Background and objectives: Arterial hypertension (HTN) is the leading preventable cause of atherosclerotic cardiovascular diseases (ASCVD) and death from all causes. This study aimed to determine the ...prevalence rates of HTN diagnosed according to the threshold diagnostic criteria 130/80 mmHg and 140/90 mmHg, to compare blood pressure (BP) control, and to evaluate their associations with cardiovascular diseases and cardiometabolic and renal risk factors. Materials and Methods: This was a cross-sectional observational study conducted in primary care with a population-based random sample: 6588 people aged 18.0–102.8 years. Crude and adjusted prevalence rates of HTN were calculated. BP control was compared in HTN patients with and without ASCVD or chronic kidney disease (CKD). Their associations with cardiovascular diseases and cardiometabolic and renal factors were assessed using bivariate and multivariate analysis. Results: Adjusted prevalence rates of HTN diagnosed according to 140/90 and 130/90 criteria were 30.9% (32.9% male; 29.7% female) and 54.9% (63.2% male; 49.3% female), respectively. BP < 130/80 mmHg was achieved in 60.5% of HTN patients without ASCVD or CKD according to 140/90 criterion, and 65.5% according to 130/80 criterion. This BP-control was achieved in 70% of HTN patients with ASCVD and 71% with CKD, according to both criteria. Coronary heart disease (CHD), heart failure, atrial fibrillation, stroke, diabetes, prediabetes, low glomerular filtration rate (eGFR), hyperuricemia, hypercholesterolemia, obesity, overweight, and increased waist-to-height ratio were independently associated with HTN according to both criteria. Conclusions: Almost a third of the adult population has HTN according to the 140/90 criterion, and more than half according to the 130/90 criterion, with a higher prevalence in men. The main clinical conditions associated with HTN were heart failure, diabetes, CHD, low eGFR, and obesity.
IntroductionAdherence to treatment and hypoglycemia awareness are strongly linked to glycemic control and hypoglycemia risk in people with type 2 diabetes mellitus (T2DM). Community pharmacies are ...suitable facilities to detect these conditions, and should be involved in the strategies to minimize the associated risks and burden.Research design and methodsThis cross-sectional study conducted at community pharmacies across Spain assessed the prevalence of low adherence to antidiabetic treatments, the frequency of impaired hypoglycemia awareness, and their predictive factors. Adherence was measured with the 8-item Morisky Medication Adherence Scale (MMAS-8) and electronic records of dispensed treatments. The Clarke questionnaire was used to assess impaired hypoglycemia awareness. Healthcare counseling provided in the pharmacy was collected.ResultsSeventy-nine pharmacists and 618 subjects with T2DM participated in the study. Mean age in the overall T2DM population was 67 years, being the majority (69%) pensioners. Adherence was high in 41% of participants, medium in 35%, and low in 24% according to the MMAS-8. Impaired hypoglycemia awareness was observed in 25% of participants. Main determinants of low adherence were the level of education, the number of treatments per patient, hypoglycemia awareness, and the type of pharmacy. Predictive factors of impaired hypoglycemia awareness were the level of education, information on diabetes-related complications, adherence levels, and the type of pharmacy. The proportion of participants who had healthcare counseling was 71% in the overall population and 100% in subjects with impaired hypoglycemia awareness and low adherence. Healthcare counseling comprised diabetes education (69%), pharmacotherapeutic assessment (20%), and physician referrals (11%).ConclusionLack of adherence to antidiabetic treatments and impaired hypoglycemia awareness are frequent and correlate in T2DM. Community pharmacies can detect these conditions and should have an active role in the design of strategies to minimize them.
Heart failure (HF) is a major health problem that causes high mortality and hospitalization rates. This study aims to determine the HF prevalence rates in populations aged both ≥18 years and ≥50 ...years and to assess its association with cardiovascular diseases and chronic kidney disease.
A cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HF were calculated. The associations of renal and cardiometabolic factors with HF were assessed in both populations using univariate, bivariate and multivariate analysis.
