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Introduction and Objectives: The healthy and sustainable dietary recommendations for the Spanish population have recently been launched. We aimed to develop a food-based dietary index to measure adherence to these guidelines and assess its association with all-cause mortality., Methods: Data were drawn from 11 904 individuals, representative of the Spanish population aged 18 and older, recruited between 2008 and 2010, and followed-up until 2022. The healthy and sustainable dietary recommendations for the Spanish population index (HS-DRSI) includes 20 food components, scored dichotomously to reflect adherence to the recommendations. The association between the HS-DRSI and all-cause mortality was examined using Cox proportional hazard models adjusted for sociodemographic, lifestyle, and morbidity factors, within a retrospective cohort design., Results: The mean±SE age of participants was 46.9±0.3 years and 50.5% were female. After a median follow-up of 12.9 years, 939 all-cause deaths were recorded. Compared with participants in the lowest quartile of adherence (HS-DRSI range: 1-5), those in the highest quartile (HS-DRSI range: 9-17) had a lower risk of mortality (HR, 0.76; 95%CI, 0.60-0.96; P for trend=.02). A 2-point increase in the HS-DRSI was associated with a 7% lower risk of mortality (HR, 0.93; 95%CI, 0.86-1.00; P=.04). This protective association was also observed among participants without chronic diseases at baseline (HR per 2-point increment: HR, 0.80; 95%CI, 0.70-0.92; P=.002). Results were robust in sensitivity analyses., Conclusions: Higher adherence to the healthy and sustainable dietary recommendations for the Spanish population was associated with lower all-cause mortality., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death., Methods: We used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression., Results: In total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8 ≤ 49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89)., Conclusions: A substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain., Methods: A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions., Results: In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men., Conclusions: There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Estimate leptin reference values and calculate leptinemia cutoff values for identifying cardiometabolic abnormalities in Spain., Methods: Cross-sectional study carried out between 2008 and 2010 in 11 540 individuals representing the Spanish population aged ≥ 18 years. Data were obtained by standardized physical examination and analyses were performed at a central laboratory. Leptinemia was measured using ELISA. Cardiometabolic abnormality was defined as the presence of at least two of the following: high blood pressure, high triglycerides, reduced high density lipoprotein cholesterol, high insulin resistance values, and elevated C-reactive protein and glucose., Results: Leptin values were higher in women than men (geometric mean, 21.9 and 6.6 ng/mL; P<.001). The median [interquartile range] was 24.5 [14.1-37.0] ng/mL in women, and 7.2 [3.3-14.3] ng/mL in men. In the multivariate analysis, leptin was significantly associated with anthropometric measures, insulin, and C-reactive protein, and inversely associated with age, smoking, and physical activity in women (r(2)=0.53; P<.001) and in men (r(2)=0.61; P<.001). The leptin values that identified cardiometabolic abnormality were 23.75 ng/mL in women (area under the curve, 0.722; sensitivity, 72.3%; specificity, 58.7%) and 6.45 ng/mL in men (area under the curve, 0.716; sensitivity, 71.4%; specificity, 60.2%)., Conclusions: These results facilitate the interpretation of leptin values in clinical and population studies. Leptin has moderate sensitivity and specificity for identifying cardiometabolic abnormalities., (Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized definition and that of premorbid metabolic syndrome, which consists of metabolic syndrome without diabetes mellitus or cardiovascular disease. Moreover, their regional distributions and clinical management are unknown. The present study examined the distributions and clinical management of both syndromes in Spain., Methods: This cross-sectional study was performed from 2008 to 2010 in 11 149 representative individuals of the Spanish population aged 18 years or older. Data were obtained through standardized physical examination, and analytical measurements were done in a central laboratory., Results: The prevalences (95% confidence interval) of metabolic syndrome and premorbid metabolic syndrome were 22.7% (21.7%-23.7%) and 16.9% (16.0%-17.8%), respectively. The frequency of both syndromes increased with age and was higher in men than in women up to 65 years; above this age, the frequency was higher in women. The communities of the south of Spain and the Balearic and Canary islands had the highest prevalence of both syndromes, in some regions reaching double that of the community with the lowest prevalence. About one third of patients with premorbid metabolic syndrome reported that they had not received health recommendations to improve their lifestyles; of those that did receive advice, adherence was low, particularly for reducing weight (31.9%) and salt intake (38.3%)., Conclusions: The prevalence of metabolic syndrome is high in Spain and considerable geographical differences exist in its distribution. There is substantial room for improvement in the