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There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Introducción: La dieta mediterránea (DMed) reduce la morbimortalidad. El confinamiento ocurrido en España entre los meses de marzo y mayo de 2020 podría generar cambios conductuales, entre ellos la adherencia a la DMed. El objetivo del presente estudio ha sido valorar la citada adherencia al concluir dicho confinamiento y compararla con la situación previa al mismo. Métodos: Los datos se obtuvieron mediante dos cuestionarios en línea uno al comienzo del confinamiento y otro al final, en personas adultas procedentes de población española, las cuales respondieron de forma anónima y voluntaria. La valoración de la adherencia a la DMed se realizó a través de dos cuestionarios: Mediterranean Diet Adherence Screener (MEDAS) y PREDIMED modificado, los cuales contenían 14 cuestiones cada uno. Otras variables incluidas fueron: edad, género, índice de masa corporal (IMC), Comunidad Autónoma de procedencia, tipo de convivencia en domicilio y nivel de estudios alcanzado. Al concluir el confinamiento la comparación entre los cambios se realizó con el estadístico t de Student y la prueba de McNemar. Resultados: Participaron 207 personas (137 mujeres), edad media de 51,3±12,4 años, intervalo de edad: 20-83 años. Transcurrido el confinamiento el IMC permaneció sin cambios (24,55±3,7 kg/m2 inicial y 24,57±3,7 kg/m2 final, p=0,752), y sí el consumo de pescado (51,2% inicial y 60,9% al final, p=0,003) a expensas fundamentalmente de las mujeres y la adherencia a la DMed, aumentando la puntuación total por término medio tanto en MEDAS (10,6±2,0) al inicio y 10,57±2,0 al final; p=0,001) como en PREDIMED modificado (9,47±2,1 al inicio y 9,93±2,1 al final, p

Objective: to assess the degree of adherence to the Mediterranean diet and the practice of physical activity in university Health Sciences students in Castile-La Mancha. Methods: this was a cross-sectional, observational study by means of a dietary and physical activity survey. The sample consisted of 575 university students (77.7 % women). An initial data collection survey was developed using the Google Forms platform (https://www.google.com/forms/about/). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used to measure physical activity. Results: we found a 58.3 % adherence to Mediterranean diet among Health Sciences students, with 38.6 % of average adherence, and 5.0 % of poor adherence, with a low consumption of fruits with no gender differences, and a high consumption of red or processed meat and butter or cream with significant differences between women and men. There is also a high consumption of carbonated beverages (more frequent in women). Likewise, a high percentage of students (22.5 %) do practically no physical activity. As for physical exercise, it is always higher in men, with significant differences (p0.05). Conclusion: this study suggests that the sample of university Health Sciences students in Castile-La Mancha shows an acceptable adherence to the Mediterranean diet and insufficient levels of physical activity.Objetivo: valorar el grado de adherencia a la dieta mediterránea y la práctica de actividad física en estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha. Método: estudio observacional transversal mediante encuesta alimentaria y de actividad física. La muestra contó con 575 estudiantes universitarios (77,7 % de mujeres). Se desarrolló una encuesta de recogida de datos inicial mediante la plataforma Google Forms (https://www.google.com/forms/about/). La adherencia a la dieta mediterránea se valoró con el cuestionario Mediterranean Diet Adherence Screener (MEDAS) y el cuestionario PREvención con DIeta MEDiterránea (PREDIMED), modificado. Para medir la actividad física se utilizó el cuestionario Rapid Assessment of Physical Activity Scale (RAPA), que valora la actividad física desempeñada. Resultados: se encontró en los estudiantes de Ciencias de la Salud una adherencia a la dieta mediterránea del 58,3 %, siendo la adherencia media del 38,6 % y la mala adherencia del 5,0 %, observándose un bajo consumo de frutas sin diferencias de sexo, un alto consumo de carne roja o procesada y de mantequillas o natas, con diferencias significativas entre mujeres y hombres. También hay un consumo alto de bebidas carbonatadas (más frecuente en mujeres). Asimismo, un porcentaje alto de estudiantes (22,5 % del total) no hace prácticamente ninguna actividad física. En cuanto al ejercicio físico, siempre es mayor entre los hombres, con diferencias significativas (p0,05). Conclusión: este estudio sugiere que la muestra de estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha presenta una aceptable adherencia a la dieta mediterránea y unos niveles de actividad física insuficientes.

