Rigidez carotídea y riesgo de eventos vasculares y mortalidad: el estudio REGICOR / Carotid artery stiffness and risk of vascular events and mortality: the REGICOR study

Introducción y objetivos: Los objetivos son analizar la relación dosis-respuesta de la rigidez de la arteria carótida y la mortalidad y evaluar su capacidad predictiva. Métodos: Estudio de cohorte poblacional que incluyó a 6.468 participantes, con una mediana de seguimiento de 6,5 años. Se evaluaron 6 índices de rigidez. Se identificaron los eventos coronarios y cerebrovasculares y la mortalidad. Resultados: La rigidez carotídea, el coeficiente de Peterson y la velocidad de la onda de pulso (VOP) se asociaron de manera lineal y directa con los eventos cerebrovasculares: aumento del 8% (IC95%, 1-16%) por unidad de rigidez, del 7% (IC95%, 2-13%) cada 10 unidades del coeficiente de Peterson y del 26% (IC95%, 8-48%) por unidad de la VOP. La tensión carotídea se asoció de modo no lineal con el riesgo de enfermedad coronaria: en valores <0,09 unidades, cada aumento de 0,01 unidades se asoció con una disminución de un 16% del riesgo (IC95%, –33 a +6%); por encima de 0,09 unidades, cada incremento de 0,01 unidades se asoció con un aumento de un 16% del riesgo (IC95%, 6-27%). La inclusión de estos índices no mejoró la capacidad predictiva de las funciones de riesgo. Conclusiones: La rigidez carotídea, el coeficiente de elasticidad de Peterson y la VOP tienen una relación lineal y directa con el riesgo de enfermedad cerebrovascular. La tensión (strain) carotídea tiene una relación en U con el riesgo de enfermedad coronaria. Estos índices no contribuyen a mejorar la capacidad predictiva de las funciones de riesgo. (AU)

Introduction and objectives: The aims of this study were to determine the dose-response association of carotid arterial stiffness with vascular outcomes and overall mortality, and to assess their added predictive capacity. Methods: Population-based cohort study including 6468 individuals, with a median follow-up of 6.5 years. Six carotid artery stiffness indices were assessed: strain, stiffness, Peterson elasticity coefficient, compliance coefficient, distensibility coefficient, and pulse wave velocity (PWV). Incident coronary, cerebrovascular, global vascular, and total fatal events were identified. Results: Carotid compliance and distensibility coefficients were not associated with any of the outcomes. Carotid stiffness, Peterson elasticity coefficient, and PWV showed a direct linear relationship to cerebrovascular disease: the risk increased by 8% (95%CI, 1-16) per stiffness unit increase, by 7% (95%CI, 2-13) per 10-unit Peterson elasticity coefficient increase, and by 26% (95%CI, 8-48) per PWV unit increase. Carotid strain showed a nonlinear association with ischemic heart disease. When strain was ≤ 0.09 units, each 0.01-unit increase was associated with a 15% lower risk of coronary events (95%CI,−33 to 6); above 0.09 units, each 0.01 increase in strain was associated with a 16% higher risk of coronary events (95%CI, 6-27). The addition of the stiffness indices did not improve the predictive capacity of validated risk functions. Conclusions: Carotid stiffness, Peterson elasticity coefficient, and PWV have a direct linear association with cerebrovascular disease risk. Carotid strain is not linearly related to U-shaped ischemic heart disease risk. The inclusion of these indexes does not improve the predictive capacity of risk functions. (AU)

Sex matters in the association between cardiovascular health and incident dementia: evidence from real world data.

