Cardiovascular Risk In Spain Research Articles

Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

BackgroundPeople with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists). MethodsA committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only). ResultsIDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation. ConclusionOur findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.

Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

BackgroundPeople with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists). MethodsA committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only). ResultsIDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation. ConclusionOur findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.

Update and validation of the lifetime cardiovascular risk in Spain: IBERLIFERISK2

IntroductionThe function to estimate lifetime cardiovascular risk –IBERLIFERISK– in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women. ObjectiveTo recalibrate the current lifetime risk equation after extending the follow-up by 3 years. MethodsRetrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell’s C index. ResultsThe mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell’s C index was 0.78 (95% CI 0.76–0.79) in men and 0.73 (95% CI 0.69–0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05). ConclusionsThe updated model continues to discriminate satisfactorily, although the model’s calibration has not substantially improved with the new update.

Association of prolonged nightly fasting with cardiovascular, renal, inflammation, and nutritional status biomarkers in community-dwelling older adults

Prolonged fasting as a dietary strategy has been linked to metabolic benefits; however, data supporting these benefits corresponded to studies in very small samples of young participants in controlled environments, with few cardiovascular risk markers, who were studied for short periods of time. We sought to assess the association of habitual prolonged nightly fasting with a wide array of cardiovascular, renal, inflammation, and nutritional status biomarkers among community-dwelling older adults. Cross-sectional analysis of data were obtained from 1047 adults aged ≥65 y from the Seniors Study on Nutrition and Cardiovascular Risk in Spain 2 (Seniors-ENRICA-2) cohort. Habitual diet was assessed through a validated diet history. Fasting time was classified into the following categories: <10, 10 to<12, and 2 h/d, the latter being considered prolonged nightly fasting. Adjusted geometric means of biomarker concentrations in blood and serum were estimated using linear regression models, by categories of fasting time. Main confounders included overall diet quality, defined as adherence to a Mediterranean diet score, and BMI (in kg/m2). Longer fasting time was associated with: lower concentration of HDL cholesterol (difference between the longest and shortest fasting category: -2.94mg/dL; 95% CI: -4.80, -1.09; P-trend: 0.01); higher potassium concentration (0.11mEq/L; 95% CI: 0.03, 0.19; P-trend: 0.01); and lower concentration of chloride (-0.50mEq/L; 95% CI: -0.91, -0.09; P-trend: 0.03). These results were slightly attenuated after additional adjustment for BMI. Habitual prolonged nightly fasting did not show beneficial associations with the examined biomarkers. By contrast, some modest detrimental associations were found suggesting that extended periods of time between meals may not be beneficial for older adults.

Analysis of the psychometric properties of the Sense of Coherence scale (SOC-13) in patients with cardiovascular risk factors: a study of the method effects associated with negatively worded items

PurposeThe objectives of this study were to analyze the psychometric properties of the Sense of Coherence scale (SOC-13), determine the role of the method effect in the performance of the instrument, and identify the relationship with health perception, quality of life, and sleep quality in patients at cardiovascular risk.MethodsThe final sample consisted of 293 patients at cardiovascular risk, with a mean age of 61.9 years (SD = 8.8), 49.8% of whom were women. The SOC-13, the Patient Health Questionnaire (PHQ-9), and the Medical Outcomes Study-Sleep Scale (MOS-Sleep) were administered. In addition, the participant's self-perceived health and quality of life were also evaluated. All analyses were carried out with SPSS 26.0 and EQS 6.1 statistical software.ResultsThe results showed adequate reliability for the SOC-13, with a Cronbach's alpha of .789. The fit of the structures was not adequate in any of the cases (.26 to .62 for one factor, .26 to.73 for three factors, .20 to .54 for one second-order factor, and .25, .42, and .54 for three first-order factors). The three structure models showed an improved fit when adding a latent factor resulting from the method effect (.6 to .85 for one factor, .11 to.90 for three factors, and .11 to .96 for one second-order factor). Moreover, positive correlations were found with health perception, perceived quality of life, and perceived sleep quality.ConclusionThe SOC-13 is a suitable instrument for patients with cardiovascular risk in Spain, and it is also an indicator of health perception, quality of life, and perceived quality of sleep. Control of the method effect improves the fit of the instrument’s structure. As a future direction, it is recommended to conduct new studies in this and other samples and using different versions of the SOC.Trial registrationInternational Standard Randomized Controlled Trial Number: ISRCTN76069254, 08/04/2015 retrospectively registered.