Introduction: home confinement due to the COVID-19 pandemic can influence the dietary profiles of the population, suddenly subjected to a stressful factor that implies important modifications in life habits. Among others, a restriction of mobility and a change in the way of carrying out work, going from being face-to-face to non-contact (teleworking). Objective: to know the usual dietary pattern prior to confinement, and to assess the evolution of adherence to the Mediterranean diet weekly until its conclusion. Methods: data were collected using a weekly anonymous online questionnaire that monitored adherence to the Mediterranean diet in real time in an initial sample of 490 adults from Spain. Adherence to the Mediterranean diet was assessed using the MEDAS (Mediterranean Diet Adherence Screener) and modified PREDIMED questionnaires. Results: confinement due to the COVID-19 pandemic influenced the eating habits of the participants, so that adherence to the Mediterranean diet increased at the end of the confinement period, which is of special interest, since it was based on a good initial adherence (MEDAS adherence: 10.03 ± 1.9 initial and 10.47 ± 2.1 final; p = 0.016; modified PREDIMED adherence: 9.26 ± 2.0 initial and 9.89 ± 2.1 final; p0.001), without observing clinically relevant changes in body composition as measured by body mass index (BMI) except in women (23.3 kg/m2 ± 2.9 initial and 23.4 kg/m2 ± 2.9 final; p0.001), with a slight increase in this parameter, but maintaining on average the healthy values recommended by the guidelines. Conclusions: in the studied population we observed an improvement in adherence to the Mediterranean diet without observing clinically relevant changes in BMI.Introducción: el confinamiento domiciliario debido a la pandemia de COVID-19 puede influir en los perfiles dietéticos de la población, sometida súbitamente a un factor estresante que implica importantes modificaciones en los hábitos de vida. Entre otros, la restricción de la movilidad y el cambio en la forma de realizar el trabajo, pasando de ser presencial a no presencial (teletrabajo). Objetivo: conocer el patrón dietético habitual previo al confinamiento y valorar la evolución de la adherencia a la dieta mediterránea semanalmente hasta la conclusión del mismo. Métodos: los datos se recopilaron mediante un cuestionario anónimo semanal en línea que monitorizó la adherencia a la dieta mediterránea en tiempo real en una muestra inicial de 490 adultos de España. La adherencia a la dieta mediterránea se valoró mediante los cuestionarios MEDAS (Mediterranean Diet Adherence Screener) y PREDIMED modificado. Resultados: el confinamiento debido a la pandemia de COVID-19 influyó en los hábitos alimenticios de los participantes, de modo que la adherencia a la dieta mediterránea aumentó al concluir el período de confinamiento, lo cual tiene especial interés, ya que se partía de una buena adherencia inicial (adherencia MEDAS: 10,03 ± 1,9 inicial y 10,47 ± 2,1 final; p = 0,016; adherencia PREDIMED modificado: 9,26 ± 2,0 inicial y 9,89 ± 2,1 final; p0,001), sin observarse cambios clínicamente relevantes en la composición corporal valorada por el índice de masa corporal (IMC) excepto en las mujeres (23,3 kg/m2 ± 2,9 inicial y 23,4 kg/m2 ± 2,9 final; p0,001), con un discreto aumento de dicho parámetro pero manteniendo en promedio los valores saludables aconsejados por las guías. Conclusiones: en la población estudiada observamos una mejora de la adherencia a la dieta mediterránea sin observar cambios clínicamente relevantes en el IMC.

