Prevalence of familial hypercholesterolemia phenotype and ten-year risk of cardiovascular events in a working population in primary prevention: The ICARIA study.

BACKGROUND AND AIMS: We aimed to assess the prevalence of familial hypercholesterolaemia (FH) and to determine the incidence of cardiovascular events during a 10-year follow up in individuals with FH, compared to unaffected individuals in a working, middle-aged/young population. METHODS AND RESULTS: 576,724 active workers (36 ± 10 years-old, 70% men) without cardiovascular disease were given regular health check-ups and followed for a median of 8.5 years (i.e., 4,123,927 person-years). The FH phenotype was defined according to validated low-density lipoprotein-cholesterol thresholds, adjusted for age and sex. The primary outcome was a first cardiovascular event, whether fatal or non-fatal. We found that 707 workers (0.12% or 1 in 816 individuals) met the criteria for a heterozygous FH phenotype. During the follow-up, cardiovascular events occurred in 23 of 707 (3.25%) subjects with the FH phenotype and in 3297 of 576,017 (0.57%) subjects without the FH phenotype (p<0.001). The hazard ratio (HR, assessed with a Cox regression model) for the primary outcome was 5.7 (99% CI 3.33-9.78), before adjustments, and 4.7 (99% CI 2.62-8.58) after adjusting for sex, age, smoking, blood pressure, and diabetes. The HRs were significant for both men and women, but the magnitude of the effect was greater for men than for women. CONCLUSIONS: Our findings confirmed the high incidence of cardiovascular disease in individuals with untreated FH. We showed that regular health check-ups in an active, and mostly young, working population could contribute to the early identification of FH. Therefore, this approach may provide an opportunity for early treatment.

Prediction of fatal and non-fatal cardiovascular events in young and middle-aged healthy workers: The IberScore model.

AIMS: Our primary objective was to improve risk assessment for fatal and non-fatal cardiovascular events in a working population, mostly young and healthy. METHODS: We conducted a prospective cohort study to derive a survival model to predict fatal and non-fatal 10-year cardiovascular risk. We recruited 992,523 workers, free of diagnosed cardiovascular disease at entry, over six years, from 2004-2009. We divided the sample into two independent cohorts: a derivation one (626,515 workers; from 2004-2006) and a temporal validation one (366,008 workers; over 2007-2009). Then, we followed both cohorts over 10 years and registered all fatal and non-fatal cardiovascular events. We built a new risk calculator using an estimation of cardiovascular biological age as a predictor and named it IberScore. There were remarkable differences between this new model and Systematic Coronary Risk Evaluation (SCORE) (in both the specification and the equation). RESULTS: Over the 10-year follow-up, we found 3762 first cardiovascular events (6‰) in the derivation cohort. Most of them (80.3%) were non-fatal ischaemic events. If we had been able to use our model at the beginning of the study, we had classified in the 'high-risk' or 'very high-risk' groups 82% of those who suffered a cardiovascular event during the follow-up. All the post-estimation tests showed superior performance (true positive rate: 81.8% vs 11.8%), higher discrimination power and better clinical utility (standardised net benefit: 58% vs 13%) for IberScore when compared to SCORE. CONCLUSION: Risk assessment of fatal and non-fatal cardiovascular events in young and healthy workers was improved when compared to the previously used model (SCORE). The latter was not reliable to predict cardiovascular risk in our sample. The new model showed superior clinical utility and provided four useful measures for risk assessment. We gained valuable insight into cardiovascular ageing and its predictors.

COVID-19 and Sick Leave: An Analysis of the Ibermutua Cohort of Over 1,651,305 Spanish Workers in the First Trimester of 2020.

