Factores de riesgo : prevalencia

Casi la mitad de la población adulta española presenta al menos un factor de riesgo cardiovascular importante: hipertensión, tabaquismo, colesterol alto, sobrepeso, sedentarismo o diabetes, y muchos de estos individuos no lo saben, o no están tratados o no están bien controlados. Por lo tanto, mejorar el grado de conocimiento, tratamiento y control de estos factores de riesgo podría contribuir sustancialmente a reducir la magnitud de la enfermedad cardiovascular como problema de salud pública. Esta situación se da en la población general y en la práctica clínica, es decir tanto en prevención primaria como en sujetos en alto riesgo o enfermos. En la población general adulta española, la prevalencia de consumo de tabaco es de 42% y 27% en varones y mujeres respectivamente, la de hipertensión arterial es de un 35%, la de dislipidemia diagnosticada un 24%, la de obesidad un 14%, la de sedentarismo un 40% y la de diabetes autorreportada de un 6%. Además, el tabaco es la primera causa de enfermedad, discapacidad y muerte prematuras y evitables, incluyendo a la enfermedad cardiovascular, en la población española. Y España, al igual que otros países desarrollados, está experimentando una epidemia de obesidad y de diabetes mellitus. Además, la prevalencia de los factores de riesgo cardiovascular en pacientes que ya han sufrido un episodio cardiovascular, es también muy elevada. Varios de los principales factores de riesgo cardiovascular tienden a presentarse agregados. La dieta española se ajusta todavía, en general, al patrón de dieta mediterránea considerada saludable. Sin embargo, hay una ingesta excesiva de grasas saturadas (procedentes principalmente de la carne y los derivados lácteos) y una ingesta deficiente de hidratos de carbono (presentes sobre todo en los cereales). El grado de control de la hipertensión arterial en hipertensos adultos tratados con fármacos antihipertensivos y que consultan en atención primaria es del 36%, el de la dislipidemia en pacientes adultos diagnosticados y tratados de la misma y atendidos en consultas ambulatorias es del 45%, y el de la glucemia basal en diabéticos tipo 2 asistidos en atención primaria es 22%.Por todo ello, los factores de riesgo cardiovascular suponen una importante carga para el sistema sanitario español y, a pesar del progreso ocurrido en su manejo, se debe mejorar sustancialmente su grado de control

Twenty-four-hour central (aortic) systolic blood pressure: Reference values and dipping patterns in untreated individuals

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de investigación, si lo hubiere, y los autores pertenecientes a la UAMCentral (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigationi24abc (International 24-Hour Ambulatory Aortic Blood Pressure Consortium) is a purely academic research project without industry funding. Funding of individual authors: J. Nemcsik was supported by the Hungarian Society of Hypertension; M. Agharazii was supported by the Canadian Institutes of Health Research; Y. Li is supported by grants from the National Natural Science Foundation (81770455 and 82070432) and the Ministry of Science and Technology, Beijing, China (2018YFC1704902); J.R. Banegas is supported by Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, and FEDER/FSE (grants PI16/01460 and PI19/00665); A. Maloberti and C. Giannatasio were supported by the Italian Ministry of University and Research (MIUR), Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); A.D. Protogerou’s team has received unrestricted research grant and equipment support from IEM Stolber

Hypertension control: population surveys vs clinical studies

Editorial commentary on Manuscript Number: JHH-14-0356. “Blood pressure levels and control in Italy: comprehensive analysis of clinical data from 2000-2005 and 2005-2010 hypertension surveys”.This work has been partially funded by FIS grant PI13/02321, and Cátedra de la Universidad Autónoma de Madrid de Epidemiología y Control del Riesgo Cardiovascular, Madrid, Spai

Only virgin type of olive oil consumption reduces the risk of mortality. Results from a Mediterranean population-based cohort