Background Although studies exist comparing low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) in the development of cardiovascular disease (CVD), most have limitations in the mathematical models used to evaluate their prognostic power adjusted for the other risk factors (cardiovascular risk). Objective The aim of this study was to compare LDL-C and non-HDL-C in patients with CVD to determine whether both parameters predict CVD similarly. Methods A cohort of 1322 subjects drawn from the general population of a Spanish region was followed between 1992 and 2006. The outcome was time to CVD. Secondary variables were gender, age, hypertension, diabetes, personal history of CVD, current smoker, body mass index, LDL-C, and non-HDL-C. Two CVD prediction models were constructed with the secondary variables, with only the lipid parameter varying (non-HDL-C or LDL-C). In the construction of the models, the following were considered: multiple imputation, events per variable of 10 or more, and continuous predictors as powers. The validation was conducted by bootstrapping obtaining the distribution of the C statistic (discrimination) and the probabilities observed by smooth curves. These results were compared in both models using graphical and analytical testing. Results There were a total of 137 CVD events. The models showed no differences in the distributions of the C statistic (discrimination, P = .536) or in the calibration plot. Conclusions In our population, LDL-C and non-HDL-C were equivalent at predicting CVD. More studies using this methodology are needed to confirm these results.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs.This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consequentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test.The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥ 2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin k. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin k in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02-4.59], p=.043).The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF.

Objective: to evaluate the effectiveness of the obesity intervention with three different approaches, one of them with a platform that promotes physical activity. Material and method: randomized, controlled, parallel clinical trial that compared 3 arms, multicenter study in overweight or obese patients with a follow-up of 12 months. The patients were randomized into three groups: Intervention in the primary care center with G1 intervention: Control group, which received the usual recommendations to lose weight following the SEEDO 2000 Consensus. G2: Motivational intervention of obesity (IMOAP) with trained nurse and small periodic work groups. G3: Motivational intervention of obesity (IMOAP) adding the use of a digital platform that allows physical activity to be recorded, monitored and at the same time favors the practice of this (iwopi). Variables were collected: weight, height, BMI, circumference of the waist, lipid parameters, blood pressure, glycosylated hemoglobin. Results: 185 patients were initially included in the study. Seventeen patients left the study. Thus, 168 patients completed the study: 47 in G1, 61 in G2 and 60 in G3. Of the population studied, 57.1% were women. observing a general average weight reduction at the end of the study of 