Search

Background and Objective: This study was aimed at determining the degree of blood pressure (BP) control in hypertensive patients attended in primary care (PC) settings., Patients and Method: Cross-sectional, multicenter study. Hypertensive patients ≥18 years under antihypertensive treatment attended in Spanish PC settings were included. BP control was regarded as optimum when BP values were <140/90mmHg in general population and <130/80mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. BP control was also calculated for all patients when it was <140/90mmHg., Results: A total of 12,961 hypertensive patients (52.0% women) with a mean age of 66.3 (±11.4) years were included. A percentage of 46.3 (95% CI: 45.4-47.1) presented good systolic BP and diastolic BP control; 61.1% (IC 95%: 60.2-61.9) of patients presented good BP control<140/90. A percentage of 63.6% was treated with combination therapy (44.1% with 2 drugs, 19.5% with 3 or more). BP control was significantly higher in evening measurements (50.4%) than in morning measurements (45.1%), and in patients who had taken the treatment before the visit (47.9%) compared with those who had not (30.5%). Factors such as not taking the medication before the visit, heavy alcohol consumption and dyslipemia were the risk factors mostly associated with a poor BP control (P<.001)., Conclusions: Five out of 10 hypertensive patients treated in PC settings have an optimal BP control. The degree of control of arterial hypertension has improved with respect to the PRESCAP 2006 study., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Background and Objective: This study estimates smoking-attributable mortality in Spain in 2006., Population and Method: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older., Results: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women., Conclusions: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high., (Copyright © 2010. Published by Elsevier Espana.)

Background and Objective: There are no studies in Spain on the extent of obesity in adult immigrants. The aim of this paper is to present the frequency and distribution of obesity among immigrants living in Madrid., Patients and Method: We selected subjects between 18 and 64 years of age. Body Mass Index was used as an estimator of obesity. Immigrant status was defined according to country of birth. The results show the unadjusted and adjusted prevalence of obesity for different immigrant groups., Results: The percentage of obesity was higher in the immigrant population than in the Spanish population, except for the group of immigrants from western countries. According to gender, male immigrants from Eastern Europe and Latin America and women from Asia, Africa and Eastern Europe were the most obese., Conclusion: The highest prevalence of obesity among immigrants has also been observed in studies conducted in other countries. The prevalence of obesity among immigrants may be due to a more intense exposure to obesogenic factors both before arrival and during their residence in Spain.

Background and Objective: Hypertension is highly prevalent in the very elderly. We studied control rates of hypertension according to clinic blood pressure (BP) and ambulatory BP monitoring (ABPM) in treated hypertensives aged > or =80 years., Patients and Method: Data came from the Spanish Society of Hypertension ABPM Registry (CARDIORISC - MAPAPRES project), which comprises a nation-wide network of more than 1,000 physicians sending standardized ABPM registries via web. Between June 2004 and April 2007 we obtained a 33.829-patient database. Control of hypertension was defined at the clinic when office BP was <140/90mmHg and at the ABPM when mean BP during the 24-h period was <130/80mmHg., Results: We identified 2,311 patients (6.8%) aged > or =80 years. Mean age (SD) was 83.1 (3.2) years and 63% were women. Control of clinic BP was observed in 21.5% of cases (95%CI: 19.1-23.9) and control of 24-h BP in ABPM was 42.1% (95%CI: 39.7-45.3). Prevalence of masked hypertension was 7.0% (95%CI: 6.0-8.0) and prevalence of office-resistant control (white coat) was 27.6% (95% CI: 25.7-29.4). Diabetes, kidney disease, and duration of hypertension were associated with lack of control in ABPM., Conclusions: In very old hypertensives, control of clinic BP was 21.5% but ambulatory-based hypertension control was 42.1%. Physicians should be aware that the likelihood of misestimating BP control is high in these subjects. A wider use of ABPM in the elderly with hypertension should be considered.

