Las actuales guías en el manejo de las dislipidemias europeas y estadounidenses no están de acuerdo en sus objetivos y recomendaciones

La prevención de la enfermedad cardiovascular (ECV) constituye una prioridad fundamental en la práctica clínica diaria, tanto en Enfermería como en Medicina. Para conseguirla, el control de la dislipidemia es fundamental y la elaboración de guías por expertos, basadas en la evidencia disponible, el modo más racional de su abordaje. Pero en ocasiones, la producción científica llega a ser tan abundante que seleccionar la calidad de los estudios puede generar controversias. Este es el caso que se presenta en este estudio, donde las guías estadounidenses, basadas en ensayos clínicos aleatorizados y controlados, han establecido un nuevo paradigma frente a las guías europeas que además han considerado los diseños de estudios observacionales. Se exponen los puntos fundamentales de ambos casos, la controversia generada y el posterior acercamiento entre ambas guías, valorando la importancia que aporta la evidencia científica

A method to construct a points system to predict cardiovascular disease considering repeated measures of risk factors

Current predictive models for cardiovascular disease based on points systems use the baseline situation of the risk factors as independent variables. These models do not take into account the variability of the risk factors over time. Predictive models for other types of disease also exist that do consider the temporal variability of a single biological marker in addition to the baseline variables. However, due to their complexity these other models are not used in daily clinical practice. Bearing in mind the clinical relevance of these issues and that cardiovascular diseases are the leading cause of death worldwide we show the properties and viability of a new methodological alternative for constructing cardiovascular risk scores to make predictions of cardiovascular disease with repeated measures of the risk factors and retaining the simplicity of the points systems so often used in clinical practice (construction, statistical validation by simulation and explanation of potential utilization). We have also applied the system clinically upon a set of simulated data solely to help readers understand the procedure constructed

11 years of architects by the University of Alicante. Study on the employment situation of graduates between 2003 and 2013

La titulación de Arquitectura en la Universidad de Alicante (UA) arrancó en el curso 1996-1997, coincidiendo casi con el inicio, en nuestro país, de la década prodigiosa 1997-2006 y produciendo sus primeros arquitectos en el curso 2002-2003. La Escuela no fue ajena a ese período de euforia como no lo ha sido a la crisis de 2008. El presente estudio tiene como principal objetivo conocer qué están haciendo, y cómo, los arquitectos de las primeras once promociones de la Escuela, tratando de dilucidar salidas profesionales, nuevas y tradicionales, y condiciones laborales de los egresados de la UA, buscando, si existe, un diferencial que pueda caracterizarlos respecto al resto. La investigación parte de una triple inquietud: la propia de los estudiantes de Proyecto Fin de Carrera ante la incertidumbre que la crisis plantea; la curiosidad por entender y explicar cómo se está transformando, ante ella, la profesión; y la responsabilidad institucional para que los planes de estudios sean capaces de atender las demandas de los nuevos perfiles. Para ello, se ha efectuado una encuesta on-line a un porcentaje representativo del colectivo (135 sobre 497 personas); se han procesado estadísticamente sus resultados; se han plasmado, en crudo, en las correspondientes tablas y figuras; y se han discutido, concluyendo que existe al menos una actividad, el diseño, que caracteriza a los arquitectos de la UA en su quehacer profesional; que su satisfacción es más que suficiente y que el reconocimiento público de su trabajo alcanza a más de la mitad de los encuestados.The degree of Architecture at the University of Alicante (UA) started in 1996-1997, coinciding almost with the beginning of the prodigious decade 1997-2006 and producing their first architects 2002-2003. The School did not miss either this period of euphoria and or the crisis of 2008. The main objective of this study is to know what the architects from the first eleven graduations of the School are working on and how. Specifically, the architects participating in the study are graduates from the academic year 2002-2003 until 2012-2013 both inclusive, being the outbreak of the crisis within this period. The study tries to elucidate the new and traditional professional exits and working conditions of the UA Architecture graduates, seeking a differential that can characterize them com-pared to the rest of Spanish architecture schools. The research starts from a triple-concern: the one from the seniors in the face of the uncertainty that the crisis poses; the curiosity to understand and explain how the profession is being transformed; and the institutional responsibility for adapting curricula to current needs. To this end, a representative percentage of the group has been surveyed online (135 out of 497 people); their results have been statistically processed, they have been expressed in tables and figures, and they have been discussed, concluding that there is at least one activity, the design, characterizes the UA architects in their professional work, their satisfaction is more than sufficient and the recognition of their work reaches more than half of the respondents.Este estudio ha sido financiado con la Beca de Colaboración de Estudiantes en Departamentos Universitarios del Ministerio de Educación para el curso 2015-2016 que obtuvo la alumna de Arquitectura, Plan 1996, Autora 3 y que tuteló la profesora doctora Autora 1

