[Luces y sombras de la Guía Europea esc-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica.] / Lights and shadows of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.

General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines for Cardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), with the aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a critical analysis of these guidelines, offering possible solutions that can be implemented in Primary Care. It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (from seventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it is proposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated using different websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implementing nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in the potential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions could delay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease. Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of the guideline in primary care.

Los médicos de familia atienden un importante número de pacientes con alto riesgo vascular (RV). Las Guías Europeas de Prevención Cardiovascular (2021) proponen una nueva clasificación del riesgo y estrategias de intervención sobre los factores de riesgo (FRV), orientada a la toma de decisiones compartidas entre profesionales y pacientes. En el presente trabajo realizamos un análisis crítico de dichas guías, ofreciendo posibles soluciones prácticas para la Atención Primaria. Son destacables aspectos positivos (luces) que los modelos de RV SCORE2 (entre cuarenta y sesenta y nueve años) y SCORE2-OP (entre setenta y ochenta y nueve años) se basan en cohortes más actuales y miden con mayor exactitud y discriminación dicho riesgo. Además, se propone actuar diferenciadamente sobre el riesgo según la edad. Pragmáticamente, se presentan nuevos modelos informáticos para calcular el riesgo. Sin embargo, entre los aspectos negativos (sombras), parece colegirse una mayor dificultad de implementación al proponerse nueve subgrupos de sujetos según su edad o nivel de riesgo, con un dintel definitorio de alto RV subjetivo que podría ocasionar un incremento sustancial en el número de sujetos susceptibles de tratar sin una discriminación objetiva que lo sustente. Además, las intervenciones sobre los FRV en dos pasos podrían retrasar la consecución de objetivos terapéuticos, sobre todo en pacientes de muy alto riesgo, diabéticos o con enfermedad cardiovascular. Ante las dificultades que plantea la valoración del riesgo, proponemos unificar criterios y simplificar los mensajes claves para hacer unas guías más atractivas y que realmente ayuden a los profesionales de Atención Primaria en su práctica habitual.

Prevalence Rates of Arterial Hypertension According to the Threshold Criteria of 140/90 or 130/80 mmHg and Associated Cardiometabolic and Renal Factors: SIMETAP-HTN Study.

Background and objectives: Arterial hypertension (HTN) is the leading preventable cause of atherosclerotic cardiovascular diseases (ASCVD) and death from all causes. This study aimed to determine the prevalence rates of HTN diagnosed according to the threshold diagnostic criteria 130/80 mmHg and 140/90 mmHg, to compare blood pressure (BP) control, and to evaluate their associations with cardiovascular diseases and cardiometabolic and renal risk factors. Materials and Methods: This was a cross-sectional observational study conducted in primary care with a population-based random sample: 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HTN were calculated. BP control was compared in HTN patients with and without ASCVD or chronic kidney disease (CKD). Their associations with cardiovascular diseases and cardiometabolic and renal factors were assessed using bivariate and multivariate analysis. Results: Adjusted prevalence rates of HTN diagnosed according to 140/90 and 130/90 criteria were 30.9% (32.9% male; 29.7% female) and 54.9% (63.2% male; 49.3% female), respectively. BP < 130/80 mmHg was achieved in 60.5% of HTN patients without ASCVD or CKD according to 140/90 criterion, and 65.5% according to 130/80 criterion. This BP-control was achieved in 70% of HTN patients with ASCVD and 71% with CKD, according to both criteria. Coronary heart disease (CHD), heart failure, atrial fibrillation, stroke, diabetes, prediabetes, low glomerular filtration rate (eGFR), hyperuricemia, hypercholesterolemia, obesity, overweight, and increased waist-to-height ratio were independently associated with HTN according to both criteria. Conclusions: Almost a third of the adult population has HTN according to the 140/90 criterion, and more than half according to the 130/90 criterion, with a higher prevalence in men. The main clinical conditions associated with HTN were heart failure, diabetes, CHD, low eGFR, and obesity.