BACKGROUND: Cardiovascular health has been associated with dementia onset, but little is known about the variation of such association by sex and age considering dementia subtypes. We assessed the role of sex and age in the association between cardiovascular risk and the onset of all-cause dementia, Alzheimer's disease, and vascular dementia in people aged 50-74 years. METHODS: This is a retrospective cohort study covering 922.973 Catalans who attended the primary care services of the Catalan Health Institute (Spain). Data were obtained from the System for the Development of Research in Primary Care (SIDIAP database). Exposure was the cardiovascular risk (CVR) at baseline categorized into four levels of Framingham-REGICOR score (FRS): low (FRS < 5%), low-intermediate (5% ≤ FRS < 7.5%), high-intermediate (7.5% ≤ FRS < 10%), high (FRS ≥ 10%), and one group with previous vascular disease. Cases of all-cause dementia and Alzheimer's disease were identified using validated algorithms, and cases of vascular dementia were identified by diagnostic codes. We fitted stratified Cox models using age parametrized as b-Spline. RESULTS: A total of 51,454 incident cases of all-cause dementia were recorded over a mean follow-up of 12.7 years. The hazard ratios in the low-intermediate and high FRS groups were 1.12 (95% confidence interval: 1.08-1.15) and 1.55 (1.50-1.60) for all-cause dementia; 1.07 (1.03-1.11) and 1.17 (1.11-1.24) for Alzheimer's disease; and 1.34 (1.21-1.50) and 1.90 (1.67-2.16) for vascular dementia. These associations were stronger in women and in midlife compared to later life in all dementia types. Women with a high Framingham-REGICOR score presented a similar risk of developing dementia - of any type - to women who had previous vascular disease, and at age 50-55, they showed three times higher risk of developing dementia risk compared to the lowest Framingham-REGICOR group. CONCLUSIONS: We found a dose‒response association between the Framingham-REGICOR score and the onset of all dementia types. Poor cardiovascular health in midlife increased the onset of all dementia types later in life, especially in women.

Genetic characteristics involved in COVID-19 severity. The CARGENCORS case-control study and meta-analysis.

Pre-existing coronary artery disease (CAD), and thrombotic, inflammatory, or virus infectivity response phenomena have been associated with COVID-19 disease severity. However, the association of candidate single nucleotide variants (SNVs) related to mechanisms of COVID-19 complications has been seldom analysed. Our aim was to test and validate the effect of candidate SNVs on COVID-19 severity. CARGENCORS (CARdiovascular GENetic risk score for Risk Stratification of patients positive for SARS-CoV-2 [COVID-19] virus) is an age- and sex-matched case-control study with 818 COVID-19 cases hospitalized with hypoxemia, and 1636 controls with COVID-19 treated at home. The association between severity and SNVs related to CAD (n = 32), inflammation (n = 19), thrombosis (n = 14), virus infectivity (n = 11), and two published to be related to COVID-19 severity was tested with adjusted logistic regression models. Two external independent cohorts were used for meta-analysis (SCOURGE and UK Biobank). After adjustment for potential confounders, 14 new SNVs were associated with COVID-19 severity in the CARGENCORS Study. These SNVs were related to CAD (n = 10), thrombosis (n = 2), and inflammation (n = 2). We also confirmed eight SNVs previously related to severe COVID-19 and virus infectivity. The meta-analysis showed five SNVs associated with severe COVID-19 in adjusted analyses (rs11385942, rs1561198, rs6632704, rs6629110, and rs12329760). We identified 14 novel SNVs and confirmed eight previously related to COVID-19 severity in the CARGENCORS data. In the meta-analysis, five SNVs were significantly associated to COVID-19 severity, one of them previously related to CAD.

Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses / Interdisciplinary intervention for the primary prevention of dental caries in children under 18 months

Introducción: la caries es la enfermedad crónica más frecuente en la infancia. La presencia de caries en la dentición temporal es el principal factor de riesgo para desarrollar caries en la dentición definitiva. La mayoría de los factores de riesgo de la caries son modificables y pueden convertirse en elementos para la prevención y control de la enfermedad. Con el objetivo de reducir la incidencia de caries a la edad de 18 meses se diseña una intervención interdisciplinaria de prevención primaria dirigida a familias con niños que se visitan siguiendo el Protocol d’activitats preventives i de promoció de la salut a l’edat pediátrica (PAPPS). Material y métodos: ensayo clínico no aleatorizado, realizado en dos centros de asistencia primaria de Catalunya desde enero de 2019 hasta junio de 2022. En uno de los centros se diseñó e implementó una intervención educativa de prevención primaria de la caries con consejos y habilidades para las familias. En el otro centro se mantuvo el protocolo habitual de recomendaciones. Se evaluó y comparó la incidencia de caries en ambos grupos a la edad de 18 meses con un modelo de regresión logística estimado con el programa R. Resultados: la incidencia de caries a los 18 meses fue superior en los niños del grupo control (OR = 6,0; IC 95% 1,8-20,2), a pesar de que la valoración del riesgo de caries basada en el sistema llamado Caries Management by Risk Assessment (CAMBRA) indicó mayor riesgo de desarrollo de caries en los lactantes del grupo intervención. Conclusión: la intervención interdisciplinaria de prevención primaria de la caries incorporada en los programas de salud infantil reduce la incidencia de caries en los primeros años de vida. (AU)

