Abstract Objective Intima-media thickness (IMT) is increased in subjects with prediabetes or newly diagnosed diabetes. However, no previous studies have evaluated the relationship between the ...severity of carotid atherosclerosis, assessed by the presence of carotid plaques or stenosis, and the glycemic status, assessed either by fasting glucose, an oral glucose tolerance test (OGTT) or A1C levels. Methods Cross-sectional analysis of 1475 subjects (mean age 62 years, 44% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and A1C levels. An OGTT was performed in non-diabetic subjects. Carotid atherosclerosis was evaluated by echo-doppler. Results A 10.5% of the population had a previous diagnosis of diabetes. Of the 1320 non-diabetic participants, 349 (26.4%) had normal fasting glucose, normal glucose tolerance and A1C < 5.7%, and were considered controls. Prediabetes was diagnosed in 850 subjects (64.4%), and diabetes was newly diagnosed in 121 (9.2%). The prevalence of patients with carotid plaques was 34.2% in controls, 45.1% in prediabetics, 64.2% in newly diagnosed diabetics, and 72.9% in established diabetic patients. These numbers were 0.3%, 1.1%, 5.0% and 7.7% for carotid stenosis, respectively. In multivariate analysis, glycemic status remained significantly associated with the prevalence of carotid plaques after adjusting for age, sex, statin treatment, and cardiovascular risk factors. Conclusions Glycemic status is associated with all grades of carotid atherosclerosis, from early signs, as demonstrated by the IMT, to intermediate degrees, as demonstrated by the presence of carotid plaques, to advance atherosclerosis, as established by the presence of carotid stenosis.
This study sought to describe and compare adherence to the Mediterranean diet and consumption of local foods from the Huelva region among Spanish university women in relation to menstrual pain and ...other menstrual characteristics. This cross-sectional study included 311 health science students. The study variables were sociodemographic and gynecologic characteristics, adherence to the Mediterranean diet using the KIDMED questionnaire, alcohol consumption (SDU) and consumption of local food. A descriptive bivariate analysis and multiple binary regression were performed for menstrual pain. Up to 55.3% of participants had moderate adherence to the Mediterranean diet and only 29.6% had high adherence. Women with low adherence had longer menstrual cycles (
< 0.01). Eating less than two pieces of fruit per day (OR = 3.574; 95%CI = 1.474-8.665;
< 0.05) and eating pulses more than one day a week (OR = 2.320; 95%CI = 1.006-5.348) raised the probability of suffering menstrual pain. A positive correlation between SDU and cycle length was identified (
= 0.119,
= 0.038), and menstrual bleeding was lower in women who consumed olive oil daily (
= 0.044). In conclusion, the Mediterranean diet, alcohol consumption and consuming typical foods from southern Spain appear to influence cycle length, menstrual flow and menstrual pain. Further research is necessary to confirm and expand these findings.
The R46L variant of the proprotein convertase subtilisin/kexin type 9 (PCSK9) gene has been related to lipid levels and cardiovascular disease.
To evaluate the influence of this polymorphism on ...subclinical vascular disease and erectile dysfunction (ED).
We analyzed the association of the PCSK9 rs11591147 single-nucleotide polymorphism with lipid levels, intima-media thickness (IMT), and the ankle-brachial index, in 1188 adults free of cardiovascular disease, randomly selected from the population. In 473 male participants, we also investigated its relationship with ED. The association of the R46L polymorphism with lipid levels was also assessed in 2 cohorts of 1103 prepuberal children and 830 adolescents.
The prevalence of the T allele was 2.9% in adults. Low-density lipoprotein cholesterol (LDL-cholesterol) levels did not vary according to this polymorphism (134 ± 32 vs 134 ± 31 mg/dL, for the TT + GT vs GG carriers, respectively, P = .931). Despite equal LDL-cholesterol levels, adults carrying the T allele had a lower mean common carotid IMT (0.685 ± 0.09 vs 0.723 ± 0.127 mm; P = .035), a lower maximum common carotid IMT (0.819 ± 0.11 vs 0.865 ± 0.159 mm; P = .040), and, in males, a lower prevalence of ED (36.8% vs 61%: P = .036), than GG carriers. Prevalence of the T allele was 3.2% in both cohorts of children. They had lower levels of LDL-cholesterol than GG subjects (100 vs 109 mg/dL; P = .060, for prepuberal children, and 85 vs 99 mg/dL; P = .010 for adolescents).