Heart Failure Prevalence Rates and Its Association with Other Cardiovascular Diseases and Chronic Kidney Disease: SIMETAP-HF Study.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is a major health problem that causes high mortality and hospitalization rates. This study aims to determine the HF prevalence rates in populations aged both ≥18 years and ≥50 years and to assess its association with cardiovascular diseases and chronic kidney disease. METHODS: A cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HF were calculated. The associations of renal and cardiometabolic factors with HF were assessed in both populations using univariate, bivariate and multivariate analysis. RESULTS: The HF crude prevalence rates were 2.8% (95%CI: 2.4-3.2) in adults (≥18 years), and 4.6% (95%CI: 4.0-5.3) in the population aged ≥ 50 years, without significant differences between males and females in both populations. The age- and sex-adjusted prevalence rates were 2.1% (male: 1.9%; female: 2.3%) in the overall adult population, and 4.5% (male: 4.2%; female: 4.8%) in the population aged ≥ 50 years, reaching 10.0% in the population aged ≥ 70 years. Atrial fibrillation, hypertension, low estimated glomerular filtration rate (eGFR), coronary heart disease (CHD), stroke, sedentary lifestyle, and diabetes were independently associated with HF in both populations. A total of 95.7% (95%CI: 92.7-98.6) of the population with HF had an elevated cardiovascular risk. CONCLUSIONS: This study reports that HF prevalence increases from 4.5% in the population over 50 years to 10% in the population over 70 years. The main clinical conditions that are HF-related are sedentary lifestyle, atrial fibrillation, hypertension, diabetes, low eGFR, stroke, and CHD.

Luces y sombras de la Guía Europea ESC-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica / Lights and shadows of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Los médicos de familia atienden un importante número de pacientes con alto riesgo vascular (RV). LasGuías Europeas de Prevención Cardio-vascular (2021) proponen una nueva clasificación del riesgo y estrategias de intervención sobre los factores de riesgo (FRV), orientada a la tomade decisiones compartidas entre profesionales y pacientes. En el presente trabajo realizamos un análisis crítico de dichas guías, ofreciendoposibles soluciones prácticas para la Atención Primaria.Son destacables aspectos positivos (luces) que los modelos de RV SCORE2 (entre cuarenta y sesenta y nueve años) y SCORE2-OP (entre setenta yochenta y nueve años) se basan en cohortes más actuales y miden con mayor exactitud y discriminación dicho riesgo. Además, se propone actuardiferenciadamente sobre el riesgo según la edad. Pragmáticamente, se presentan nuevos modelos informáticos para calcular el riesgo. Sin embargo,entre los aspectos negativos (sombras), parece colegirse una mayor dificultad de implementación al proponerse nueve subgrupos de sujetos segúnsu edad o nivel de riesgo, con un dintel definitorio de alto RV subjetivo que podría ocasionar un incremento sustancial en el número de sujetossusceptibles de tratar sin una discriminación objetiva que lo sustente. Además, las intervenciones sobre los FRV en dos pasos podrían retrasar laconsecución de objetivos terapéuticos, sobre todo en pacientes de muy alto riesgo, diabéticos o con enfermedad cardiovascular.Ante las dificultades que plantea la valoración del riesgo, proponemos unificar criterios y simplificar los mensajes claves para hacer unas guíasmás atractivas y que realmente ayuden a los profesionales de Atención Primaria en su práctica habitual.(AU)

General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines forCardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), withthe aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a criticalanalysis of these guidelines, offering possible solutions that can be implemented in Primary Care.It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (fromseventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it isproposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated usingdifferent websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implemen-ting nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in thepotential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions coulddelay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease.Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of theguideline in primary care.(AU)

Elevated pulse pressure and cardiovascular risk associated in Spanish population attended in primary care: IBERICAN study.

Introduction: Elevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD. Objective: To evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD). Materials and methods: Observational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out. Results: The mean of PP was 52.35 mmHg, and was significantly higher (p < 0.001) in patients with HTN (56.58 vs. 48.45 mmHg) The prevalence of ePP adjusted for age and sex was 23.54% (25.40% men vs. 21.75% women; p < 0.0001). The ePP prevalence rates increased linearly with age (R2 = 0.979) and were significantly more frequent in population aged ≥65 than in population aged <65 (45.47% vs. 20.98%; p < 0.001). HTN, left ventricular hypertrophy, low estimated glomerular filtration rate, alcohol consumption, abdominal obesity, and CVD were independently associated with ePP. 66.27% of patients with ePP had a high or very high CVR, as compared with 36.57% of patients without ePP (OR: 3.41 [95% CI 3.08-3.77]). Conclusions: The ePP was present in a quarter of our sample, and it was increased with the age. Also, the ePP was more frequent in men, patients with HTN, other TOD (as left ventricular hypertrophy or low estimated glomerular filtration rate) and CVD; because of this, the ePP was associated a higher cardiovascular risk. In our opinion, the ePP is an importer risk marker and its early identification lets to improve better diagnostic and therapeutic management.

Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials.

BACKGROUND: The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs. RESULTS: Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants' mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91-0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87-1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes. CONCLUSIONS: The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.

Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC / Prevalence rates of chronic kidney disease and its association with cardiometabolic factors and cardiovascular diseases. SIMETAP-CKD study

Introducción: La enfermedad renal crónica (ERC) constituye un importante problema de salud que contribuye al desarrollo de alteraciones cardiovasculares como la insuficiencia cardíaca y la enfermedad cardiovascular arteriosclerótica (ECVA). Los objetivos de este estudio fueron determinar la prevalencia de ERC y evaluar su asociación con factores de riesgo cardiometabólicos y la ECVA. Métodos: Estudio observacional transversal realizado en el ámbito de atención primaria. Muestra aleatoria de base poblacional: 6.588 personas entre 18 y 102 años (tasa de respuesta: 66%). Se determinaron las tasas de prevalencia brutas y ajustadas por sexo y edad de ERC según KDIGO valorando albuminuria y filtrado glomerular estimado según CKD-EPI, y sus asociaciones con factores cardiometabólicos y ECVA. Resultados: La prevalencia cruda de ERC fue 11,48% (IC95%: 10,72–12,27%), sin diferencia significativa entre hombres (11,64% [IC95%: 10,49–12,86%]) y mujeres (11,35% [IC95%: 10,34–12,41%]). La tasa de prevalencia ajustada por edad y sexo de ERC fue 9,16% (hombres: 8,61%; mujeres: 9,69%). La prevalencia del filtrado glomerular estimado reducido (<60mL/min/1,73m2) y de albuminuria (≥30mg/g) fueron 7,95% (IC95%: 7,30–8,61) y 5,98% (IC95%: 5,41–6,55), respectivamente. Hipertensión, diabetes, prediabetes, índice cintura-talla aumentado, insuficiencia cardíaca, fibrilación auricular y ECVA se asociaban independientemente con ERC (p<0,001). El 77,51% (IC95%: 74,54–80,49) de la población con ERC tenía un riesgo cardiovascular muy alto según SCORE. Conclusiones: La prevalencia ajustada de ERC era del 9,2% (filtrado glomerular estimado reducido: 8%; albuminuria: 6%). La mayoría de los pacientes con ERC tenía riesgo cardiovascular muy alto. Hipertensión, diabetes, prediabetes, índice cintura-talla aumentado y ECVA se asociaban independientemente con la ERC.(AU)

Introduction: Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors. Methods: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined. Results: The crude prevalence of CKD was 11.48% (95%CI: 10.72–12.27%), without significant difference between men (11.64% [95%CI: 10.49–12.86%]) and women (11.35% [95%CI: 10.34–12.41%]). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m2) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30–8.61) and 5.98% (95%CI: 5.41–6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54–80.49) of the population with CKD. Conclusions: The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.(AU)

Successful restoration of corneal surface integrity with a tissue-engineered allogeneic implant in severe keratitis patients.

OBJECTIVES: Corneal diseases are among the main causes of blindness, with approximately 4.6 and 23 million patients worldwide suffering from bilateral and unilateral corneal blindness, respectively. The standard treatment for severe corneal diseases is corneal transplantation. However, relevant disadvantages, particularly in high-risk conditions, have focused the attention on the search for alternatives. METHODS: We report interim findings of a phase I-II clinical study evaluating the safety and preliminary efficacy of a tissue-engineered corneal substitute composed of a nanostructured fibrin-agarose biocompatible scaffold combined with allogeneic corneal epithelial and stromal cells (NANOULCOR). 5 subjects (5 eyes) suffering from trophic corneal ulcers refractory to conventional treatments, who combined stromal degradation or fibrosis and limbal stem cell deficiency, were included and treated with this allogeneic anterior corneal substitute. RESULTS: The implant completely covered the corneal surface, and ocular surface inflammation decreased following surgery. Only four adverse reactions were registered, and none of them were severe. No detachment, ulcer relapse nor surgical re-interventions were registered after 2 years of follow-up. No signs of graft rejection, local infection or corneal neovascularization were observed either. Efficacy was measured as a significant postoperative improvement in terms of the eye complication grading scales. Anterior segment optical coherence tomography images revealed a more homogeneous and stable ocular surface, with complete scaffold degradation occurring within 3-12 weeks after surgery. CONCLUSIONS: Our findings suggest that the surgical application of this allogeneic anterior human corneal substitute is feasible and safe, showing partial efficacy in the restoration of the corneal surface.