Objectives: The worldwide SARS-COV2 pandemic has impacted the health of workers and companies. The aim is to quantify it according to sick leave. Methods: Using ICD-9 codes, we analyzed Ibermutua records of all sick leaves during the first trimester of 2020, compared to during the same months of 2017, 2018, and 2019. We stratified the analysis by causes, patient sex, activity sectors, and regional data. All sick leaves were adjusted by the number of Ibermutua-affiliated persons in each period. Results: In March 2020, there was an unprecedented (116%) increase in total sick leaves, mainly due to infectious and respiratory diseases. Men and women were equally affected. All activity sectors were impacted, with the highest increase (457%) observed among health-related workers, especially due to contagious disease. The incidences of sick leaves were heterogeneous among different regions. Cost-analysis of sick leaves during the first trimester of 2020 compared with in previous years showed 40.3% increment (mean 2,813 vs. 2,005 € per 100 affiliated workers). Conclusions: The SARS-COV2 pandemic is having a huge impact on workers' health, as shown by data regarding sick leaves in March 2020. This is associated with greater economic burden for companies, both due to the cost associated with sick leaves and the losses in productivity due to confinement.

Asociación entre la mejora en el perfil de riesgo cardiovascular y los cambios en la incapacidad temporal: resultados del estudio ICARIA / Association between improvement in cardiovascular risk profile and changes in sickness absence: results of the ICARIA study

Introducción y objetivos: El propósito de este estudio es investigar si los cambios en el riesgo cardiovascular (RCV) se asocian con la duración y los costes de la incapacidad temporal. Métodos: Se evaluó una cohorte prospectiva de 179.186 sujetos. Se calculó su RCV (SCORE) en 2 exámenes médicos consecutivos, separados aproximadamente 1 año (365 ± 90 días). Se categorizó el RCV en < 4% o ≥ 4% y se crearon 4 grupos de pacientes en función de los cambios en el RCV entre los 2 exámenes. Después de la segunda estimación, se realizó un seguimiento de 1 año para evaluar la incapacidad temporal. Las diferencias entre los 4 grupos en el recuento total de días de incapacidad temporal se evaluaron mediante modelos de regresión de Poisson. Resultados: Tras ajustar por covariables, los sujetos que mejoraron su RCV tuvieron un menor recuento de días de incapacidad temporal que los que empeoraron su RCV y aquellos cuyo riesgo permaneció estabilizado en ≥ 4% (RR, 0,91; IC95%, 0,84-0,98). Comparados con los que no mejoraron el nivel de RCV, entre los que sí mejoraron más individuos habían dejado de fumar (+17,2%; p < 0,001) y habían controlado su presión arterial (+26,0%; p < 0,001), el colesterol total (+9,3%; p < 0,001), el colesterol unido a lipoproteínas de baja densidad (+14,9%; p < 0,001) y los triglicéridos (+14,6%; p < 0,001). Conclusiones: Nuestros resultados indican que la mejora del RCV se acompaña de una disminución de la incapacidad temporal en el seguimiento a 1 año (AU)

Introduction and objectives: The purpose of this study was to investigate whether changes in cardiovascular risk (CVR) are associated with the length and cost of sickness absence. Methods: A prospective cohort of 179 186 participants was evaluated. Each participant's CVR (SCORE) was assessed on 2 consecutive medical examinations, approximately 1 year apart (365 ± 90 days). Cardiovascular risk was categorized as < 4% or ≥ 4%, and participants were divided into 4 groups according to changes in their risk between the 2 assessments. After the second CVR estimate, a 1-year follow-up was carried out to assess sickness absence. Differences between the 4 groups in terms of the total count of sickness absence days during the follow-up period were tested using Poisson regression models. Results: After adjustment for covariates, participants who showed an improvement in CVR had a lower count of sickness absence days compared with both those who showed a worsening in risk and those who remained stable at ≥ 4% (RR, 0.91; 95%CI, 0.84-0.98). In comparison with participants whose CVR did not improve, more of the participants whose risk did improve had quit smoking (+17.2%; P < .001), and had controlled their blood pressure (+26.0%, P < .001), total cholesterol (+9.3%; P < .001), low-density lipoprotein cholesterol (+14.9%; P < .001), and triglyceride levels (+14.6%; P < .001). Conclusions: Our results suggest that an improvement in CVR profile is accompanied by a decrease in sickness absence during a 1-year follow-up (AU)

