Importancia pronóstica de la enfermedad arterial periférica diagnosticada mediante el índice tobillo-brazo en población general española / Prognostic importance of diagnosticated peripheral arterial disease through the ankle brachial index in spanish general population

OBJETIVO: Determinar el valor pronóstico de tener un índice tobillo-brazo (ITB) bajo para padecer distintas enfermedades cardiovasculares y si mejora la capacidad predictiva de las principales funciones de riesgo cardiovascular. DISEÑO: Estudio de cohorte poblacional. EMPLAZAMIENTO: Área sanitaria Don Benito-Villanueva de la Serena (Badajoz). España. PARTICIPANTES: Se seleccionaron 2.833 sujetos representativos de los residentes, entre 25 y 79 años. MEDICIONES: Se midió el ITB en la inclusión y se registró el primer episodio de cardiopatía isquémica o ictus, la mortalidad cardiovascular y total en siete años de seguimiento. Se calcularon los hazard ratio (HR), ajustados por factores de riesgo cardiovascular, para el ITB bajo (< 0,9). Se determinaron los índices de reclasificación neta por categorías, clínica y continua para las funciones REGICOR, FRESCO cardiopatía isquémica, FRESCO enfermedad cardiovascular y SCORE. RESULTADOS: Se analizaron 2.665 sujetos tras excluir las personas con antecedentes cardiovasculares y las pérdidas. El ITB bajo se asoció con un mayor riesgo, alcanzando una HR (IC 95%) de 6,45 (3,00 - 13,86), 2,60 (1,15 - 5,91), 3,43 (1,39 - 8,44), 2,21 (1,27 - 3,86) para ictus, cardiopatía isquémica, mortalidad cardiovascular y total, respectivamente. La inclusión del ITB mejoró el índice de reclasificación (IC 95%) en el riesgo intermedio según FRESCO cardiovascular en un 24,1% (10,1 - 38,2). CONCLUSIONES: El ITB bajo está asociado con un incremento importante del riesgo de ictus, cardiopatía isquémica, mortalidad cardiovascular y total en nuestro medio. La inclusión del ITB mejoró la reclasificación de las personas con riesgo intermedio, según FRESCO cardiovascular, por lo que estaría justificada su utilización en esa categoría de riesgo

OBJECTIVE. The objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain. DESIGN: Population-based cohort study. LOCATION: A health area of the province of Badajoz (Spain). PARTICIPANTS: 2,833 subjects, representative of residents, between 25 and 79 years old, MEASUREMENTS: The ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated. RESULTS: 2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2). CONCLUSIONS: Low ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified

[Prognostic importance of diagnosticated peripheral arterial disease through the ankle brachial index in spanish general population]. / Importancia pronóstica de la enfermedad arterial periférica diagnosticada mediante el índice tobillo-brazo en población general española.

OBJECTIVE: The objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain. DESIGN: Population-based cohort study LOCATION: A health area of the province of Badajoz (Spain) PARTICIPANTS: 2,833 subjects, representative of residents, between 25 and 79 years old, MEASUREMENTS: The ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated. RESULTS: 2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2). CONCLUSIONS: Low ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified.

A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score.

BACKGROUND: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs. METHODS: This is a development and validation study in patients -randomly divided into two cohorts- from a large randomized clinical trial (iPROVE) that enrolled 964 intermediate-to-high risk patients scheduled for abdominal surgery. Arterial oxygenation was assessed on room-air in the preoperative period (preoperative air-test) and 3h after admission to the postoperative care unit (postoperative air-test). The air-test was defined as positive or negative if SpO2 was ≤96% or >96%, respectively. Positive air-tests were stratified into weak (93-96%) or strong (<93%). The primary outcome was a composite of moderate-to-severe PPCs during the first seven postoperative days. RESULTS: A total of 902 patients were included in the final analysis (542 in the development cohort and 360 in the validation cohort). Regression analysis identified five independent risk factors for PPC: age, type of surgery, pre- and postoperative air-test, and atelectasis. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI: 0.75-0.82) when including these five independent predictors. We built a simplified score termed "air-test score" by using only the pre- and postoperative SpO2, resulting in an AUC of 0.72 (95% CI: 0.67-0.76) for the derivation and 0.72 (95% CI: 0.66-0.78) for the validation cohort, respectively. The air-test score stratified patients into four levels of risk, with PPCs ranging from <15% to >75%. CONCLUSIONS: The simple, non-invasive and inexpensive bedside air-test score, evaluating pre- and postoperatively SpO2 measured on room-air, helps to predict the risk for PPCs.

Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial.

BACKGROUND: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. METHODS: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. RESULTS: We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. CONCLUSIONS: An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. CLINICAL TRIAL REGISTRATION: NCT02776046.

Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial.

BACKGROUND: The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. METHODS: We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m2. Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. FINDINGS: Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0·89 [95% CI 0·74-1·07; p=0·25]), OLA-CPAP (111 [47%] of 238, 0·91 [0·76-1·09; p=0·35]), or STD-CPAP groups (118 [48%] of 244, 0·95 [0·80-1·14; p=0·65]) when compared with patients in the STD-O2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. INTERPRETATION: In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation. FUNDING: Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, and Grants Programme of the European Society of Anaesthesiology.

Efecto del sexo y la actividad física doméstica en el fenotipo obeso metabólicamente sano y el obeso con alteraciones metabólicas. Estudio HERMEX / The role of sex and domestic physical activity on the metabolically healthy and unhealthy obesity. The HERMEX Study

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Severity of obesity and cardiometabolic risk factors in adults: Sex differences and role of physical activity. The HERMEX study.

BACKGROUND: The aims of this study were 1) to examine potential sex-related differences in major cardiometabolic risk factors among severe/morbid obese (body mass index [BMI]≥35) individuals; 2) to assess whether severity of obesity is associated with more adverse cardiometabolic risk factors in women and men, and 3) to assess whether being physically active (≥500 metabolic equivalents [MET-minutes per week]) may play a role in the association between severity of obesity and the cardiometabolic risk profile. METHODS: A total of 886 (438 men) obese individuals participated in a population-based cross-sectional study. We categorized participants as grade I (BMI 30-34.99) and grade II/III (BMI≥35) obese. We measured markers of lipid and glucose metabolism, inflammation (high sensitivity C-reactive protein [hs-CRP]) blood pressure and renal function, as well as self-reported physical activity. RESULTS: Triglycerides, insulin, HOMA-IR, systolic blood pressure and creatinine levels were higher in severe/morbid obese men than women (all, P<0.05), while women presented higher HDL cholesterol and hs-CRP (P<0.05) than men. Severe/morbid obesity was associated with higher triglycerides, hs-CRP, insulin and insulin resistance, diastolic blood pressure and higher odds of hypertension than grade I obesity both in women and men (all, P<0.05). Severe/morbid obese individuals who were physically inactive presented the least favorable cardiometabolic profile (P<0.05). CONCLUSIONS: Severe/morbid obesity is associated with more adverse cardiometabolic risk factors both in women and men. Severe/morbid obese men are more affected than women regarding their cardiometabolic profile, although women presented higher inflammation. Physically inactive individuals with severe/morbid obesity had the most adverse clustered cardiometabolic risk profile.

Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial.

BACKGROUND: Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. METHODS: This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. DISCUSSION: The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications. TRIAL REGISTRATION: Registered on 5 June 2014 with identification no. NCT02158923 .

Cholesterol and cardiovascular disease in the elderly. Facts and gaps.

Hypercholesterolemia is a major cardiovascular risk factor that increases the incidence of atherosclerotic diseases in adults, although the association is less well established in the elderly. The role of statins is well characterized for the reduction of myocardial infarction incidence or death in individuals with a history or high risk of cardiovascular diseases, regardless of age. Therapeutic measures recommended to prevent cardiovascular diseases and to reduce cholesterol levels in the elderly, such as lifestyle changes and lipid-lowering drugs, particularly statins, are based on studies conducted in younger adults. This narrative review aims to summarize the main observational studies and randomized clinical trials that have studied the relationship between cholesterol and cardiovascular diseases and the potential benefits and drawbacks of statins use in elderly patients.