The HF crude prevalence rates were 2.8% (95%CI: 2.4-3.2) in adults (≥18 years), and 4.6% (95%CI: 4.0-5.3) in the population aged ≥ 50 years, without significant differences between males and females in both populations. The age- and sex-adjusted prevalence rates were 2.1% (male: 1.9%; female: 2.3%) in the overall adult population, and 4.5% (male: 4.2%; female: 4.8%) in the population aged ≥ 50 years, reaching 10.0% in the population aged ≥ 70 years. Atrial fibrillation, hypertension, low estimated glomerular filtration rate (eGFR), coronary heart disease (CHD), stroke, sedentary lifestyle, and diabetes were independently associated with HF in both populations. A total of 95.7% (95%CI: 92.7-98.6) of the population with HF had an elevated cardiovascular risk.
This study reports that HF prevalence increases from 4.5% in the population over 50 years to 10% in the population over 70 years. The main clinical conditions that are HF-related are sedentary lifestyle, atrial fibrillation, hypertension, diabetes, low eGFR, stroke, and CHD.
Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The ...aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors.
Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined.
The crude prevalence of CKD was 11.48% (95%CI: 10.72-12.27%), without significant difference between men (11.64% 95%CI: 10.49-12.86%) and women (11.35% 95%CI: 10.34-12.41%). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m
) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30-8.61) and 5.98% (95%CI: 5.41-6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54-80.49) of the population with CKD.
The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.
A consensus document of the Diabetes working group of the Spanish Society of Arteriosclerosis (SEA) is presented, based on the latest studies and conceptual changes that have appeared. It presents ...the cardiovascular risk in type 2 diabetes mellitus (T2DM) and the action guidelines for the prevention and treatment of cardiovascular disease (CVD) associated with T2DM. The importance of lipid control, based on the objective of LDL-C and non-HDL-C when there is hypertriglyceridemia, and the blood pressure control in the prevention and treatment of CVD is evaluated. The new hypoglycemic drugs and their effects on CVD are reviewed, as well as the treatment and control guidelines of hyperglycemia. Likewise, the use of antiplatelet agents is considered. Emphasis is placed on the importance of global and simultaneous action on all risk factors to achieve a significant reduction in cardiovascular events. This supplement is sponsored by Laboratorios Esteve, S.A.
Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The ...aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors.
Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate (eGFR) according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined.
The crude prevalence of CKD was 11.48% (95%CI: 10.72–12.27%), without significant difference between men (11.64% 95%CI: 10.49–12.86%) and women (11.35% 95%CI: 10.34–12.41%). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low eGFR (<60 mL/min/1.73 m2) and albuminuria (≥30 mg/g) were 7.95% (95%CI: 7.30–8.61) and 5.98% (95%CI: 5.41–6.55), respectively.Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (p < 0.001). Very high cardiovascular risk (CVR) according to SCORE was found in 77.51% (95%CI 74.54–80.49) of the population with CKD.
The adjusted prevalence of CKD was 9.2% (low eGFR: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high CVR. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.
La enfermedad renal crónica (ERC) constituye un importante problema de salud que contribuye al desarrollo de alteraciones cardiovasculares como la insuficiencia cardíaca y la enfermedad cardiovascular arteriosclerótica (ECVA). Los objetivos de este estudio fueron determinar la prevalencia de ERC y evaluar su asociación con factores de riesgo cardiometabólicos y la ECVA.
Estudio observacional transversal realizado en el ámbito de atención primaria. Muestra aleatoria de base poblacional: 6.588 personas entre 18 y 102 años (tasa de respuesta: 66%). Se determinaron las tasas de prevalencia brutas y ajustadas por sexo y edad de ERC según KDIGO valorando albuminuria y filtrado glomerular estimado (FGe) según CKD-EPI, y sus asociaciones con factores cardiometabólicos y ECVA.