Background and Objective: Cardiovascular mortality attributable to high blood pressure in Spain is not available at present., Patients and Method: Population attributable risk and number of cardiovascular deaths attributable to high systolic blood pressure (> or = 120 mmHg) were estimated for the Spanish population aged 50-89 years, according to classical formulae. Relative risk data were drawn from the Prospective Studies Collaboration, meta-analysis of 61 studies on blood pressure and mortality, with data on one million subjects (30,000 from South Europe) with no prior vascular disease. Blood pressure prevalence was drawn from 2 nationwide surveys in Spain, for subjects aged 50-59 years and 60-89 years old, respectively. Cardiovascular deaths occurred in Spain were drawn from official statistics (year 2004)., Results: The number of annual cardiovascular deaths attributable to high blood pressure was 44,401, which represents 54% of the carFdiovascular deaths occurred in people over 50 years: 17,312 for ischemic heart disease, 15,599 for stroke, and 11,490 for other cardiovascular diseases. The highest number of attributable deaths lie in hypertension grade 1 and 2 (32,638) and in those over 70 years (36,345). Normal and high-normal blood pressure accounted for 6% of all attributable cardiovascular deaths., Conclusions: One in 2 cardiovascular deaths occurred annually in Spanish individuals over 50 years are attributable to high blood pressure, 90% of them are attributable to hypertension.

Background and Objectives: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control., Patients and Method: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients >or= 18 years, with antihypertensive treatment (>or= 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and <130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease., Results: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p<0.001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p<0.001)., Conclusions: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study.

Background and Objective: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area., Patients and Method: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments., Results: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index., Conclusions: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area.

Background and Objective: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients., Patients and Method: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was > or = 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed., Results: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3)., Conclusions: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients.

Background and Objective: Ambulatory blood pressure monitoring (ABPM) is a useful diagnostic and therapeutic tool in hypertensive patients. This study reports the clinical characteristics of 31,530 patients included in the Spanish Registry of ABPM., Patients and Method: A total number of 767 investigators recruited patients with suspected or confirmed hypertension to whom an ABPM was indicated with a validated device and included them in the study. Mean blood pressures from daytime, nighttime, and the whole 24-hour period were all measured. Circadian patterns were defined depending on nocturnal systolic blood pressure fall: extreme dipper (> 20%), dipper (10%-20%), non-dipper (< 10%) and riser (nocturnal blood pressure increase)., Results: 24-hour, daytime, and nighttime blood pressure values were lower than those obtained at the office. Twenty percent of patients exhibited elevated office blood pressure with normal values on ABPM (<> hypertensives or false resistant) whereas 9% showed increased values on ABPM, but normal at the office (masked hypertension). The non-dipper or riser circadian patterns were present in more than half of the patients (40.2% and 13.4%, respectively) and were associated with an increased cardiovascular risk., Conclusions: Almost one third of hypertensive patients exhibit blood pressure values that are not concordant between office and ABPM. More than a half of patients, especially those at higher risk, present a circadian pattern with an inadequate nocturnal blood pressure fall.

Background and Objective: We intended to estimate the prevalence of dyslipidemia among patients attending outpatient clinics of the Spanish health service., Patients and Method: HISPALIPID is a multicenter, cross-sectional study performed in 33,913 patients (55.7% women) with a mean age of 54.6 +/- 18.3 years attended in outpatient clinics across 15 of the 17 autonomous communities of Spain. 1,461 physicians (78.8% primary care physicians, and 21.2% specialists) participated in the study. Patients were considered having dyslipidemia if their doctor had established a previous diagnosis., Results: A total of 8,256 patients (52.4% women, mean age 62.4 +/- 12.4 years) had been diagnosed with dyslipidemia, representing a global prevalence of 24.3% (CI95%: 23.8-24.8) (M: 26.2%; W:22.9%; P<0.001). The communities with the higher and lower prevalence were the Canary Islands (33.9%) and Cantabria (18.6%), respectively. About 87% dyslipemic patients presented an additional cardiovascular risk factor and 36.7% of dyslipemic patients had an associated cardiovascular disease., Conclusions: The prevalence of dyslipidemia is high in patients attending outpatient clinics of the Spanish health service (one out of four patients). In addition, these patients are at a high cardiovascular risk.

