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

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

[Prevalence of cardiovascular risk factors in the Spanish working population]. / Prevalencia de factores de riesgo vascular en la población laboral española.

INTRODUCTION AND OBJECTIVES: The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. METHODS: The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. RESULTS: Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (< or =140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index > or =30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol > or =200 mg/dL, LDL cholesterol > or =160 mg/dL, triglycerides > or =200 mg/dL, or HDL cholesterol < 40 mg/dL in males or < 50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. CONCLUSIONS: The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment.

Atorvastatin in dyslipidaemia of the nephrotic syndrome.

The combined dyslipidaemia that accompanies the nephrotic syndrome increases the cardiovascular risk and appears to worsen long-term renal function. Our aim was to determine the efficacy and safety of 10 mg atorvastatin in the control of dyslipidaemia in these patients. We carried out a prospective, open, 6 month study of 10 patients with primary or secondary nephrotic syndrome (proteinuria >3.5 g/day, hypoalbuminaemia, oedema and hyperlipidaemia). The changes in lipids and plasma lipoproteins were measured, as well as the safety profile (transaminases, creatine phosphokinase, fibrinogen and antithrombin III activity) and parameters of renal function. The addition of 10 mg atorvastatin daily for 6 months resulted in a 41% reduction in low density lipoprotein (LDL) cholesterol and 31% in triglycerides (both P < 0.05), and a 15% increase in high density lipoprotein (HDL) cholesterol (NS). The drug was well tolerated and there was no change in the safety profile or deterioration in renal function. In fact, the levels of proteinuria fell in all but one patient (6.2 +/- 2.6 vs 4.8 +/- 2.5 g/24 h; P < 0.05). Atorvastatin, at the above dose, and for the time used proved to be a safe drug that effectively reduced dyslipidaemia in patients with nephrotic syndrome.

Prevalencia de factores de riesgo vascular en la población laboral española / Prevalence of cardiovascular risk factors in the spanish working population

Introducción y objetivos. Los reconocimientos de la salud de los trabajadores constituyen una oportunidad de detección precoz de factores de riesgo vascular. El presente estudio investiga la prevalencia de factores de riesgo vascular en la población laboral española. Métodos. Se incluyó a 216.914 trabajadores (edad media, 36,4 años; intervalo, 16-74 años; el 73,1% eran varones) en los que se realizó un reconocimiento en una mutua laboral, que incluyó un cuestionario estructurado, una exploración física y determinaciones bioquímicas. Resultados. Tenían diagnóstico previo de enfermedad cardiovascular el 0,7%, de hipertensión arterial el 6,2%, de diabetes el 1,2% y de dislipidemia el 8,9%. Durante el reconocimiento se detectó la presencia de tabaquismo en el 49,3% (el 51,3% varones y el 43,8% mujeres), presión arterial elevada (≥ 140/90 mmHg) en el 22,1% (el 27,0% varones y el 8,8% mujeres), obesidad (índice de masa corporal ≥ 30) en el 15,5% (el 18,3% varones y el 13,3% mujeres), hiperglucemia (> 110 mg/dl) en el 6,2% (el 7,8% varones y el 1,9% mujeres) y alguna forma de dislipidemia (colesterol total ≥ 200 mg/dl, cLDL ≥ 160 mg/dl, triglicéridos ≥ 200 mg/dl o cHDL < 40 mg/dl en varones o < 50 mg/dl en mujeres) en el 64,2%. Con respecto al sector «servicios», y tras ajustar por factores de confusión, los trabajadores del sector industria y sobre todo de la construcción mostraron una mayor prevalencia de elevación de la presión arterial y, especialmente, de tabaquismo. Conclusiones. Hay una alta prevalencia de factores de riesgo en la población laboral española, especialmente en varones y en determinados sectores de actividad (AU)

Introduction and objectives. The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. Methods. The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. Results. Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (≥140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index ≥30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol ≥200 mg/dL, LDL cholesterol ≥160 mg/dL, triglycerides ≥200 mg/dL, or HDL cholesterol <40 mg/dL in males or <50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. Conclusions. The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment (AU)