Effectiveness of Statins as Primary Prevention in People With Different Cardiovascular Risk: A Population-Based Cohort Study

The purpose was to analyze statin effectiveness in a general population with differing levels of coronary heart disease (CHD) risk. Patients (35-74 years) without previous cardiovascular disease were included and stratified according to 10-year CHD risk ( < 5%, 5-7.4%, 7.5-9.9%, and 10-19.9%). New users were categorized according to their medical possession ratio (MPR). The main outcome was atherosclerotic cardiovascular disease (ASCVD) (myocardial infarction and ischemic stroke). In adherent patients (MPR 70%), statin treatment decreased ASCVD risk across the range of coronary risk (from 16-30%). The 5-year number needed to treat (NNT) was 470 and 204 in the risk categories < 5% and 5-7.4%, respectively, and 75 and 62 in the 7.5-9.9% category than in the 10-19.9% category, respectively. Statin therapy should remain a priority in patients at high 10-year CHD risk (10-19.9%). Most patients with intermediate risk could benefit from statin treatment, but the treatment decision should focus on the net benefit, safety, and patient preference, given the higher NNT

Palaeoenvironmental reconstructions through compositional data analysis: the CoDaMAT method

We present a modern analog technique (CoDaMAT) based on compositional data analysis (Aitchison, 2003). In order to reconstruct palaeoenvironmental parameters, CoDaMAT adopts the Aitchison distance (Aitchison, 2000; 2003), obtained from relative abundances expressed in log-ratios (logarithm of ratios), as a “natural” measure of similarity between modern and fossil assemblages. The number of modern analogs from which obtain the palaeoestimates was determined through cross-validation techniques taking modern assemblages as the training data set. Atypicality index was considered to detect past no-analog conditions. The average of distances and expected maximum estimate errors were taken into account to evaluate the quality of palaeoestimates. The method has been tested on Mediterranean and Atlantic planktonic foraminiferal assemblages to reconstruct past sea surface temperatures (SST). Due to the peculiar oceanographical asset of the Mediterranean, no-analog conditions may represent an important problem in attempting the reconstruction of glacial SST. Keeping in mind these limitations, we obtained for the Tyrrhenian sea, at 15 ka BP (during the Greenland stadial GS2-a), summer and winter SST estimates respectively 12°C and 6°C lower than present. These are the lowest values reached during the last 34 ka. In the coldest interval of the Greenland stadial GS1 (Younger Dryas), reconstructed summer and winter SST were respectively 11°C and 5°C lower than present. In comparison with previous foraminiferal based reconstructions (de Abreu et al., 2003), the CoDaMAT palaeoestimates of Atlantic ocean surface temperatures for the last 200 ka show a stronger coherence with the alkenones and stable isotope record (Pailler and Bard, 2002)

Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study

Background Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. Objective To study the association between deprivation and incidence of common cancer types in a Southern European region. Methods Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009–2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. Results SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64–2.01], IRR 1.60 [1.34–1.90], IRR 1.22 [1.07–1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80–1.00], IRR 0.91 [0.78–1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08–1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84–0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11–1.45]), prostate (0.74 [0.69–0.80]), and breast (0.76 [0.71–0.81]) cancer. Conclusions Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas

Association between chronic immune-mediated inflammatory diseases and cardiovascular risk

