Estilos de vida y función vascular. Estudio EVIDENT

[ES] El envejecimiento se asocia a una mayor rigidez arterial y función vascular. Entre los estilos de vida modificables los mas importantes que han demostrado relación con la enfermedad cardiovascular es el tabaco, la falta de actividad fisica y los patrones de alimentacion poco saludables. Existe una relación entre el tabaquismo activo y la aterosclerosis carotídea, medida con el grosor de la íntima media de la arteria carótida. Se ha asociado también con un incremento en la rigidez arterial y en los parámetros hemodinámicos centrales. A pesar de toda la evidencia, no hemos encontrado ningún estudio que evalúe en la misma base poblacional los efectos crónicos del consumo de tabaco en el envejecimiento vascular valorado con diferentes parámetros de estructura y función vascular. Entre los patrones de alimentación, es la Dieta mediterránea, el que más probabilidades tiene de proporcionar protección contra la enfermedad cardiovascular. El estudio PREDIMED consiguió un 30% de reducción de complicaciones cardiovasculares a los 4 años de seguimiento. Estos efectos antiaterogénicos podrian ser debidos a sus múltiples componentes: Ácidos grasos omega 3, antioxidantes, flavonoides. Kiwi: Los patrones de alimentación saludables se caracterizan por un alto consumo de frutas y verduras. Una de las frutas con mayor capacidad antioxidante es el kiwi. Estos efectos anti-oxidantes ya se han descrito en vivo sobre las plaquetas, lípidos plasmáticos y resistencia a la insulina. A pesar de toda la evidencia, el efecto del consumo de kiwi sobre variables clínicas en grandes poblaciones ha sido mínimamente testado. Cada vez está cobrando una mayor relevancia los efectos de los carbohidratos (CHO) y su composición sobre la función endotelial. El índice glucémico (IG) es una medida de la rapidez con la que un CHO es absorbido en comparación con un producto de referencia (glucosa pura). La carga glucémica (CG) se utiliza para representar la cantidad y la calidad de los hidratos de carbono. Dietas altas en IG o CG se asocian con un mayor riesgo de enfermedad cardiovascular. Sin embargo, el efecto del IG y de la CG sobre marcadores intermedios de enfermedad cardiovascular no ha sido descrito. La falta de actividad física es un factor de riesgo para la enfermedad y la mortalidad cardiovascular. Existe una relación dosis-respuesta entre el tiempo sentado y mortalidad global y enfermedad cardiovascular. El tiempo viendo la televisión se asocia a factores de riesgo cardiovascular como la DM 2, la obesidad, el colesterol, marcadores inflamatorios y presión arterial. Sin embargo, no hemos encontrado descrita la relación entre el tiempo diario sentado invertido delante de una pantalla de televisión y el envejecimiento vascular en personas sanas. Objetivos: 1. Explorar la existencia de agrupaciones de individuos en función de sus estilos de vida, incluyendo actividad física, tabaco, consumo de alcohol y hábitos de alimentación en una muestra aleatoria de población adulta procedente del estudio EVIDENT. 2. Analizar la asociación del índice glucémico y la carga glucémica de la dieta habitual con el índice de aumento periférico en una muestra aleatoria de población adulta procedente del estudio EVIDENT. 3. Analizar la relación del consumo de kiwi con valores plasmáticos de lípidos, fibrinógeno y resistencia a la insulina en una muestra aleatoria de población adulta procedente del estudio EVIDENT en el contexto de una dieta y ejercicio físico habituales. 4. Evaluar la relación entre el consumo de tabaco y los parámetros de estructura y función vascular en una muestra aleatoria de población adulta procedente del estudio EVIDENT. 5. Explorar la relación del tiempo sentado viendo la televisión con el índice de aumento periférico y otros parámetros hemodinámicos centrales en una muestra aleatoria de población adulta procedente del estudio EVIDENT. A raíz del estudio llevado a cabo se estrajeron las siguientes conclusiones: 1. En los participantes del estudio EVIDENT se han identificado tres patrones de comportamiento de acuerdo con sus estilos de vida: "Cluster no saludable" con los estilos de vida menos sanos y los parámetros clínicos más desfavorables; "Cluster saludable/actividad física", caracterizado por ser el que realiza más actividad física y por tener las cifras más elevadas de HDL; y "Cluster saludable/dieta" que se caracteriza por tener los mejores hábitos alimentarios y menor presión arterial. 2. El índice y la carga glucémica se asociaron directamente con el índice de aumento periférico en adultos sin enfermedad cardiovascular independientemente de la edad, sexo, actividad física y otros factores de confusión. 3. El consumo de al menos un kiwi por semana se asocia con concentraciones plasmáticas más bajas de fibrinógeno, un mejor perfil de lípidos en plasma y una mejora en la resistencia a la insulina en el contexto de una dieta y ejercicio regulares. 4. Entre los parámetros de estructura y la función vascular analizados, sólo el GIM muestra asociación con el tabaquismo, después de ajustar por factores de confusión. 5. El tiempo dedicado a ver la televisión se correlacionó directamente con el índice de aumento periférico en población adulta. Esta relación se mantuvo incluso después de ajustar por la actividad física, la edad, el sexo y otros factores de riesgo cardiovascular