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the goal of reducing the incidence of caries in children at age 18 months, we designed an interdisciplinary primary prevention intervention aimed at families with children who attended routine preventive visits within the PAPPS (“Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica”) child health programme. Methodology: non-randomized clinical trial carried out in two primary care centres in Catalonia between January 2019 and June 2022. In one of the centres, an educational intervention for the primary prevention of caries was designed and implemented to provide families with guidance and skills. In the other centre, patients received standard care. The incidence of caries was assessed and compared in both groups at age 18 months by means of a logistic regression model fitted with the R software. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI: 1.8-20.2), despite the fact that the caries risk assessment by means of the “Caries Management by Risk Assessment” (CAMBRA) protocol indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention integrated into the child health prevention and promotion programme achieved a reduction in the incidence of caries in early childhood. (AU)

Carotid artery stiffness and risk of vascular events and mortality: the REGICOR study.

INTRODUCTION AND OBJECTIVES: The aims of this study were to determine the dose-response association of carotid arterial stiffness with vascular outcomes and overall mortality, and to assess their added predictive capacity. METHODS: Population-based cohort study including 6468 individuals, with a median follow-up of 6.5 years. Six carotid artery stiffness indices were assessed: strain, stiffness, Peterson elasticity coefficient, compliance coefficient, distensibility coefficient, and pulse wave velocity (PWV). Incident coronary, cerebrovascular, global vascular, and total fatal events were identified. RESULTS: Carotid compliance and distensibility coefficients were not associated with any of the outcomes. Carotid stiffness, Peterson elasticity coefficient, and PWV showed a direct linear relationship to cerebrovascular disease: the risk increased by 8% (95%CI, 1-16) per stiffness unit increase, by 7% (95%CI, 2-13) per 10-unit Peterson elasticity coefficient increase, and by 26% (95%CI, 8-48) per PWV unit increase. Carotid strain showed a nonlinear association with ischemic heart disease. When strain was ≤ 0.09 units, each 0.01-unit increase was associated with a 15% lower risk of coronary events (95%CI,-33 to 6); above 0.09 units, each 0.01 increase in strain was associated with a 16% higher risk of coronary events (95%CI, 6-27). The addition of the stiffness indices did not improve the predictive capacity of validated risk functions. CONCLUSIONS: Carotid stiffness, Peterson elasticity coefficient, and PWV have a direct linear association with cerebrovascular disease risk. Carotid strain is not linearly related to U-shaped ischemic heart disease risk. The inclusion of these indexes does not improve the predictive capacity of risk functions.

Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study.

Objective: This study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort. Methods: A community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality. Results: The cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11-4.44) and women (HR = 3.69; 95% CI = 1.69-8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46-3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10-6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76-4.90) only in the male population. Conclusion: C-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality.

Safety and immunogenicity of a recombinant protein RBD fusion heterodimer vaccine against SARS-CoV-2.