Alfalfa nodules elicited by a flavodoxin-overexpressing Ensifer meliloti strain display nitrogen-fixing activity with enhanced tolerance to salinity stress.

Nitrogen fixation by legumes is very sensitive to salinity stress, which can severely reduce the productivity of legume crops and their soil-enriching capacity. Salinity is known to cause oxidative stress in the nodule by generating reactive oxygen species (ROS). Flavodoxins are involved in the response to oxidative stress in bacteria and cyanobacteria. Prevention of ROS production by flavodoxin overexpression in bacteroids might lead to a protective effect on nodule functioning under salinity stress. Tolerance to salinity stress was evaluated in alfalfa nodules elicited by an Ensifer meliloti strain that overexpressed a cyanobacterial flavodoxin compared with nodules produced by the wild-type bacteria. Nitrogen fixation, antioxidant and carbon metabolism enzyme activities were determined. The decline in nitrogenase activity associated to salinity stress was significantly less in flavodoxin-expressing than in wild-type nodules. We detected small but significant changes in nodule antioxidant metabolism involving the ascorbate-glutathione cycle enzymes and metabolites, as well as differences in activity of the carbon metabolism enzyme sucrose synthase, and an atypical starch accumulation pattern in flavodoxin-containing nodules. Salt-induced structural and ultrastructural alterations were examined in detail in alfalfa wild-type nodules by light and electron microscopy and compared to flavodoxin-containing nodules. Flavodoxin reduced salt-induced structural damage, which primarily affected young infected tissues and not fully differentiated bacteroids. The results indicate that overexpression of flavodoxin in bacteroids has a protective effect on the function and structure of alfalfa nodules subjected to salinity stress conditions. Putative protection mechanisms are discussed.

Prevalencia y características clínicas de la enfermedad arterial periférica en la población general del estudio Hermex / Prevalence and clinical characteristics of peripheral arterial disease in the study population hermex

Introducción y objetivos. Determinar la prevalencia de enfermedad arterial periférica mediante el índice tobillo-brazo y evaluar los factores de riesgo, clínicos y diagnósticos asociados. Métodos. Estudio transversal realizado entre 2007 y 2009, con muestra aleatoria de 2.833 sujetos entre 25 y 79 años representativa del área de salud de Don Benito (Badajoz). Se consideró diagnóstico de enfermedad arterial periférica un índice tobillo-brazo < 0,90. Se utilizó el cuestionario de Edimburgo para identificar formas sintomáticas. Se evaluaron las recomendaciones actuales de cribado, los cambios del riesgo coronario estimado conseguidos con su uso y la asociación con los factores de riesgo. Resultados. La prevalencia de enfermedad arterial periférica fue del 3,7% (intervalo de confianza del 95%, 3,0-4,5%); el 5,0% (3,9-6,3%) en varones y el 2,6% (1,8-3,5%) en mujeres (p=0,001). Las prevalencias acumuladas a partir de 50, 60 y 70 años fueron del 6,2, el 9,1 y el 13,1% respectivamente. La enfermedad era sintomática en el 13,3% (6,8-19,8%) de los casos. Las recomendaciones actuales de cribado no detectaron al 29,6% de los enfermos asintomáticos. El uso del índice aumentó el 32,7% los casos de riesgo coronario alto. Se halló asociación positiva de la enfermedad con edad, tabaquismo, hipercolesterolemia, sedentarismo, microalbuminuria y enfermedad cardiovascular, y negativa con el consumo de alcohol. Conclusiones. El uso del índice tobillo-brazo es aconsejable para el diagnóstico de esta enfermedad, dada la baja prevalencia de formas sintomáticas y su capacidad para cambiar el riesgo coronario estimado. Se debería adaptar los grupos de cribado a la población española. Tabaquismo e hipercolesterolemia son los principales factores de riesgo (AU)