La prevalencia cruda de ERC fue 11,48% (IC95%: 10,72–12,27%), sin diferencia significativa entre hombres (11,64% IC95%: 10,49–12,86%) y mujeres (11,35% IC95%: 10,34–12,41%). La tasa de prevalencia ajustada por edad y sexo de ERC fue 9,16% (hombres: 8,61%; mujeres: 9,69%). La prevalencia del FGe reducido (<60 mL/min/1,73 m2) y de albuminuria (≥30 mg/g) fueron 7,95% (IC95%: 7,30–8,61) y 5,98% (IC95% 5,41–6,55), respectivamente. Hipertensión, diabetes, prediabetes, índice cintura-talla aumentado, insuficiencia cardíaca, fibrilación auricular y ECVA se asociaban independientemente con ERC (p < 0,001). El 77,51% (IC95%: 74,54–80,49) de la población con ERC tenía un riesgo cardiovascular (RCV) muy alto según SCORE.
La prevalencia ajustada de ERC era del 9,2% (FGe reducido: 8,0%; albuminuria: 6,0%). La mayoría de los pacientes con ERC tenía RCV muy alto. Hipertensión, diabetes, prediabetes, índice cintura-talla aumentado y ECVA se asociaban independientemente con la ERC.
Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk ...factors between obese and non-obese populations, and between overweight and non-overweight populations.
Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis.
The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0–53.9) of the overweight population and 62.3% (95%CI: 60.1–64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity.
The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.
El exceso de peso constituye un importante problema de salud. Los objetivos del estudio fueron determinar las tasas de prevalencia de sobrepeso y obesidad, y comparar sus asociaciones con factores de riesgo cardiometabólicos y renales entre las poblaciones con y sin obesidad, y entre las poblaciones con y sin sobrepeso.
Estudio observacional transversal realizado en Atención Primaria. Muestra aleatoria de base poblacional: 6.588 sujetos de estudio entre 18 y 102 años (tasa de respuesta: 66%). Se calcularon las prevalencias crudas y ajustadas por edad y sexo de sobrepeso y obesidad, y se evaluaron sus asociaciones con variables cardiometabólicas y renales mediante análisis bivariado y multivariado.
Las prevalencias ajustadas por edad y sexo de sobrepeso y obesidad fueron 36,0% (42,1% en hombres; 33,1% en mujeres) y 25,0% (26,2% en hombres; 24,5% en mujeres), respectivamente. Estas prevalencias se incrementaban con la edad, y eran más elevadas en hombres que en mujeres. El 52,0% (IC95%: 50,0–53,9) de la población con sobrepeso y el 62,3% (IC95%: 60,1–64,5) de la población con obesidad tenían un riesgo cardiovascular alto o muy alto. Obesidad abdominal, inactividad física, prediabetes, hipertensión, hipertrigliceridemia, y el c-HDL bajo se asociaban independientemente con ambas entidades. Además, la diabetes se asociaba independientemente con sobrepeso y la hipercolesterolemia con obesidad.
La prevalencia de sobrepeso y obesidad era del 61,0% (68,4% en hombres y 59,0% en mujeres). Más de la mitad de la población con sobrepeso y casi dos tercios de la población con obesidad tenían un riesgo cardiovascular elevado. Hiperglucemia, sedentarismo, hipertensión, hipercolesterolemia, c-HDL bajo e hipertrigliceridemia se asociaban independientemente con sobrepeso y obesidad.
Current guidelines for the management of hypercholesterolemia identify LDL cholesterol (LDL-c) reduction as the primary therapeutic target and have highlighted the need to use statins to achieve it. ...There are six statins with four different doses and with different power-reducing LDL-c. By adding ezetimibe, there are 48 therapeutic possibilities. This extensive offer provides pharmaceutical treatment, but it is difficult to choose the most cost-effective statin because it is very difficult to remember all the powers and costs of treatment options. This paper offers a method to prioritize the best cost-effective lipid lowering, and chooses the cheapest statin that achieves the desired therapeutic goal of LDL-c.
PDF