In response to COVID-19 pandemic, we have launched a vaccine development program against SARS-CoV-2. Here we report the safety, tolerability, and immunogenicity of a recombinant protein RBD fusion heterodimeric vaccine against SARS-CoV-2 (PHH-1V) evaluated in a phase 1-2a dose-escalation, randomized clinical trial conducted in Catalonia, Spain. 30 young healthy adults were enrolled and received two intramuscular doses, 21 days apart of PHH-1V vaccine formulations [10 µg (n = 5), 20 µg (n = 10), 40 µg (n = 10)] or control [BNT162b2 (n = 5)]. Each PHH-1V group had one safety sentinel and the remaining participants were randomly assigned. The primary endpoint was solicited events within 7 days and unsolicited events within 28 days after each vaccination. Secondary endpoints were humoral and cellular immunogenicity against the variants of concern (VOCs) alpha, beta, delta and gamma. All formulations were safe and well tolerated, with tenderness and pain at the site of injection being the most frequently reported solicited events. Throughout the study, all participants reported having at least one mild to moderate unsolicited event. Two unrelated severe adverse events (AE) were reported and fully resolved. No AE of special interest was reported. Fourteen days after the second vaccine dose, all participants had a >4-fold change in total binding antibodies from baseline. PHH-1V induced robust humoral responses with neutralizing activities against all VOCs assessed (geometric mean fold rise at 35 days p < 0.0001). The specific T-cell response assessed by ELISpot was moderate. This initial evaluation has contributed significantly to the further development of PHH-1V, which is now included in the European vaccine portfolio.ClinicalTrials.gov Identifier NCT05007509EudraCT No. 2021-001411-82.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis.

Introduction: The healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals' approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up. Methods: This protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC. Discussion: The analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of the health services and mortality (DESVELA cohort): qualitative study protocol for a prospective cohort study in a hybrid analysis.

Introduction: Maintaining or acquiring healthier health-oriented behaviours and promoting physical and mental health amongst the Spanish population is a significant challenge for Primary Health Care. Although the role of personal aptitudes (characteristics of each individual) in influencing health behaviours is not yet clear, these factors, in conjunction with social determinants such as gender and social class, can create axes of social inequity that affect individuals' opportunities to engage in health-oriented behaviours. Additionally, lack of access to health-related resources and opportunities can further exacerbate the issue for individuals with healthy personal aptitudes. Therefore, it is crucial to investigate the relationship between personal aptitudes and health behaviours, as well as their impact on health equity. Objectives: This paper outlines the development, design and rationale of a descriptive qualitative study that explores in a novel way the views and experiences on the relationship between personal aptitudes (activation, health literacy and personality traits) and their perception of health, health-oriented behaviours, quality of life and current health status. Method and analysis: This qualitative research is carried out from a phenomenological perspective. Participants will be between 35 and 74 years of age, will be recruited in Primary Health Care Centres throughout Spain from a more extensive study called DESVELA Cohort. Theoretical sampling will be carried out. Data will be collected through video and audio recording of 16 focus groups in total, which are planned to be held in 8 different Autonomous Communities, and finally transcribed for a triangulated thematic analysis supported by the Atlas-ti program. Discussion: We consider it essential to understand the interaction between health-related behaviours as predictors of lifestyles in the population, so this study will delve into a subset of issues related to personality traits, activation and health literacy.Clinical trial registration: ClinicalTrials.gov, identifier NCT04386135.

A multiple health behaviour change intervention to prevent depression: A randomized controlled trial.

OBJECTIVE: To examine the effectiveness of a 12-month MHBC intervention in the prevention of onset depression in primary health care (PHC). METHODS: Twenty-two PHC centres took part in the cluster-randomized controlled trial. Patients were randomized to receive either usual care or an MHBC intervention. The endpoints were onset of major depression and reduction of depressive symptoms in participants without baseline depression at a 12-month follow-up. RESULTS: 2531 patients agreed and were eligible to participate. At baseline, around 43% were smokers, 82% were non-adherent to the Mediterranean diet and 55% did not perform enough physical activity. The intervention group exhibited a greater positive change in two or more behaviours (OR 1.75 [95%CI: 1.17 to 2.62]; p = 0.006); any behaviour (OR 1.58 [95%CI: 1.13 to 2.20]; p = 0.007); and adherence to the Mediterranean diet (OR 1.94 [95%CI: 1.29 to 2.94]; p = 0.002), while this increase was not statistically significant for smoking and physical activity. The intervention was not effective in preventing major depression (OR 1.17; [95% CI 0.53 to 2.59)]; p = 0.690) or reducing depressive symptoms (Mean difference: 0.30; [95% CI -0.77 to 1.36]; p = 0.726) during follow-up. CONCLUSIONS: As compared to usual care, the MHBC intervention provided a non-significant reduction in the incidence of major depression. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03136211.