4.37 kg, being 5.34 kg in the group 2.6.29 kg in the group 3 and 1.25 kg in the control group (G1). It was also observed that cholesterol levels in three groups were reduced. at did not reach a statistically significant value. The clinically relevant parameters were: group 1 (control) versus group 2 (IMOAP): relative risk (RR), 0.10 to 0.46; relative risk reduction (RRR), 0.54 to 0.90; absolute risk reduction (ARR), from 0.30 to 0.61; number needed to treat (NNT), 3 to 2. Group 1 versus group 3 (IMOAP-PA): RR, 0.07 to 0.30; RRR, 0.70 to 0.93; ARR, 0.61 to 0.86; NNT: 2 to 1. Group 2 versus group 3: RR, 0.54 to 0.84; RRR, 0.16 to 0.46; ARR, 0.14 to 0.43; NNT, 7 to 2. Conclusions: The digital health platform that stimulates physical activity added to an interventionist motivation in overweight or obese patients is a significant additional benefit in terms of weight loss results, reduction of BMI and lipid profile in patients affected by overweight or obesity and a more effective cost.Objetivo: evaluar la efectividad de la intervención de la obesidad con tres enfoques diferentes, uno de ellos con una plataforma que promueve la actividad física. Material y métodos: ensayo clínico aleatorizado, controlado, paralelo que comparó 3 brazos, estudio multicéntrico en pacientes con sobrepeso u obesos con un seguimiento de 12 meses. Los pacientes fueron asignados al azar en tres grupos: Intervención en el centro de Atención Primaria con intervención G1: Grupo control, el cual recibía las recomendaciones habituales de perder peso siguiendo el Consenso SEEDO 2000 G2: Intervención motivacional de la obesidad (IMOAP) con enfermera entrenada y pequeños grupos de trabajo periódico. G3: Intervención Motivacional de la obesidad (IMOAP) añadiendo el uso de una plataforma digital que permite registrar la actividad física, Se recolectaron variables: peso, talla, IMC, circunferencia de la cintura, parámetros lipídicos, presión arterial, hemoglobina glicosilada. Resultados: 185 pacientes fueron incluidos inicialmente en el estudio. 17 pacientes abandonaron el estudio. De ese modo, 168 pacientes completaron el estudio: 47 en G1, 61 en G2 y 60 en G3. De la población estudiada, el 57,1% eran mujeres. Se observa una reducción de peso promedio general al final del estudio de 4,37 kg, siendo 5,34 kg en el grupo 2,6,29 kg en el grupo 3 y 1,25 kg en el grupo control (G1). También se observó que los niveles de colesterol en tres grupos se redujeron. El IMC mostró una reducción promedio general de -1,56, siendo -1,70 en G2, -2,26 en G3 y 0,47 en G1. Los parámetros clínicamente relevantes fueron: grupo 1 (control) versus grupo 2 (IMOAP): riesgo relativo (RR), 0,10 a 0,46; reducción del riesgo relativo (RRR), 0.54 a 0.90; reducción del riesgo absoluto (ARR), de 0.30 a 0.61; número necesario para tratar (NNT), 3 a 2. Grupo 1 versus grupo 3 (IMOAP-PA): RR, 0.07 a 0.30; RRR, 0,70 a 0,93; ARR, 0,61 a 0,86; NNT: 2 a 1. Grupo 2 versus grupo 3: RR, 0.54 a 0.84; RRR, 0,16 a 0,46; ARR, 0,14 a 0,43; NNT, 7 a 2. Conclusiones: la plataforma de salud digital que estimula actividad física agregada a una motivación intervencionista en pacientes con sobrepeso u obesidad es un beneficio adicional significativo en términos de resultados de pérdida de peso, reducción del IMC y perfil de lípidos en pacientes afectados por sobrepeso u obesidad y un costo más efectivo.