Variables that enhance the development of resilience in young gay people affected by the COVID-19 pandemic.

AIMS: Sexual and gender minorities are more likely to suffer from depression and anxiety caused by COVID-19. However, they also have specific variables that have been little studied but which may protect them from this adverse situation. The aim of this study was to find out whether there were differences in socio-demographic and psychosocial variables in two groups of Spanish gay young people (high and low resilience), and predictors of risk and protective factors were examined. METHODS: Nine hundred and seventy-nine young homosexuals (389; 39.73% self-reported as women) aged between 18 and 26 years old who experienced mandatory confinement due to COVID-19, completed an anonymous online questionnaire. Hope, perceived self-efficacy, reappraisal index, coping humour, anxiety, depression were assessed along with socio-demographic information. Data were collected between 15 and 26 April 2020. RESULTS: Socio-demographic variables that were predictive of highly resilient behaviour included being between 24 and 26 years old, living with LGBTI+ peers and living in big cities, protective psychosocial variables included reframing in reappraising the confinement situation, humour as coping, social support from significant others and self-efficacy. CONCLUSION: This is one of the first studies on this subject of compulsory COVID-19 confinement on young homosexuals in Spain. Mental health professionals and organizations should also include work on psychosocial protective factors, not just risk factors, to enhance resilient outcomes in this group.

Prevalence rates of chronic kidney disease and its association with cardiometabolic factors and cardiovascular diseases. SIMETAP-CKD study. / Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC.

INTRODUCTION: Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors. METHODS: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined. RESULTS: The crude prevalence of CKD was 11.48% (95%CI: 10.72-12.27%), without significant difference between men (11.64% [95%CI: 10.49-12.86%]) and women (11.35% [95%CI: 10.34-12.41%]). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m2) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30-8.61) and 5.98% (95%CI: 5.41-6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54-80.49) of the population with CKD. CONCLUSIONS: The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.

Validación y propiedades psicométricas del “Cuestionario de valores de vida” (VLQ) para población española / Validation and psychometric properties of the "Life Values Questionnaire" (VLQ) for the Spanish population

El objetivo de este trabajo es presentar la adaptación española del “Cuestionario de valores de vida” (VLQ; Wilson et al., 2010), aportando datos sobre sus propiedades psicométricas. Se aplicó el cuestionario a 531 participantes de entre 18 y 70 años (M= 28,73), siendo el 70% mujeres universitarias. El análisis factorial exploratorio mostró tres factores principales: comunidad, cercanía y obligaciones, cuyos niveles de consistencia interna fueron de 0,70, 0,71 y 0,68, respectivamente, mientras que para la puntuación total fue de 0,71 que resultaron similares a los del original. En cuanto a la validez concurrente, el VLQ mostró correlaciones moderadas con el “Cuestionario de valores personales” (Schwartz, 1992) (r= 0,47) y con el “Cuestionario de instantánea vital” (Ruiz-García et al., 2021; Tsai et al., 2023) (r= 0,65). Se discute la utilidad del VLQ para evaluar y hacer seguimiento a los procesos clave involucrados en los cambios clínicos, así como para mejorar y evaluar los valores personales íntimamente relacionados con la calidad de vida, el sentido de la vida y el bienestar de la comunidad. (AU)

Tasas de prevalencia de sobrepeso y obesidad y sus asociaciones con factores cardiometabólicos y renales. Estudio SIMETAP-OB / Prevalence rates of overweight and obesity and their associations with cardiometabolic and renal factors. SIMETAP-OB study

