Abstract Aims To compare diabetes-related mortality rates and factors associated with this disease in the Canary Islands compared with other 10 Spanish regions. Methods In a cross-sectional study of ...28,887 participants aged 35–74 years in Spain, data were obtained for diabetes, hypertension, dyslipidemia, obesity, insulin resistance (IR), and metabolic syndrome. Healthcare was measured as awareness, treatment and control of diabetes, dyslipidemia, and hypertension. Standardized mortality rate ratios (SRR) were calculated for the years 1981 to 2011 in the same regions. Results Diabetes, obesity, and hypertension were more prevalent in people under the age of 64 in the Canary Islands than in Spain. For all ages, metabolic syndrome and insulin resistance (IR) were also more prevalent in those from the Canary Islands. Healthcare parameters were similar in those from the Canary Islands and the rest of Spain. Diabetes-related mortality in the Canary Islands was the highest in Spain since 1981; the maximum SRR was reached in 2011 in men (6.3 versus the region of Madrid; p < 0.001) and women (9.5 versus Madrid; p < 0.001). Excess mortality was prevalent from the age of 45 years and above. Conclusions Diabetes-related mortality is higher in the Canary Islands population than in any other Spanish region. The high mortality and prevalence of IR warrants investigation of the genetic background associated with a higher incidence and poor prognosis for diabetes in this population. The rise in SRR calls for a rapid public health policy response.
Aims: The serum resistin level is associated with the incidence of ischemic heart disease in the general population. We analyzed the associations between serum resistin and fat intake, serum lipid ...concentrations and adiposity in the general population. Methods: A cross-sectional study of 6,637 randomly recruited adults was conducted. The resistin levels were measured in thawed aliquots of serum using an enzyme immunoanalysis technique. Results: The resistin level exhibited a positive nonparametric correlation with saturated fat intake(p＜0.001) and an inverse correlation with adherence to the Mediterranean diet(p＜0.001), monounsaturated fat intake(p＜0.05), total serum cholesterol(p＜0.001), non-HDL cholesterol(p＜0.001), LDL cholesterol(p＜0.001), body mass index(p＜0.001), waist circumference(p＜0.001) and the waist/height ratio(p＜0.001). An elevated resistin concentration(fifth quintile) was associated with adherence to the Mediterranean diet(OR=0.82 CI95%=0.71-0.93), saturated fat intake(OR=1.34 CI95%=1.16-1.56), monounsaturated fat intake(OR=0.88 CI95%=0.78-0.99), a total cholesterol level of ≥200 mg/dL(OR=0.81 CI95%=0.72-0.91), a low HDL cholesterol level(OR=0.84 CI95%= 0.76-0.93), a high non-HDL cholesterol level(OR=0.84 CI95%=0.72-0.99), a high LDL cholesterol level(OR=0.82 CI95%=0.70-0.97) and a waist/height ratio of ≥0.55(OR=0.76 CI95%=0.67-0.85). The multivariate models corroborated the positive associations between the resistin level and saturated fat intake(p＜0.001) and serum triglycerides(p=0.004) and the inverse associations between the resistin level and adherence to the Mediterranean diet(p=0.002), total serum cholesterol(p＜ 0.001) and cholesterol fractions and the waist/height ratio(p=0.02). Conclusions: In the general population, the serum resistin level is associated with fat intake: positively with saturated fat intake and inversely with monounsaturated fat intake. As a consequence, the resistin level is also inversely associated with adherence to the Mediterranean diet. In addition, the resistin level is inversely associated with the serum cholesterol level and adiposity.