clinical management of premorbid metabolic syndrome., (Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: The prevalence of resistant hypertension has recently been reported, but there are no studies on its demography. This study aimed to examine the demography and clinical characteristics of resistant hypertension in a large sample of primary care patients., Methods: A cross-sectional study was performed of all computerized medical records of hypertensive patients in Health Area 6 of Madrid (Spain). Of 63 167 hypertensive patients, we selected 48 744 with prescription of antihypertensive medication; of these, we selected those who met the American Heart Association criteria for resistant hypertension., Results: A total of 6292 patients had resistant hypertension, representing 9.9% of all hypertensive patients and 12.9% of those treated. A total of 5.5% were < 50 years (8.5% men and 3.2% women) and 24.7% were > 80 years (15.8% men and 31.4% women) (P < .001). In patients < 50 years, resistant hypertension was associated with male sex (odds ratio female/male = 0.006; 95% confidence interval, 0.000-0.042; P < .001), systolic blood pressure, obesity, stroke, and chronic kidney disease (P < .001). In those > 80 years, resistant hypertension was associated with female sex (odds ratio female/male = 1.27; 95% confidence interval, 1.08-1,10; P = .004), systolic blood pressure, diabetes mellitus, obesity, chronic kidney disease, coronary heart disease, and atrial fibrillation (P < .001). More than 50% of patients > 80 years with resistant hypertension had cardiovascular disease., Conclusions: One in 4 patients with resistant hypertension is > 80 years. Resistant hypertension is associated with cardiovascular disease, age < 50 years in men and age > 80 years in women. There is a high proportion of cardiovascular disease in elderly patients with resistant hypertension., (Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: Few studies have used time-dependent correction to analyze the relationship between blood pressure and all-cause mortality, and to our knowledge none has been performed in older people from the Mediterranean area. This study aimed to estimate the relationship between baseline blood pressure and blood pressure as a time-dependent covariate with the risk of all-cause mortality in a population cohort of persons aged 65 or older in Spain., Methods: Data were taken from the population-based study "Aging in Leganés" with 17 years of follow-up, launched in 1993 in a random sample (n=1560) of persons aged ≥65 years. Mortality was assessed in 2010. Cox proportional hazards models were fitted to examine the effects on mortality of blood pressure at baseline and of blood pressure as a time-dependent covariate., Results: The lowest mortality was observed at baseline systolic blood pressure of 136 mmHg and time-dependent covariate value of 147 mmHg. The highest risk of mortality for time-dependent covariates occurred with systolic blood pressure <115 mmHg and >93 mmHg and diastolic blood pressure <80 mmHg. Diastolic blood pressure over 85 mmHg did not increase the risk of death., Conclusions: Based on the dynamic association between blood pressure and mortality, a U-shaped relationship was found for systolic blood pressure and a negative relationship for diastolic blood pressure and all-cause mortality. The lowest mortality corresponded to a systolic blood pressure level slightly over the diagnostic hypertension value and suggests that a value of 140 mmHg is not adequate as a diagnostic and therapeutic threshold in an elderly population., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: Only a few studies have reported nationwide population-based data on the magnitude and control of hypercholesterolemia. This work examines the prevalence and management of hypercholesterolemia in Spain., Methods: Cross-sectional study conducted from June 2008 to October 2010 on 11,554 individuals representative of the population aged ≥ 18 years in Spain. Study participants provided 12-h fasting blood samples, which were analyzed in a central laboratory with standardized methods., Results: In the whole population, 50.5% had hypercholesterolemia (total cholesterol ≥ 200 mg/dL or drug treatment) and 44.9% high levels of low-density lipoprotein cholesterol (≥ 130 mg/dL or drug treatment), with no substantial sex-related differences. Moreover, 25.5% of men showed high-density lipoprotein cholesterol < 40 mg/dL and 26.4% of women high-density lipoprotein cholesterol <50mg/dL. Also, 23.2% of men and 11.7% of women had triglycerides ≥ 150 mg/dL. Frequency of dyslipidemia increased up to 65 years, except for low high-density lipoprotein cholesterol which did not vary with age. Among those with high low-density lipoprotein cholesterol, 53.6% knew of it and 44.1% of them received lipid-lowering treatment; among the latter, 55.7% had a controlled level (13.2% of all hypercholesterolemics). Control of high low-density lipoprotein cholesterol increased with age and with the number of visits to the specialist physician, but was lower among diabetics (odds ratio=0.38; 95% confidence interval, 0.28-0.53) and patients with cardiovascular disease (odds ratio=0.55; 95% confidence interval, 0.33-0.92)., Conclusions: About half of the Spanish population has elevated serum cholesterol; moreover, cholesterol control is poor, particularly among those with highest cardiovascular risk, such as diabetics or patients with cardiovascular disease., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)