Axes of social inequities in COVID-19 clinical trials: A systematic review.

Objective: The representativeness of participants is crucial to ensure external validity of clinical trials. We focused on the randomized clinical trials which assessed COVID-19 vaccines to assess the reporting of age, sex, gender identity, race, ethnicity, obesity, sexual orientation, and socioeconomic status in the results (description of the participants' characteristics, loss of follow-up, stratification of efficacy and safety results). Methods: We searched the following databases for randomized clinical trials published before 1st February 2022: PubMed, Scopus, Web of Science, and Excerpta Medica. We included peer-reviewed articles written in English or Spanish. Four researchers used the Rayyan platform to filter citations, first reading the title and abstract, and then accessing the full text. Articles were excluded if both reviewers agreed, or if a third reviewer decided to discard them. Results: Sixty three articles were included, which assessed 20 different vaccines, mainly in phase 2 or 3. When describing the participants' characteristics, all the studies reported sex or gender, 73.0% race, ethnicity, 68.9% age groups, and 22.2% obesity. Only one article described the age of participants lost to follow-up. Efficacy results were stratified by age in 61.9%, sex or gender in 26.9%, race and/or, ethnicity in 9.5%, and obesity in 4.8% of the articles. Safety results were stratified by age in 41.0%, and by sex or gender in 7.9% of the analysis. Reporting of gender identity, sexual orientation or socioeconomic status of participants was rare. Parity was reached in 49.2% of the studies, and sex-specific outcomes were mentioned in 22.9% of the analysis, most of the latter were related to females' health. Conclusions: Axes of social inequity other than age and sex were hardly reported in randomized clinical trials that assessed COVID-19 vaccines. This undermines their representativeness and external validity and sustains health inequities.

Women with familial hypercholesterolemia phenotype are undertreated and poorly controlled compared to men.

Familial hypercholesterolemia (FH) is an autosomal dominant disease that has a prevalence of approximately 1/250 inhabitants and is the most frequent cause of early coronary heart disease (CHD). We included 1.343.973 women and 1.210.671 men with at least one LDL-c measurement from the Catalan primary care database. We identified 14.699 subjects with Familial hypercholesterolemia-Phenotype (FH-P) based on LDL-c cut-off points by age (7.033 and 919 women, and 5.088 and 1659 men in primary and secondary prevention, respectively). Lipid lower therapy (LLT), medication possession ratio (MPR) as an indicator of adherence, and number of patients that reached their goal on lipid levels were compared by sex. In primary and secondary prevention, 69% and 54% of women (P = 0.001) and 64% and 51% of men (P = 0.001) were on low-to-moderate-potency LLT. Adherence to LLT was reduced in women older than 55 years, especially in secondary prevention (P = 0.03), where the percentage of women and men with LDL-c > 1.81 mmol/L were 99.9% and 98.9%, respectively (P = 0.001). Women with FH-P are less often treated with high-intensity LLT, less adherent to LLT, and have a lower probability of meeting their LDL-c goals than men, especially in secondary prevention.

Polyvascular Subclinical Atherosclerosis: Correlation Between Ankle Brachial Index and Carotid Atherosclerosis in a Population-Based Sample.

We assessed the correlation between the biomarkers of lower limb atherosclerosis (eg, ankle-brachial index [ABI]) and of carotid atherosclerosis (eg, common carotid intima-media thickness (IMT) and presence of atherosclerotic plaque) in a population-based cohort from Girona (Northwest Spain) recruited in 2010. Ankle-brachial index and carotid ultrasound were performed in all participants. Generalized additive multivariable models were used to adjust a regression model of common carotid IMT on ABI. Logistic regression multivariable models were adjusted to assess the probability of carotid plaque in individuals with peripheral artery disease. We included 3307 individuals (54.2% women), mean age 60 years (standard deviation 11). Two patterns of association were observed between subclinical biomarkers of atherosclerosis at the lower limb and carotid artery. Ankle-brachial index and common carotid IMT showed a linear trend in men [beta coefficient (95% confidence interval) =-.068 (-.123; -.012); P = .016]. Women with peripheral artery disease presented with high risk of atherosclerotic plaque at the carotid artery [Odds ratio (95% confidence interval) = 2.61, (1.46; 4.69); P = .001]. Men showed a significant linear association between ABI levels and common carotid IMT values. Women with peripheral artery disease presented with high risk of atherosclerotic plaque at the carotid artery.

