[Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. / Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022.

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.

[Cardiovascular preventive recommendations. PAPPS 2020 update]. / Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2020.

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: Epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; Cardiovascular (CV) risk tables and recommendations for the calculation of CV risk; Main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; Indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation. The quality of testing and the strength of the recommendation are included in the main recommendations.

[Prevalence of obesity in immigrants in Madrid, Spain]. / Prevalencia de obesidad en inmigrantes en Madrid.

BACKGROUND AND OBJECTIVE: There are no studies in Spain on the extent of obesity in adult immigrants. The aim of this paper is to present the frequency and distribution of obesity among immigrants living in Madrid. PATIENTS AND METHOD: We selected subjects between 18 and 64 years of age. Body Mass Index was used as an estimator of obesity. Immigrant status was defined according to country of birth. The results show the unadjusted and adjusted prevalence of obesity for different immigrant groups. RESULTS: The percentage of obesity was higher in the immigrant population than in the Spanish population, except for the group of immigrants from western countries. According to gender, male immigrants from Eastern Europe and Latin America and women from Asia, Africa and Eastern Europe were the most obese. CONCLUSION: The highest prevalence of obesity among immigrants has also been observed in studies conducted in other countries. The prevalence of obesity among immigrants may be due to a more intense exposure to obesogenic factors both before arrival and during their residence in Spain.

Cardiovascular risk and blood pressure control in a Spanish hypertensive population attended in a Primary Care setting. Data from the PRESCAP 2006 study.

AIMS: To analyse the cardiovascular risk of a broad sample of hypertensive patients and to examine whether there are differences in blood pressure control and associated factors according to the different cardiovascular risk categories. MAJOR FINDINGS: A total of 10,520 patients > or = 18 years old were included (mean age 64.6+/-11.3 years; 53.7% women). In this cohort, 3.3% were average risk, 22.6% low added risk, 22.2% moderate added risk, 33.5% high added risk and 18.4% very high added risk. Blood pressure was controlled in 41.4% (95% CI 40.5-42.4) of the total population, in 91.7% of patients with low added risk, in 19.4% with moderate added risk, in 27.4% with high added risk and in 6.8% with very high added risk. Diabetes was the factor most strongly associated with poor blood pressure control in patients with high to very high added risk (OR=7.2; p<0.0001). PRINCIPAL CONCLUSION: More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

[Cross-sectional epidemiological study of clinical profiles and glycemic control in diabetic patients in primary care in Spain (the EPIDIAP study)]. / Estudio epidemiológico del perfil clínico y control glucémico del paciente diabético atendido en centros de atención primaria en España (estudio EPIDIAP).

OBJECTIVE: To assess the degree of glycemic control and its associated factors in patients with diabetes mellitus (DM) attended by primary care teams in Spain. MATERIAL AND METHODS: A cross-sectional multicenter study was carried out using a structured questionnaire in diabetic patients consecutively attended from January to August 2007. Three groups were assessed: patients with type 1 diabetes mellitus (DM) and those with insulin-treated or non-insulin-treated type 2 DM. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Good glycemic control was defined as a glycated hemoglobin (HbA1c) value

[Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006.

BACKGROUND AND OBJECTIVES: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. PATIENTS AND METHOD: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients >or= 18 years, with antihypertensive treatment (>or= 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and <130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. RESULTS: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p<0.001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p<0.001). CONCLUSIONS: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study.

[Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study]. / Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP.

BACKGROUND AND OBJECTIVE: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. PATIENTS AND METHOD: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. RESULTS: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. CONCLUSIONS: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area.

[Arterial hypertension in immigrant patients in Spanish primary health care]. / Prevalencia de la hipertensión arterial en la población inmigrante asistida en atención primaria en España.

BACKGROUND AND OBJECTIVE: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients. PATIENTS AND METHOD: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was > or = 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed. RESULTS: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3). CONCLUSIONS: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients.

[Determinants of the adherence to therapeutic plan in elderly Spaniards, over 60 years of age]. / Determinantes del cumplimiento terapéutico en personas mayores de 60 años en España.