Association Between Improvement in Cardiovascular Risk Profile and Changes in Sickness Absence: Results of the ICARIA Study.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to investigate whether changes in cardiovascular risk (CVR) are associated with the length and cost of sickness absence. METHODS: A prospective cohort of 179 186 participants was evaluated. Each participant's CVR (SCORE) was assessed on 2 consecutive medical examinations, approximately 1 year apart (365 ± 90 days). Cardiovascular risk was categorized as < 4% or ≥ 4%, and participants were divided into 4 groups according to changes in their risk between the 2 assessments. After the second CVR estimate, a 1-year follow-up was carried out to assess sickness absence. Differences between the 4 groups in terms of the total count of sickness absence days during the follow-up period were tested using Poisson regression models. RESULTS: After adjustment for covariates, participants who showed an improvement in CVR had a lower count of sickness absence days compared with both those who showed a worsening in risk and those who remained stable at ≥ 4% (RR, 0.91; 95%CI, 0.84-0.98). In comparison with participants whose CVR did not improve, more of the participants whose risk did improve had quit smoking (+17.2%; P < .001), and had controlled their blood pressure (+26.0%, P < .001), total cholesterol (+9.3%; P < .001), low-density lipoprotein cholesterol (+14.9%; P < .001), and triglyceride levels (+14.6%; P < .001). CONCLUSIONS: Our results suggest that an improvement in CVR profile is accompanied by a decrease in sickness absence during a 1-year follow-up.

Factors influencing return-to-work after cerebrovascular disease: the importance of previous cardiovascular risk.

BACKGROUND: The role of prior cardiovascular risk (CVR) in the multifactorial process of returning to work after a cerebrovascular event has not been adequately investigated. Therefore, the objective of the present study was to analyse the association between previous CVR level, cardiovascular risk factors (CVRFs) and return-to-work (RTW) following cerebrovascular disease. DESIGN: This was a prospective observational study. METHODS: We analysed a cohort of 348 patients who had experienced an episode of cerebrovascular disease-related work absence. These individuals were selected from the ICARIA study (Ibermutuamur CArdiovascular RIsk Assessment). Global CVR was assessed using the SCORE system. We investigated the association between demographics, work-related variables, CVRFs and RTW following a cerebrovascular event. RESULTS: We found that a total of 254 individuals (73.0%; 95% CI: 68.3-77.7) returned to work after cerebrovascular disease. Also, we observed a median loss of 12 working years due to disability. Moreover, adjusting for potential confounders revealed that low CVR level and the absence of the following CVRFs was associated with a higher likelihood of RTW: low vs moderate-to-high CVR level (OR: 2.55; 95% CI: 1.42-4.57), no hypertension before stroke (OR: 1.95; 95% CI: 1.11-3.41), non-smoker status (OR: 2.26; 95% CI: 1.30-3.93) and no previous diabetes (OR: 2.46; 95% CI: 1.26-4.79). CONCLUSIONS: Low CVR, along with the absence of several CVRFs, can be used to predict RTW rates following cerebrovascular events. Therefore, controlling hypertension, tobacco consumption and diabetes might contribute to the effectiveness of multidisciplinary rehabilitation and/or secondary/tertiary prevention programs for cerebrovascular disease.

Estimating the glomerular filtration rate in the Spanish working population: chronic kidney disease prevalence and its association with risk factors.