The smoking represents a serious problem of public health. It is in and of itself high-priority to describe the genetic bases of the addiction, the susceptibility to begin the consumption, to be smoking and to develop pathologies related with the tobacco. Markers of susceptibility (I begin, consolidation, modulation and ceasing of the habit), of damage potential -chronic obstructive pulmonary disease (COPD), lung carcinoma-, and of valuation of the adverse goods of the exhibition. Dependence markers, motivation, depression, anxiety and stress are reviewed. As well as tests to value syndrome of abstinence, breathing analytic and functional parameters and quality of life.

Background and Objective: Our purpose was to examine sociodemographic factors and lifestyle customs associated with weight change in the older adult population of Spain., Subjects and Method: Prospective cohort study conducted from 2001 to 2003 among a cohort of 2,384 people representative of the non-institutionalized Spanish population aged 60 years and over. Data were collected through home interviews, and main statistical analysis was performed through polytomous logistic regression., Results: Over the 2-year follow-up, 27.9% of men and 27.3% of women lost > or = 3 kg, and 18.2% of men and 16.9% of women gained > or = 3 kg. Among men, a loss of > or = 3 kg was more likely among former smokers (odds ratio [OR] = 1.58; 95% confidence interval [CI], 1.13-2.23) and among those with higher body mass index (BMI) (p for linear trend < 0.0001). A weight gain of > or = 3 kg was also more frequent in former smokers (OR = 1.93; 95% IC, 1.28-2.90). In addition, the risk of gaining > or = 3 kg decreased progressively with the increase in the frequency of physical activity at leisure time (p for linear trend < 0.0001). Among women, results were similar to those in men, though in former smokers there was no association with weight changes., Conclusions: In the older adult population, BMI, physical activity at leisure time, and a former smoker status are associated with weight change in the short term. Intervention on physical activity should be a priority, because it is the main modifiable factor, is associated with health-related quality of life, and it could contribute to avoid excess weight.

Background and Objective: Certain diseases related to smoking have recently decreased in Spanish adults. This study estimated the burden of smoking-attributable mortality in Spain currently and in previous years., Population and Method: Smoking prevalence and mortality in Spain, and relative risks for death from the Cancer Prevention Study II were used to estimate tobacco-attributable mortality in the Spanish population aged 35 years and over., Results: In 2001, 54,233 deaths were attributable to tobacco use (49,366 in men and 4,867 in women). This represents a global reduction in comparison with the 55,613 deaths attributed to tobacco in 1998 (51,431 in men and 4,182 in women). One out of four current attributable deaths were untimely deaths occurred before age 65 years., Conclusions: A reduction in the number of smoking-attributable deaths is observed for the first time in Spain, as a result of a clear reduction among men. However, the overall decrease of smoking-related deaths is too small, and the burden of smoking-attributable mortality in Spain remains too high.

Background and Objective: Most studies of cardiovascular risk factors (CVRF) conducted in our environment concentrate in a single CVRF. The PREVENCAT study was designed to estimate the control of CVRF in the population attended in primary care presenting arterial hypertension (HT), type 2 diabetes mellitus (DM2) and/or hypercholesterolemia (HC) as well as to assess the prevalence of Metabolic Syndrome in these patients., Patients and Method: Multicenter, cross-sectional study, in patients with HT, DM2 and/or HC, consecutively recruited by primary care physicians in Spain. The blood pressure, cholesterol, basal glycaemia, obesity, smoking and physical activity were assessed. The degree of control of these CVRF and the prevalence of MS were estimated., Results: 2,649 patients were recruited, aged 64 (11.3) years, with a 51.6% of women. The most frequent diagnosis was HT (78.9%), followed by HC (58.4%) and DM2 (37.4%). In the whole sample, the percentages of patients who had a control or had initially normal values of blood pressure, cholesterol and basal glycemia were 40.0% (confidence interval [CI], 95% 38.2-41.9), 42.6% (95% CI, 40.5-44.7) and 62.7% (95% CI, 60.8-64.5), respectively. 15.6% of cases (95% CI, 14.3-17.0) had body mass index < or = 25 kg/m2; 87.5% were non-current smokers (95% CI, 86.2-88.8); and 46.2% practiced regular physical activity (95% CI, 44.3-48.1). 40% of patients had < or = 2 CVRF in good control. The prevalence of metabolic syndrome was 50.6% (95% CI, 48.7-52.5)., Conclusions: The control of the CVRF considered in primary care attended population is insufficient. Hardly one of each 2 patients with HT, DM2 and HC is under control. The overweight and sedentarism control is still poorer.