Five-color Nutri-Score labeling and mortality risk in a nationwide, population-based cohort in Spain: the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA)

The 5-color Nutri-Score (5-CNS) front-of-package labeling system classifies products according to their nutritional quality, so healthier choices are easier when shopping. We examined the association between 5-CNS-based food consumption and long-term mortality in a Spanish, adult population. We recruited 12,054 individuals, representative of the Spanish population aged≥18 years, in 2008-10 and followed up with them to 2017. Habitual food consumption was collected at baseline with a validated computerized dietary history, conducted by trained interviewers. Based on nutritional quality, foods consumed were categorized into 5 labels [A/Green (best quality), B, C, D, and E/Red (worst quality)] using an established algorithm. For each individual, a 5-CNS dietary index (DI) was calculated by summing up the amount of g/day from the foods consumed by their corresponding nutritional quality rate (e.g., A rated 1 and E rated 5) and dividing it by kg of weight. The associations between baseline 5-CNS DI and mortality were analyzed using multivariate-adjusted Cox models. After a mean follow-up of 8.7 years, 514 deaths occurred (140 cardiovascular and 144 cancer deaths). The all-cause mortality HR for the highest versus the lowest quartile of baseline 5-CNS DI was 1.93 (95% CI, 1.34-2.79; P-trend, 0.001). The association was slightly higher for cardiovascular mortality and was similar for cancer. Those with the highest intake of foods labeled as D or E also had a higher all-cause mortality risk than those with the lowest intake (HR, 2.15; 95% CI, 1.56-2.97; P-trend<0.001). Further, the isocaloric replacement of food products labeled as D or E with fresh foods decreases the risk of death. The consumption of poor nutritional quality 5-CNS-labeled food products was associated with higher mortality in Spain. Pending further studies, these findings provide additional evidence to reinforce food policies on the use of this simple labeling tool at a country level.

Prolonged nightly fasting and lower-extremity functioning in community-dwelling older adults.

It is unknown if time-restricted feeding confers a protective effect on the physical function of older adults. The aim of this study was to assess prolonged nightly fasting in association with performance-based lower-extremity function (LEF) in a large population of community-dwelling older adults. A cross-sectional study was carried out among 1226 individuals ≥64 years from the Seniors-ENRICA-II (Study on Nutrition and Cardiovascular Risk in Spain) cohort. Habitual diet was assessed through a validated diet history. Fasting time was classified into the following categories: ≤9, 10-11 and ≥12 h/d (prolonged nightly fasting). Performance-based LEF was assessed with the Short Physical Performance Battery (SPPB). After adjusting for potential confounders, a longer fasting period was associated with a higher likelihood of impaired LEF (OR for the second and third categories v. ≤ 9 h/d fasting: 2·27 (95 % CI 1·56, 3·33) and 2·70 (95 % CI 1·80, 4·04), respectively; Ptrend < 0·001). Fasting time showed a significant association with the SPPB subtests balance impairment (OR for highest v. shortest fasting time: 2.48; 95 % CI 1·51, 4·08; Ptrend = 0·001) and difficulty to rise from a chair (OR 1·47; 95 % CI 1·05, 2·06; Ptrend = 0·01). The risk associated with ≥12 h fasting among those with the lowest levels of physical activity was three times higher than among those with ≤9 h fasting with the same low level of physical activity. Prolonged nightly fasting was associated with a higher likelihood of impaired LEF, balance impairment, and difficulty to rise from a chair in older adults, especially among those with low levels of physical activity.

Adherence to the Mediterranean Diet and Physical Resilience in Older Adults: The Seniors-ENRICA Cohort.