Introduction and objectives. To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. Introduction and objectives. The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors. To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. Methods. El uso del índice tobillo-brazo es aconsejable para el diagnóstico de esta enfermedad, dada la baja prevalencia de formas sintomáticas y su capacidad para cambiar el riesgo coronario estimado. Se debería adaptar los grupos de cribado a la población española. Tabaquismo e hipercolesterolemia son los principales factores de riesgo. Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. La prevalencia de enfermedad arterial periférica fue del 3,7% (intervalo de confianza del 95%, 3,0-4,5%); el 5,0% (3,9-6,3%) en varones y el 2,6% (1,8-3,5%) en mujeres (p=0,001). Las prevalencias acumuladas a partir de 50, 60 y 70 años fueron del 6,2, el 9,1 y el 13,1% respectivamente. La enfermedad era sintomática en el 13,3% (6,8-19,8%) de los casos. Las recomendaciones actuales de cribado no detectaron al 29,6% de los enfermos asintomáticos. El uso del índice aumentó el 32,7% los casos de riesgo coronario alto. Se halló asociación positiva de la enfermedad con edad, tabaquismo, hipercolesterolemia, sedentarismo, microalbuminuria y enfermedad cardiovascular, y negativa con el consumo de alcohol. Methods. Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. Results. The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. Results. The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. Conclusions: The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors (AU)

Prevalence and clinical characteristics of peripheral arterial disease in the study population Hermex.

INTRODUCTION AND OBJECTIVES: To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. METHODS: Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. RESULTS: The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. CONCLUSIONS: The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors.

Prevalence of left-ventricular hypertrophy by multiple electrocardiographic criteria in general population: Hermex study.

OBJECTIVES: To determine the prevalence of left-ventricular hypertrophy (LVH) in the general population by means of multiple electrocardiographic criteria and those variables independently associated. METHODS: Random-sample cross-sectional study of the general population aged between 25 and 79 years, representative of a health area, was conducted. An electrocardiogram was recorded 'on line' in the Electropres project website; 17 LVH criteria together with two combined criteria were used. By multivariate analysis we examined those variables independently associated with the presence of electrocardiographic LVH. RESULTS: We recruited 2564 individuals, mean age 50.9 [standard deviation (SD) 14.7] years, 45.7% men. The criteria more prevalent were: Dalfó 19.4%, RV6/V5 14.5%, Perugia 10.9%, any combination with at least three positive criteria (Combined 3) 9.4%, Romhilt 7.5%, Lewis 6.2% and the recommended criteria of the European Society of Hypertension 4%. The best prevalence ratio between hypertensive and normotensive individuals was achieved with Lewis, Dalfó and Perugia criteria. The least prevalence was Sokolow 0.7%. The variables that were independently associated with the presence of LVH by Combined 3 criterion were pulse pressure at least 50 [odds ratio (OR) 2.13, 95% confidence interval (CI) 1.47-3.09], arterial hypertension (OR 1.75, 95% CI 1.21-2.53) and smoking (OR 0.69, 95% CI 0.50-0.95). CONCLUSIONS: The detection ability of the electrocardiogram with regard to the LVH may improve with the use of other criteria than those currently recommended by the guidelines. The presence of LVH is positively associated with hypertension and elevated pulse pressure and negatively with a history of smoking.

Prevalencia de síndrome metabólico en una población de niños y adolescentes con obesidad / Prevalence of metabolic syndrome in a population of obese children and adolescents