Background and Objective: This study examined the relationship between leisure-time physical activity (LTPA) and health-related quality of life (HRQL) in the older adult population of Spain., Subjects and Method: Household cross-sectional survey on 3,066 subjects representatives of the non-institutionalized Spanish population aged 60 years and over. Data on LTPA was obtained with a structured questionnaire and HRQL was measured with the SF-36 instrument. Analyses were done through linear regression, where the dependent variable was each of the eight scales of the SF-36 and the main independent variable was LTPA. Analyses were adjusted for sociodemographic and social network variables, health habits, health services use, and chronic diseases., Results: A total of 42.7% subjects had a sedentary activity, 54.2% light LTPA and 3% moderate/intense LTPA. As compared with sedentary activity, light LTPA was associated with a higher score in all SF-36 scales, except for the physical role and emotional role, among men and women. For subjects with light LTPA the increase in score was over 3 points in most SF-scales, which is usually considered as a clinically relevant change in HRQL. Results did not vary materially by age, level of education, obesity or chronic disease. The higher LTPA, the better HRQL (p for linear trend < 0.05 in most scales of the SF-36 questionnaire)., Conclusions: Light LTPA is associated with better HRQL than sedentary activity. Because this association did not change with age, level of education, obesity or chronic disease, it is suggested that most older adults could improve their HRQL with, at least, a light LTPA.

Background and Objective: More information is needed on hypertension control in clinical practice, which includes taking at least two blood pressure (BP) readings and taking into account surgery times and previous antihypertensive drug intake. Our study aimed to assess the optimum degree of BP control in a broad sample of Spanish hypertensive patients in primary care and to determine factors associated with a poor control., Patients and Method: Cross-sectional, multicenter study of hypertensive patients aged over 18 years and treated with drugs during the preceeding three months, who were recruited by general practitioners through consecutive sampling in primary care settings throughout Spain over 3 consecutive days. BP measurements were performed in surgery hours (morning and evening) following standardized methods and averaging two consecutive readings. An average BP lower than 140/90 mm Hg (values lower than 130/85 mm Hg in diabetics) was regarded as optimum BP control., Results: 12 754 patients were included, mean age 63.3 years (10.8), 57.2% women. 36.1% (95% CI, 35.2-36.9) had good systolic blood pressure (SBP) and diastolic blood pressure (DBP) controls, 39.1% (95% CI, 38.3-40.0) had good SBP control only, and 73.1% (95% CI, 72.3-73.9) had good DBP control only. BP control was significantly (*2, p < 0.001) better during evening than during morning measurements (43.6% vs 37.1%) and in patients who had taken antihypertensive treatment before measurement (37.2%) vs. those who had not taken it (21.0%). Factors such as alcohol consumption, sedentary lifestyle, obesity and age were all associated with poor BP control (Wald's (chi 2, p < 0.001)., Conclusions: The results of the PRESCAP 2002 study indicate that approximately 4 out of 10 hypertensive patients treated pharmacologically by primary health care centers in Spain have optimal BP control. Significant differences were found in the degree of control depending on surgery hours and the previous intake of antihypertensive medication.