OBJECTIVE: To identify factors associated with the adherence to a therapeutic plan of awareness of hypertension. MATERIAL AND METHODS: The data of the study "Arterial hypertension and other factors of risk in the elderly (> or = 60 years) Spanish population". This was a population-based survey of 4.009 older Spaniards. Information for this survey was obtained thorough household personal interviews to evaluate if these determining factors are independent of socio-demographic variables, the use of health system, lifestyles and the quality of life related to health. RESULTS: In men, the adherence to a therapeutic plan according to the regions studied (OR Rural = 3.9; OR Cantabrian = 1.9). Beside general health (OR = 1.01). With respect to the women, the ones that complied with the therapeutic plan more frequently had a low scholastic level (OR = 1.8), physical condition (OR = 1.02), and had more frequent home medical visits monthly (OR = 3.0). The women with poor adherence had two chronic illnesses (OR = 0.6) CONCLUSIONS: There are regional differences, gender, educational and to measure health-related quality of life. This demonstrates poor adherence, so the strategy should be directed toward in this variables mentioned.

[Factors associated the control of hypertension among older Spaniards, over 60 years of age]. / Factores asociados al control de la hipertension arterial en personas mayores de 60 años en España.

BACKGROUND: In the last decade, improvement has been observed in the control of arterial hypertension in Spain. Such control has an effect in the decrease of cardiovascular morbidity and mortality. The objective of the study was to identify factors associated to the control of arterial hypertension in awareness of hypertension among males and females who receive pharmacological treatment. METHODS: A cross-sectional analysis, made in basis of the following study data: "Arterial Hypertension and other risk factors in the population of 60 years old and more in Spain". The sample included 1461 hypertensive patients treated pharmacologically, selected by probabilistic and multistage sampling. The information recollected about the control of arterial hypertension, social and demographic variables, lifestyle, healthcare service usage, and life quality related to health, by residence interviewing. RESULTS: No differences between gender were observed in the control of hypertension (p = 0.09), In men control were significantly linked to: residence in rural areas (OR = 1.83; CI at 95%: 1.06-3.14); being single (OR = 3.40; CI at 95%: 1.32-8.74); and exercising (OR = 1.69; CI at 95%: 1.06-2.69). Women who consume alcohol in a moderate way controlled themselves more (OR = 1.63; CI at 95% 1.14-2.33). CONCLUSIONS: This research determines, according to gender, some factors related with the control of arterial hypertension in awareness of hypertension patients treated pharmacologically. In male patients the control is related to: living in rural areas, being single and physical activity. While in females control was associated with moderate alcohol consumption.

[Control of hypertension in elderly patients receiving primary care in Spain]. / Control de la hipertensión arterial en la población española > or = 65 años asistida en atención primaria.

INTRODUCTION AND OBJECTIVES: Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners' responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain. PATIENTS AND METHOD: A cross-sectional study of elderly hypertensive patients taking antihypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg. RESULTS: The study included 5970 patients (mean age, 72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P <.001). Some 12.9% of diabetics had pressures less than 130/85 mmHg and 9.7% had pressures less than 130/80 mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients. CONCLUSIONS: Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners' therapeutic responses to poor control were too conservative.

[Epidemiology of heart failure]. / Epidemiología de la insuficiencia cardíaca.

Of all persons aged over 40 years, approximately 1% have heart failure. The prevalence of heart failure doubles with each decade of life, and is around 10% in persons over 70 years of age. In Spain, heart failure causes nearly 80,000 hospital admissions every year. As in other developed countries, heart failure is the most frequent cause of hospitalization among persons 65 years of age and over, and is responsible for 5% of all hospitalizations. The incidence of heart failure increases with age, and reaches 1% per year in those over 65. Heart failure is a progressive, lethal disorder, even with adequate treatment. Five-year survival is around 50%, which is no better than that for many cancers. In Spain, heart failure is the third leading cause of cardiovascular mortality, after coronary disease and stroke. In 2000, heart failure caused 4% of all deaths and 10% of cardiovascular deaths in men; the corresponding figures for women were 8% and 18%. In recent decades the prevalence and number of hospitalizations due to heart failure have increased steadily in developed countries. Heart failure will probably continue to increase in coming years: although its incidence has not materially decreased, survival is increasing due to better treatment. The control of risk factors for hypertension and ischemic heart disease, the main causes of heart failure in Spain, is the only method to halt the foreseeable increase in heart failure in the near future.