Evidence on the association between virgin olive oil (OO) and mortality is limited since no attempt has previously been made to discern about main OO varieties. We examined the association between OO consumption (differentiating by common and virgin varieties) and total as well as cause-specific long-term mortality. 12,161 individuals, representative of the Spanish population ≥18 years old, were recruited between 2008 and 2010 and followed up through 2019. Habitual food consumption was collected at baseline with a validated computerized dietary history. The association between tertiles of OO main varieties and all-cause, cardiovascular and cancer mortality were analyzed using Cox models. After a mean follow-up of 10.7 years (129,272 person-years), 143 cardiovascular deaths, and 146 cancer deaths occurred. The hazard ratio (HR) (95% confidence interval) for all-cause mortality in the highest tertile of common and virgin OO consumption were 0.96 (0.75–1.23; P-trend 0.891) and 0.66 (0.49–0.90; P-trend 0.040). The HR for all-cause mortality per a 10 g/day increase in virgin OO was 0.91 (0.83–1.00). Virgin OO consumption was also inversely associated with cardiovascular mortality, with a HR of 0.43 (0.20–0.91; P-trend 0.017), but common OO was not, with a HR of 0.88 (0.49–1.60; P-trend 0.242). No variety of OO was associated with cancer mortality. Daily moderate consumption of virgin OO (1 and 1/2 tablespoons) was associated with a one-third lower risk of allcause as well as half the risk of cardiovascular mortality. These effects were not seen for common OO. These findings may be useful to reappraise dietary guideline

Consumption of meat in relation to physical functioning in the Seniors-ENRICA cohort

Background: Meat is an important source of high-quality protein and vitamin B but also has a relatively high content of saturated and trans fatty acids. Although protein and vitamin B intake seems to protect people from functional limitations, little is known about the effect of habitual meat consumption on physical function. The objective of this study was to examine the prospective association between the intake of meat (processed meat, red meat, and poultry) and physical function impairment in older adults. Methods: Data were collected for 2982 participants in the Seniors-ENRICA cohort, who were aged ≥60 years and free of physical function impairment. In 2008-2010, their habitual diet was assessed through a validated computer-assisted face-to-face diet history. Study participants were followed up through 2015 to assess self-reported incident impairment in agility, mobility, and performance-based lower-extremity function. Results: Over a median follow-up of 5.2 years, we identified 625 participants with impaired agility, 455 with impaired mobility, and 446 with impaired lower-extremity function. After adjustment for potential confounders, processed meat intake was associated with a higher risk of impaired agility (hazard ratio [HR] for highest vs. lowest tertile: 1.33; 95% confidence interval [CI]: 1.08-1.64; p trend = 0.01) and of impaired lower-extremity function (HR for highest vs. lowest tertile: 1.31; 95% CI: 1.02-1.68; p trend = 0.04). No significant associations were found for red meat and poultry. Replacing one serving per day of processed meat with one serving per day of red meat, poultry, or with other important protein sources (fish, legumes, dairy, and nuts) was associated with lower risk of impaired agility and lower-extremity function. Conclusions: A higher consumption of processed meat was associated with a higher risk of impairment in agility and lower-extremity function. Replacing processed meat by other protein sources may slow the decline in physical functioning in older adultsThis work was supported by grants from the Instituto de Salud Carlos III, State Secretary of R+D+I of Spain and FEDER/FSE (FIS 13/0288, 16/609 and 16/1512), and the European Union: FP7-HEALTH-2012-Proposal No: 305483-2, "Utility of omic-based biomarkers in characterizing older individuals at risk for frailty, its progression to disability and general consequences to health and wellbeing - The FRAILOMIC Initiative"; EU H2020- Project ID: 635316, " Ageing Trajectories of Health: Longitudinal Opportunities and Synergies- The ATHLOS project"; and the JPI HDHL: "Salivary Markers of Diet and Health- The SALAMANDER project"

The inflammatory potential of diet and pain incidence: a cohort study in older adults