Construction and Validation of a 14-Year Cardiovascular Risk Score for Use in the General Population: The Puras-GEVA Chart

The current cardiovascular risk tables are based on a 10-year period and therefore, do not allow for predictions in the short or medium term. Thus, we are unable to take more aggressive therapeutic decisions when this risk is very high. To develop and validate a predictive model of cardiovascular disease (CVD), to enable calculation of risk in the short, medium and long term in the general population. Cohort study with 14 years of follow-up (1992–2006) was obtained through random sampling of 342,667 inhabitants in a Spanish region. Main outcome: time-to-CVD. The sample was randomly divided into 2 parts [823 (80%), construction; 227 (20%), validation]. A stepwise Cox model was constructed to determine which variables at baseline (age, sex, blood pressure, etc) were associated with CVD. The model was adapted to a points system and risk groups based on epidemiological criteria (sensitivity and specificity) were established. The risk associated with each score was calculated every 2 years up to a maximum of 14. The estimated model was validated by calculating the C-statistic and comparison between observed and expected events. In the construction sample, 76 patients experienced a CVD during the follow-up (82 cases per 10,000 person-years). Factors in the model included sex, diabetes, left ventricular hypertrophy, occupational physical activity, age, systolic blood pressure × heart rate, number of cigarettes, and total cholesterol. Validation yielded a C-statistic of 0.886 and the comparison between expected and observed events was not significant (P: 0.49–0.75). We constructed and validated a scoring system able to determine, with a very high discriminating power, which patients will develop a CVD in the short, medium, and long term (maximum 14 years). Validation studies are needed for the model constructed.This study has been partially funded by: 1) The Community Board of Castilla-La Mancha, Regional Ministry of Health and Social Affairs (Order of July 3rd, 1992 and Order of September 14th, 1993, both published in Diario Oficial de Castilla-La Mancha, DOCM); 2) Grant from the Foundation for Health Research in Castilla-La Mancha (FISCAM), file number 03069–00

Cambios en las lipoproteínas de alta densidad, sus subfracciones y otras partículas lipoproteicas, inducidos por el ejercicio físico moderado, y su regresión tras el cese de la actividad física / Julio Antonio Carbayo Herencia ; director Jacinto Fernández Pardo.

Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 514.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-1529

A method to construct a points system to predict cardiovascular disease considering repeated measures of risk factors

Current predictive models for cardiovascular disease based on points systems use the baseline situation of the risk factors as independent variables. These models do not take into account the variability of the risk factors over time. Predictive models for other types of disease also exist that do consider the temporal variability of a single biological marker in addition to the baseline variables. However, due to their complexity these other models are not used in daily clinical practice. Bearing in mind the clinical relevance of these issues and that cardiovascular diseases are the leading cause of death worldwide we show the properties and viability of a new methodological alternative for constructing cardiovascular risk scores to make predictions of cardiovascular disease with repeated measures of the risk factors and retaining the simplicity of the points systems so often used in clinical practice (construction, statistical validation by simulation and explanation of potential utilization). We have also applied the system clinically upon a set of simulated data solely to help readers understand the procedure constructed

Evolución de la prevalencia de los factores de riesgo y del riesgo cardiovascular global en población mayor de 18 años de la provincia de Albacete (1992-94 a 2004-06)