Influencia de los hábitos dietéticos en la lesión vascular arterioesclerótica de diabéticos e hipertensos

Trabajo de Grado realizado en el Departamento de Fisiología y Farmacología de la Universidad de Salamanca

Cocoa intake and arterial stiffness in subjects with cardiovascular risk factors

<p>Abstract</p> <p>Background</p> <p>To analyze the relationship of cocoa intake to central and peripheral blood pressure, arterial stiffness, and carotid intima-media thickness in subjects with some cardiovascular risk factor.</p> <p>Findings</p> <p>Design: A cross-sectional study of 351 subjects (mean age 54.76 years, 62.4% males). Measurements: Intake of cocoa and other foods using a food frequency questionnaire, central and peripheral (ambulatory and office) blood pressure, central and peripheral augmentation index, pulse wave velocity, ambulatory arterial stiffness index, carotid intima-media thickness, and ankle-brachial index.</p> <p>Results: Higher pulse wave velocity and greater cardiovascular risk were found in non-cocoa consumers as compared to high consumers (<it>p </it>< 0.05). In a multivariate analysis, these differences disappeared after adjusting for age, gender, the presence of diabetes, systolic blood pressure and antihypertensive and lipid-lowering drug use. All other arterial stiffness measures (central and peripheral augmentation index, ambulatory arterial stiffness index, ankle-brachial index, and carotid intima-media thickness) showed no differences between the different consumption groups.</p> <p>Conclusions</p> <p>In subjects with some cardiovascular risk factors, cocoa consumption does not imply improvement in the arterial stiffness values.</p> <p>Trial Registration</p> <p>Clinical Trials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01325064">NCT01325064</a>.</p

Platform Image Processing Applied to the Study of Retinal Vessels

Recent studies have found retinal vessel caliber to be related to the risk of hypertension, left ventricular hypertrophy, metabolic syndrome, stroke and others coronary artery diseases. The vascular system in the human retina is easily perceived in its natural living state by the use of a retinal camera. Nowadays, there is general experimental agreement on the analysis of the patterns of the retinal blood vessels in the normal human retina. The development of automated tools designed to improve performance and decrease interobserver variability, therefore, appears necessary. This paper presents a study focused on developing a technological platform specialized in assessing retinal vessel caliber and describing the relationship of the results obtained to cardiovascular risk

Utilización de una cuenta de Twitter como herramienta docente complementaria en asignaturas del Grado de Enfermería y en la búsqueda de información científica relacionada con la COVID-19

Memoria ID-077 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Relationship between intima-media thickness of the common carotid artery and arterial stiffness in subjects with and without type 2 diabetes: a case-series report

Background: We examined the relationship between the intima-media thickness of the common carotid artery (CCA-IMT) and arterial stiffness, assessed by pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI) and the augmentation index (AIx) in subjects with and without type 2 diabetes. Methods: A case-series study was made in 366 patients (105 diabetics and 261-non-diabetics). Ambulatory blood pressure monitoring was performed on a day of standard activity with the SpaceLabs 90207 system. AASI was calculated as "1-slope" from the within-person regression of diastolic-on-systolic ambulatory blood pressure readings. PWV and AIx were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of CCA-IMT. Results: PWV, AASI and CCA-IMT were found to be greater in diabetic patients, while no differences in AIx were observed between the two groups. CCA-IMT was independently correlated to the three measures of arterial stiffness in both groups. We found an increase in CCA-IMT of 0.40, 0.24 and 0.36 mm in diabetics, and of 0.48, 0.17 and 0.55 mm in non-diabetics for each unit increase in AASI, AIx and PWV. The variability of CCA-IMT was explained mainly by AASI, AIx and gender in diabetic patients, and by age, gender, AASI and PWV in non-diabetic patients. Conclusions: CCA-IMT showed a positive correlation to PWV, AASI and AIx in subjects with and without type 2 diabetes. However, when adjusting for age, gender and heart rate, the association to PWV was lost in diabetic patients, in the same way as the association to Alx in non-diabetic patients. The present study demonstrates that the three measures taken to assess arterial stiffness in clinical practice are not interchangeable, nor do they behave equally in all subjects

Screening Physical Activity in Family Practice : Validity of the Spanish Version of a Brief Physical Activity Questionnaire