This article has been accepted for publication in The Journals of Gerontology: Series A Published by Oxford University PressBackground: Pain is a highly prevalent and on-the-rise symptom with heavy associated healthcare and social burdens among older adults, yet evidence regarding its prevention is inadequate. The growing knowledge on how diet regulates inflammation may be utilized for pain prevention. Objective: To examine the association of 3-year changes in the inflammatory potential of diet (2008-2010 to 2012) with pain incidence over the subsequent 3 years (2012 to 2014-2015) among older adults. Methods: We used data from 820 individuals aged ≥60 years and free of pain in 2012, drawn from the Seniors-ENRICA cohort study in Spain. Food consumption was collected with a validated diet history, and the inflammatory potential of diet was estimated via the a priori empirical dietary inflammatory index (EDII) and the a posteriori dietary inflammatory index (DII). The frequency, severity (impact on daily activities), and number of locations of incident pain were combined into a scale that classified subjects as suffering from no pain, intermediate pain, and highest pain. The associations were summarized with relative risk ratios (RRR) and their 95% confidence interval (CI), estimated with multinomial logistic regression, and adjusted for potential sociodemographic, lifestyle, and morbidity confounders. Results: Shifting the diet towards a higher inflammatory potential was associated with a subsequent increased risk of intermediate pain [fully adjusted RRR (95% CI) per 1-point increment in the EDII=1.30 (1.03,1.65)] and highest pain [DII=1.14 (1.03,1.26)]. The three components of the pain scale followed similar trends, the most consistent one being with moderate-to-severe pain [EDII=1.26 (1.04,1.54); DII=1.12 (1.01,1.24)]. The association of increasing DII with highest incident pain was only apparent among the least physically active subjects [1.35 (1.17,1.56) vs 0.96 (0.83,1.10); p for interaction <0.001]. Conclusions: An increase in the inflammatory potential of diet was associated with higher pain incidence over the following years. Future studies in older adults should assess the efficacy of pain prevention interventions targeting the inflammatory potential of dietThe present study was supported by Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE (FIS grants 16/1512, 18/287, and 19/319

Prevalence, geographic distribution, and geographic variability of major cardiovascular risk factors in Spain: pooled analysis of data from population-based epidemiological studies: the ERICE study

[Abstract] Introduction and objectives. To determine the prevalence and geographic distribution of major cardiovascular risk factors in the Spanish population. To investigate whether geographic variability exists. Methods. Data were pooled from eight cross-sectional epidemiologic studies carried out in Spain between 1992 and 2001 whose methodological quality satisfied predefined criteria. Individual data were reassessed and analyzed by age group (20-44 years, 45-64 years, and [.greaterequal] 65 years), sex, and geographic area. The study population included 19 729 individuals. Mean values and unadjusted and adjusted prevalence rates were derived for various risk factors. Results. The most common cardiovascular risk factors in the Spanish population were, in descending order: hypercholesterolemia (ie, total cholesterol >200 mg/dL) in46.7%, hypertension in 37.6%, smoking in 32.2%, obesity in 22.8%, and diabetes mellitus in 6.2%. The mean values for blood pressure, body mass index, high-density lipoprotein cholesterol, and glycemia varied considerably with age, sex, and geographic area. The highest levels of cardiovascular risk factors were observed in Mediterranean and south-eastern areas of the country and the lowest, in northern, and central areas. Conclusions. The prevalence of major cardiovascular risk factors in Spain was high. Their distribution varied considerably with geographic area.[Resumen] Introducción y objetivos. Estimar la prevalencia y la distribución geográfica de los principales factores de riesgo cardiovascular en la población española. Investigar la existencia de diferencias geográficas. Métodos. Agregación de ocho estudios epidemiológicos transversales, realizados en España entre 1992 y 2001, que superaron criterios de calidad metodológica. Reanálisis conjunto de los datos individuales por grupos de edad (20-44, 45-64 y [.greaterequal] 65 años), sexo y grandes áreas geográficas. Población de estudio: 19.729 sujetos. Estimación de valores medios y prevalencias crudas y ajustadas. Resultados. Por orden decreciente, los factores de riesgo cardiovascular más frecuentes en la población española fueron la hipercolesterolemia (colesterol total > 200 mg/dl, 46,7%), hipertensión arterial (37,6%), tabaquismo (32,2%), obesidad (22,8%) y diabetes mellitus (6,2%). Los valores medios de presión arterial, índice de masa corporal, colesterol de las lipoproteínas de alta densidad y glucemia varían ampliamente con la edad, el sexo y las áreas geográficas. La mayor carga de factores de riesgo cardiovascular se observa en las zonas sureste y mediterránea y la menor, en las áreas norte y centro. Conclusiones. En España la prevalencia de los principales factores de riesgo cardiovascular es elevada. Hay marcadas diferencias geográficas en su distribución

Major dietary patterns and risk of frailty in older adults: A prospective cohort study