In our population, an association between the PCSK9 R46L variant and LDL-cholesterol levels is observed in children. In adults, although its association with lipid levels is not evident, there is a significant relationship between the PCSK9 R46L variant and markers of subclinical atherosclerosis, including IMT and ED.
•R46L proprotein convertase subtilisin/kexin type 9 (PCSK9) mutations modulate LDL-cholesterol levels in Spanish children but not in adults.•Carriers of the R46L PCSK9 T allele have a reduced intima-media thickness.•Carriers of the R46L PCSK9 T allele have a lower prevalence or erectile dysfunction.
The presence of erectile dysfunction (ED) could be a warning of vascular disease in different arterial territories.
The aim of this study was to investigate the association between ED and the ...presence of atherosclerosis in 2 different vascular beds: carotid and lower limbs.
A total of 614 volunteers between 45 and 74 years of age (mean age 61.0 years) were randomly selected from the general population. ED was assessed using the International Index of Erectile Function (IIEF-5). Ankle-brachial index (ABI) measurement and carotid atherosclerosis were evaluated by echo-Doppler.
Mean carotid intima-media thickness (IMT), prevalence of carotid plaques, mean ABI, and prevalence of ABI < 0.9 were the main outcome measures.
ED was present in 373 subjects (59.7%). Mean carotid IMT was significantly higher in men with ED (0.762 ± 0.151 mm vs 0.718 ± 0.114 mm, P < .001). Also the global prevalence of carotid plaques was more frequent in men with ED (63.8% vs 44.8%, P < .001), even after adjusting by age, cardiovascular risk factors, and ongoing treatment (P = .039). Both the IMT and the prevalence of carotid plaques increased significantly with ED severity (P trend .004 and <.001, respectively). There were no significant differences between groups neither in mean ABI nor in the prevalence of subjects with ABI < 0.9. However, there was a trend to a lower ABI and a higher prevalence of ABI < 0.9 with increasing ED severity.
In the general population, the presence of ED identifies subjects with higher atherosclerosis burden in carotid arteries but not in the lower extremities.
Resumen En este estudio se presentan los resultados de un ejercicio de priorización de lenguajes enfermeros estandarizados, pertenecientes al área psicosocial, realizado en el contexto de un programa ...formativo de 20 horas. Participaron un total de 15 enfermeras, la mayoría del ámbito de atención especializada, con experiencia laboral, utilizadoras habituales de estos lenguajes, con formación previa al respecto y actitud favorable. Se priorizaron los siguientes diagnósticos de NANDA-I: 00146 Ansiedad, 00054 Riesgo de soledad, 00150 Riesgo de suicidio, 00053 Aislamiento social y 00214 Disconfort. Entre los criterios de resultado NOC, se priorizaron: 1205 Autoestima, 0300 Autocuidados: actividades de la vida diaria, 1209 Motivación, 1204 Equilibrio emocional y 1211 Nivel de ansiedad. Y entre las intervenciones NIC: 4920 Escucha activa, 5270 Apoyo emocional, 5250 Apoyo en la toma de decisiones, 7040 Apoyo al cuidador principal y 7140 Apoyo a la familia. Posteriormente, se seleccionaron los principales indicadores diagnósticos y de resultado, describiendo el grado de solapamiento entre ellos. Asimismo, para las intervenciones, se relacionaron las actividades priorizadas por el grupo de trabajo con la evidencia disponible.
ObjectivesTo evaluate the external validity of the FINDRISC, DESIR and ADA risk scores for the prediction of diabetes in a Spanish population aged >45 years and to test the possible improvement of ...FINDRISC by adding a new variable of high risk of depression when Patient Health Questionnaire-9 (PHQ-9) questionnaire score ≥10 (FINDRISC-MOOD).DesignProspective population-based cohort study.Setting10 primary healthcare centres in the north of the city of Madrid (Spain).ParticipantsA total of 1242 participants without a history of diabetes and with 2-hour oral glucose tolerance test (OGTT) plasma glucose <200 mg/dL (<11.1 mmol/L) were followed up for 7.3 years (median) using their electronic health records (EHRs) and telephone contact.Primary and secondary outcome measuresDiabetes risk scores (FINDRISC, DESIR, ADA), PHQ-9 questionnaire and 2-hour-OGTT were measured at baseline. Incident diabetes was defined as treatment for diabetes, fasting plasma glucose ≥126 mg/dL (≥7.0 mmol/L), new EHR diagnosis or self-reported diagnosis. External validation was performed according to optimal cut-off, sensitivity, specificity and Youden Index. Comparison between diabetes risk scores, including FINDRISC-MOOD (original FINDRISC score plus five points if PHQ-9 ≥10), was measured by area under the receiver operating characteristic curve (AUROC).ResultsDuring follow-up, 104 (8.4%; 95% CI, 6.8 to 9.9) participants developed diabetes and 185 had a PHQ-9 score ≥10. The AUROC values were 0.70 (95% CI, 0.67 to 0.72) for FINDRISC-MOOD and 0.68 (95% CI, 0.65 to 0.71) for the original FINDRISC. The AUROCs for DESIR and ADA were 0.66 (95% CI, 0.63 to 0.68) and 0.66 (95% CI, 0.63 to 0.69), respectively. There were no significant differences in AUROC between FINDRISC-MOOD and the other scores.ConclusionsThe results of FINDRISC-MOOD were like those of the other risk scores and do not allow it to be recommended for clinical use.