Introducción: El exceso de peso constituye un importante problema de salud. Los objetivos del estudio fueron determinar las tasas de prevalencia de sobrepeso y obesidad, y comparar sus asociaciones con factores de riesgo cardiometabólicos y renales entre las poblaciones con y sin obesidad, y entre las poblaciones con y sin sobrepeso. Métodos: Estudio observacional transversal realizado en Atención Primaria. Muestra aleatoria de base poblacional: 6.588 sujetos de estudio entre 18 y 102 años (tasa de respuesta: 66%). Se calcularon las prevalencias brutas y ajustadas por edad y sexo de sobrepeso y obesidad, y se evaluaron sus asociaciones con variables cardiometabólicas y renales mediante análisis bivariado y multivariado. Resultados: Las prevalencias ajustadas por edad y sexo de sobrepeso y obesidad fueron 36,0% (42,1% en hombres; 33,1% en mujeres) y 25,0% (26,2% en hombres; 24,5% en mujeres), respectivamente. Estas prevalencias se incrementaban con la edad, y eran más elevadas en hombres que en mujeres. El 52,0% (IC95%: 50,0-53,9) de la población con sobrepeso y el 62,3% (IC95%: 60,1-64,5) de la población con obesidad tenían un riesgo cardiovascular alto o muy alto. La obesidad abdominal, la inactividad física, la prediabetes, la hipertensión, la hipertrigliceridemia y el c-HDL bajo se asociaban independientemente con ambas entidades. Además, la diabetes se asociaba independientemente con el sobrepeso y la hipercolesterolemia con la obesidad. Conclusiones: La prevalencia de sobrepeso y obesidad era del 61,0% (68,4% en hombres y 59,0% en mujeres). Más de la mitad de la población con sobrepeso y casi dos tercios de la población con obesidad tenían un riesgo cardiovascular elevado. La hiperglucemia, el sedentarismo, la hipertensión, la hipercolesterolemia, el c-HDL bajo y la hipertrigliceridemia se asociaban independientemente con el sobrepeso y la obesidad.(AU)

Introduction: Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations. Methods: Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis. Results: The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity. Conclusions: The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.(AU)

Prevalencia de prediabetes y asociación con factores cardiometabólicos y renales. Estudio SIMETAP-PRED / Prevalence of prediabetes and association with cardiometabolic and renal factors. SIMETAP-PRED study

Introducción: La prediabetes constituye un importante problema de salud pública. Los objetivos del estudio fueron determinar la prevalencia de prediabetes según dos criterios diagnósticos, y comparar la asociación de factores de riesgo cardiometabólicos y renales entre las poblaciones con y sin prediabetes. Métodos: Estudio observacional transversal realizado en el ámbito de Atención Primaria. Muestra aleatoria de base poblacional: 6.588 sujetos de estudio (tasa de respuesta: 66%). Se utilizaron dos criterios diagnósticos: 1) prediabetes según la Sociedad Española de Diabetes (PRED-SED): glucosa plasmática en ayunas 110–125mg/dL o HbA1c 6,0%–6,4%; 2) prediabetes según la Asociación Americana de Diabetes (PRED-ADA): glucosa plasmática en ayunas 100–125mg/dL o HbA1c 5,7%–6,4%. Se evaluaron las prevalencias crudas y ajustadas por edad y sexo, y las variables cardiometabólicas y renales asociadas con prediabetes. Resultados: Las prevalencias crudas de PRED-SED y PRED-ADA fueron 7,9% (IC95% 7,3–8,6%), y 22,0% (IC95% 21,0–23,0%) respectivamente, y sus prevalencias ajustadas fueron 6,6% y 19,1% respectivamente. El riesgo cardiovascular alto o muy alto de las poblaciones PRED-SED y PRED-ADA fueron 68,6% (IC95% 64,5–72,6%) y 61,7% (IC95% 59,1–64,1%) respectivamente. La hipertensión, hipertrigliceridemia, sobrepeso, obesidad y el índice cintura-talla aumentado se asociaban independientemente con PRED-SED. Además de estos factores, el filtrado glomerular bajo y la hipercolesterolemia también se asociaban independientemente con PRED-ADA. Conclusiones: La prevalencia de PRED-ADA triplica a la PRED-SED. Dos tercios de la población con prediabetes tenían un riesgo cardiovascular elevado. Varios factores de riesgo cardiometabólicos y renales se asociaban con la prediabetes. En comparación con los criterios de la SED, los criterios de la ADA facilitan más el diagnóstico de la prediabetes. (AU)