OBJECTIVE: This study aims to investigate the influence of estimated glomerular filtration rate (eGFR) with two equations (and by one or two separate measurements), on the prevalence of chronic kidney disease (CKD) and its association with blood pressure, and cardiovascular and metabolic risk factors. METHODS: Between January 2010 and October 2011, the Ibermutuamur CArdiovascular RIsk Assessment project included 128 588 workers (77.2% men, mean age 39.3 years, range 16-75), who underwent two consecutive yearly medical check-ups and had information for eGFR according to the MDRD-IDMS and CKD-EPI equations (serum creatinine was measured by a isotope-dilution mass spectrometry traceable method in a single central laboratory). CKD was defined by an eGFR less than 60 ml/min per 1.73 m. Subclinical (occult) renal disease was defined as an eGFR less than 60 ml/min per 1.73 m in patients with serum creatinine below 1.3 mg/dl and below 1.2 mg/dl in men and women, respectively. RESULTS: In this working population, prevalence of CKD was very low, but two to six times lower when two separate eGFRs below 60 ml/min per 1.73 m were used. The prevalence of CKD was significantly lower with the CKD-EPI compared to the MDRD-IDMS equation. The same applies to occult CKD. In male workers, occult CKD was practically nonexistent.Multivariate analyses show that blood pressure, total serum cholesterol, and serum glucose (positively), and high-density lipoprotein and low-density lipoprotein (negatively) were associated with CKD, with both equations. Another metabolic factor (waist circumference) was only associated (positively) with CKD defined by the CKD-EPI equation, which appears to be associated with most components of the metabolic syndrome. CONCLUSIONS: The CKD-EPI formula, calculated on the basis of two reported blood samples, may provide the most specific definition of CKD.

Predictores de la duración de la incapacidad temporal por contingenciascomunes en los trastornos de ansiedad / Predictors of the duration of non-work-related sick leave due to anxiety disorders

Objetivos: Analizar la duración de la incapacidad temporal por contingencias comunes (ITCC) en lostrastornos de ansiedad e identificar variables demográficas, laborales y clínicas que puedan contribuir asu predicción.Métodos: Estudio de una cohorte prospectiva de 1161 trabajadores con un episodio de ITCC por trastornode ansiedad, pertenecientes a la población protegida de una mutua de accidentes de trabajo y enfermedades profesionales. Se evaluaron la duración de la ITCC y las principales variables demográficas, laboralesy clínicas potencialmente relacionadas con ésta. Se realizó un seguimiento de todos los procesos hasta elalta. Se establecieron predictores de la duración de la ITCC mediante regresión de Cox.Resultados: La duración mediana de la ITCC en los trastornos de ansiedad fue de 83 días. Tras el análisismultivariado, tener más de 35 anos, un menor nivel de estudios (primarios, secundarios o titulación ˜media frente a titulación superior), la existencia de comorbilidad y las situaciones de desempleo quesobrevienen durante la baja, se asociaron de forma significativa con incrementos en la duración de laITCC (p <0,05). Por el contrario, encontrarse separado o divorciado se relacionó con una reincorporaciónlaboral más precoz (p <0,05).Conclusiones: Los trastornos de ansiedad se asocian con periodos de ITCC largos respecto a otras enfermedades y a los tiempos estándar de duración. Variables demográficas, laborales y clínicas presentes en laevaluación inicial del proceso permiten identificar grupos con mayor riesgo de que la ITCC se prolongue,y que requerirán estrategias orientadas a facilitar la reincorporación laboral (AU)

Objectives: To analyze the duration of non-work-related sick leave due to anxiety disorders and to identifydemographic, occupational and clinical variables that may contribute to its prediction.Methods: We performed a prospective cohort study of 1,161 workers with an episode of non-workrelated sick leave due to an anxiety disorder, belonging to the insured population of a mutual insurancecompany. We assessed the duration of non-work-related sick leave episodes and the main potentiallyrelated demographic, occupational and clinical variables. All non-work-related sick leave processes werefollowed-up until discharge. Cox regression analyses were conducted to establish the predictors of nonwork-related sick leave duration.Results: The median duration of non-work-related sick leave due to anxiety disorders was 83 days. In amultivariate analysis, the following factors were identified as being significantly associated with increasesin the duration of sick leave (p <0.05): age of over 35 years, lower educational level (primary schoolstudies, secondary school studies or high-school diploma vs. university degree), and the existence ofcomorbidity and unemployment occurring during the sick leave. In contrast, being separated or divorcedwas associated with an earlier return to work (p <0.05).Conclusions: Anxiety disorders are associated with long periods of non-work-related sick leave comparedwith other disorders and standard time duration. Demographic, occupational and clinical variables collected at the initial assessment of the sick leave episode would help to identify groups with an increasedrisk of prolonged sick leave, requiring strategies to facilitate return to work (AU)

[Predictors of the duration of non-work-related sick leave due to anxiety disorders]. / Predictores de la duración de la incapacidad temporal por contingencias comunes en los trastornos de ansiedad.

