ECV y renal en España

BACKGROUND AND OBJECTIVE: Cardiovascular diseases (CVD) are the leading cause of death in Spain, and although the incidence rates have been declining for years due to improvements in prevention and treatment, there is still room for further reduction. Primary Care has a leading role in the prevention and control of these diseases. Determining the prevalence and incidence of cardiovascular risk factors and cardiovascular diseases in the Spanish adult population attended in Primary Care is the objective of the study to identify the Spanish population at cardiovascular and renal risk (IBERICAN). MATERIAL AND METHODS: A prospective cohort study was conducted using a consecutive non-probabilistic sampling population between 18 and 85 years that attended Primary Care centres between April 1, 2014 and October 31, 2018. By reviewing the medical history, laboratory results, and medical visits, the Primary Care physicians collected socio-demographic information, personal and family history of the patients, as well as prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease. The incidents and associated factors will be estimated using proportional risk models of Cox and Kaplan-Meier Curves. RESULTS: A total of 8,066 patients have been recruited by 531 Primary Care physicians from all Autonomous Communities of Spain as part of the IBERICAN cohort, with the exception of Ceuta. The mean age of the cohort is 57.9 years with 54.5% women. Obesity, dyslipidaemia, and hypertension are the most prevalent cardiovascular risk factors. There was a history of CVD in16.3%, and 25.5% had a subclinical organ lesion. CONCLUSION: The IBERICAN study is a cohort of people treated in Primary Care that expects to provide relevant information on the factors that determine the incidence of cardiovascular and renal disease in Spain

[Description of the sample, design and methods of the study for the identification of the Spanish population at cardiovascular and renal risk (IBERICAN)]. / Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN).

BACKGROUND AND OBJECTIVE: Cardiovascular diseases (CVD) are the leading cause of death in Spain, and although the incidence rates have been declining for years due to improvements in prevention and treatment, there is still room for further reduction. Primary Care has a leading role in the prevention and control of these diseases. Determining the prevalence and incidence of cardiovascular risk factors and cardiovascular diseases in the Spanish adult population attended in Primary Care is the objective of the study to identify the Spanish population at cardiovascular and renal risk (IBERICAN). MATERIAL AND METHODS: A prospective cohort study was conducted using a consecutive non-probabilistic sampling population between 18 and 85 years that attended Primary Care centres between April 1, 2014 and October 31, 2018. By reviewing the medical history, laboratory results, and medical visits, the Primary Care physicians collected socio-demographic information, personal and family history of the patients, as well as prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease. The incidents and associated factors will be estimated using proportional risk models of Cox and Kaplan-Meier Curves. RESULTS: A total of 8,066 patients have been recruited by 531 Primary Care physicians from all Autonomous Communities of Spain as part of the IBERICAN cohort, with the exception of Ceuta. The mean age of the cohort is 57.9 years with 54.5% women. Obesity, dyslipidaemia, and hypertension are the most prevalent cardiovascular risk factors. There was a history of CVD in16.3%, and 25.5% had a subclinical organ lesion. CONCLUSION: The IBERICAN study is a cohort of people treated in Primary Care that expects to provide relevant information on the factors that determine the incidence of cardiovascular and renal disease in Spain.

Medicina personalizada en atención primaria / Personalized medicine in primary care

No disponible

Fibromialgia como paradigma de retos pendientes en la atención primaria / Fibromyalgia as a paradigm of outstanding challenges in primary care

No disponible