Introduction: Prediabetes is a major public health problem. The aims of the SIMETAP-PRED study were to determine the prevalence rates of prediabetes according to two diagnostic criteria, and to compare the association of cardiometabolic and renal risk factors between populations with and without prediabetes. Methods: Cross-sectional observational study conducted in Primary Care. Based random sample: 6,588 study subjects (response rate: 66%). Two diagnostic criteria for prediabetes were used: 1) prediabetes according to the Spanish Diabetes Society (PRED-SDS): Fasting plasma glucose (FPG) 110–125mg/dL or HbA1c 6.0% –6.4%; 2) prediabetes according to the American Diabetes Association (PRED-ADA): FPG 100–125mg/dL or HbA1c 5.7%–6.4%. The crude and sex- and age-adjusted prevalence rates, and cardiometabolic and renal variables associated with prediabetes were assessed. Results: The crude prevalence rates of PRED-SDS and PRED-ADA were 7.9% (95% CI 7.3–8.6%), and 22.0% (95% CI 21.0–23.0%) respectively, their age-adjusted prevalence rates were 6.6% and 19.1 respectively. The high or very high cardiovascular risk of the PRED-SDS or PRED-ADA populations were 68.6% (95%CI 64.5–72.6%) and 61.7% (95%CI 59.1–64.1%) respectively. Hypertension, hypertriglyceridemia, overweight, obesity, and increased waist-to-height ratio were independently associated with PRED-SDS. In addition to these factors, low glomerular filtration rate and hypercholesterolemia were also independently associated with PRED-ADA. Conclusions: The prevalence of PRED-ADA triples that of PRED-SDS. Two thirds of the population with prediabetes had a high cardiovascular risk. Several cardiometabolic and renal risk factors were associated with prediabetes. Compared to the SDS criteria, the ADA criteria make the diagnosis of prediabetes easier. (AU)

Differences in the diabetogenic effect of statins in patients with prediabetes. The PRELIPID study / Diferencias en cuanto al efecto diabetógeno de las estatinas en pacientes con prediabetes. Estudio Prelipid

Introduction:Statins are used with the understanding that a slightly increased risk of diabetes is outweighed by their cardiovascular benefits. However, it may be necessary to reconsider whether statin therapy really increase this risk mainly in the population with prediabetes.Methods:A multicenter, cross-sectional, observational study was conducted to assess the relationship between statin therapy and glucose metabolism in 407 patients aged 63.1 years (11SD) diagnosed with dyslipidemia and prediabetes treated in specialized lipid clinics in Spain.Results:Significant differences were found in HbA1c values among treatment groups (p=0.015). Patients treated with pitavastatin (1–4mg/day) showed the lowest HbA1c levels, with significant differences compared to patients treated with atorvastatin 40–80mg/day (p=0.016) and simvastatin 10–40mg/day (p=0.036). By contrast, patients treated with atorvastatin 40–80mg/day showed the highest HbA1c levels compared to those receiving atorvastatin 10–20mg/day (p=0.003), pitavastatin 1–4mg/day (p=0.016), pravastatin 20–40mg/day (p=0.027), rosuvastatin 5–10mg/day (p=0.043), and no statin treatment (p=0.004). Patients treated with simvastatin 10–40mg/day also had higher values than those treated with atorvastatin 10–20mg/day (p=0.016) and pitavastatin 1–4mg/day (p=0.036) or with no statin treatment (p=0.018).Conclusions:This study suggests that there are differences in the diabetogenic effect of statins. Simvastatin and high doses of atorvastatin may be associated with greater impairment in glucose metabolism than pitavastatin and other statins with less lipid-lowering potency such as pravastatin. (AU)