Cancer and cardiovascular disease Lahoz, Carlos; Valdivielso, Pedro; González-Alegre, María Teresa ...
Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis,
2015 Sep-Oct, Volume:
27, Issue:
5
Journal Article
Peer reviewed
Survivors of cancer have a shorter survival in the long term partly due to the increase in cardiovascular diseases (CVD). Some chemotherapy drugs, thoracic and cranial radiotherapy and above all the ...transplantation of hematopoietic cells are associated with an increase in the incidence of cardiovascular events compared with general population. Some of these treatments favor the development of a metabolic syndrome that could be the intermediary between these treatments and the development of CVD. It is recommended for cancer survivors to promote healthy lifestyles and the strict control of cardiovascular risk factors.
Resumen En este estudio se presentan los resultados de un ejercicio de priorización de lenguajes enfermeros estandarizados, pertenecientes al área psicosocial, realizado en el contexto de un programa ...formativo de 20 horas. Participaron un total de 15 enfermeras, la mayoría del ámbito de atención especializada, con experiencia laboral, utilizadoras habituales de estos lenguajes, con formación previa al respecto y actitud favorable. Se priorizaron los siguientes diagnósticos de NANDA-I: 00146 Ansiedad, 00054 Riesgo de soledad, 00150 Riesgo de suicidio, 00053 Aislamiento social y 00214 Disconfort. Entre los criterios de resultado NOC, se priorizaron: 1205 Autoestima, 0300 Autocuidados: actividades de la vida diaria, 1209 Motivación, 1204 Equilibrio emocional y 1211 Nivel de ansiedad. Y entre las intervenciones NIC: 4920 Escucha activa, 5270 Apoyo emocional, 5250 Apoyo en la toma de decisiones, 7040 Apoyo al cuidador principal y 7140 Apoyo a la familia. Posteriormente, se seleccionaron los principales indicadores diagnósticos y de resultado, describiendo el grado de solapamiento entre ellos. Asimismo, para las intervenciones, se relacionaron las actividades priorizadas por el grupo de trabajo con la evidencia disponible.
The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following ...protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency.
The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3-8,and 1 mg/month in weeks 9-52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1-8 and 1 mg/week in weeks 9-52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses.
The results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment.
This trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.
The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. An abnormal ABI (< 0.9 or > 1.4) is associated with the ...development of cardiovascular disease and cardiovascular and all-cause mortality. Despite this, its measurement in clinical practice is underused. The objective of the present study was to evaluate the relation of the ABI with the cardiovascular risk determined by traditional risk functions in a population in primary prevention.
1001 subjects without known cardiovascular disease attended in primary care were invited to participate in the study. Cardiovascular risk and ABI measurements were calculated in all participants.
A low (< 0.9) ABI was found in a 3.8% of the participants, 3.9% females and 3.6% males. An abnormal ABI (< 0.9 or > 1.4) was found in 6.4% of all subjects, 5.2% females and 8.8% males. In a multivariable analysis age (OR = 1.09 for each year; 95% CI 1.03-1.15), smoking habit (OR = 2.96; 95% CI 1.51-5.80), HDL-cholesterol levels (OR = 0.98 for each mg/dl; 95% CI, 0.95-0.99) and hypertension (OR = 1.80; 95% CI, 1.05-3.06) were related with an abnormal ABI. Subjects were divided according to their risk stratification. The percentage of low, moderate and high risk individuals with an abnormal ABI was 2.6%, 8.7% and 14.9% respectively.
In primary prevention, one in ten individuals with moderate risk and one in six individuals with high risk have an abnormal ABI. In these subjects there is an indication for intensive preventive strategies and antiagregation.
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