No prior studies have studied the association between diet and physical resilience, thus our aim was to assess the association between the adherence to the Mediterranean diet and other healthy dietary patterns and physical resilience, assessed empirically as a trajectory through exposure to chronic and acute stressors, in older adults participating in the Seniors-ENRICA (The Study on Nutrition and Cardiovascular Risk in Spain) cohort. Data were assessed from 1301 individuals aged 60 and older, participating in the ENRICA prospective cohort study and recruited in 2008-2010 and followed up to 2012 (trial registration: NCT02804672). A Mediterranean Diet Adherence Screener score and the Alternate Healthy Eating Index 2010 were derived at baseline from a validated diet history. Health status was assessed at baseline and at the end of follow-up with a 52-item health Deficit Accumulation Index (DAI) including 4 domains (physical and cognitive function, mental health, self-rated health/vitality, and morbidity); higher DAI values indicate worse health. Physical resilience was defined as accumulating fewer health deficits than the expected age-related increase in DAI over follow-up, despite exposure to chronic and acute stressors. Over a 3.2-year follow-up, 610 individuals showed physical resilience. In multivariate analyses, the odds ratio (95% confidence interval) of physical resilience for the highest versus lowest tertile (lowest adherence) of the Mediterranean Diet Adherence Screener score was 1.47 (1.10-1.98). The association held for those maintaining or improving the DAI over follow-up (over-resilience): 1.58 (1.10-2.26). Results were consistent in those with unintentional weight loss (2.21 [1.10-4.88]) or hospitalization (2.32 [1.18, 4.57]) as acute stressors. In older adults, a higher adherence to the Mediterranean diet is associated with a greater likelihood of physical resilience.

Ultra-Processed Food Consumption Is Associated with Abdominal Obesity: A Prospective Cohort Study in Older Adults.

Introduction and objectives. Ultra-processed food (UPF) consumption has been associated with increased incidence of cardiovascular disease and its risk factors. The aim of this study was to assess, for the first time in the literature, the prospective association between UPF consumption and the incidence of abdominal obesity (AO) in older adults. Methods. The study sample consists of 652 participants in the Seniors Study on Nutrition and Cardiovascular Risk in Spain: Seniors-ENRICA-1 study, (mean age 67, 44% women). At baseline, standardized anthropometric measurements were collected (including abdominal circumference). After a median follow-up of six years, the abdominal circumference was measured again, and the incidence of abdominal obesity (AO) was calculated, defined as an abdominal perimeter ≥102 cm in men and ≥88 cm in women. At baseline, dietary information was collected using a computerized and validated dietary history. Information was obtained on the usual diet in the previous year. A total number of 880 foods were classified according to their degree of processing following the NOVA classification. Foods or drinks formulated mostly or entirely from substances derived from foods, with little or no presence of the unaltered original food were classified as UPF. For each participant, the percentage of energy from UPF was derived and sex-specific tertiles were calculated. Logistic regression models were built and adjusted for sociodemographic, lifestyle, morbidity, and drug treatment variables. Results. Among those participants without AO at baseline, 177 developed AO during follow-up. The average consumption of UPF was 17% of total energy (7% in the first tertile; 29% in the third tertile). The odds ratio (95% confidence interval) for incident AO risk when compared to the lowest tertile was: 1.55 (0.99–2.44) for the second tertile of UPF consumption and 1.62 (1.04–2.54) for the third tertile; p for linear trend: 0.037. Results remained statistically significant after adjusting for potential dietary confounding factors such as fiber consumption, the intake of very long chain omega-3 fatty acids and adherence to the Mediterranean diet. Conclusions. A higher UPF consumption is positively associated with incident AO in older adults in Spain. These findings extend the current evidence of the detrimental effect of UPF consumption on cardiometabolic health.

Habitual coffee consumption and risk of falls in 2 European cohorts of older adults

Habitual coffee consumption has been associated with lower risk of type 2 diabetes, cardiovascular disease, and sarcopenia, which are strong risk factors of falls. In addition, caffeine intake stimulates attention and vigilance, and reduces reaction time. Therefore, a protective effect of coffee on the risk of falling can be hypothesized. The aim of this study was to examine the association between habitual coffee consumption and the risk of ≥1 falls, injurious falls, and falls with fracture in older people. Data were taken from 2964 participants aged ≥60 y from the Seniors-ENRICA (Study on Nutrition and Cardiovascular Risk in Spain) cohort and 8999 participants aged ≥60 y from the UK Biobank cohort. In the Seniors-ENRICA study, habitual coffee consumption was assessed with a validated diet history in 2008-2010, and falls were ascertained up to 2015. In the UK Biobank study, coffee was measured with 3-5 multiple-pass 24-h food records starting in 2006, and falls were assessed up to 2016. A total of 793 individuals in Seniors-ENRICA and 199 in UK Biobank experienced ≥1 fall during follow-up. After multivariable adjustment for major lifestyle and dietary risk factors and compared with daily consumption of <1 cup of coffee, the pooled HR for ≥1 fall was 0.75 (95% CI: 0.52, 1.07) for total coffee consumption of 1 cup/d and 0.74 (95% CI: 0.62, 0.90) for ≥2 cups/d (P-trend = 0.001). The corresponding figures for caffeinated coffee were 0.67 (95% CI: 0.42, 1.07) and 0.70 (95% CI: 0.56, 0.87) (P-trend<0.001). Decaffeinated coffee was not associated with risk of falling in the analyzed cohorts. In Seniors-ENRICA, there was a tendency to lower risk of injurious falls among those consuming caffeinated coffee (HR: 0.83; 95% CI: 0.68, 1.00 for 1 cup/d; HR: 0.83; 95% CI: 0.64, 1.09 for ≥2 cups/d; P-trend = 0.09). No association was observed between caffeinated or decaffeinated coffee consumption and risk of falls with fracture. Habitual coffee consumption was associated with lower risk of falling in older adults in Spain and the United Kingdom.