Introducción:Las estatinas son utilizadas de acuerdo con el entendimiento de que el pequeño riesgo de incremento de diabetes se ve compensado por sus beneficios cardiovasculares. Sin embargo, puede resultar necesario reconsiderar si la terapia con estatinas incrementa realmente el riesgo, principalmente en la población con prediabetes.Métodos:Se realizó un estudio multicéntrico, transversal y observacional para evaluar la relación entre la terapia con estatinas y el metabolismo de la glucosa en 407 pacientes de 63,1 años (11 DE) diagnosticados de dislipidemia y prediabetes tratados en clínicas especializadas en lípidos en España.Resultados:Se encontraron diferencias significativas en los valores de HbA1c entre los grupos de tratamiento (p=0,015). Los pacientes tratados con pitavastatina (1-4mg/día) reflejaron los menores niveles de HbA1c, con diferencias significativas en comparación con los pacientes tratados con atorvastatina 40-80mg/día (p=0,016) y simvastatina 10-40mg/día (p=0,036). Por contra, los pacientes tratados con atorvastatina 40-80mg/día reflejaron los mayores niveles de HbA1c en comparación con los pacientes que recibieron atorvastatina 10-20mg/día (p=0,003), pitavastatina 1-4mg/día (p=0,016), pravastatina 20-40mg/día (p=0,027), rosuvastatina 5-10mg/día (p=0,043) y los que no recibieron estatinas (p=0,004). Los pacientes tratados con simvastatina 10-40mg/día tuvieron también valores más elevados que aquellos pacientes tratados con atorvastatina 10-20mg/día (p=0,016) y pitavastatina 1-4mg/día (p=0,036) que no recibieron estatinas (p=0,018).Conclusiones:El presente estudio sugiere que existen diferencias en cuanto al efecto diabetógeno de las estatinas. Simvastatina y las altas dosis de atorvastatina pueden guardar relación con un mayor deterioro del metabolismo de la glucosa que pitavastatina y demás estatinas con menor potencia de reducción de lípidos, tales como pravastatina. (AU)

Prevalence rates of overweight and obesity and their associations with cardiometabolic and renal factors. SIMETAP-OB study. / Tasas de prevalencia de sobrepeso y obesidad y sus asociaciones con factores cardiometabólicos y renales. Estudio SIMETAP-OB.

INTRODUCTION: Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations. METHODS: Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis. RESULTS: The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity. CONCLUSIONS: The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.

Prevalence of prediabetes and association with cardiometabolic and renal factors. SIMETAP-PRED study. / Prevalencia de prediabetes y asociación con factores cardiometabólicos y renales. Estudio SIMETAP-PRED.

INTRODUCTION: Prediabetes is a major public health problem. The aims of the SIMETAP-PRED study were to determine the prevalence rates of prediabetes according to two diagnostic criteria, and to compare the association of cardiometabolic and renal risk factors between populations with and without prediabetes. METHODS: Cross-sectional observational study conducted in Primary Care. Based random sample: 6,588 study subjects (response rate: 66%). Two diagnostic criteria for prediabetes were used: 1) prediabetes according to the Spanish Diabetes Society (PRED-SDS): Fasting plasma glucose (FPG) 110-125mg/dL or HbA1c 6.0% -6.4%; 2) prediabetes according to the American Diabetes Association (PRED-ADA): FPG 100-125mg/dL or HbA1c 5.7%-6.4%. The crude and sex- and age-adjusted prevalence rates, and cardiometabolic and renal variables associated with prediabetes were assessed. RESULTS: The crude prevalence rates of PRED-SDS and PRED-ADA were 7.9% (95% CI 7.3-8.6%), and 22.0% (95% CI 21.0-23.0%) respectively, their age-adjusted prevalence rates were 6.6% and 19.1 respectively. The high or very high cardiovascular risk of the PRED-SDS or PRED-ADA populations were 68.6% (95%CI 64.5-72.6%) and 61.7% (95%CI 59.1-64.1%) respectively. Hypertension, hypertriglyceridemia, overweight, obesity, and increased waist-to-height ratio were independently associated with PRED-SDS. In addition to these factors, low glomerular filtration rate and hypercholesterolemia were also independently associated with PRED-ADA. CONCLUSIONS: The prevalence of PRED-ADA triples that of PRED-SDS. Two thirds of the population with prediabetes had a high cardiovascular risk. Several cardiometabolic and renal risk factors were associated with prediabetes. Compared to the SDS criteria, the ADA criteria make the diagnosis of prediabetes easier.

Morphological description and DNA-based association of the last instar larva of Erotesis schachti Malicky 1982 (Trichoptera: Leptoceridae), an endemic of the Iberian Peninsula.

In this paper we describe the main morphological characteristics that distinguish the full-grown larva of Erotesis schachti, an endemic of the Iberian Peninsula. The conspecificity of the larva and adult was confirmed by DNA analysis. Morphological features that easily discriminate it from the similar species Erotesis baltica are given.

Mediterranean diet and diabetes risk in a cohort study of individuals with prediabetes: propensity score analyses.

