Background
Oxygen desaturation during exercise is mainly observed in severe cases of chronic obstructive pulmonary disease (COPD) and is associated with a worse prognosis, but little is known about ...the type of desaturation that causes the greatest risk of mortality.
Material and Methods
We studied all of the 6-min walk tests performed periodically at a tertiary hospital over a period of 12 years in patients with moderate or severe COPD. We classified patients as non-desaturators if they did not suffer a drop in oxygen saturation (SpO2 < 88%) during the test, early desaturators if the time until desaturation was < 1 min, and non-early desaturators if it was longer than 1 min. The average length of follow-up per patient was 5.6 years.
Results
Of the 319 patients analyzed, 126 non-desaturators, 91 non-early desaturators and 102 early desaturators were identified. The mortality analysis showed that early desaturators had a mortality of 73%, while it was 38% for non-early desaturators and 28% for non-desaturators, with a survival of 5.9 years compared to 7.5 years and 9.6 years, respectively (hazard ratio of 3.50; 95% CI 2.3–5.3;
p
< 0.0001).
Conclusions
The early desaturation seen in patients with chronic obstructive pulmonary disease is associated with greater mortality and is likely responsible for the poor prognosis shown globally in patients who desaturate. The survival of patients with early desaturation is almost 4 years less with respect to non-desaturators, and they, thus, require closer observation.
Asthma exacerbations are a major contributor to the global disease burden, but no significant predictive biomarkers are known. The Genomics and Metagenomics of Asthma Severity (GEMAS) study aims to ...assess the role of genomics and the microbiome in severe asthma exacerbations. Here, we present the design of GEMAS and the characteristics of patients recruited from March 2018 to March 2020. Different biological samples and demographic and clinical variables were collected from asthma patients recruited by allergy and pulmonary medicine units in several hospitals from Spain. Cases and controls were defined by the presence/absence of severe asthma exacerbations in the past year (oral corticosteroid use, emergency room visits, and/or asthma-related hospitalizations). A total of 137 cases and 120 controls were recruited. After stratifying by recruitment location (i.e., Canary Islands and Basque Country), cases and controls did not differ for most demographic and clinical variables (p > 0.05). However, cases showed a higher proportion of characteristics inherent to asthma exacerbations (impaired lung function, severe disease, uncontrolled asthma, gastroesophageal reflux, and use of asthma medications) compared to controls (p < 0.05). Similar results were found after stratification by recruitment unit. Thereby, asthma patients enrolled in GEMAS are balanced for potential confounders and have clinical characteristics that support the phenotype definition. GEMAS will improve the knowledge of potential biomarkers of asthma exacerbations.
Objective: The lower mortality from coronary ischemic disease in populations living at high altitude has been related to an increase of high‐density lipoprotein (HDL)‐cholesterol at altitude. Leptin ...has been proposed as a cardiovascular risk factor. We investigated whether leptin varies according to the altitude at which people live.
Research Methods and Procedures: This was a cross‐sectional study of the first 889 people enrolled in a cohort study in the Canary Islands, Spain. The relationship among serum leptin, altitude, obesity, and other cardiovascular risk factors was analyzed by bivariate and multivariate tests.
Results: Leptin levels showed an inverse correlation to altitude expressed in meters (r = −0.10). Obese subjects had this leptin‐altitude association (r = −0.19), but they also had a direct correlation of leptin to HDL‐cholesterol (r = 0.27) and an inverse correlation of leptin to the total cholesterol‐to‐HDL‐cholesterol ratio (r = −0.34), triglycerides (r = −0.29), apolipoprotein B (r = −0.21), and glycemia (r = −0.19). Nonobese subjects had only the leptin‐altitude association (r = −0.11). The final regression model included altitude as predictor. Other associated variables were gender, physical activity, BMI, age, smoking (reducing leptin independently of BMI), alcohol, heart rate, and income.
Discussion: Serum leptin level decreases when altitude increases, and this association could help to explain the lower cardiovascular mortality rate at high altitude. However, because in obese subjects there is a direct association of leptin with HDL‐cholesterol and an inverse association with the lipid atherogenic fractions, we suggest the hypothesis of different roles for bound and free leptin, with free leptin being a cardiovascular protective factor in obese people.
Background Sun exposure, light skin pigmentation, and melanocortin 1 receptor (MC1R) gene variants are independent risk factors for skin cancer. The Canary Islands have a sunny and temperate ...climate, but data regarding the phenotypic and genotypic risk factors among the population are lacking.
Methods The main phenotypic features (skin color, hair color, eye color, and freckling) of 5116 healthy individuals are described. The genotypic findings of six MC1R gene variants (V60L, D84E, R150C, R160W, R163Q, and T314T) in 116 healthy individuals from a population‐based cohort with at least three generations of Canary Islands’ ancestry are evaluated. The variants were analyzed by SNaPshot.
Results Fifty per cent of the population showed at least one phenotypic risk factor (fair skin, 34.3%; freckling, 17.4%; green or blue eyes, 16.8%; red or blonde hair, 7.8%), although brown skin (65.7%), dark eyes (83.2%), and dark hair (92.2%) prevailed. Forty‐three per cent of the individuals showed at least one of the MC1R variants studied. Allelic frequencies for V60L, D84E, R150C, R160W, R163Q, and T314T were 9.1%, 1.7%, 3.0%, 0.8%, 3.0%, and 8.2%, respectively.
Conclusion A significant proportion of the population showed risk factors for skin cancer. The inhabitants of the Canary Islands are phenotypically and genotypically close to Mediterranean populations.
The Canary Islands rank first in Spain with respect to the ischaemic heart disease and diabetes mortality rates. The Islands female population leads the country in deaths from breast cancer. The "CDC ...de Canarias" is a general population cohort study in order to analyse the prevalence and incidence of these diseases and the exposure to their risk factors (RF) in the adult population of the archipelago.
Prospective study with a random sampling of the general population, in which 6,729 individuals participated between 2000 and 2005 (aged 18-75). Anthropometric measurements were taken, and blood was drawn for the storage of serum and genetic samples. The following information was gathered through a questionnaire: eating habits, physical activity, personal and family medical history, exposure to occupational or environmental risk factors, smoking, etc.
The prevalence of obesity is close to 30%, without differences between sexes, however, more male subjects were overweight than women (45 vs. 33%; p <0.001) and also presented a greater prevalence of diabetes (12 vs. 10%; p =0.005), high blood pressure (43 vs. 33%; p <0.001), excessive intake of alcohol (13 vs. 2%; p <0.001) and lack of sun protection (46 vs. 18%; p <0.001). Exposure to low levels of HDL cholesterol is more frequent in women (37 vs. 30%; p <0.001) as is also the case with a sedentary life style (71 vs. 55%; p <0.001). The exposure to the risk factors studied, including poverty, is greater in advanced age groups, except for smoking (26%) which is greater in the younger subjects. The estimate of relative risks of exposure to cardiovascular and cancer risk factors is higher in low-income social classes.
The current adult population of the Canaries presents a high prevalence of exposure to risk factors for cardiovascular disease, diabetes and cancer, among which overweight, obesity and lack of exercise stand out particularly.
Although ischemic cardiopathy mortality in the Canary Islands is among the highest in Spain, the specific coronary risk for its population has not been estimated. This study presents the first ...cardiovascular risk charts for the Canarian adult population and compares them with those previously published on Gerona, Spain.
A cross-sectional study of 4915 subjects, aged 25-74, that had been enrolled in the cohort study CDC of the Canary Islands. The standardized prevalence of obesity, overweight, smoking, hypertension and diabetes were estimated with the information obtained from personnel interviews, physical exams and blood samples. Those prevalences were used to calibrate the Framingham coronary function and to elaborate coronary risk charts.
The crude prevalence of obesity was 30% (95% confidence interval CI, 28.7-31.3), overweight 39% (95% CI, 37.6-40.4), smoking 26% (95% CI, 24.8-27.2), hypertension 40% (95% CI, 38.6-41.4) and diabetes 12% (95% CI, 11.1-12.9). In most of the factors, these prevalences were higher than Gerona's population in every age group and gender. On average, the estimated coronary risk of the islanders was 89% higher than Gerona's risk (94% higher in males and 87% in females), which is concordant with the distance between both populations in the national mortality statistics.
The high prevalence of obesity and other factors in the Canarian population implies important coronary risks and it explains the position of the Canary Islands in the Spanish statistics of ischemic cardiopathy mortality. The use of these calibrated risk charts would be helpful to intensify the prevention of cardiovascular diseases.
Fundamento: Canarias ocupa el primer lugar de España en
mortalidad por cardiopatía isquémica y por diabetes. Sus mujeres son
las primeras en mortalidad por cáncer de mama. El CDC de Canarias
es el ...estudio de una cohorte de población general para analizar
la prevalencia e incidencia de estas enfermedades y la exposición a
sus factores de riesgo (FR) en la población adulta del archipiélago.
Métodos: Estudio prospectivo con muestreo aleatorio en
población general, en el que participaron 6.729 personas entre los
años 2000 y 2005 (edad 18-75 años). Se les realizó antropometría
y se extrajo sangre para almacenamiento de muestras séricas y
genéticas. Mediante cuestionario se recogió: hábitos dietéticos,
actividad física, antecedentes personales y familiares de enfermedad,
exposición a FR laborales o ambientales, tabaquismo, etc.
Resultados: La prevalencia de obesidad es casi del 30%, sin
diferencias entre sexos, pero el sobrepeso afecta más a los varones
(45 vs. 33%; p<0 001), los cuales presentan también mayor
prevalencia de diabetes (12 vs. 10%; p =0 005), hipertensión (43
vs. 33%; p<0 001), ingesta excesiva de alcohol (13 vs. 2%;
p<0 001) y falta de protección solar (46 vs. 18%; p<0 001). En
las mujeres es más frecuente la exposición a bajos niveles de
colesterol HDL (37 vs. 30%; p<0 001) y al sedentarismo (71 vs.
55%; p<0 001). La exposición a los FR estudiados, entre ellos la
pobreza, es mayor en edades avanzadas, salvo el tabaquismo
(26%) que es mayor en edades jóvenes. La estimación de riesgos
relativos de exposición a los factores de riesgo cardiovascular y de
cáncer es más alta en las clases sociales pobres.
Conclusiones: La actual población adulta de Canarias presenta
una elevada prevalencia de exposición a factores de riesgo para
las enfermedades cardiovasculares, la diabetes y el cáncer, destacando
especialmente el sobrepeso, la obesidad y el sedentarismo.
PDF