Influence of habitual chocolate consumption over the Mini-Mental State Examination in Spanish older adults

There are associations described between dementia, mild cognitive impairment (MCI) and foods with a high content of polyphenols. To assess the infl uence of habitual chocolate consumption over the MMSE in Spanish older adults. Cross-sectional study, using data of the follow-up of the Seniors-Study on Nutrition and Cardiovascular Risk in Spain (ENRICA) cohort. Habitual chocolate consumption in the last year was assessed with a computerized dietary history; differences between dark chocolate and milk chocolate were recorded. Chocolate intake was classified into the following categories: no consumption, < 10 g/day, and ≥ 10 g/day. Validated MMSE scores for Spain were obtained during an interview and different cutoff points were used to define ≤ 25, ≤ 24 and ≤ 23. Linear and logistic regression models were used to calculate adjusted beta coefficients and odds ratios (OR). Compared to non-consumers, participants with a habitual chocolate consumption of ≥ 10 g/d had a better MMSE score (adjusted beta coefficient and 95% confidence interval: 0.26 (0.02-0.50; p trend = 0.05); for dark chocolate, the results were also statistically significant (0.48 [0.18-0.78]; p trend < 0.001). Total chocolate consumption was not associated with higher likelihood of having MCI. However, dark chocolate consumption was associated with less likelihood of MCI (OR and 95%CI for MMSE ≤ 25: 0.39 [0.20-0.77]; for MMSE ≤ 24: 0.26 [0.10-0.67]; and for MMSE ≤ 23: 0.25 [0.07-0.82]). Our results suggest that habitual dark chocolate consumption might improve cognitive function among the older population.

Cost-effectiveness of Evolocumab in Patients With High Cardiovascular Risk in Spain

PurposeOur objective was to assess the cost-effectiveness of evolocumab in patients at high risk of cardiovascular (CV) events from the Spanish National Health System perspective. MethodsA Markov model was used to assess the cost-effectiveness (incremental [∆] cost per ∆ quality-adjusted life-year [QALY]; or cost utility) of evolocumab plus standard of care (SoC; statins) versus SoC, assuming lifetime treatment. Cohorts with baseline LDL-C >100 mg/dL and familial hypercholesterolemia (FH) or CV event history (secondary prevention [SP]) were considered. Lifetime CV event rates were predicted either (1) using risk equations considering local risk factors (Spanish Familial Hypercholesterolemia Cohort Study) adjusted to reflect the increased risk of FH patients or (2) using CV event rates from local registries (Information System for the Development of Research in Primary Care) for SP patients. LDL-C relative reductions from evolocumab trials (Evolocumab 140 mg Q2W (bi-weekly) and 420 mg QM (monthly)) were converted into CV event reductions using rate ratios per millimole per liter (mmol/L; 38.67 mg/dL) from a meta-analysis of statin trials (Cholesterol Treatment Trialists’ Collaboration). FindingsPredicted 10-year/lifetime CV risks were 50%/95% (FH) and 62%/82% (SP) for SoC and 27%/83% (FH) and 44%/69% (SP) for evolocumab plus SoC. Predicted 10-year/lifetime major CV event risks were 42%/86% (FH) and 47%/67% (SP) for SoC and 21%/68% (FH) and 31%/52% (SP) for evolocumab plus SoC. Predicted per patient-year rates of non-fatal/fatal CV events were 2.2/0.8 (FH) and 1.1/0.6 (SP) for SoC and 1.2/0.6 (FH) and 0.7/0.5 (SP) for evolocumab plus SoC. Predicted CV event reductions per mmol/L were 17% (FH) and 15% (SP). Evolocumab treatment was associated with increased QALYs and costs compared with SoC (FH: ∆cost, €65,369; ∆QALY, 2.12; incremental cost-effectiveness ratio [ICER], €30,893; SP: ∆cost, €42,266; ∆QALY, 0.93; ICER, €45,340). ImplicationsEvolocumab plus to SoC may provide a cost-effective option for LDL-C lowering in FH and SP patients in Spain.

