Interaction between cardiovascular risk factors and body mass index and 10-year incidence of cardiovascular disease, cancer death, and overall mortality.

The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity [Hazard Ratio=2.34 (95% confidence interval: 1.19-4.61) and 5.65 (1.54-20.73), respectively]. Overweight and obesity significantly increased the risk of cancer death in women [3.98 (1.53-10.37) and 11.61 (1.93-69.72)]. Finally, obese men had an increased risk of cancer death and overall mortality [1.62 (1.03-2.54) and 1.34 (1.01-1.76), respectively]. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations.

Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2.

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

[Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study]. / Papel de la presión de pulso, presión arterial sistólica y presión arterial diastólica en la predicción del riesgo cardiovascular. Estudio de cohortes.

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk. PATIENTS AND METHOD: A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models, adjusting for age, sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors. RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (>/= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1); upper SBP tertile (>/= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>/= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r = 0.242; p < 0.001), and smoking (r = -0.158; p = 0.01), with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9). CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.

Antihypertensive overtreatment in people 80 years old and older. / Sobretratamiento antihipertensivo en mayores de 80 años.

BACKGROUND AND OBJECTIVE: To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment. PATIENTS AND METHODS: Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications. RESULTS: The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication. CONCLUSIONS: The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription.

Validity Assessment of Low-risk SCORE Function and SCORE Function Calibrated to the Spanish Population in the FRESCO Cohorts.

INTRODUCTION AND OBJECTIVES: To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. METHODS: Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. RESULTS: Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. CONCLUSIONS: All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate.

[Estimation of overall cardiovascular risk from coronary risk. A cohort study]. / Estimación del riesgo cardiovascular global a partir del riesgo coronario. Estudio de cohortes.

BACKGROUND AND OBJECTIVE: The coronary risk (CR) is a good approximation of the global cardiovascular risk (GCR). Multiplying the CR per 1.3 we obtain the GCR, but we don't know if it is certain in our country. PATIENTS AND METHOD: Prospective cohort study with 851 patients of ages between 35-74 years old, without cardiovascular disease and followed during 5 years. CR include myocardial ischemia (angor pectoris or myocardial infarction). GCR include CR, cerebrovascular disease, and peripheral vascular disease. RESULTS: We registered 21 myocardial ischemia cases, 15 cerebrovascular disease cases and 8 peripheral vascular disease cases. The accumulated incidence was: 2.5% for CR and 5.2% for GCR (difference 2.7%; 95% confidence interval for the difference 0.9-4.6%; p < 0.05). To estimated GCR we should multiple CR per 2.1. CONCLUSIONS: CR is not a good approximation of GCR. We need to developed equation that include not only CR but also GCR.

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis.

OBJECTIVE: Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODS: We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTS: We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONS: Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.

Evaluación de la validez de las funciones SCORE de bajo riesgo y calibrada para población española en las cohortes FRESCO / Validity assessment of low-risk SCORE function and SCORE function calibrated to the Spanish population in the FRESCO cohorts

Introducción y objetivos. Estudiar la validez de la función SCORE original de bajo riesgo sin y con colesterol unido a lipoproteínas de alta densidad y SCORE calibrada en población española. Métodos. Análisis agrupado con datos individuales de 12 estudios de cohorte de base poblacional. Se incluyó a 30.919 participantes de 40-64 años sin enfermedades cardiovasculares en el momento del reclutamiento, que se siguieron durante 10 años para la mortalidad cardiovascular contemplada en el proyecto SCORE. La validez de las funciones se analizó mediante el área bajo la curva ROC (discriminación) y el test de Hosmer-Lemeshow (calibración), respectivamente. Resultados. Se dispuso de 286.105 personas/año. La mortalidad a 10 años por causas cardiovasculares fue del 0,6%. La razón de casos esperados/observados fue de 9,1, 6,5 y 9,1 en varones y de 3,3, 1,3 y 1,9 en mujeres con las funciones SCORE original de bajo riesgo sin y con colesterol unido a lipoproteínas de alta densidad y SCORE calibrada, respectivamente; diferencias estadísticamente significativas con el test de calibración de Hosmer-Lemeshow entre la mortalidad predicha con SCORE y la observada (p < 0,001 en ambos sexos y en todas las funciones). Las áreas bajo la curva ROC con SCORE original fueron 0,68 en varones y 0,69 en mujeres. Conclusiones. Todas las versiones de las funciones SCORE disponibles en España sobreestiman significativamente la mortalidad cardiovascular observada en la población española. A pesar de la aceptable capacidad de discriminación, la predicción del número de acontecimientos cardiovasculares mortales (calibración) fue significativamente imprecisa (AU)