Cardiovascular Risk Age Reflects Arterial Status: Middle-Aged People Showed Equivalent Arterial Stiffness to Older People in the Same Risk Category.

AIM: The concept of risk age may help overcome an excessive weight of age in cardiovascular risk functions. This study aimed to evaluate the equivalence of risk age with arterial stiffness by comparing people with increased risk age and individuals with the same chronological and risk age. In order to materialize this aim, we categorized individuals based on cardiovascular risk and compared groups with increased risk factors (other than age) and groups with normal levels. METHODS: This is a cross-sectional population-level study carried out in Girona province within the context of the REGICOR study (Girona Heart Registry). In this study, individuals aged 35-90 years who had a brachial-ankle pulse wave velocity measurement and with no previous cardiovascular disease or peripheral arterial disease were included. Cardiovascular risk was estimated with the FRESCO (in 35-79 year-olds), SCORE2 (in 35-69 year-olds), and SCORE2-OP (in 70-90 year-olds) functions and categorized to calculate and compare (in each category) the median chronological age in the group with increased risk factors and the reference. Arterial stiffness was assessed with the brachial-ankle pulse wave velocity (baPWV). The analyses were carried out separately by sex. RESULTS: In this study, 2499 individuals were included, with a mean age of 59.7 and 46.9% of men. Men presented worse health condition, including a higher mean cardiovascular disease risk score. Both men and women with increased levels of risk factors showed worse health condition than the respective men and women with optimal levels. In each risk category, the groups with higher risk age than chronological age (increased risk factors) were similar in baPWV values to the groups with the same chronological and risk ages (reference), who were consistently older. CONCLUSIONS: In categories with the same cardiovascular risk, the arterial stiffness of participants with a higher risk factor burden (increased risk age) matched that of older participants with the rest of the risk factors at optimal levels (same chronological and risk age). These results support the guidelines on the utilization of risk age to explain heightened cardiovascular risk, particularly among individuals in middle age.

SARS-CoV-2 transmission risk screening for safer social events: a non-randomised controlled study.

There is an ongoing debate on the implementation of the COVID-19 passport throughout Europe. We sought to build and test a feasible prevention strategy to ensure low SARS-CoV transmission risk in public events. We conducted a non-randomised controlled study. The intervention group obtained a confidential digital certificate of very low capacity for transmitting SARS-CoV-2 and attended socio-cultural events in Girona (Spain) between 1 April and 21 May 2021. The primary care services and a network of pharmacies cooperated in providing the certification. A group of non-attendees was randomly selected from pseudonymised health records as controls. We estimated the incidences of SARS-CoV-2 infection and recorded the challenges in the process. Follow-up was complete for 1351 participants, who were matched with 4050 controls. Mean age of the study population was 31.1 years, and 53% of participants were women. Incidence rates of SARS-CoV infection at 14 days in the group of attendees and non-attendees were 15.9 and 17.7 per 100,000 person-days, respectively; the difference between incidences was - 1.8 (95% CI - 22.8, 19.3). Implementation problems were minor, and 89.2% of respondents to a survey were satisfied with the process. The incidence rate of SARS-CoV-2 infection was not different in the intervention and control groups. These results are in favour of establishing a COVID-19 certificate to attend public events, and connote feasibility of implementation at a population level.