Objective To examine the association between chronic immune-mediated diseases (rheumatoid arthritis, systemic lupus erythematosus, or the following chronic immune-mediated inflammatory diagnoses groups: inflammatory bowel diseases, inflammatory polyarthropathies, systemic connective tissue disorders and spondylopathies) and the 6-year coronary artery disease, stroke, cardiovascular disease incidence and overall mortality; and to estimate the population attributable fractions for all four end-points for each chronic immune-mediated inflammatory disease. Methods Cohort study of individuals aged 35-85 years, with no history of cardiovascular disease from Catalonia (Spain). The coded diagnoses of chronic immune-mediated diseases and cardiovascular diseases were ascertained and registered using validated codes, and date of death was obtained from administrative data. Cox regression models for each outcome according to exposure were fitted to estimate hazard ratios (HR) in two models: (1) after adjustment for sex, age, cardiovascular risk factors and (2) further adjusted for drug use. Population attributable fractions were estimated for each exposure. Results Data were collected from 991,546 participants. The risk of cardiovascular disease was increased in systemic connective tissue disorders [Model 1: HR=1.38 (95% confidence interval=1.21-1.57) and 2: HR=1.31 (1.15-1.49)], rheumatoid arthritis [HR=1.43 (1.26-1.62) and HR=1.31 (1.15-1.49)] and inflammatory bowel diseases [HR=1.18 (1.06-1.32) and HR=1.12 (1.01-1.25)]. The effect of anti-inflammatory treatment was significant in all instances [HR=1.50 (1.24-1.81); HR=1.47 (1.23-1.75); HR=1.43 (1.19-1.73), respectively]. The population attributable fractions for all three disorders were 13.4%, 15.7%, and 10.7%, respectively. Conclusion Systemic connective tissue disorders and rheumatoid arthritis conferred the highest cardiovascular risk and population impact, followed by inflammatory bowel diseases

Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care

Anna Ponjoan,1&ndash;3 Josep Garre-Olmo,2 Jordi Blanch,1 Ester Fages,1 Lia Alves-Cabratosa,1 Ruth Mart&iacute;-Lluch,1&ndash;3 Marc Comas-Cuf&iacute;,1 D&iacute;dac Parramon,1,4 Mar&iacute;a Garcia-Gil,1 Rafel Ramos1,5 1Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain; 2Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain; 3Santa Clara Primary Care Health Center, Catalan Health Institute, Girona, Catalonia, Spain; 4Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vall&egrave;s), Catalonia, Spain; 5Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain Purpose: Updated estimates of incidence and prevalence of dementia are crucial to ensure adequate public health policy. However, most of the epidemiological studies in the population in Spain were conducted before 2010. This study assessed the validity of dementia diagnoses recorded in electronic health records contained in a large primary-care database to determine if they could be used for research purposes. Then, to update the epidemiology of dementia in Catalonia (Spain), we estimated crude and standardized prevalence and incidence rates of dementia in Catalonia in 2016. Methods: The System for the Development of Research in Primary Care (SIDIAP) database contains anonymized information for &gt;80% of the Catalan population. Validity of dementia codes in SIDIAP was assessed in patients at least 40 years old by asking general practitioners for additional evidence to support the diagnosis. Crude and standardized incidence and prevalence (95% CI) in people aged &ge;65 years were estimated assuming a Poisson distribution. Results: The positive predictive value of dementia diagnoses recorded in SIDIAP was estimated as 91.0% (95% CI 87.5%&ndash;94.5%). Age- and sex-standardized incidence and prevalence of dementia were 8.6/1,000 person-years (95% CI 8.0&ndash;9.3) and 5.1% (95% CI 4.5%&ndash;5.7%), respectively. Conclusion: SIDIAP contains valid dementia records. We observed incidence and prevalence estimations similar to recent face-to-face studies conducted in Spain and higher than studies using electronic health data from other European populations. Keywords: family physician, accuracy, quality, positive predictive value, electronic medical record, real-world dat

Effectiveness of statins as primary prevention in people with gout: A population-based cohort study

Background: Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. Aim: To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. Methods: A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. Results: Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). Conclusions: Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.</p

Association between chronic immune-mediated inflammatory diseases and cardiovascular risk