Introduction and objectives. To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. Methods. Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. Results. Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. Conclusions. All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate (AU)

Sobretratamiento antihipertensivo en mayores de 80 años / Antihypertensive overtreatment in people 80 years old and older

Fundamento y objetivo: Estudiar la proporción de pacientes mayores de 80 años con hipertensión arterial y sobretratamiento farmacológico. Pacientes y métodos: Estudio de simulación, descriptivo transversal, incluyendo 281 pacientes mayores de 80 años de prevención primaria, seleccionados aleatoriamente, con buen control (presión arterial sistólica<150mmHg, presión arterial diastólica<90mmHg), tratados con 3 principios activos como máximo. Se consideró sobretratamiento si se podía retirar al menos un principio activo y persistía el buen control, calculando cuánto subiría la presión con el metaanálisis de Law, que estima las reducciones de presión arterial según pretratamiento, número y dosis del principio activo. Resultados: La edad media fue de 85,3 años (64,8% mujeres). Tomaban un principio activo el 33,6%, 2 el 46,3% y 3 el 22,1%, siendo los más prescritos tiazidas (69,4%), IECA (51,3%), ARA-II(23,4%), antagonistas del calcio (21%) y betabloqueantes (19,6%). El sobretratamiento fue del 90,7%, pudiéndose retirar 2 principios activos en un 63,1% y 3 en el 43,1%. La polifarmacia (OR 2,47; IC 95% 1,07-5,69; p=0,033) se asoció a una probable retirada de al menos un principio activo. Conclusiones: La proporción de pacientes con sobretratamiento es elevada. El cambio de criterios de control puede contribuir a una deprescripción razonada (AU)

Background and objective: To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment. Patients and methods: Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications. Results: The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication. Conclusions: The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription (AU)

Papel de la presión de pulso, presión arterial sistólica y presión arterial diastólica en la predicción del riesgo cardiovascular. Estudio de cohortes / Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study

FUNDAMENTO Y OBJETIVO: Analizar el papel de la presión de pulso (PP), la presión arterial sistólica(PAS) y la diastólica (PAD) en la predicción del riesgo cardiovascular.PACIENTES Y MÉTODO: Se realizó un estudio de cohortes, prospectivo, en 2 centros de salud, queincluyó a 932 personas de 35-84 años sin episodios cardiovasculares, seleccionadas por muestreoaleatorio simple y seguidas durante 8 años. La PP, PAS y PAD se categorizaron en tercilesy el superior se comparó con los 2 inferiores. Se registró como variable combinada el primerepisodio cardiovascular, mortal o no, en forma de cardiopatía isquémica, enfermedad cerebrovasculary arteriopatía periférica. Los resultados se analizaron mediante modelos de Cox ajustandopor edad, sexo, tabaquismo, colesterol total, colesterol unido a lipoproteínas de alta densidady diabetes mellitus. Se estudió la correlación entre PP y PAS, PAD y factores de riesgocardiovascular.RESULTADOS: Se registraron 85 episodios cardiovasculares: 43 casos de cardiopatía isquémica,27 de enfermedad cerebrovascular y 17 de arteriopatía periférica. Los cocientes de riesgo ajustadospara la variable combinada fueron: tercil superior (>= 59 mmHg) de la PP = 1,3 (intervalode confianza [IC] del 95%, 0,8-2,1); tercil superior (>= 140 mmHg) de la PAS = 1,5 (IC del95%, 1,0-2,5); tercil superior (>= 84 mmHg) de la PAD = 1,1 (IC del 95%, 0,7-1,8). Los resultadosfueron similares para los episodios cardiovasculares específicos. La PP se correlacionócon la PAS (r = 0,825; p < 0,001), la edad (r = 0,422; p < 0,001), la diabetes mellitus(r = 0,242; p < 0,001) y el tabaquismo (r = –0,158; p = 0,01), siendo su cociente de riesgoajustado por estas variables de 1,0 (IC del 95%, 0,6-1,9).CONCLUSIONES: La PP es un componente de la presión arterial muy relacionado con la PAS yotros factores de riesgo, pero no es mejor predictor del riesgo cardiovascular que la PAS