Background and Objective: The SF-36 Health Survey questionnaire is the most widely used instrument to measure health-related quality of life. Reference measures are needed to interpret its results in clinical and population studies. In 1996, a study provided population-based norms for Spain, but these were not disaggregated by age in subjects aged 75 years and over, even though health status changes with aging among those who overpass such age. Moreover, health status in elderly people from developed countries has improved over the last years. This study obtains population-based norms for the Spanish version of the SF-36 Health Survey in five-year age-groups for those aged 60 to 85 and over., Subjects and Method: Cross-sectional survey on a sample of 3,949 non-institutionalised subjects representative of the Spanish population aged 60 years and over. Information on the SF-36 Health Survey was obtained through house-hold personal interviews. Central position and dispersion statistics, as well as percentiles, were calculated for each of the eight SF-36 scales by age and sex. Cronbach's alpha coefficients were calculated to assess the internal reliability of each scale., Results: Subjects reported higher scores for emotional role (mean [SD] 84.8 [32.9]), social functioning (79.2 [28.0]) and physical role (73.3 [41.1]). For all scales, mean scores were higher (better perceived health) among men than women (p < 0.0001). As age increased, mean scores in all scales decreased (p for linear trend < 0.001) except for mental health (p for linear trend = 0.29 in women, p for lineal trend = 0.14 in men), yet the decrease was greater for physical functioning and physical role. Reliability was very high for all scales (Cronbach's alpha from 0.84 to 0.95). RESULTS were similar to those of the study carried out in 1996., Conclusions: These results extend those obtained in 1996 and facilitate the interpretation of the SF-36 Health Survey values in clinical and population studies in the Spanish population aged 60 years and older.

Background: Our purpose was to examine the relationship of overweight and obesity with cardiovascular disorders., Patients and Method: Data from the 1993 Spanish National Health Survey (16,692 subjects with a body mass index [BMI] >= 18.5 kg/m2)., Results: After adjustment for age, residence city size and tobacco consumption, we observed a positive dose-response relationship (p linear trend < 0.05) of BMI >= 18.5 kg/m2 with hypertension, hypercholesterolemia and diabetes in both sexes, as well as with heart diseases in women. These associations decreased with age., Conclusions: Overweight and obesity are associated with a greater frequency of cardiovascular disorders in Spain.

Background: Between 1993 and 1997, smoking prevalence remained stable in Spain yet age-adjusted death rates by smoking-related diseases decreased. Our study aimed to estimate the burden of smoking-attributable mortality in Spain in 1998., Population and Method: Spain's smoking prevalence, mortality and relative risks for death from the Cancer Prevention Study II were used to estimate smoking-attributable mortality in the population aged 35 years and over., Results: In 1998, 55,613 deaths were attributable to smoking. One out of 4 deaths in males and one out of 40 deaths in females were attributable to tobacco. Two thirds of the attributable mortality corresponded to deaths due to lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and stroke., Conclusions: Smoking actually represents a remarkable burden of avoidable deaths in Spain. Smoking-attributable mortality appears to continue increasing in the last years.

Background: To examine whether provincial mortality from ischaemic heart disease and cerebrovascular disease in Spain in 1991-1995 is associated with infant mortality in 1930-1934, independently of illiteracy (an estimator of socioeconomic status) in 1991., Material and Methods: Population-correlation study., Results: Infant mortality is correlated with mortality from ischaemic heart disease (r = 0.38; p < 0.01) and cerebrovascular disease (r = 0.41; p < 0.01). When adjusting for illiteracy rate in 1991, the correlation of infant mortality with ischaemic heart disease mortality is r = 0.01 (p = 0.93), and with cerebrovascular disease mortality is r = 0.25 (p = 0.08)., Conclusions: Ischaemic heart disease and cerebrovascular disease mortality are moderately associated with infant mortality during the 1930s. This association might be explained by present socioeconomic status.

Background: To examine whether the decline in alcohol consumption among moderate drinkers, which has occurred in Spain in the period 1987-1993, has been associated with changes in the proportion of heavy drinkers and abstainers., Subjects and Methods: The units of analysis have been the 17 administrative regions of Spain. Alcohol consumption data have been taken from the 1987 and 1993 National Health Interview Surveys., Results: A decrease of 10 g/week in mean alcohol consumption among male moderate drinkers has been associated with a decrease of 1.2% (95% CI: 0.7-1.7%) in the proportion of heavy drinkers. The association was also observed among women, those over and below 45 years of age, and was stronger for wine than for other alcoholic beverages., Conclusion: The decrease in moderate consumption of alcohol has probably had a beneficial effect on the health of the Spanish population.