OBJECTIVE: To examine the association between chronic immune-mediated diseases (rheumatoid arthritis, systemic lupus erythematosus or the following chronic immune-mediated inflammatory diagnoses groups: inflammatory bowel diseases, inflammatory polyarthropathies, systemic connective tissue disorders and spondylopathies) and the 6-year coronary artery disease, stroke, cardiovascular disease incidence and overall mortality; and to estimate the population attributable fractions for all four end-points for each chronic immune-mediated inflammatory disease. METHODS: Cohort study of individuals aged 35-85 years, with no history of cardiovascular disease from Catalonia (Spain). The coded diagnoses of chronic immune-mediated diseases and cardiovascular diseases were ascertained and registered using validated codes, and date of death was obtained from administrative data. Cox regression models for each outcome according to exposure were fitted to estimate HRs in two models 1 : after adjustment for sex, age, cardiovascular risk factors and 2 further adjusted for drug use. Population attributable fractions were estimated for each exposure. RESULTS: Data were collected from 991 546 participants. The risk of cardiovascular disease was increased in systemic connective tissue disorders (model 1: HR=1.38 (95% CI 1.21 to 1.57) and model 2: HR=1.31 (95% CI 1.15 to 1.49)), rheumatoid arthritis (HR=1.43 (95% CI 1.26 to 1.62) and HR=1.31 (95% CI 1.15 to 1.49)) and inflammatory bowel diseases (HR=1.18 (95% CI 1.06 to 1.32) and HR=1.12 (95% CI 1.01 to 1.25)). The effect of anti-inflammatory treatment was significant in all instances (HR=1.50 (95% CI 1.24 to 1.81); HR=1.47 (95% CI 1.23 to 1.75); HR=1.43 (95% CI 1.19 to 1.73), respectively). The population attributable fractions for all three disorders were 13.4%, 15.7% and 10.7%, respectively. CONCLUSION: Systemic connective tissue disorders and rheumatoid arthritis conferred the highest cardiovascular risk and population impact, followed by inflammatory bowel diseases

Prevalence of lower extremity peripheral arterial disease in individuals with chronic immune mediated inflammatory disorders.

OBJECTIVE: To compare the prevalence of lower extremity peripheral artery disease (PAD) and to assess whether age-associated progression in ankle-brachial index (ABI) differs between individuals with chronic immune-mediated inflammatory diseases (CIID) and the general population. METHODS: Pooled analysis with data from individuals aged 50 years and older with ABI measurements, obtained from population-based cross-sectional studies conducted in Catalonia (Spain). Information on three CIID diagnoses (i.e., inflammatory bowel disease, systemic connective tissue disorders, and inflammatory polyarthropathies and spondylopathies, considered as one entity for purposes of analysis) was obtained from electronic medical records. To ascertain the statistical association between PAD and CIID, logistic regression models were fitted and adjusted for age, sex, and cardiovascular risk factors. We tested the interaction between age and CIID diagnosis for ABI values. RESULTS: We included 8799 individuals, 312 (3.6%) with CIID. The age-standardized prevalence of PAD was higher in the CIID group (12% vs. 6% in general population, p = 0.001), and the model adjusted for age, sex, and cardiovascular risk factors also showed higher risk in individuals with CIID [Odds Ratio (95% confidence interval) = 1.65 (1.15-2.38); p = 0.007]. The inflammatory polyarthropathies/spondylopathies diagnosis was significantly associated with PAD in the fully adjusted model [1.80 (1.18-2.75); p = 0.006]. The atherosclerotic process was accelerated in individuals with CIID, compared to the general population (p for interaction<0.001). CONCLUSION: In individuals with CIID, age-standardized prevalence of PAD was significantly higher than in the general population and the atherosclerotic process was accelerated. However, only inflammatory polyarthropathies/spondylopathies was associated with significant risk of PAD.Supported by grants from the Instituto de Salud Carlos III FEDER (Programa HERACLES RD12/0042; RedIAPP RD12/0005; CP12/ 03287), AGAUR (2014 SGR 240 and 2011BP-B00169 postdoctoral contract to IRD eBeatriu de Pinos Program co- financed by the European Commission), Health Research Fund (FIS 2003/HERMES PI20471; PI070403; ETES: I07/90415; FIS11/06765); and Ministry of Education and Science (SAF2003/1240)