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

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

Control de la hipertensión arterial en la población española = 65 años asistida en atención primaria

Introducción y objetivos. Se dispone de escasa información sobre el control de la hipertensión arterial en la población de mayor edad. El objetivo de este estudio fue analizar el grado de control de la hipertensión arterial en una amplia muestra de españoles = 65 años asistidos en atención primaria, los factores asociados al mal control y la conducta del médico ante esa situación. Pacientes y método. Estudio transversal realizado en hipertensos = 65 años tratados farmacológicamente. Se midió la presión arterial (PA) siguiendo normas estandarizadas y se consideró que había un control óptimo si era < 140/90 mmHg (en diabéticos < 130/85 mmHg). Resultados. Se incluyó a 5.970 pacientes (edad media, 72,4 años; 62,8%, mujeres). El 33,5% presentó un buen control sistólico-diastólico, el 35,5% sólo sistólico y el 76,2% únicamente diastólico. El grado de control fue significativamente mayor (p < 0,001) por las tardes (39,8%) y en los pacientes que habían tomado la medicación antihipertensiva el día de la visita (35,1%). El 12,9% de los diabéticos mostró una PA < 130/85 mmHg y el 9,7% < 130/80 mmHg. El médico modificó su conducta terapéutica en el 17,2% de los no controlados. Conclusiones. Tan sólo 3 de cada 10 hipertensos españoles = 65 años tienen la PA bien controlada. Hay diferencias apreciables en el grado de control según el horario de consulta y la toma previa de antihipertensivos. La conducta terapéutica del médico ante el mal control es demasiado tolerante

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

Study sample diagram and main results after an average follow-up of 10.6 years.

<p>BMI: body mass index; CI, confidence interval; CVD: cardiovascular disease.</p

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

Survival probability for either cardiovascular morbidity or overall mortality between obesity classes.

<p>Survival probability for either cardiovascular morbidity or overall mortality between obesity classes.</p

Hazard ratios of predictor variables for outcomes.

<p>Adj. HR: adjusted hazard ratio; CI: confidence interval; CVD: cardiovascular disease; HDL-c: high-density lipoprotein cholesterol; BMI: body mass index. Control variables in all models were age, gender, diabetes, hypertension, smoking status, personal history of cardiovascular disease, hypercholesterolemia, high-density lipoprotein cholesterol/triglycerides ratio and BMI.</p><p>Hazard ratios of predictor variables for outcomes.</p