[Association of cardiovascular disease with overweight and obesity in Spain]. / Asociación de la enfermedad cardiovascular con el sobrepeso y la obesidad en España.

BACKGROUND: Our purpose was to examine the relationship of overweight and obesity with cardiovascular disorders. PATIENTS AND METHOD: Data from the 1993 Spanish National Health Survey (16,692 subjects with a body mass index [BMI] >= 18.5 kg/m2). RESULTS: After adjustment for age, residence city size and tobacco consumption, we observed a positive dose-response relationship (p linear trend < 0.05) of BMI >= 18.5 kg/m2 with hypertension, hypercholesterolemia and diabetes in both sexes, as well as with heart diseases in women. These associations decreased with age. CONCLUSIONS: Overweight and obesity are associated with a greater frequency of cardiovascular disorders in Spain.

[Blood pressure control in Spanish hypertensive patients in Primary Health Care Centres. PRESCAP 2002 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2002.

BACKGROUND AND OBJECTIVE: More information is needed on hypertension control in clinical practice, which includes taking at least two blood pressure (BP) readings and taking into account surgery times and previous antihypertensive drug intake. Our study aimed to assess the optimum degree of BP control in a broad sample of Spanish hypertensive patients in primary care and to determine factors associated with a poor control. PATIENTS AND METHOD: Cross-sectional, multicenter study of hypertensive patients aged over 18 years and treated with drugs during the preceeding three months, who were recruited by general practitioners through consecutive sampling in primary care settings throughout Spain over 3 consecutive days. BP measurements were performed in surgery hours (morning and evening) following standardized methods and averaging two consecutive readings. An average BP lower than 140/90 mm Hg (values lower than 130/85 mm Hg in diabetics) was regarded as optimum BP control. RESULTS: 12 754 patients were included, mean age 63.3 years (10.8), 57.2% women. 36.1% (95% CI, 35.2-36.9) had good systolic blood pressure (SBP) and diastolic blood pressure (DBP) controls, 39.1% (95% CI, 38.3-40.0) had good SBP control only, and 73.1% (95% CI, 72.3-73.9) had good DBP control only. BP control was significantly (*2, p < 0.001) better during evening than during morning measurements (43.6% vs 37.1%) and in patients who had taken antihypertensive treatment before measurement (37.2%) vs. those who had not taken it (21.0%). Factors such as alcohol consumption, sedentary lifestyle, obesity and age were all associated with poor BP control (Wald's (chi 2, p < 0.001). CONCLUSIONS: The results of the PRESCAP 2002 study indicate that approximately 4 out of 10 hypertensive patients treated pharmacologically by primary health care centers in Spain have optimal BP control. Significant differences were found in the degree of control depending on surgery hours and the previous intake of antihypertensive medication.

[The obesity epidemic and related factors: the case of Spain]. / La epidemia de obesidad y sus factores relacionados: el caso de España.

The obesity epidemic is a global phenomenon that does not respect geographic or socio-demographic boundaries. Thus, research on factors related to the obesity epidemic has focused on social and economic characteristics of modern societies. This article discusses obesity in Spain and trends in several associated factors. Together with the increase in the prevalence of obesity, important changes in the population's dietary pattern have been observed, although total energy and fat intake appear to be stable. According to several indirect indicators, sedentary behavior predominates, although the percentage of the population reporting some leisure exercise is increasing. An increase in the amount of leisure time in modern societies is suggested as an explanation for this paradox. Factors related to energy expenditure could be as important as dietary factors in the genesis of the obesity epidemic.