Background: To establish strategies for prevention of cardiovascular disease implies to know its epidemiology and evolution in time. The objective of this study is to know the prevalence of risk factors and cardiovascular risk in two moments during the following of a grownup general population. Methods: Study of cohorts, followed at random selected general population during 12 years (1992-94 to 2204-06). Two transversal studies were made, one at the beginning and the other one at the end of this follow-up. The population in this study was 18 years and older registered in the province of Albacete. Random sampling, stratified and two-stage. The sample size for the first cut was 2121 subjects and for second one 1577. One specific anamnesis was made, physical examination, measurement of blood pressure, electrocardiogram and extraction of venous blood. The studied variables were: age, sex, personal and familiar antecedents, risk factors and global cardiovascular risk. Results: 1322 subjects went to the appointment for the first examination (mean age 48.2 years. 53.6% women) and 997 for the second (mean age 52.8 years. 56.7% women). Has Increased the prevalence of hypertension (32.7% to 41,2%), diabetes (9,8 to 11,4%), obesity (27,8 to 34,3%) and hypercolesterolemia (47,5 to 53,5%), whereas smokers have decreased (32,6 to 23,7%) and have handicapped the average values of arterial pressure (132/81 to 129/73 mmHg), glycaemia (100,8 to 92,8 mg/dl) and LDL-cholesterol (128,7 to 116,7 mg/dl) and also a lowering of cardiovascular risk with Framingham (10,8% to 8,2%) and Score (2,3% to 1,6%). Conclusions: In the last years an increasing prevalence of risk factors has been seen (hypertension, diabetes and hypercolesterolemia), a better control of them, and lower prevalence of smoking and cardiovascular risk in the population has also be seen.Fundamento: Establecer estrategias de prevención de la enfermedad cardiovascular implica conocer su epidemiología y evolución en el tiempo. El objetivo del estudio es conocer las prevalencias de los factores de riesgo y del riesgo cardiovascular en dos momentos de seguimiento de una población general adulta. Métodos: Dentro de un estudio longitudinal y prospectivo con población general seleccionada al azar seguida durante 12 años (1992-94 a 2004-2006) se hacen dos análisis trasversales al inicio y en el último corte de seguimiento. La población objeto de estudio fueron personas mayores de 18 años censadas en la provincia de Albacete. Muestreo aleatorio, estratificado y bietápico. Tamaño muestral 2.121 y 1.577 sujetos en cada uno de los cortes. Se hizo anamnesis, exploración física, medida de presión arterial, electrocardiograma y extracción de sangre venosa. Las variables estudiadas fueron: edad, sexo, antecedentes personales y familiares, factores de riesgo y riesgo cardiovascular global. Resultados: En el primer examen acudieron a la cita 1.322 sujetos (edad media 48,2 años. 53,6% mujeres) y 997 en el segundo (edad media 52,8 años. 56,7% mujeres). Hubo un aumento en la prevalencia de hipertensión (32,7% a 41,2%) diabetes mellitus (9,8 a 11,4%), obesidad (27,8 a 34,3%) e hipercolesterolemia (47,5 a 53,5%), una disminución de fumadores (32,6 a 23,7%), de valores medios de presión arterial (132/81 a 129/73 mmHg), glucemia (100,8 a 92,8 mg/dl) y col-LDL (128,7 a 116,7 mg/dl) y un descenso del riesgo cardiovascular con Framingham (10,8% a 8,2%) y Score (2,3% a 1,6%). Conclusiones: En los últimos años se observa un aumento en la prevalencia de factores de riesgo (hipertensión, diabetes e hipercolestrerolemia), un mejor control de los mismos, una menor prevalencia de fumadores y menor riesgo cardiovascular en la población

Prognostic value of obesity on both overall mortality and cardiovascular disease in the general population.

Obesity represents an important health problem and its association with cardiovascular risk factors is well-known. The aim of this work was to assess the correlation between obesity and mortality (both, all-cause mortality and the combined variable of all-cause mortality plus the appearance of a non-fatal first cardiovascular event) in a general population sample from the south-east of Spain.This prospective cohort study used stratified and randomized two-stage sampling. Obesity [body mass index (BMI) ≥ 30 kg/m(2)] as a predictive variable of mortality and cardiovascular events was assessed after controlling for age, sex, cardiovascular disease history, high blood pressure, diabetes mellitus, hypercholesterolemia, high-density lipoprotein/triglycerides ratio, total cholesterol and smoking with the Cox regression model.The mean follow-up time of the 1,248 participants was 10.6 years. The incidence of all-cause mortality during this period was 97 deaths for every 10,000 person/years (95% CI: 80-113) and the incidence of all-cause mortality+cardiovascular morbidity was 143 cases for every 10,000 person/years (95% CI: 124-163). A BMI ≥ 35 kg/m(2) yielded a hazard ratio for all-cause mortality of 1.94 (95% CI: 1.11-3.42) in comparison to non-obese subjects (BMI <30 kg/m(2)). For the combination of cardiovascular morbidity plus all-cause mortality, a BMI ≥ 35 kg/m(2) had a hazard ratio of 1.84 (95% CI: 1.15-2.93) compared to non-obese subjects.A BMI ≥ 35 kg/m(2) is an important predictor of both overall mortality and of the combination of cardiovascular morbidity plus all-cause mortality

Characteristics of the participants who were and were not lost to follow-up.

<p>Quantitative variables are summarized through mean and standard deviation (SD). Categorical variables are expressed as percentages.</p><p>SBP: systolic blood pressure; DPB: diastolic blood pressure; BMI: body mass index; IHD: ischemic heart disease; CVD: cardiovascular diseases; HDL: high-density lipoprotein.</p><p>Characteristics of the participants who were and were not lost to follow-up.</p

Survival probability when assessing overall mortality for obesity classes.

<p>Survival probability when assessing overall mortality for obesity classes.</p