PCV87 - Cost-Effectiveness of Evolocumab in Patients with High Cardiovascular Risk in Spain

PCV87 - Cost-Effectiveness of Evolocumab in Patients with High Cardiovascular Risk in Spain

Habitual coffee consumption and 24-h blood pressure control in older adults with hypertension

In normotensive and hypertensive individuals, blood pressure (BP) rises acutely during a few hours following coffee or caffeine consumption. However, the effect of habitual coffee consumption on BP and BP control is uncertain. The aim of this study was to assess the association of habitual coffee consumption on 24-h BP and BP control among older adults with hypertension. Data were taken from the Seniors-Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), a cross-sectional study conducted in 2012 among 1164 individuals aged ≥63 years. Habitual coffee consumption was assessed with a validated diet history. BP was recorded by 24-h ambulatory monitoring. Ambulatory hypertension was defined as BP≥130/80mm Hg or being under antihypertensive treatment, and uncontrolled BP was deemed as BP≥130/80mm Hg among hypertensives. Analyses were performed with linear and logistic regressions adjusted for the main confounders, including diet, time since diagnosis of hypertension and the number of antihypertensive drugs. Among the 715 hypertensive participants, those consuming ≥3 cups of coffee/day showed higher 24-h systolic BP (beta: 3.25mm Hg, p value=0.04) and diastolic BP (beta: 2.24mm Hg, p value=0.02) than non-coffee drinkers. Compared to non-coffee drinkers, the odds ratios (95% confidence interval) for uncontrolled BP among those consuming 1, 2, and ≥3 cups of coffee/day were, respectively: 1.95 (1.15-3.30), 1.41 (0.75-2.68), and 2.55 (1.28-5.09); p for trend=0.05. The association was similar among individuals who were smokers, had excess weight (body mass index ≥25kg/m2), low adherence to the Mediterranean diet, or hypercholesterolemia. No association was found between coffee consumption and having a non-dipper BP pattern (<10% nocturnal decline in BP) among hypertensives. Habitual coffee consumption was associated with uncontrolled BP in a hypertensive older population.

A descriptive study of health status and health related quality of life in selected outpatients with type 2 diabetes, pathological body mass index and cardiovascular risk in Spain.

BackgroundOttawa Charter defined health as a resource for everyday life and as an important dimension of health related quality of life (HRqol). Diabetes and obesity have repeatedly been shown as diseases that diminish health status and HRqol. The aim of this study was to measure health status and HRqol in a Spanish sample of obese patients with type 2 diabetes at cardiovascular risk and analyze behavioural, biological and social determinants of health.MethodsOutpatients from external specialized clinic in Endocrinology were evaluated. Measurements: sex, age, family history, employment status, comorbidities, pain, lifestyle habits, anthropometrics, blood pressure, blood analysis and HRqol with COOP/WONCA questionnaire (7 dimensions). Statistics: univariate, bivariate, multivariate and comparative analysis.ResultsMean age was 59.1 ± 7.6 [95%IC: 56.6-61.6], 74% were women and 63.2% were physically active. WONCA values were; summary index (SI): 18.7 ± 4 [95%IC: 17.3-20] (maximum 35); physical fitness: 3.3 ± 1, feelings: 2.3 ± 1.1, social activities: 1.5 ± 1, daily activities: 2.1 ± 1.2, change in health: 2.7 ± 0.9, overall health: 3.6 ± 0.7 and pain: 3.5 ± 1.2 (maximum 5). High fibrinogen values (339.3 ± 85.8 [95%IC: 309.8-368.8]) negatively influenced pain visual analogic scale (p = 0.029). Physically active patients (63.2%) had better values in daily activities dimension (p = 0.025). More than the half of the sample (51.5%) reported a good quality of sleep, but the pain worsened it (p = 0.040). High BMI values (34.8 ± 5.8 [95%IC: 32.9-36.7]) harmed the COOP-WONCA SI (p = 0.009). High glycated hemoglobin (HbA1c) values (6.8 ± 1.3 [95%IC: 6.3-7.2]) had a negative impact on COOP-WONCA SI (p = 0.018). Nor tailored diet (15.8%) or being employed (18.4%) influenced the HRqol. The regression that best models COOP-WONCA SI was adjusted for BMI and HbA1c. SI = 3.509 + 0.335BMI +0.330HbA1c.ConclusionsHRqol was worse than in general population, but better than in previous studies of diabetes patients, without differences by sex or age, though feelings, daily activities and pain dimensions scored worse than in these studies.Higher levels of HbA1c, obesity and procoagulative state had a negative impact in these last dimensions. Pain impaired quality of sleep and physical activity had a positive impact in daily activities. BMI and HbA1c modeled the HRqol.

Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

Introduction and objectivesThere are no nationwide, population-based studies in Spain assessing overall cardiovascular risk. We aimed to describe cardiovascular risk and achievement of treatment goals following the 2012 European Guidelines on cardiovascular disease prevention strategy. We also investigated clinical characteristics (non-classical risk factors) associated with moderate risk. MethodsParticipants (n=2310, 58% women) aged 40 to 65 years from a national population-based study (Di@bet.es Study) were identified. First, a priori high/very-high risk individuals were identified. Next, total cardiovascular risk (Systematic Coronary Risk Evaluation equation including high-density lipoprotein cholesterol) was used to assess risk of a priori non-high risk individuals. Variables independently associated with moderate versus low-risk were investigated by multiple logistic regression analysis. ResultsAge-and-sex standardized (direct method) percentages of high/very-high, moderate, and low-risk were 22.8%, 43.5%, and 33.7%, respectively. Most men were at moderate (56.2%), while 55.4% of women were at low risk. Low-density lipoprotein cholesterol (< 70,<100, < 115mg/dL) and blood pressure (<140/90mmHg) goals for very-high, high and moderate risk were met in 15%, 26% and 46%, and 77%, 68% and 85% of the individuals, respectively. Body mass index, high triglycerides concentrations, diastolic blood pressure, and low Mediterranean diet adherence (in women) were independently associated with moderate (versus low) risk. ConclusionsCardiovascular risk in Spain is mainly moderate in men and low in women. Achievement of treatment goals in high-risk individuals should be improved. The prevalence of non-classical cardiovascular risk factors is elevated in subjects at moderate risk, an important aspect to consider in a population-based strategy to decrease cardiovascular disease in the most prevalent group.

The ERICE-score: the New Native Cardiovascular Score for the Low-risk and Aged Mediterranean Population of Spain

Introduction and objectivesIn Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. MethodsSeven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11800 people (6387 women) representing 107915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. ResultsAge was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic=0.789 in men and C=0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. ConclusionsThe ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain.

Consumption of Sugar-Sweetened Beverages Is Positively Related to Insulin Resistance and Higher Plasma Leptin Concentrations in Men and Nonoverweight Women

The mechanisms for the association of the consumption of sugar-sweetened beverages (SSBs) with obesity and type 2 diabetes are only partly understood. The objective of the study was to examine the association of habitual SSB consumption with biomarkers of energy metabolism, including serum glucose, glycated hemoglobin, insulin, insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)], and leptin. Data were taken from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), a cross-sectional study conducted during 2008–2010 in 7842 individuals representative of the population of Spain aged 18–59 y. Diet was assessed with a validated computerized diet history. Biomarkers were determined in 12-h fasting blood samples. Analyses were performed with linear regression with adjustment for the main confounders, including body mass index (BMI), waist circumference, and morbidity. In men, a 1-serving (200 mL)/d increase in the consumption of SSBs was associated with higher plasma concentrations of insulin (2.14%, P = 0.01), higher HOMA-IR (1.90%, P = 0.04), and higher concentrations of leptin (2.73%, P = 0.01). Among women, these associations were found only in those with a BMI <25 kg/m2 (insulin: 2.88%, P = 0.004; HOMA-IR: 3.03%, P = 0.01; and leptin: 4.57%, P = 0.01) or with a waist circumference <80 cm (insulin: 2.79%, P = 0.01; HOMA-IR: 3.00%, P = 0.01; and leptin: 3.63%, P = 0.05). In conclusion, the consumption of SSBs was associated with higher concentrations of insulin and leptin and a higher HOMA-IR in men and in nonoverweight women. Insulin resistance and higher leptin may be early markers of metabolic dysfunction associated with SSBs.