Background: Given the high figures of cardiovascular disease and hypertension in Spain, and the continuity of cardiovascular and total mortality risks at any level of blood pressure, mortality related to hypertension and blood pressure is estimated., Subjects and Methods: Blood pressure distribution from a representative sample of the 35 to 64 years old Spanish population and the relative risks for death coming from valid and reasonably generalizable international studies (MRFIT, Framingham and Chicago Project) were used. The proportions and absolute numbers of cardiovascular and total deaths related to blood pressure and hypertension (categories of the US Joint National Committee VI [JNC VI]) have been calculated in middle-aged men and women., Results: As many as 42% of the coronary deaths, 46.4% of the stroke deaths and 25.5% of the total deaths are related to hypertension (> or = 140/90 mmHg), most of them in stages 1 and 2. It follows high-normal plus normal blood pressure group (8.3, 10.2 and 6.2% of these deaths, respectively). All together, 17,266 total deaths and 4,502 cardiovascular deaths related to blood pressure took place annually, three-quarters of them in males. Over the last ones, 65.5% are coronary and 34.5% cerebrovascular, prevailing the first ones in both sexes. Eight out of 10 deaths, cardiovascular or total, related to blood pressure are concentrated in the hypertension categories, and two out of 10 in the high-normal or normal blood pressure groups., Conclusions: One out of 3 total deaths and one out of 2 cardiovascular deaths are related to blood pressure. One out of 4 total deaths and one out of 2.5 cardiovascular deaths are related to hypertension. A substantial part of these deaths come from stages 1 and 2 hypertension and from high-normal and normal blood pressure group.

The importance of the atherosclerotic cardiovascular disease (which is multifactorial in its origin) in Spain and the need for and efficient management of the treatments make especially useful to consider the overall cardiovascular risk of the individual in order to take clinical decisions towards the follow-up and treatment of the disease. Current evidence from cardiovascular risk situations supports this strategy of considering all the risk factors as a whole instead of evaluating each of them separately. This paper tries to revalidate this approach with the most reliable of the available evidence from case studies. The global cardiovascular risk is suggested to be evaluated by a risk chart based on Framingham's study. A revision of the clinical priorities in cardiovascular disease prevention is made. Finally, some views on ordinary clinical cases are given, suggesting the treatment based on a global risk evaluation, considering and opposing evidence and recommended guidelines from the most common Spanish guides on prevention of cardiovascular diseases, evaluating the potential benefit of treatment for the patient, and making a clinical decision.

Background: To identify the determinants of the geographic distribution of ischaemic heart disease (IHD) mortality in Spain., Population and Methods: Ecological study at the provincial level. Data are obtained from the 1976-1980 vital statistics, the 1964-1965 Household Budget Survey and the 1970 Population Census., Results: Consumption of wine, chicken, fish, and vegetables, as well as illiteracy, explain 47% of IHD mortality. Consumption of wine alone exhibits a statistically significant relationship (p < 0.05) with IHD mortality. Moderate consumption of wine is negatively associated with IHD mortality, whereas higher consumption reveals a positive association., Conclusion: Results are consistent with those from an earlier study in Spain for the 1983-1987 period.

Background: Given the great relevancy of the cardiovascular diseases, were analyzed the cardiovascular mortality in the Spanish autonomous communities and its trend during the period 1975-1992, to identify communities with a high death risk by these diseases and to as certain the underlying factors., Material and Methods: The mortality rates standardized by age are calculated for the diseases of the circulatory system (DCS), ischaemic heart disease (IHD) and cerebrovascular disease (CVD). The mortality trend has been quantified through the percentual change annual means, using a log-lineal model., Results: The Communities of Valencia, Extremadura, Andalusia and Murcia show the highest cardiovascular diseases mortality rates while the Communities of Madrid, Navarra, Castilla and Leon and Aragon present the most decreases. In all the communities a decrease of the mortality by DCS has occurred, that ranges from a percentual decrease annual means higher than 3% in Navarre (-3.7%) and Madrid (-3.4%) to values that they do not reach to the 2% of decrease in Murcia (-1.8%) and Balearic Islands (-1.9%). In males as well as in females, the mortality by IHD and CVD falls in all the communities in the period 1975-1992, though the decrease is much greater for CVD., Conclusions: This study demonstrates a consistent fall of the cardiovascular mortality in all the Spanish autonomous communities and some considerable differences in the level and in the trends of the magnitude mortality among these communities during all the studied period.

