Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study

BACKGROUND: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization. METHODS: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008-2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care. RESULTS: A total of 11,003 (57%) patients had uncontrolled diabetes defined as HbA1c ≥6.5%, and, among those, 5325 participants had HbA1c ≥7.5%. During an average follow-up time of 3.3 years, 499 deaths, 912 hospitalizations for coronary heart disease (CHD) and 786 hospitalizations for stroke were recorded. We observed a linear and increasingly positive dose-response of HbA1c levels and CHD hospitalization. The relative risk for all-cause mortality and CHD and stroke hospitalization comparing patients with and without uncontrolled diabetes was 1.29 (95 CI 1.08,1.55), 1.38 (95 CI 1.20,1.59) and 1.05 (95 CI 0.91, 1.21), respectively. The population attributable risk (PAR) associated with uncontrolled diabetes was 13.6% (95% CI; 4.0-23.9) for all-cause mortality, 17.9% (95% CI; 10.5-25.2) for CHD and 2.7% (95% CI; - 5.5-10.8) for stroke hospitalization. CONCLUSIONS: In a large general-practice cohort of patients with diabetes, uncontrolled glucose levels were associated with a substantial mortality and cardiovascular disease burden

Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: the ESCARVAL-RISK study

The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all cause mortality and hospitalization due to cardiovascular events in a high-risk population. Methods This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008±2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles. Results 51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/ HDL-Cholesterol: 8.94, 15.09, 6.92. Conclusions In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers

Correction: Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study.

The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk populatio

Automedidas domiciliarias de presión arterial: "Situación actual y nuevas perspectivas"

El método utilizado habitualmente para el diagnóstico y seguimiento de los pacientes hipertensos ha sido la medida de la presión arterial en consulta, pero es un hecho conocido que este método plantea problemas, sesgos del observador, no detecta reacción de alerta en la clínica…, dificultades que afectan a su precisión como método diagnóstico. En los últimos años, las diferentes sociedades científicas internacionales recomiendan, de forma insistente, el uso de medidas de presión arterial fuera de la consulta (domiciliarias o ambulatorias), y con aparatos automáticos validados. Datos de algunos estudios sugieren que si solo utilizamos las medidas de la consulta nos podemos equivocar en torno al 15 o 20% de las veces que tomemos decisiones, tanto en el diagnóstico como en el seguimiento de los pacientes. Las medidas domiciliarias de presión arterial son un método sencillo y muy accesible que tienen una reproducibilidad y un valor pronóstico similar al de las medidas que se realizan con monitorización ambulatoria, cuya disponibilidad actualmente es muy limitada. Las auto medidas ambulatorias aportan además la importante utilidad de poder mejorar el control de los hipertensos. Los profesionales sanitarios y los pacientes deben conocer la metodología de uso de la medida de presión arterial domiciliaria, sus utilidades y sus limitaciones

Is the physician's behavior in dyslipidemia diagnosis in accordance with guidelines? Cross-sectional ESCARVAL study.

Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires ≥2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC).To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors.Cross-sectional.All health center visits in the second half of 2010 in the Valencian Community (Spain).11,386 nondyslipidemic individuals aged ≥20 years with ≥2 lipid determinations.Gender, atrial fibrillation, hypertension, diabetes, cardiovascular disease, age, and ESCARVAL training course. Lipid groups: normal (TC<5.17 mmol/L and normal HDL-c [≥1.03 mmol/L in men and ≥1.29 mmol/L in women], TC inertia (TC≥5.17 mmol/L and normal HDL-c), HDL-c inertia (TC<5.17 mmol/L and low HDL-c), and combined inertia (TC≥5.17 mmol/L and low HDL-c).TC inertia: 38.0% (95% CI: 37.2-38.9%); HDL-c inertia: 17.7% (95% CI: 17.0-18.4%); and combined inertia: 9.6% (95% CI: 9.1-10.2%). The profile associated with TC inertia was: female, no cardiovascular risk factors, no cardiovascular disease, middle or advanced age; for HDL-c inertia: female, cardiovascular risk factors and cardiovascular disease; and for combined inertia: female, hypertension and middle age.Cross-sectional study, under-reporting, no analysis of some cardiovascular risk factors or other lipid parameters.A more proactive attitude should be adopted, focusing on the full diagnosis of dyslipidemia in clinical practice. Special emphasis should be placed on patients with low HDL-c levels and an increased cardiovascular risk

Descriptive analysis of inertia groups for dyslipidemia at primary health care centers in a Spanish region.

<p>Abbreviations: n(%), absolute frequency(relative frequency); TC, total cholesterol; HDL-c, high density lipoprotein cholesterol.</p

Analysis of factors associated with inertia groups for dyslipidemia at primary health care centers in a Spanish region.

<p>Abbreviations: TC, total cholesterol; HDL-c, high density lipoprotein cholesterol; Adj. OR, Adjusted Odds Ratio; CI, Confidence Interval.</p><p>Goodness-of-fit of the inertia models: TC: <i>X²</i> = 552.7, p<0.001; HDL-c: <i>X</i>² = 182.9, p<0.001; Combined: <i>X</i>² = 205.7, p<0.001.</p><p>OR adjusted for gender, atrial fibrillation, hypertension, diabetes mellitus, cardiovascular disease, age groups and the on-line course.</p><p>^*: Reference.</p