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP), systolic (SBP) and diastolicblood pressure (DBP), in the prediction of cardiovascular risk.PATIENS AND METHOD: A prospective cohort study carried out in 2 primary care center, including932 patients aged between 35-84 years old, without cardiovascular events, selected by simplerandom sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles,comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such ascoronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded asa composite variable. Results were studied according to Cox models, adjusting for age, sex,smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studiedthe correlation between PP with SBP, DBP, and cardiovascular risk factors.RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovasculardisease, and 17 peripheral arterial disease. The adjusted hazard ratios for compositevariable were: upper PP tertile (>= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1);upper SBP tertile (>= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>= 84 mmHg) =1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlatedwith SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r =0.242; p < 0.001), and smoking (r = –0.158; p = 0.01), with adjusted hazard ratio for thesevariables of 1.0 (95% CI, 0.6-1.9).CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors,but is not a better cardiovascular risk predictor than SBP

Estimación del riesgo cardiovascular global a partir del riesgo coronario. Estudio de cohortes / Estimation of overall cardiovascular risk from coronary risk. A cohort study

Fundamento y objetivo: Se considera que el riesgo coronario (RC) es una buena aproximación al riesgo cardiovascular global (RCG). Si se multiplica el RC por 1,3, se obtendría el RCG, pero desconocemos si esto es cierto en España. Pacientes y método: Estudio de cohorte prospectiva, con 851 pacientes de 35-74 años sin enfermedades cardiovasculares, seguidos durante 5 años. El RC incluyó la cardiopatía isquémica (angina o infarto agudo de miocardio) y el RCG, el RC más la enfermedad cerebrovascular y la arteriopatía periférica de extremidades inferiores. Resultados: Se registró 21 casos de cardiopatía isquémica, 15 de enfermedad cerebrovascular y 8 de arteriopatía periférica. La incidencia acumulada fue del 2,5% para el RC y el 5,2% para el RCG (diferencia del 2,7%; intervalo de confianza del 95% de la diferencia, 0,9-4,6%; p < 0,05). Para estimar el RCG tendríamos que multiplicar el RC por 2,1. Conclusiones: El RC no es una buena aproximación al RCG. Es preciso desarrollar ecuaciones que incluyan el RCG y no sólo el RC

Background and objective: The coronary risk (CR) is a good approximation of the global cardiovascular risk (GCR). Multiplying the CR per 1.3 we obtain the GCR, but we don't know if it is certain in our country. Patients and method: Prospective cohort study with 851 patients of ages between 35-74 years old, without cardiovascular disease and followed during 5 years. CR include myocardial ischemia (angor pectoris or myocardial infarction). GCR include CR, cerebrovascular disease, and peripheral vascular disease. Results: We registered 21 myocardial ischemia cases, 15 cerebrovascular disease cases and 8 peripheral vascular disease cases. The accumulated incidence was: 2.5% for CR and 5.2% for GCR (difference 2.7%; 95% confidence interval for the difference 0.9-4.6%; p < 0.05). To estimated GCR we should multiple CR per 2.1. Conclusions: CR is not a good approximation of GCR. We need to developed equation that include not only CR but also GCR