Metabolic Syndrome, Adiponectin, and Cardiovascular Risk in Spain (The Segovia Study): Impact of Consensus Societies Criteria

We aimed to investigate the prevalence of metabolic syndrome in rural and urban areas in the province of Segovia, Spain, and its relationship to lifestyle habits, cardiovascular risk, and serum adiponectin concentrations. The study had a cross-sectional design and included 888 individual residents in the province of Segovia, Autonomous Community of Castilla-León. The age/sex standardized prevalence of the metabolic syndrome was by: (1) American Heart Association/National Heart Lung and Blood Institute criteria (AHA/NHLBI), 17%; (2) International Diabetes Federation (IDF), 24.3%; and (3) Consensus Societies/Joint Interim Statement (CS), 27.8%. A high correlation was found between the different criteria. No formal education [odds ratio (OR) 6.9 (2.4-20.2)] and primary education [6.7 (2.8-15.9)] were independently associated with metabolic syndrome. An inverse association with metabolic syndrome was found for subjects doing a high level of exercise during work [0.4 (0.2-0.7)] as well as those who were mild drinkers [alcohol intake of less than 15 grams/daily, 0.4 (0.3-0.8)]. Among subjects with low estimated cardiovascular risk, adiponectin levels are higher in those who do not meet criteria of metabolic syndrome. A total of 29.7% of subjects meeting CS criteria had >20% 10-year predicted risk of cardiovascular disease (CVD) by the Framingham risk score criteria [4.5 (2.4-8.5)]. Our results show: (1) A higher estimated prevalence of metabolic syndrome according to IDF and CS criteria. (2) Low educational level was independently associated with metabolic syndrome. A high level of physical activity and a daily alcohol intake of less than 15 grams/day were inversely associated with metabolic syndrome. (3) Metabolic syndrome increases the predicted CVD risk. (4) Adiponectin levels are not inversely related to insulin resistance in subjects with high cardiovascular risk and metabolic syndrome.

Knowledge of Stroke Warning Symptoms and Intended Action in Response to Stroke in Spain: A Nationwide Population-Based Study

Background: Worldwide thrombolysis rates remain suboptimal. Ambulance transfer is associated with greater use of this time-dependent treatment. Information on public awareness of stroke symptoms is important for planning effective education programs to promote calling of emergency services for suspected stroke. However, there is a paucity of data on this subject in European countries. Our objectives were to explore the recognition of stroke symptoms, awareness of the need to activate the emergency medical services for acute stroke events, and the association between knowledge of warning symptoms and intent to call for an ambulance among a sample representative of the adult population of Spain. This is the largest study on this subject to date in Europe. Methods: The data were taken from the Study on Nutrition and Cardiovascular Risk in Spain, a cross-sectional study conducted in a sample representative of the Spanish noninstitutionalized population aged ≥18 years in 2008–2010. Study participants were selected by multistage clustered random sampling. The households within each section were selected by random telephone dialing using the landline telephone directory as the sampling frame. Subjects in the households were selected proportionally to the distribution of the population of Spain by sex and age. The study included a computer-assisted telephone interview on stroke symptom knowledge and the first action to perform in a stroke event, based on the American Heart Association and American Stroke Association recommendations, and two home visits to perform a physical examination and to obtain blood samples. Results: Among 11,827 adults, 7,711 (65.2%; 95% CI = 64.1–66.3) identified 4–6 stroke warning symptoms, considered as adequate knowledge. A total of 1,348 (11.4%) were unable to classify any of the symptoms correctly. In the multivariate analysis, higher education was significantly associated with better knowledge of symptoms, and age ≥65 years, fair/poor self-rated health, history of obesity and known diabetes were significantly associated with less knowledge of stroke symptoms. One in 5 individuals indicated they would do something other than calling for an ambulance if they thought someone was having a stroke. The number of specific stroke warning symptoms known was directly associated with the intent to call an ambulance in a stroke event (OR adjusted for sociodemographic and clinical variables = 1.06 per symptom, 95% CI = 1.03–1.09; p < 0.001). Conclusions: In this population-based study, stroke symptom knowledge was suboptimal and only modestly associated with the intent to call for an ambulance. Educational interventions are needed to link stroke recognition more strongly to an immediate need to call for an ambulance in order to increase stroke patients’ access to thrombolysis.