The use of brief screening tools to identify inactive patients is essential to improve the efficiency of primary care-based physical activity (PA) programs. However, the current employment of short PA questionnaires within the Spanish primary care pathway is unclear. This study evaluated the validity of the Spanish version of a Brief Physical Activity Assessment Tool (SBPAAT). A validation study was carried out within the EVIDENT project. A convenience sample of patients (n = 1,184; age 58.9±13.7 years; 60.5% female) completed the SBPAAT and the 7-day Physical Activity Recall (7DPAR) and, in addition, wore an accelerometer (ActiGraph GT3X) for seven consecutive days. Validity was evaluated by measuring agreement, Kappa correlation coefficients, sensitivity and specificity in achieving current PA recommendations with the 7DPAR. Pearson correlation coefficients with the number of daily minutes engaged in moderate and vigorous intensity PA according to the accelerometer were also assessed. Comparison with accelerometer counts, daily minutes engaged in sedentary, light, moderate, and vigorous intensity PA, total daily kilocalories, and total PA and leisure time expenditure (METs-hour-week) between the sufficiently and insufficiently active groups identified by SBPAAT were reported. The SBPAAT identified 41.3% sufficiently active (n = 489) and 58.7% insufficiently active (n = 695) patients; it showed moderate validity (k = 0.454, 95% CI: 0.402-0.505) and a specificity and sensitivity of 74.3% and 74.6%, respectively. Validity was fair for identifying daily minutes engaged in moderate (r = 0.215, 95% CI:0.156 to 0.272) and vigorous PA (r = 0.282, 95% CI:0.165 to 0.391). Insufficiently active patients according to the SBPAAT significantly reported fewer counts/minute (-22%), fewer minutes/day of moderate (-11.38) and vigorous PA (-2.69), spent fewer total kilocalories/day (-753), and reported a lower energy cost (METs-hour-week) of physical activities globally (-26.82) and during leisure time (-19.62). The SBPAAT is a valid tool to identify Spanish-speaking patients who are insufficiently active to achieve health benefits

Sedentary behaviour patterns and carotid intima-media thickness in Spanish healthy adult population

Objective: The aim of this study was to analyze the association between sedentary behaviour, as assessed by an accelerometer, and mean carotid intima-media thickness (IMT). Methods: The study included 263 healthy subjects belonging to the EVIDENT study (59.3% women). Carotid IMT was measured by carotid ultrasonography. Sedentary behaviour was measured objectively over 7 days using ActiGraph accelerometers. Thresholds of 10 consecutive minutes were used to establish sedentary bouts, and assess the number (n/day), and length 10 min (min/day). Results: Total sedentary time and sedentary time in bouts 10 min was higher in participants with a larger mean carotid IMT (>P75). Otherwise, this sedentary time in bouts 10 min parameter was weakly associated with augmented carotid IMT injury in the logistic regression model. Conclusion: Total sedentary time and sedentary time in bouts 10 min, as assessed by accelerometer, was positively but weakly associated with carotid IMT. Equally, this sedentary time in bouts 10 min was associated with carotid injury, but disappears after adjusting for potential confounders. These findings support that reducing sedentary time and increasing breaks in bouts of sedentary time might represent a useful additional strategy in the cardiovascular disease prevention. Trial Registration: Clinical Trials.gov Identifier: NCT01083082.The EVIDENT Grou

Abdominal obesity as a mediator of the influence of physical activity on insulin resistance in Spanish adults

Objective. The aim of the study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and insulin resistance (IR) in Spanish adults and to examine whether this relationship is mediated by abdominal obesity (waist circumference —WC). Methods. The cross-sectional study included 1162 healthy subjects belonging to the EVIDENT study (mean age 55.0±13.3 years; 61.8%women) from six different Spanish provinces. Moderate-to-vigorous physical activiity (MVPA) was measured objectively over 7 days using Actigraph accelerometers, collecting data in 60-second epochs, and retaining respondents with ≥4 valid days for the analysis. The homeostasis model of assessment (HOMA-IR) was used to determine IR, and its individual components – fasting glucose and insulin – were determined using standard protocols. Linear regressionmodelswere fitted according to Baron and Kenny's procedures for mediation analysis. Results. Fasting insulin and HOMA-IR levels were significantly worse in adults who spent fewer minutes in MVPA (first quartile ≤ 30.1 and 22.7 min/day in men and women, respectively) after adjusting for age, sex, smoking habits, drinking habits, accelerometer wear time, sedentary time, and Mediterranean diet adherence. However,when WC was added to the ANCOVA models as a covariate, the effects disappeared.Mediation analysis reported that WC acts as a fullmediator in the relationship between MVPA and IR (HOMA-IR and fasting insulin). Conclusion. These findings show that WC plays a pivotal role in the relationship between MVPA and IR, and therefore highlights that decreasing abdominal obesity might be considered as an intermediate outcome for evaluating interventions aimed at preventing diabetes mellitus.The Evident Grou

Altair: Automatic Image Analyzer to Assess Retinal Vessel Caliber

The scope of this work is to develop a technological platform specialized in assessing retinal vessel caliber and describing the relationship of the results obtained to cardiovascular risk. Population studies conducted have found retinal vessel caliber to be related to the risk of hypertension, left ventricular hypertrophy, metabolic syndrome, stroke, and coronary artery disease. The vascular system in the human retina has a unique property: it is easily observed in its natural living state in the human retina by the use of a retinal camera. Retinal circulation is an area of active research by numerous groups, and there is general experimental agreement on the analysis of the patterns of the retinal blood vessels in the normal human retina. The development of automated tools designed to improve performance and decrease interobserver variability, therefore, appears necessary