Introducción La obesidad infantil es un problema sanitario creciente y de primer orden para la sociedad, ya que aumenta el riesgo de padecer enfermedades cardiovasculares, diabetes mellitus tipo 2 e hipertensión arterial. Así, cuando los niños obesos se convierten en adultos obesos, los efectos sobre su salud y expectativas de vida pueden ser devastadores.Objetivos1). Determinar la prevalencia de síndrome metabólico (SM) en una población infanto-juvenil con obesidad, y 2). Comparación de parámetros antropométricos y bioquímicos en pacientes con 1 o 2 parámetros de SM frente a los pacientes que cumplen criterios de SM. Material y métodos Estudio transversal descriptivo en niños y adolescentes con obesidad (>p97) tratados en el Servicio de Endocrinología del Hospital de Getafe. Las variables estudiadas fueron: edad, sexo, talla, peso, índice de masa corporal (IMC), circunferencia de cintura (CC), glucemia basal y tras sobrecarga oral de glucosa (SOG), insulinemia, resistencia a la insulina (RI) medida mediante HOMA, triglicéridos (TG), HDL, tensión arterial sistólica y diastólica (TAS y TAD). La definición de SM en adolescentes se hizo de acuerdo a criterios de la International Diabetes Federation (IDF) de 2007.Resultados133 pacientes, 67 varones (50,4%) y 66 mujeres (49,6%), con edad media de 12,17±3,27 años. Todos los pacientes presentaban obesidad superior al p97 para edad y sexo. La prevalencia de los distintos parámetros del SM fue la siguiente: 100% CC>p90 para edad y sexo; 26,08% hipertensión arterial; 15,94% hipertrigliceridemia superior a 150mg/dl; 10,86% HDL < 40mg/dl; 7,97% glucemia en ayunas por encima de 100mg/dl. En conjunto, la prevalencia de SM fue del 19,6%. Cuando comparamos distintos parámetros antropométricos y bioquímicos en los pacientes con 1 o 2 criterios de SM frente a los que presentan SM completo, se observa que a mayor número de criterios de SM, el grado de obesidad y la (..) (AU)

Introduction Childhood obesity is a major and increasing health problem for society because it increases the risk of cardiovascular disease, type 2 diabetes mellitus, and hypertension. Thus, when obese children become obese adults, effects on their health and life expectation may be devastating. Objectives(1) To assess the prevalence of metabolic syndrome (MS) in a child population with obesity and (2) to compare anthropometric and biochemical parameters in patients with one or two parameters of MS syndrome to those of patients who meet MS criteria. Patients and methods A descriptive, cross-sectional study was conducted in children and adolescents with severe obesity (weight >p97) seen at the endocrinology department of Hospital de Getafe. Variables examined included age, sex, height, weight, body mass index (BMI), waist circumference (WC), oral glucose tolerance test (OGTT), insulin, insulin resistance (IR) measured by HOMA, triglycerides (Tg), high density lipoprotein (HDL), and systolic and diastolic blood pressure (SBP and DBP). The definition of MS in adolescents was made according to criteria of the International Diabetes Federation (IDF), 2007.ResultsA total of 133 patients, 67 males (50.4%) and 66 females (49.6%) with a mean age of 12.17±3.27 years, were enrolled into the study. All patients were obese, with a weight greater than the 97h percentile for age and sex. Prevalence of several cardiovascular risk factors was as follows: WC ≥90th percentile for age and sex, 100%; hypertension, 26.08%; hypertriglyceridemia ≥150mg/dL, 15.94%; HDL <40mg/dL, 10.86%; fasting blood glucose levels ≥100mg/dL, 7.97%. The overall prevalence of (..) (AU)

Prevalencia de obesidad y riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Estudio Hermex / Prevalence of obesity and cardiovascular risk in the general population of a health area in Extremadura (Spain). The Hermex study