La financiación pública de la investigación en salud LGTBIQ+ en España / Public funding of health research on LGTBIQ+ population in Spain

Objetivo: Describir la financiación pública a proyectos de investigación sobre salud LGTBIQ+ en España. Método: Se realizó un estudio cuantitativo observacional de alcance descriptivo. Se revisaron los proyectos concedidos en la convocatoria pública de Proyectos de Investigación en Salud del Instituto de Salud Carlos III entre 2013 y 2019. Se consultó el portal del Fondo de Investigación en Salud para identificar los proyectos de salud financiados que incluían, total o parcialmente, al colectivo LGTBIQ+ . Se calcularon las frecuencias absolutas y relativas de los proyectos LGTBIQ+ sobre el total de los proyectos financiados, así como los porcentajes por año de concesión, tema, población específica LGTBIQ+ y financiación recibida. Resultados: Solo el 0,4% (n=16) de los 4404 proyectos financiados y el 0,3% del presupuesto otorgado en la convocatoria incluyeron total o parcialmente al colectivo LGTBIQ+ . Los proyectos LGTBIQ+ se centraban mayoritariamente en hombres que tienen sexo con hombres (n=14) y en el virus de la inmunodeficiencia humana (VIH) (n=11). El número de proyectos LGTBIQ+ financiados disminuyó entre 2013 (n=6) y 2019 (n=0). Conclusiones: En España, los proyectos de investigación sobre salud LGTBIQ+ financiados con fondos públicos son escasos. Los pocos estudios financiados se centran en hombres y en el VIH, por lo que no se genera suficiente conocimiento sobre otros temas o poblaciones específicas. Es necesario fomentar la investigación en salud de las personas LGTBIQ+ para mitigar las inequidades en salud, ofrecer servicios de salud inclusivos y mejorar la salud de tres millones de personas LGTBIQ+ residentes en España. (AU)

Objective: To describe the public funding of research on LGTBIQ+ health in Spain. Method: We conducted an observational and descriptive study. We sought research projects dealing with LGTBIQ+ health funded by the research projects grant from the Instituto Carlos III from 2013 to 2019. We consulted the webpage and the FIS portal and we identified projects that included LGTB community, totally or partially. We estimated the absolute and relative frequencies of LGTBIQ+ projects in relation to total funded projects; and we described the LGTBIQ+ funded projects by year of funding, topics, LGTBIQ+ subpopulation, or funding. Results: Only 0,4% (n=16) of 4404 funded projects included -totally or partially- LGTBIQ+ community, which represents only 0,3% of the funding. LGTBIQ+ projects mainly focused on men who have sex with men (n=14) and the human immunodeficiency viruses (HIV) (n=11). The number of funded LGTBIQ+ projects decreased from 2013 (n=6) to 2019 (n=0). Conclusions: Research projects on LGTBIQ+ health are scarce in Spain. Current funding for research on LGTBIQ+ health is insufficient to care for population other than HIV and men within LGTBIQ+ . There is a compelling necessity to promote the LGTBIQ+ health research to mitigate health disparities, to offer inclusive health services, and to improve healthcare of about 3 million LGTBIQ+ people living in Spain. (AU)

Gender analysis of the frequency and course of depressive disorders and relationship with personality traits in general population: A prospective cohort study.

BACKGROUND: We aimed to determine the prevalence and course of subthreshold depressive symptomatology (sDS) and probable major depressive episode (MDE) and to examine their association with personality traits among men and women. METHODS: A community-based sample aged 35 years or older was examined in two waves (median follow-up of 6.9 years). The Patient Health Questionnaire-9 (PHQ-9) was used to assess sDS and MDE. The 10-item version of the Big Five Inventory was used to assess personality traits. Prevalence was assessed at baseline (n = 5,557) and incidence and persistence-recurrence rates were computed at follow up (n = 3,102). Logistic regression models were adjusted to explore the association of personality traits with prevalence and course of depressive disorders. RESULTS: The prevalence of sDS and MDE was 14.04% (95% CI = 17.04-19.08) and 8.54 (95% CI=7.82-9.31), the incidence was 14.30 per 1,000 person-years (95% CI=12.49-16.31) and 4.34 per 1,000 person-years (95% CI=3.46-5.36), and the persistence-recurrence was 35.04 per 1,000 person-years (95% CI=29.00-41.96) and 28.8 per 1,000 person-years (95% CI=20.49-38.14). The gender gap was higher for MDE. Personality traits were differentially associated with the prevalence and course of depressive disorders between men and women. LIMITATIONS: Because this study used questionnaires to assess depressive disorders and personality traits, information bias could not be ruled out. CONCLUSIONS: The gender gap was higher for the prevalence and course of the probable MDE. There were more personality traits related with the course of the sDS and they had a major role in the course of the probable MDE in women.