Hereditary angioedema (HAE) is a rare genetic condition whose main symptoms are recurrent swelling in the skin, mucosa, and internal organs. Recent studies suggested that the regulation of the ...inflammatory response and the complement cascade are two of the pathways significantly enriched in the Canary Islands, Spain. Here, we describe the first HAE patient series in this region. Forty-one patients (33 F, 8 M) and nine healthy relatives belonging to twenty-nine families were recruited for this study, obtaining their clinical and demographic features using a data collection form, as well as blood samples for biochemical analysis. The mean age of patients was 36.8 years (ranging from 4 to 72 years). Positive family history of HAE was reported in 13 patients (32.5%), and a mean diagnosis delay of 7.9 (±12.5) years was estimated, ranging from months to 50 years. Cutaneous edema was the most common symptom (53.6%), while airway symptoms was present in 11 patients. Prophylactic treatment was indicated for 23 patients, while 14 also require on-demand rescue treatment. We estimate a minimum prevalence of 1.25:100,000 for HAE due to C1-INH deficiency or dysfunction in the Canary Islands, which is higher than the estimates for mainland Spanish populations. HAE continues to be a disease poorly recognized by health care professionals due to its confusing symptoms, leading to longer diagnosis delay. Altogether, the evidence reinforces the need for a rapid and accurate diagnosis and precision medicine-based studies to improve the patient’s quality of life.
Aims
To analyze the serum lipid and inflammatory biomarker profile in the early insulin resistance (e-IR).
Methods
Cross-sectional study of 5943 adults without diabetes, stratified into no IR group ...(C-peptide <third tertile and glucose <100 mg/dL), e-IR group (C-peptide ≥third tertile and glucose <100 mg/dL) and advanced IR group (glucose ≥100 mg/dL).
Results
E-IR showed significant differences with no IR in the serum concentration of triglycerides (
P
< 0.001), HDL cholesterol (
P
< 0.001), LDL cholesterol (
P
< 0.001), sCD40L (
P
< 0.001), C-reactive protein (
P
< 0.004), leptin (
P
< 0.001) and adiponectin (
P
< 0.001). Adjusting for age, gender and abdominal obesity, corroborated the association of e-IR with highest quintile of triglycerides (OR 3.88 3.07–4.89), HDL cholesterol (OR 0.35 0.28–0.44), sCD40L (OR 0.47 0.24–0.94), C-reactive protein (OR 2.31 1.29–4.12), adiponectin (OR 0.11 0.04–0.32), PAI-1 (OR 3.29 1.29–8.40) and resistin (OR 1.25 1.01–1.54); the same biomarkers were associated with advanced IR although resistin was a protective factor (OR 0.73 0.58–0.93).
Conclusions
Euglycemic patients with e-IR present an unfavorable serum lipid and inflammatory biomarker profile. Measuring C-peptide in euglycemic patients with elevated triglycerides identifies e-IR.
AbstractIntroduction and objectivesThe Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute ...myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes.MethodsCross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set.ResultsA total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. ConclusionsMortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.
Several methods have been used to measure anti-double-stranded DNA auto-antibody (anti-dsDNA). Our aim was to determine the most efficient strategy to test anti-dsDNA in systemic lupus erythematosus ...(SLE). In this study, anti-dsDNA and anti-nuclear antibody (ANA) tests were requested for 644 patients. Anti-dsDNA was tested by RIA, ELISA and CLIA in all patients. The results indicated that 78 patients had a positive anti-dsDNA test according to at least one of the methods. After a 3-year follow-up period only 26 patients were diagnosed with SLE. We evaluated each method and combination of methods. Specificity and positive predictive value (PPV) increased with the number of assay methods used (p=0.002 for trend), and PPV was 100% in patients whose results were positive by all three anti-dsDNA assay methods. The proportion of anti-dsDNA-positive patients who had SLE was highest (82%; p<0.001) among those with a homogeneous pattern of ANA staining, followed by those with a speckled pattern. In ANA positive patients, when only RIA was considered, 59% of anti-dsDNA-positive patients had SLE, but when RIA and CLIA were both considered, all patients with positive results on both tests had SLE. The combination of RIA+CLIA in patients with homogeneous and speckled ANA staining showed a similar cost and higher sensitivity than RIA alone in ANA positive patients (p<0.001). We conclude that the most efficient strategy was to combine simultaneously two quantitative and sensitive methods but only in patients with a homogeneous or speckled pattern of ANA staining. This approach maximized specificity and PPV, and reduced costs.
•Efficiency in Anti-dsDNA testing improves if requests indicate whether the test is for screening or for follow-up purposes.•The most efficient screening for SLE combines two quantitative Anti-dsDNA methods in ANA homogeneous or speckled patients.•In patients with SLE, testing for anti-dsDNA antibodies should be done for all patients regardless of their ANA results.
Aims: To explore the association between resistin expression and the incidence of ischemic heart disease in the general population. Methods: A follow-up study of 6636 adults recruited randomly from ...the general population. Results: The serum resistin concentration was higher in women (6.1 ng/mL; CI95%=6.0-6.2) than in men (5.6 ng/mL; CI95%=5.5-5.7). Individuals in the 5th quintile or higher of resistin (RQ5) were younger (P＜0.001) and had a lower prevalence of arterial hypertension (P＜0.001), abdominal obesity (P＜0.001), diabetes (P＜0.001) and dyslipidemia (P＜0.001). The cardiovascular risk estimated by the Framingham function was also lower in the RQ5 subgroup (P＜0.001); however, the prevalence of smoking was higher (P＜0.001), as was the prevalence of low HDL cholesterol (P＜0.001). After 3.5 years of follow-up, the RQ5 subgroup had a higher incidence of acute myocardial infarction (AMI, RR=1.9; CI95%=1.01-3.54). In the population without diabetes, the RQ5 subgroup had a higher risk of AMI (RR=2.4; CI95%=1.10-5.17), and the risk of AMI was highest in women in this group (4.97; CI95%=1.33-18.57). The risk levels were significant in the Cox models adjusted for age, sex and smoking; and the hazard ratio was 2.5 for AMI (CI95%=1.29-4.70) in the sample of patients matched by sex and smoking status. Conclusions: Resistin may be a risk marker for ischemic heart disease in the general population. The serum resistin concentration is higher in women, and the associated increase in the risk of AMI based on the resistin level is also higher in women than in men.
ETAP: A smoking scale for Primary Health Care González Romero, Pilar María; Cuevas Fernández, Francisco Javier; Marcelino Rodríguez, Itahisa ...
Atención primaria
48, Številka:
5
Journal Article
Recenzirano
Odprti dostop
To obtain a scale of tobacco exposure to address smoking cessation.
Follow-up of a cohort. Scale validation.
Primary Care Research Unit. Tenerife.
A total of 6729 participants from the "CDC de ...Canarias" cohort.
A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI).
The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors.
The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking.
Despite the genetic resemblance of Canary Islanders to other southern European populations, their geographical isolation and the historical admixture of aborigines (from North Africa) with ...sub-Saharan Africans and Europeans have shaped a distinctive genetic makeup that likely affects disease susceptibility and health disparities. Based on single nucleotide polymorphism array data and whole genome sequencing (30×), we inferred that the last African admixture took place ∼14 generations ago and estimated that up to 34% of the Canary Islander genome is of recent African descent. The length of regions in homozygosis and the ancestry-related mosaic organization of the Canary Islander genome support the view that isolation has been strongest on the two smallest islands. Furthermore, several genomic regions showed significant and large deviations in African or European ancestry and were significantly enriched in genes involved in prevalent diseases in this community, such as diabetes, asthma, and allergy. The most prominent of these regions were located near LCT and the HLA, two well-known targets of selection, at which 40‒50% of the Canarian genome is of recent African descent according to our estimates. Putative selective signals were also identified in these regions near the SLC6A11-SLC6A1, KCNMB2, and PCDH20-PCDH9 genes. Taken together, our findings provide solid evidence of a significant recent African admixture, population isolation, and adaptation in this part of Europe, with the favoring of African alleles in some chromosome regions. These findings may have medical implications for populations of recent African ancestry.
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