Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

BACKGROUND: Ischaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors) using the information gathered by primary care practitioners on cardiovascular health of their population. METHODS: A prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses. RESULTS: Mean age at recruitment was 51.6 ± 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate analyses. After multivariate adjustments, age, male gender, smoking, high total cholesterol, high HDL/LDL ratio, diabetes and overweight remained strongly associated with risk. Relative risks for hypertension in women and for diabetes in men did not reach statistical significance. CONCLUSION: Despite high prevalence of vascular risk factors, incidence rates were lower than those reported for other countries and other periods, but similar to those reported in the few population-based studies in Spain. Effect measures of vascular risk factors were mainly as reported worldwide and support the hypothesis that protective factors not considered in this study must exist as to explain low rates. This study shows the feasibility of conducting epidemiological cohort studies in primary-care settings

Prevalencia del consumo de medicamentos en la población adulta de Cataluña

Objetivos: Describir la prevalencia de la utilización de medicamentos según factores sociodemográficos y estado de salud autopercibido en la población adulta. Métodos: Examen de salud transversal del estudio CRONICAT/MONICA-Cataluña realizado en 1994-1996 en una muestra aleatoria de la población general de 25 a 64 años. Se interrogó a 3.421 participantes (tasa de respuesta del 72%) con cuestionario abierto sobre los medicamentos consumidos durante las dos semanas previas y otros hábitos de salud. Los medicamentos se codificaron posteriormente según la clasificación ATC (versión 1993). Resultados: Mayor proporción de mujeres (38%) que de varones (26%) autopercibió peor estado de salud (p < 0,001). El consumo total de medicamentos ajustado por edad fue: varones, del 57% (intervalo de confianza [IC] del 95%, 55-59), y en mujeres, del 76% (IC del 95%, 74-78). Excluyendo los anticonceptivos, el consumo regular fue: varones, del 35% (IC del 95%, 33-37), y en mujeres, del 48% (IC del 95%, 46-51). Tomaron más de un medicamento el 29% de los varones y el 48% de las mujeres (p < 0,001). Ni el nivel educativo ni el estado civil influyeron en la toma de medicamentos. Mayor proporción de jubilados o pensionistas consumieron medicamentos (68%; IC del 95%, 62-74) que los trabajadores activos (54%; IC del 95%, 52-57) sólo en los varones. Los medicamentos más consumidos fueron para el sistema nervioso (35% en varones; 51% en mujeres; p < 0,001); digestivo (15%) y cardiovascular (9% en varones; 13% en mujeres; p < 0,001). La mayoría de la medicación consumida fue prescrita por el especialista (40%) y una cuarta parte fue autoprescrita. Conclusiones: La prevalencia del consumo total de medicamentos en la población adulta de Cataluña es alta, especialmente entre las mujeres, quienes autoperciben peor salud. Las políticas de racionalización del gasto farmacéutico deberían considerar el patrón epidemiológico

Prevalencia del consumo de medicamentos en la población adulta de Cataluña Prevalence of drug utilization in the adult population of Catalonia, Spain

Objetivos: Describir la prevalencia de la utilización de medicamentos según factores sociodemográficos y estado de salud autopercibido en la población adulta. Métodos: Examen de salud transversal del estudio CRONICAT/MONICA-Cataluña realizado en 1994-1996 en una muestra aleatoria de la población general de 25 a 64 años. Se interrogó a 3.421 participantes (tasa de respuesta del 72%) con cuestionario abierto sobre los medicamentos consumidos durante las dos semanas previas y otros hábitos de salud. Los medicamentos se codificaron posteriormente según la clasificación ATC (versión 1993). Resultados: Mayor proporción de mujeres (38%) que de varones (26%) autopercibió peor estado de salud (p Objectives: To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. Methods: Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). Results: A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was higher in retired individuals and pensioners (68%; 95%CI: 62-74) than in active workers (54%; 95%CI: 52-57). The most frequently used drugs were those for the nervous system (35% men and 51% women; p < 0.001), alimentary tract (15%) and the cardiovascular system (9% and 13%; p < 0.001). Most drugs (40%) were prescribed by specialists and one quarter was self-prescribed. Conclusions: The prevalence of total drug utilization in the adult population of Catalonia is high, specially among women, who self-perceived worse health status. Policies of rationalization of drug expenditures should take the epidemiological pattern into account