Background: The main objective is to describe time trends and evolution of mortality attributable to tobacco use in Spain in the period 1978-1992., Material and Methods: Spanish pevalences for never smokers, current smokers and former smokers estimated from national health surveys, and relative risks for death attributed to tobacco use from the Cancer Prevention Study II were used. The proportion and number of deaths attributed to tobacco use in the Spanish population of 35 years and over have been calculated by cause of death, sex and age. The trend in mortality attributable to tobacco use over the period 1978-1992 has also been calculated, expressed as the mean percentage change per year in the standardised mortality rates, estimated by a log-lineal model., Results: Tobacco consumption caused 46,226 deaths in Spain in 1992. Most of them occurred in males (93.4%). One of every 4 deaths in males, and one of every 50 in females were attributable to tobacco consumption. One third of the deaths attributed to tobacco use were premature deaths (under 65 years). Lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and cerebrovascular disease caused 75% of deaths attributed to tobacco use. Lung cancer was the first specific cause in males, and chronic obstructive pulmonary disease was the main cause in females. A total of 621,678 deaths attributed to tobacco consumption were produced in the period (1978-1992). The main percentage change per year in the mortality rates shows a moderate increment of 0.1% (-0.2% in males +6.7% in females)., Conclusions: Mortality attributable to tobacco use in Spain represents a high cost in terms of avoidable deaths and shows the limited impact of the interventions directed to tobacco control in Spain. One of every 4 deaths in males and a disturbing and rapidly increasing proportion in females are attributable to smoking.

Background: This paper has two objectives. The first is to examine the consistency of the main nutritional studies carried out in Spain over the last fifty years. The second is to use these studies to describe the changes in the Spanish diet over this period and to characterize the present dietary pattern., Material and Methods: We have used three types of studies. First, food balance sheets elaborated by Barbancho, FAO, OECD and the Department of Agriculture. Second, surveys on the foods purchased by population groups, in particular the household budget surveys, and the "panel de consumo alimentario" from the Department of Agriculture. Third, food consumption surveys from Catalonia, Vasque Country, Murcia, Madrid, and Reus., Results: Protein, lipid and total caloric intake have increased over the last fifty years. Carbohydrate intake has been stable. Caloric intake from lipids has increased, caloric intake from protein has been stable and that from carbohydrates has decreased. All studies are consistent in that, from 1980 onwards, caloric intake from protein has been 12.5-16.7%, caloric intake from carbohydrates has been 39.3-48.1%, and that from lipids has been 36.6-46.0%. The monounsaturated/saturated ratio has been 1.2-1.7 and the polyunsaturated/saturated ratio 0.4-0.7. All data sources show a high consumption of foods typical of the Mediterranean diet, in particular fruit, vegetables, fish and vegetable oil, rich in unsaturated fats. Consistency among data sources is higher when data are expressed as percentage of total caloric intake than when they are expelled in absolute quantities., Conclusions: All data sources suggest that the Spanish diet has changed with the economic development, but it still keeps most of the characteristics of the Mediterranean diet.