Background: There is emerging evidence of the role of certain nutrients as risk factors for frailty. However, people eat food, rather than nutrients, and no previous study has examined the association between dietary patterns empirically derived from food consumption and the risk of frailty in older adults. Methods: This is a prospective cohort study of 1,872 non-institutionalized individuals aged ≥60 years recruited between 2008 and 2010. At baseline, food consumption was obtained with a validated diet history and, by using factor analysis, two dietary patterns were identified: a ‘prudent’ pattern, characterized by high intake of olive oil and vegetables, and a ‘Westernized’ pattern, with a high intake of refined bread, whole dairy products, and red and processed meat, as well as low consumption of fruit and vegetables. Participants were followed-up until 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss). Results: Over a 3.5-year follow-up, 96 cases of incident frailty were ascertained. The multivariate odds ratios (95% confidence interval) of frailty among those in the first (lowest), second, and third tertile of adherence to the prudent dietary pattern were 1, 0.64 (0.37–1.12), and 0.40 (0.2–0.81), respectively; P-trend = 0.009. The corresponding values for the Westernized pattern were 1, 1.53 (0.85–2.75), and 1.61 (0.85–3.03); P-trend = 0.14. Moreover, a greater adherence to the Westernized pattern was associated with an increasing risk of slow walking speed and weight loss. Conclusions: In older adults, a prudent dietary pattern showed an inverse dose-response relationship with the risk of frailty while a Westernized pattern had a direct relationship with some of their components. Clinical trials should test whether a prudent pattern is effective in preventing or delaying frailtyBaseline data collection was funded by Sanofi-Aventis. Data collection during follow-up was funded by the Spanish Government grants 09/1626 and 09/0104 (Ministry of Health of Spain). Funding specific for this analysis was obtained from the Spanish Government grant 12/1166 (Ministry of Health of Spain) and the FP7-HEALTH-2012-Proposal No: 305483–2 (FRAILOMIC Initiative). Funders had no role in data analyses, preparation of the manuscript, or in the decision to submit it for publicatio

Valores de referencia y puntos de corte de leptina para identificar anormalidad cardiometabólica en la población española

Antecedentes y objetivo: Estimar los valores de referencia de leptina y calcular los puntos de corte de leptinemia que identifiquen anormalidad cardiometabólica en España. Métodos: Estudio transversal realizado de 2008 a 2010 sobre 11.540 individuos representativos de la población española ≥ 18 años. La información se obtuvo mediante examen físico estandarizado y las analíticas se realizaron en un laboratorio central. La leptinemia se midió por inmunoensayo enzimático. Se definió anormalidad cardiometabólica como la presencia de ≥ 2 de las siguientes anormalidades: presión arterial elevada; triglicéridos elevados; colesterol unido a lipoproteínas de alta densidad bajo; valores altos de resistencia a insulina según homeostasis model assessment; proteína C reactiva y glucosa elevada. Resultados: Los niveles de leptina fueron mayores en mujeres que en varones (media geométrica 21,9 ng/ml y 6,6 ng/ml, respectivamente, p<0.001) y aumentaban con la edad y el índice de masa corporal (p<0,001). La mediana fue 24,5 ng/ml en mujeres (rango intercuartílico P25-P75: 14,1-37,0) y 7,2 ng/ml en varones (P25-P75: 3,3-14,3). La leptinemia fue mayor en sujetos con obesidad general o abdominal, diabetes, hipertensión o síndrome metabólico (p<0.001 en todos los casos). Los valores de leptinemia que identificaron anormalidad cardiometabólica fueron 23,75 ng/ml en mujeres (área bajo la curva 0,722, 72,3% sensibilidad y 58,7% especificidad), y 6,45 ng/ml en varones (área bajo la curva 0,716, 71,4% sensibilidad y 60,2% especificidad). Conclusiones: Estos resultados facilitan la interpretación de los valores de leptinemia en estudios clínicos y poblacionales. La leptina tiene sensibilidad y especificidad moderadas para identificar anormalidad cardiometabólica en ambos sexosLos datos de este análisis proceden del estudio ENRICA, que fue financiado por Sanofi-Aventis. La financiación específica para este análisis procede de los proyectos FIS PI13/02321 y “Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular”, Madri