OBJECTIVES: To analyze the duration of non-work-related sick leave due to anxiety disorders and to identify demographic, occupational and clinical variables that may contribute to its prediction. METHODS: We performed a prospective cohort study of 1,161 workers with an episode of non-work-related sick leave due to an anxiety disorder, belonging to the insured population of a mutual insurance company. We assessed the duration of non-work-related sick leave episodes and the main potentially related demographic, occupational and clinical variables. All non-work-related sick leave processes were followed-up until discharge. Cox regression analyses were conducted to establish the predictors of non-work-related sick leave duration. RESULTS: The median duration of non-work-related sick leave due to anxiety disorders was 83 days. In a multivariate analysis, the following factors were identified as being significantly associated with increases in the duration of sick leave (p <0.05): age of over 35 years, lower educational level (primary school studies, secondary school studies or high-school diploma vs. university degree), and the existence of comorbidity and unemployment occurring during the sick leave. In contrast, being separated or divorced was associated with an earlier return to work (p <0.05). CONCLUSIONS: Anxiety disorders are associated with long periods of non-work-related sick leave compared with other disorders and standard time duration. Demographic, occupational and clinical variables collected at the initial assessment of the sick leave episode would help to identify groups with an increased risk of prolonged sick leave, requiring strategies to facilitate return to work.

Association of moderate and severe hypertriglyceridemia with obesity, diabetes mellitus and vascular disease in the Spanish working population: results of the ICARIA study.

AIM: To study the prevalence, risk factors, and vascular disease associated with moderate and severe hypertriglyceridemia in an active working population. DESIGN AND METHODS: Cross-sectional study of 594,701 workers from all Spanish geographical areas, occupation sectors, ages, and sexes who underwent a yearly routine checkup. Data collected from participants included age, sex, anthropometric measurements, vascular risk factors, lipidic profile and basic biochemical analysis, from a fasting blood sample. A cardiovascular risk assessment was performed. RESULTS: The study population included 428,334 males and 166,367 females, mean age 36+/-10 years. A total of 95,673 (16%) workers had mild hypertriglyceridemia (HTg) (Tg 150-399mg/dL), 7,081 (1.1%) had moderate HTg (400-999mg/dL), and 224 (0.03%) had severe HTg (>or=1000mg/dL). Of workers with hypertriglyceridemia, 90% were male. Age, obesity, type 1 and 2 diabetes, alcohol consumption, and vascular disease were associated with hypertriglyceridemia. Cardiovascular risk gradually increased for each HTg category. Amongst risk factors, the major independent predictor of mild-HTg was obesity (OR 2.42, CI 95% 2.37-2.48), whereas diabetes was a predictor of moderate HTg (OR 3.64, CI 95% 3.17-4.18) and severe HTg (OR 7.35, CI 95% 4.27-12.66). In multivariate analyses, HTg was gradually associated with vascular disease, even after adjusting for other risk factors. CONCLUSION: In this working population, preventive programs for HTg and associated vascular disease should consider obesity-diabetes control as its first objective.

Occupation-related differences in the prevalence of metabolic syndrome.

OBJECTIVE: To investigate the prevalence of metabolic syndrome in the Spanish working population and determine how the prevalence varies according to occupation and sex. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of 259,014 workers (mean age 36.4 years, range [16-74]; 72.9% male) who underwent a routine medical checkup. The Adult Treatment Panel III (2001) definition for metabolic syndrome was used. RESULTS: The prevalence of metabolic syndrome was 11.6% (95% CI 11.5-11.7) in male subjects and 4.1% (4.0-4.2) in female subjects and increased with age. The prevalence of metabolic syndrome varied in the different categories of occupational activity depending on the sex considered. Among female subjects, the age-adjusted prevalence of metabolic syndrome was higher in blue-collar than in white-collar workers, but this difference was not evident among male workers. CONCLUSIONS: The prevalence of metabolic syndrome varies in the different categories of occupational activity in the Spanish working population. This variation also depends on sex.