Introducción y objetivos Estimar la prevalencia de la obesidad y el riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Material y métodos Estudio transversal sobre una muestra aleatoria de población entre 25 y 79 años procedente del área de salud de Don Benito-Villanueva (Badajoz). Se estudió la presencia de factores de riesgo y enfermedad cardiovascular. Se recogieron medidas antropométricas, de presión arterial y muestra sanguínea. Se categorizó a la población obesa en distintos niveles de riesgo tal como propone la Sociedad Española para el Estudio de la Obesidad y se estudió la influencia de la obesidad en la estimación del riesgo de cardiopatía isquémica según la función de Framinghan adaptada para España. Resultados De los 3.521 sujetos seleccionados participaron 2.833 (80,5%). La edad media fue 51,2 años (DE 14,7) y el 46,5% fueron hombres. La prevalencia de sobrepeso y obesidad fue superior en hombres (46,2 y 37,7%) con respecto a las mujeres (37,7 y 32,6%) (p<0,005 y p<0,05 respectivamente). Solo el 10% de los obesos no mostraron un riesgo cardiovascular aumentado. La obesidad se asoció a un incremento de presentar riesgo alto de cardiopatía isquémica de 8 veces en la mujer (p<0,001) por 1,4 veces en el hombre (p=0,095).Conclusiones La obesidad es muy prevalente y afecta junto al sobrepeso al 74,1% de la población de un área de salud de Extremadura. La amplia mayoría de los obesos tienen un riesgo cardiovascular aumentado, siendo de gran magnitud para la cardiopatía isquémica en la mujer (AU)

Introduction and objectives To estimate the prevalence of obesity and its associated cardiovascular risk in the general population of a health area in Extremadura. Materials and methods A cross-sectional study on a random population sample aged 25-79 years from the Don Benito-Villanueva (Badajoz) health area. Risk factors and cardiovascular disease were examined. Anthropometric and blood pressure measurements were collected, and a blood sample was taken. Obese subjects were categorized into different risk levels as proposed by the Spanish Society for the Study of Obesity, and the influence of obesity on estimation of the risk of ischemic heart disease was studied using the Framingham function, as adapted for Spain. Results A total of 2833 of the 3521 subjects screened (80.5%) participated in the study. Mean age was 51.2 years (SD 14.7), and 46.5% were males. Male subjects had a greater prevalence of overweight and obesity (46.2% and 37.7% respectively) as compared to females (37.7% and 32.6%) (p<0.005 and p<0.05, respectively). Only 10% of obese subjects had no increased cardiovascular risk. Obesity was associated to an 8-fold increase in the presence of a high risk for ischemic heart disease in females (p<0.001), as compared to a 1.4-fold increase in males (p=0.095).Conclusions Obesity is highly prevalent and affects, together with overweight, 74.1% of the population in an Extremadura health area. A vast majority of obese subjects have an increased cardiovascular risk, which is very marked for ischemic heart disease in females (AU)

Síndrome metabólico en España: prevalencia y riesgo coronario asociado a la definición armonizada y a la propuesta por la OMS. Estudio DARIOS / Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study

Introducción y objetivos. Actualizar la prevalencia del síndrome metabólico en España y su riesgo coronario asociado, empleando la definición armonizada y la nueva propuesta de la Organización Mundial de la Salud (síndrome metabólico premórbido), que excluye diabetes mellitus y enfermedad cardiovascular. Métodos. Análisis agrupado con datos individuales de 11 estudios, incluyendo a 24.670 individuos de 10 comunidades autónomas con edad 35-74 años. El riesgo coronario se estimó con la función REGICOR. Resultados. La prevalencia de síndrome metabólico fue del 31% (mujeres, 29%; intervalo de confianza del 95%, 25-33%; varones, 32%; intervalo de confianza del 95%, 29-35%). Entre los varones con síndrome metabólico, fueron más frecuentes la elevación de glucemia (p=0,019) y triglicéridos (p<0,001); por contra, entre las mujeres predominaron obesidad abdominal (p<0,001) y colesterol unido a las lipoproteínas de alta densidad bajo (p=0,001). Las personas con síndrome metabólico mostraron riesgo coronario moderado (varones, 8%; mujeres, 5%), pero mayor (p<0,001) que la población sin síndrome metabólico (varones, 4%; mujeres, 2%). El incremento de riesgo coronario asociado al síndrome metabólico fue mayor en mujeres que en varones (2,5 frente a 2 veces, respectivamente; p<0,001). La prevalencia de síndrome metabólico premórbido fue del 24% y su riesgo coronario asociado también aumentó más en las mujeres que en los varones (2 frente a 1,5; p<0,001). Conclusiones. La prevalencia de síndrome metabólico es del 31%; el síndrome metabólico premórbido la rebaja al 24% y delimita la población para prevención primaria. El incremento de riesgo coronario es proporcionalmente mayor en las mujeres, tanto en síndrome metabólico como en síndrome metabólico premórbido (AU)