AIMS: Randomized controlled trials have demonstrated the efficacy of several dietary patterns plus physical activity to reduce diabetes onset in people with prediabetes. However, there is no evidence on the effect from the Mediterranean diet on the progression from prediabetes to diabetes. We aimed to evaluate the effect from high adherence to Mediterranean diet on the risk of diabetes in individuals with prediabetes. METHODS: Prospective cohort study in Spanish Primary Care setting. A total of 1184 participants with prediabetes based on levels of fasting plasma glucose and/or glycated hemoglobin were followed up for a mean of 4.2 years. A total of 210 participants developed diabetes type 2 during the follow up. Hazard ratios of diabetes onset were estimated by Cox proportional regression models associated to high versus low/medium adherence to Mediterranean diet. Different propensity score methods were used to control for potential confounders. RESULTS: Incidence rate of diabetes in participants with high versus low/medium adherence to Mediterranean diet was 2.9 versus 4.8 per 100 persons-years. The hazard ratios adjusted for propensity score and by inverse probability weighting (IPW) had identical magnitude: 0.63 (95% confidence interval, 0.43-0.93). The hazard ratio in the adjusted model using propensity score matching 1:2 was 0.56 (95% confidence interval, 0.37-0.84). CONCLUSIONS: These propensity score analyses suggest that high adherence to Mediterranean diet reduces diabetes risk in people with prediabetes.

Differences in the diabetogenic effect of statins in patients with prediabetes. The PRELIPID study.

INTRODUCTION: Statins are used with the understanding that a slightly increased risk of diabetes is outweighed by their cardiovascular benefits. However, it may be necessary to reconsider whether statin therapy really increase this risk mainly in the population with prediabetes. METHODS: A multicenter, cross-sectional, observational study was conducted to assess the relationship between statin therapy and glucose metabolism in 407 patients aged 63.1 years (11SD) diagnosed with dyslipidemia and prediabetes treated in specialized lipid clinics in Spain. RESULTS: Significant differences were found in HbA1c values among treatment groups (p=0.015). Patients treated with pitavastatin (1-4mg/day) showed the lowest HbA1c levels, with significant differences compared to patients treated with atorvastatin 40-80mg/day (p=0.016) and simvastatin 10-40mg/day (p=0.036). By contrast, patients treated with atorvastatin 40-80mg/day showed the highest HbA1c levels compared to those receiving atorvastatin 10-20mg/day (p=0.003), pitavastatin 1-4mg/day (p=0.016), pravastatin 20-40mg/day (p=0.027), rosuvastatin 5-10mg/day (p=0.043), and no statin treatment (p=0.004). Patients treated with simvastatin 10-40mg/day also had higher values than those treated with atorvastatin 10-20mg/day (p=0.016) and pitavastatin 1-4mg/day (p=0.036) or with no statin treatment (p=0.018). CONCLUSIONS: This study suggests that there are differences in the diabetogenic effect of statins. Simvastatin and high doses of atorvastatin may be associated with greater impairment in glucose metabolism than pitavastatin and other statins with less lipid-lowering potency such as pravastatin.

Gender Differences in Psychological Impact of the Confinement During the COVID-19 Outbreak in Spain: A Longitudinal Study.

The rapid spread of the coronavirus disease 2019 (COVID-19) has led the authorities to establish compulsory confinement for most of the Spanish population from March to May 2020. Severe isolation combined with the uncertainty and fear associated with the public health crisis can have a psychological impact on the general population. The aim of the current study was to compare possible gender differences in mental health and psychological measures throughout the confinement. One hundred and sixty-four Spanish participants (75% female; Mage = 39.8; SD = 13.5) completed the surveys at the beginning, middle, and end of the forced confinement. The psychological variables were associated with depressive, anxiety, stress, and intrusive/avoidance symptoms, as well as a total score for overall mental health, and a positive/negative affect measure. The results showed that although females had significantly higher scores than males in almost all measures at the beginning of the confinement, the gender differences were quickly vanishing away over time. In fact, intra-group analysis showed that while the female group significantly improved their results on most psychological measures, the male group improved on only one single measure. In summary, the results showed that although the female group started the confinement with higher levels of negative emotions (particularly symptoms of stress and avoidance) than the male group, these differences were significantly reduced in the first few weeks due to the overall improvement in the results of the female group.