The Association of Dietary Intake with Arterial Stiffness and Vascular Ageing in a Population with Intermediate Cardiovascular Risk-A MARK Study.

The aim of this study was to analyse the association of diet with arterial stiffness and vascular ageing in a Caucasian population with intermediate cardiovascular risk. We recruited 2475 individuals aged 35-75 years with intermediate cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500® device. Vascular ageing was defined in two steps. Step 1: The 20 individuals who presented kidney disease, peripheral arterial disease, or heart failure were classified as early vascular ageing (EVA). Step 2: The individuals with percentiles by age and sex above the 90th percentile of baPWV among the participants of this study were classified as EVA, and the rest of the individuals were classified as non-EVA. The diet of the participants was analysed with two questionnaires: (1) the diet quality index (DQI) questionnaire and (2) the Mediterranean diet (MD) adherence questionnaire. The mean age of the sample was 61.34 ± 7.70 years, and 61.60% were men. Adherence to the MD was 53.30%. The DQI was 54.90%. Of the entire sample, 10.70% (11.15% of the men and 9.95% of the women) were EVA. In the multiple linear regression analysis, for each additional point in the DQI questionnaire, there was a decrease of -0.081 (95%CI (confidence intervals) -0.105--0.028) in baPWV; in the MD adherence questionnaire, there was a decrease of -0.052 (95%CI -0141--0.008). When performing the analysis, separated by sex, the association remained significant in men but not in women. In the logistic regression analysis, there was an increase in MD adherence and a decrease in the probability of presenting EVA, both with the DQI questionnaire (OR (odds ratio) = 0.65; 95%CI 0.50-0.84) and with the MD adherence questionnaire (OR = 0.75; 95%CI 0.58-0.97). In the analysis by sex, the association was only maintained in men (with DQI, OR = 0.54; 95%CI 0.37-0.56) (with MD, OR = 0.72; 95%CI 0.52-0.99). The results of this study suggest that a greater score in the DQI and MD adherence questionnaires is associated with lower arterial stiffness and a lower probability of presenting EVA. In the analysis by sex, this association is only observed in men.

Impact of residential greenness on myocardial infarction in the population with diabetes: A sex-dependent association?

Living in urban areas with abundant greenness might provide health benefits in general population. Literature suggests that sex/gender plays a role in the association between greenness and health outcomes. But the impact of greenness in populations with moderate to high cardiovascular risk, such as persons with diabetes, is still unknown. Our aim was to evaluate the relationship between urban greenness and myocardial infarction incidence in persons with type 2 diabetes in Barcelona (Catalonia, Spain), and seek potential gender/sex differences in this association. This retrospective cohort study is based on data from the System for the Development of Research in Primary Care (SIDIAP database). We used Cox models to estimate if a 0.01 increase in Normalized Difference Vegetation Index (NDVI) at census tract level was associated to reduced risk of developing a myocardial infarction. Models were adjusted by demographic and clinical characteristics at individual level, and by environmental and socioeconomic variables at census tract level. Amongst 41,463 persons with diabetes and 154,803.85 person-years of follow-up, we observed 449 incident cases of acute myocardial infarction. For each 0.01 increment in NDVI the risk of developing a myocardial infarction decreased by 6% (Hazard Ratio, HR = 0.94; 95%CI, 0.89-0.99) in the population with diabetes. When stratifying by sex, we observed a significant association only in men (HR = 0.91; 95%CI, 0.86-0.97). People with diabetes living in urban greener areas might benefit from reduced cardiovascular risk, specially men. We observed sex/gender disparities, which could be related to different exposures and activities performed in green spaces between men and women. Further studies are needed to confirm sex/gender disparities between greenness exposure and cardiovascular outcomes. Our findings contribute to improve the health of people with diabetes who should be recommended to spent time and exercise in green areas.

Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data.

BACKGROUND: A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. OBJECTIVE: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. METHODS: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. RESULTS: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. CONCLUSIONS: Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition.