The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 ...years being treated and controlled in relation to their level of coronary risk.
Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure < 140/90 mm Hg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria.
We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P<.001), 66% and 69% respectively, of patients with diabetes (P=.03), and 39% and 42% respectively, of those with hypercholesterolemia (P<.001). Control was good in 34% of men and 42% of women with hypertension (P<.001); 65% and 63% respectively, of those with diabetes (P=.626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P=.092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P<.001). The proportion of uncontrolled participants increased with coronary risk (P<.001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥ 10% coronary risk than to men (59% vs. 50%, P = 0,024). corrected
The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.
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.
The Canary Islands population experiences the highest type 2 diabetes (DM2) mortality in Spain. We studied lifestyle, unknown DM2 and treatment adherence in diabetics of these islands.
...Cross-sectional study of 6729 subjects from the general population (age 18-75) that participate in the cohort study "CDC of the Canary Islands". We found out their medical problems, diet, physical activity, medications, smoking, etc.
Prevalence of DM2 was 12% in men and 10% in women (p=0.005). The disease was unknown in 22% of men and 9% of women (p < 0.001). Considering unknown DM2, lack of treatment and lack of adherence, 48% of men and 28% of women did not follow a regular treatment. Diabetics' men prevalences of smoking (28%; CI(95%)=23-33) and sedentariness (62%; CI(95%)=56-68) were similar to non diabetic men, but obesity was more frequent in diabetics (45 versus 25%; p < 0.001). Diabetics women showed a higher obesity (54 versus 27%; p < 0.001) and a lower smoking prevalence (11 versus 22%; p < 0,001) than non diabetics, but they presented a similar sedentariness (75%; CI(95%)=70-79). In both sexes, energy intake was lower in diabetics (p < 0.001), but 93% of them (CI(95%)=91-95) showed a high consumption of calories from saturated fat and 69% (CI(95%)=65-72) presented metabolic syndrome.
The Canarian diabetics are a sedentary and obese population that show a high consumption of saturated fats and high prevalence of metabolic syndrome. The proportion of them following regular treatment is low, specially in diabetic men that, in addition, still smoke.
Fundamento: La clase social generalmente se mide de manera
categórica y basada en la ocupación laboral, lo cual tiene múltiples
limitaciones. El objetivo de este trabajo es elaborar un indicador ...cuantitativo
de clase social, fácilmente estandarizable, validarlo en población
adulta y comprobar su aptitud para medir el impacto de la clase
social como determinante de salud.
Métodos: estudio transversal de 6.729 individuos para medir la
clase social con las variables: Renta familiar per cápita, Índice de hacinamiento,
Estudios realizados, Ocupación laboral y Situación laboral.
Se crearon dos modelos y mediante curvas COR se seleccionó el mejor
para validarlo analizando su capacidad de estimar los riesgos relativos
de: residir en barrio pobre o rico, mantener un patrón dietético típico de
clases sociales pobres y presentar problemas de salud actualmente asociados
a la pobreza.
Resultados: el modelo sólo incluyó las variables Renta, Estudios e
Índice de hacinamiento (REI), produjo un indicador con rango de valores
entre 4 y 21 y mostró correlación inversa con la edad (r= -0,28; p<0,001),
con el consumo de papas (r= -0,17; p<0,001) y con el consumo de legumbres
(r= -0,03; p=0,01), además de correlación directa con el consumo de
ensalada (r = 0,10; p<0,001); su sensibilidad para detectar la residencia en
barrio pobre alcanzó el 97% para valores menores a 10. REI estimó que
las clases sociales pobres presentan riesgos significativos de situación
laboral de desempleo (OR=5,4), ocupación laboral de baja cualificación
(OR=40,9), habitar en barrios pobres (OR =30,2), bajo consumo de ensaladas
(OR = 2,2), gran consumo de papas (OR = 4,5) y alto consumo de
legumbres (OR = 1,6). En ambos sexos las clases pobres presentaron
mayor riesgo de problemas de salud, con mayor fuerza en las mujeres:
sedentarismo (OR = 1,8), obesidad (OR = 4,4), obesidad abdominal (OR
= 5,4), síndrome metabólico (OR = 3,4) y diabetes mellitus (OR = 2,0).
Conclusiones: REI es un indicador válido, no basado en la ocupación
ni en la situación laboral, fácilmente estandarizable, apto para
medir cuantitativamente la clase social en estudios que precisen analizar
el impacto de la misma como determinante de salud.
To identify the anthropometric index that best detects cardiovascular risk (CVR) and type 2 diabetes (DM2) in the adult Spanish population and to determine its cut-off point.
Cross-sectional study in ...the general population (n=6279). Sensitivity and specificity were estimated for the anthropometric indexes: abdominal waist, body mass index, waist to hip ratio and waist to height ratio (WtHR). The areas of these indexes under ROC curve (AUC) were obtained for the following CVR factors: high coronary risk computed with Framingham model, Hypertension, Hyperlipemia, DM2, Metabolic Syndrome (MS) and Impaired Fasting Glucose (IFG). The odds ratio, with 95% confidence interval (CI(95%)), was calculated.
WtHR was the index showing the highest AUC for DM2 and the remaining CVR factors, varying between 0.65 (CI(95%)=0.63-0.68) for IFG in men and 0.87 (CI(95%)=0.86-0.89) for MS in women. RA/E reached the maximum sensitivity (0.91) and specificity (0.70) in SM and its optimal cut-off point was 0.55, which displayed the highest risks amongst indexes, varying from 2.30 (1.96-2.70) in IFG to 16'20 (13.68-19.20) in MS.
RA/E is the index presenting the best ability to detect DM2 and CVR in this population, and it shows the stronger association with them. Its cut-off point, 0.55, confirms the convenience of keeping the abdominal waist to less than half the height.
The registering of eating habits requires a valid and reliable method. The purpose of this study is to validate the food intake frequency questionnaire, CDC-FFQ, which is an adaptation of another ...questionnaire, in order to assess the nutrition of the adult population of the Canary Islands.
The CDC-FFQ questionnaire was given to 1,067 individuals taken from the general population (GP) and to 106 university students, aged 19 to 30. The second group was surveyed also in three 24-hour follow-ups. The nutrients were compared according to the CDC-FFQ in the GP and university students. The correlations were estimated between the CDC-FFQ and the follow-ups for nutrients and groups of foods and the concordance of the intakes of nutrients and groups of foods in the extreme quintiles, for the university students.
The mean values between nutrients of the CDC-FFQ between the GP, university students and the general population with university studies showed no significant differences except for vitamin B12 (p=0.004) and vitamin D (p=0.005). Correlations between the CDC-FFQ and the mean of the three follow-ups were obtained in the 0.202-0.601 range between nutrients adjusted by calories consumed in the case of the university students. By groups of foods, the correlations ranged between 0.243-0.542 for the CDC-FFQ and the follow-ups. The concordance of nutrients ranged between 39% and 100% and for groups of foods, between 41% and 100%.
The CDC-FFQ questionnaire is valid for classifying the subjects in the relative ranges of their level of intake of foods and nutrients and, therefore, it could be useful in epidemiological studies with a diet assessment in the adult population of the Canary Islands.
Numerous studies have shown a high prevalence of cardiovascular disease in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the prevalence of ...cardiovascular risk factors and comorbidity in a Canary Islands population diagnosed with COPD, and compared it with data from the general population.
A cross-sectional study was carried out in 300 patients with COPD and 524 subjects without respiratory disease (control group). The two groups were compared using standard bivariate methods. Logistic regression models were used to estimate the cardiovascular risks in COPD patients compared to control group.
Patients with COPD showed a high prevalence of hypertension (72%), dyslipidaemia (73%), obesity (41%), diabetes type 2 (39%), and sleep apnoea syndrome (30%) from mild stages of the disease (GOLD 2009). There was a 22% prevalence of cardiac arrhythmia, 16% of ischaemic heart disease, 16% heart failure, 12% peripheral vascular disease, and 8% cerebrovascular disease. Compared to the control group, patients with COPD had a higher risk of dyslipidaemia (OR 3.24, 95% CI; 2.21–4.75), diabetes type 2 (OR 1.52, 95% CI; 1.01–2.28), and ischaemic heart disease (OR 2.34, 95% CI; 1.22–4.49). In the case of dyslipidaemia, an increased risk was obtained when adjusted for age, gender, and consumption of tobacco (OR 5.04, 95% CI; 2.36–10.74).
Patients with COPD resident in the Canary Islands have a high prevalence of hypertension, dyslipidaemia, ischaemic heart disease, and cardiac arrhythmia. Compared to general population, patients with COPD have a significant increase in the risk of dyslipidaemia.
Múltiples estudios han revelado una alta prevalencia de patología cardiovascular en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). El objetivo de este estudio ha sido analizar la prevalencia de factores de riesgo y comorbilidad cardiovascular en una muestra de pacientes canarios diagnosticados de EPOC y compararla con datos procedentes de la población general de Canarias.
Estudio trasversal en 300 pacientes con EPOC y en 524 sujetos del grupo control sin patología respiratoria. Los pacientes fueron seleccionados según criterios de inclusión de las consultas ambulatorias de Neumología, mientras que los grupos control procedían de la población general adulta. Se registró información referente a: edad, sexo, hábito tabáquico, pruebas de función pulmonar y comorbilidad cardiovascular. Se compararon mediante análisis bivariado las dos muestras en cuanto al riesgo cardiovascular y, mediante modelos de regresión logística, se estimaron los riesgos en relación con la morbilidad cardiovascular de los pacientes con EPOC sobre la del grupo control.
Los pacientes con EPOC presentaron una elevada prevalencia de hipertensión arterial (72%), dislipidemia (73%), obesidad (41%), diabetes tipo 2 (39%) y síndrome apnea-hipopnea del sueño (30%) desde estadios leves de la enfermedad (GOLD 2009). La prevalencia de arritmia cardíaca fue del 22%, la de cardiopatía isquémica del 16%, la de insuficiencia cardíaca del 16%, la de enfermedad vascular periférica del 12% y la de enfermedad cerebrovascular del 8%. Respecto al grupo control, los pacientes con EPOC presentaban un mayor riesgo de tener dislipidemia (OR 3,24; IC del 95%: 2,21–4,75), diabetes tipo 2 (OR 1,52; IC del 95%: 1,01–2,28) y cardiopatía isquémica (OR 2,34; IC del 95%: 1,22–4,49). En el caso de la dislipidemia, se obtuvo un incremento del riesgo cuando se ajustó por edad, sexo y consumo de tabaco acumulado (OR 5,04; IC del 95%:2,36–10,74).
Los pacientes con EPOC residentes en Canarias tienen una alta prevalencia de hipertensión arterial, dislipidemia, cardiopatía isquémica y arritmia cardíaca. Frente a población general, los pacientes con EPOC presentan un importante incremento en el riesgo de presentar dislipidemia.
Abstract Aim To develop a straightforward risk score for type 2 diabetes (DM2) screening to use in clinical practice. Methods A sample of 6237 adult inhabitants of the Canary Islands (Spain) was ...randomly divided into two subgroups: one yielded data used to develop the instrument, and the other yielded data used for validation testing. Performance of the instrument was compared in persons with clinically diagnosed DM2 and undiagnosed diabetes. The risk score, calculated by multivariate logistic regression, included the potential risk variables that yielded the highest odds ratio in the univariate analysis. A cut-off point for screening purposes was established at a 99% negative predictive value. Results In men, variables included in the risk score were age, waist/height ratio, familial antecedents of diabetes, and systolic blood pressure (ROC curve 0.837, 95% CI: 0.803–0.871). In women, the risk score contained the same variables plus gestational diabetes history (ROC curve 0.874, 95% CI: 0.847–0901). Excluding systolic blood pressure from the score had no significant effect on the area under the curve. This instrument resulted valid only for people aged less than 55 years. Conclusions This simple risk score for DM2 would be easy to apply in clinical practice.
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