Introduction and objectives. To update the prevalence of metabolic syndrome and associated coronary risk in Spain, using the harmonized definition and the new World Health Organization proposal (metabolic premorbid syndrome), which excludes diabetes mellitus and cardiovascular disease. Methods. Individual data pooled analysis study of 24 670 individuals from 10 autonomous communities aged 35 to 74 years. Coronary risk was estimated using the REGICOR function. Results.Prevalence of metabolic syndrome was 31% (women 29% [95% confidence interval, 25%-33%], men 32% [95% confidence interval, 29%-35%]). High blood glucose (P=.019) and triglycerides (P<.001) were more frequent in men with metabolic syndrome, but abdominal obesity (P<.001) and low high-density lipoprotein cholesterol (P=.001) predominated in women. Individuals with metabolic syndrome showed moderate coronary risk (8% men, 5% women), although values were higher (P<.001) than in the population without the syndrome (4% men, 2% women). Women and men with metabolic syndrome had 2.5 and 2 times higher levels of coronary risk, respectively (P<.001). Prevalence of metabolic premorbid syndrome was 24% and the increase in coronary risk was also proportionately larger in women than in men (2 vs 1.5, respectively; P<.001). Conclusions. Prevalence of metabolic syndrome is 31%; metabolic premorbid syndrome lowers this prevalence to 24% and delimits the population for primary prevention. The increase in coronary risk is proportionally larger in women, in both metabolic syndrome and metabolic premorbid syndrome (AU)

Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study.

INTRODUCTION AND OBJECTIVES: To update the prevalence of metabolic syndrome and associated coronary risk in Spain, using the harmonized definition and the new World Health Organization proposal (metabolic premorbid syndrome), which excludes diabetes mellitus and cardiovascular disease. METHODS: Individual data pooled analysis study of 24,670 individuals from 10 autonomous communities aged 35 to 74 years. Coronary risk was estimated using the REGICOR function. RESULTS: Prevalence of metabolic syndrome was 31% (women 29% [95% confidence interval, 25%-33%], men 32% [95% confidence interval, 29%-35%]). High blood glucose (P=.019) and triglycerides (P<.001) were more frequent in men with metabolic syndrome, but abdominal obesity (P<.001) and low high-density lipoprotein cholesterol (P=.001) predominated in women. Individuals with metabolic syndrome showed moderate coronary risk (8% men, 5% women), although values were higher (P<.001) than in the population without the syndrome (4% men, 2% women). Women and men with metabolic syndrome had 2.5 and 2 times higher levels of coronary risk, respectively (P<.001). Prevalence of metabolic premorbid syndrome was 24% and the increase in coronary risk was also proportionately larger in women than in men (2 vs 1.5, respectively; P<.001). CONCLUSIONS: Prevalence of metabolic syndrome is 31%; metabolic premorbid syndrome lowers this prevalence to 24% and delimits the population for primary prevention. The increase in coronary risk is proportionally larger in women, in both metabolic syndrome and metabolic premorbid syndrome.

[Prevalence of obesity and cardiovascular risk in the general population of a health area in Extremadura (Spain): the Hermex study]. / Prevalencia de obesidad y riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Estudio Hermex.