Background: Not enough information is available regarding Spanish alimentation from the Civil War up to the present. Furthermore, there are some evidence that the Spaniards are leaving behind their traditional, healthy Mediterranean diet. The aim of this study was therefore to describe the food and nutrient intake trends of the Spanish population from 1940-1988 and establish to what extent the pattern of the Mediterranean diet has been maintained., Methods: New food balance sheets for the Spanish population have been elaborated using all the information available and consistently applying the methodology of the European Union over the period from 1940-1988., Results: Total caloric intake and that of all the macronutrients increased over the study period although this increase was greater after 1960. The contribution of lipids to total caloric intake has increased (30% in 1960-1968 and 42% from 1980-1988), protein contribution has remained the same (13% 1960-1968 and 13% 1980-1988) and carbohydrate intake has decreased (58% from 1960-1968 to 45% from 1980-1988). These changes are the result of an important increase in the consumption of meat, eggs, milk and derivatives. Nonetheless the high intake of fruit and vegetables, fish and olive and seed oils has been maintained. Thus, from 1980-1988 the ingestion of monounsaturated/saturated fatty acids and polyunsaturated/saturated fatty acids was 1.3 and 0.5, respectively., Conclusions: The first systematic reconstruction of the alimentary and nutritional history of the Spanish population over the last fifty years has been carried out. The Spanish diet has undergone typical changes associated with economic development but continues to be consistent with the pattern of the Mediterranean diet. These changes in diet are, however, of worry because of their deviation from optimum nutritional patterns.

Background: Smoking continues to be an important public health problem in Spain. With the aim to know some of the health care consequences derived from the evolution of this habit in the Spanish population and to anticipate the health care benefits which would be a result of intervention on the same the estimations of mortality related with smoking and its control in the next few decades were predicted., Methods: Mathematic models of simulation of the effects derived from changes in the prevalence of smoking based on the techniques of attributable risk, the multiplicity of the diseases involved and the time of reversal of the risk of death following health care intervention were used., Results: In absence of intervention on smoking the number of total deaths by the causes under consideration will, in general, increase, from 1987 to 2020. The reduction of 40% in the prevalence of smoking in adult Spanish smokers over a period of 8 years (1992-2000) would potentially decrease the number of cardiovascular deaths by 6,035, deaths by COPD by 394 and the deaths by malignant tumors studied in the year 2020 by 5,237. By the year 2020 the effects of intervention would, in general, be completely manifest. A part of this reduction of mortality would translate in a gaining of 57,323 real years of life in the year 2020. These benefits are also appreciable, although lesser, in the previous years from the beginning of intervention., Conclusions: Smoking will continue to be an important public health problem in Spain in the future. The health care benefits which may be derived from correct application of effective control programs of the same would be appreciable.

Background: The aim of the application of population and individual strategies for the control of cholesterolemia recommended by several commissions of experts in Spain is to obtain marked decreases in mortality by ischemic heart disease. This study is the first to estimate the potential benefits obtained by the application of both strategies in males from 35 to 64 years of age in Spain., Methods: Upon fixing the population dietetic aims for the ingestion of fats and cholesterol, the foreseen decrease in mean serum cholesterol was estimated by predictive equations. For individuals at risk, more ambitious objectives were made in regard to decrease in cholesterolemia. The consequent reduction of coronary death risk was obtained for each strategy comparing the foreseen coronary risks by logistic functions for previous serum cholesterol values and those posterior to the health intervention., Results: The population decrease of saturated fat to 7-10% of total calories of the diet and of the consumption of cholesterol to 300 mg/day would produce a reduction of serum cholesterol of between 6.5 and 21.4 mg/dl (0.2-0.6 mmol/l) which would represent nearly 200 mg/dl (5.2 mmol/l). This would then produce a decrease in coronary deaths of 5.5 to 17.1%. This population strategy must reach 934 to 2,857 people per death avoided. With the individual strategy, the reduction of 55 mg/dl (1.4 mmol/l) in mean cholesterolemia of subjects with more than 250 mg/dl (mean 7.1 mmol/l) or of 36 mg/dl (0.9 mmol/l) in those with more than 200 mg/dl (mean 6.2 mmol/l) would produce a decrease of population coronary death between 3.3 and 12.5% in the first group, and 5.2 to 20% in the second requiring 237 or 454 subjects in each group, respectively per death avoided. The joint application of both strategies would reduce the risk from 8.4 to 24.5%. This would delay the appearance of 570 to 1,640 coronary deaths each year., Conclusions: The population strategy for cholesterolemia control provides greater health benefits, within a short term, than those of individual strategy although it must be applied to more subjects per unit of benefit. The joint application of both strategies may produce a modest but appreciable reduction, within a medium term, of coronary death in Spain.