INTRODUCTION AND OBJECTIVES: To estimate the prevalence of obesity and its associated cardiovascular risk in the general population of a health area in Extremadura. MATERIALS AND METHODS: A cross-sectional study on a random population sample aged 25-79 years from the Don Benito-Villanueva (Badajoz) health area. Risk factors and cardiovascular disease were examined. Anthropometric and blood pressure measurements were collected, and a blood sample was taken. Obese subjects were categorized into different risk levels as proposed by the Spanish Society for the Study of Obesity, and the influence of obesity on estimation of the risk of ischemic heart disease was studied using the Framingham function, as adapted for Spain. RESULTS: A total of 2833 of the 3521 subjects screened (80.5%) participated in the study. Mean age was 51.2 years (SD 14.7), and 46.5% were males. Male subjects had a greater prevalence of overweight and obesity (46.2% and 37.7% respectively) as compared to females (37.7% and 32.6%) (p<0.005 and p<0.05 respectively). Only 10% of obese subjects had no increased cardiovascular risk. Obesity was associated to an 8-fold increase in the presence of a high risk for ischemic heart disease in females (p<0.001), as compared to a 1.4-fold increase in males (p=0.095). CONCLUSIONS: Obesity is highly prevalent and affects, together with overweight, 74.1% of the population in an Extremadura health area. A vast majority of obese subjects have an increased cardiovascular risk, which is very marked for ischemic heart disease in females.

Prevalencia de síndrome metabólico según las nuevas recomendaciones de la OMS. Estudio HERMEX / Prevalence of metabolic syndrome estimated with the new World Health Organization recommendations. The HERMEX study

Objetivos La unificación de criterios para el diagnóstico del síndrome metabólico, junto con la propuesta de la Organización Mundial de la Salud de eliminar de ellos a los pacientes con diabetes o con enfermedades cardiovasculares, cambiará la estimación de su prevalencia. Nuestro objetivo fue determinar la prevalencia del síndrome metabólico en un área de salud extremeña siguiendo ambas recomendaciones. Métodos Estudio transversal, poblacional, con selección aleatoria de individuos entre 25 y 79 años de edad, en un Área de Salud de Badajoz. Se recogieron los antecedentes de factores de riesgo cardiovascular, la presión arterial y el perímetro abdominal, y una muestra de sangre en ayunas. Se comparó la prevalencia del síndrome metabólico siguiendo los recientes criterios, por sexo y edad. Resultados Se reclutaron 2.833 personas, el 46,5% eran hombres, y la edad media 51,2 años. La prevalencia del síndrome metabólico fue del 33,6%, significativamente mayor en los hombres (36,7% frente a 30,9%; p<0,001) y con una disminución significativa al excluir la diabetes y la enfermedad cardiovascular (20,8%; p<0,001). La diferencia de prevalencia con los distintos criterios fue significativa para el total y por sexo (p<0,001), a partir del decenio de edad de 45-54 años en los hombres y de 55-64 años en las mujeres. Conclusiones La prevalencia de síndrome metabólico en el área estudiada es de las más altas halladas en España en estudios poblacionales. Aunque se reduce con las nuevas recomendaciones internacionales, indica una población considerable y joven en la cual aplicar medidas preventivas (AU)

Objectives The unification of criteria for the diagnosis of metabolic syndrome, together with the subsequent World Health Organization (WHO) proposal to eliminate diabetes and cardiovascular diseases from the diagnostic criteria, will change estimates of the known prevalence of this syndrome. The aim of this study was to determine the prevalence of metabolic syndrome in a health area of Badajoz (Spain) using the latest consensus criteria and eliminating diabetes and cardiovascular disease. Methods We performed a cross-sectional population-wide study of randomly selected individuals aged between 25 and 79 years old in a health area of Badajoz. In all patients, data on their history of cardiovascular risk factors were gathered, waist circumference and blood pressure were measured and a fasting blood sample was collected. The prevalence of metabolic syndrome, following recent criteria, was compared by age and gender. Results We recruited 2,833 individuals (46.5% men). The mean age was 51.2 years The prevalence of metabolic syndrome was 33.6% and was significantly higher in men (36.7% vs 30.9%; p<0.001). The prevalence of metabolic syndrome fell significantly after exclusion of patients with diabetes or cardiovascular disease (20.8%; p<0.001). The difference in prevalence between the distinct criteria was significant for the whole population and by sex (p<0.000). A significant difference in prevalence between genders was observed from the age of 45-54 years in men and 55-64 years in women Conclusions The prevalence of metabolic syndrome in a health area of Badajoz is among the highest reported in population-based studies in Spain. Although estimates of the prevalence are decreased by the new international recommendations, a considerable proportion of the young population requires preventive measures (AU)