Clustering of cardiovascular risk factors (CVRFs) is extraordinarily common and is associated with an increased risk of cardiovascular disease (CVD). However, the particular impact of the sum of CVRFs on cardiovascular morbidity and mortality has not been sufficiently explored in Europe.The aim of this study was to analyze the differences in survival-free probability of CVD in relation to the number of CVRFs in a Spanish population.A prospective cohort study was conducted from 1992 to 2016 in a Spanish population that included 1144 subjects with no history of CVD (mean age, 46.7 years) drawn from the general population. We calculated the number of CVRFs for each subject (male sex, smoking, diabetes, hypertension, dyslipidemia, obesity, and left ventricular hypertrophy). Cardiovascular morbidity and mortality records were collected, and survival analysis was applied (competing risk models).There were 196 cardiovascular events (17.1%). The differences in total survival-free probability of cardiovascular morbidity and mortality of the different values of the sum of CVRFs were significant, increasing the risk of CVD (hazard ratio, 1.30; 95% confidence interval, 1.13-1.50) per each additional risk factor.Differences in survival-free probability of CVD in relation to the number of CVRFs present were statistically significant. Further studies are needed to corroborate our results.

To assess the effect of a motivated physical activity program on the lipid parameters most related to excess weight (triglycerides [TG], and high density lipoprotein cholesterol [HDL]) in a weight-loss intervention in obese and overweight patients.A randomised and controlled, 2-arm, clinical trial and a 12-months follow-up was conducted. The patients included in the study were randomised into 2 intervention groups: Motivational intervention of obesity with a previously trained nurse (G1), motivational group, with digital platform support and motivated physical activity program (iwopi [G2]). The anthropometric variables measured were height, weight, Body Mass Index (BMI), as well as the analytical variables, total cholesterol, TG and HDL-C.A total of 123 patients participated in the study, of which 61 were randomised to G1, and 62 to G2. Both groups significantly decreased weight at the end of the study, with the decrease in G1 being 4.898kg, and 6.292kg in G2. In both groups there was also a significantly decrease (P.05) in total cholesterol and TG, and increase in HDL cholesterol, with these changes being more intense in the G2 group, as well as being the group that lost more weight.Weight reduction is accompanied by favourable changes in lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

Background Familial chylomicronemia syndrome (FCS) is an extremely rare lipoprotein disorder caused by mutations in at least 5 genes of the lipoprotein lipase (LPL) complex. Objective This work shows the molecular analysis of patients diagnosed with FCS, who attended the Spanish Arteriosclerosis Society lipid units and were included in the National Dyslipidemia Registry. Methods Among the 238 patients registered with severe hypertriglyceridemia (fasting triglycerides >1000 mg/dL), 26 were diagnosed with FCS as they had confirmed postheparin plasma LPL activity deficiency and/or homozygosity for loss-of-function mutations in LPL, GPIHBP1, APOC2, LMF1, or Apolipoprotein A5 (APOA5). Results Among the 26 FCS cases, 23 had mutations in the homozygous state: 19 in LPL and 4 in the GPIHBP1 gene. The molecular analysis revealed 3 novel mutations: 2 in LPL, in 2 unrelated patients (c.312delA; p.Asp105Thrfs*66 and c.629A>G; p.His210Arg), and 1 in GPHIBP1 in a third patient (c.502delC; p.Leu168Serfs*83). These 3 patients had confirmed lack of LPL activity. Three additional patients with confirmed LPL activity deficiency were heterozygous carriers of mutations in the genes analyzed. Among these, we found 2 novel mutations in APOA5 (c.50-1G>A and c.326_327insC; p.Tyr110Leufs*158). Conclusion We have identified 5 novel pathogenic mutations: 2 in LPL, 1 in GPIHBP1, and 2 in the APOA5 gene. The genetic defaults accounting for the LPL activity deficiency of 23 of them have been clearly identified and 3 patients, who harbored mutations in heterozygosity, were diagnosed based on LPL activity deficiency, which raises the question of the involvement of new genes in the manifestation of FCS.

Non-HDL cholesterol (non-HDL-C) is becoming relevant both in its participation in cardiovascular risk assessment and as a therapeutic target. The objective of the present study was to assess the independent predictive capacity of both non-HDL-C and LDL-C (the main priority in dyslipidemias to reduce cardiovascular risk), in cardiovascular morbidity in a population-based sample.A prospective cohort study involving 1186 individuals in the non-HDL-C group and 1177 in the LDL-C group, followed for 10.7years (SD=2.2), who had not had any previous cardiovascular event. The predictor variables included in the adjustment were: gender, age, arterial hypertension, diabetes mellitus, smoker status and non-HDL-C in one group. In the other group, consisting of patients presenting TG levels of 400mg/dL, non-HDL-C was replaced by LDL-C. Survival curves (Kaplan-Meier) were calculated and two Cox regression models were applied, one for each group.Non-HDL-C group presented 6.2% of non-fatal cardiovascular episodes during follow-up and the LDL-C group 6.0%. After adjustment, for each 30mg/dL increase in non-HDL-C, the incidence of new non-fatal cardiovascular events increased by 31% (HR=1.31, 95%CI: 1.06-1.61; P=.018) and in the LDL-C group by 27% (HR=1.27, 95%CI: 0.97-1.61, P=.068).After a follow-up of 10.7years, non-HDL-C has been shown in our population as a prognostic factor of non-fatal cardiovascular disease, but not LDL-C, although its HR is close to statistical significance.

To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care.The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them.A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70.The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.

To assess the effect on lipid parameters most associated with excess weight (triglycerides [TG], cholesterol, and high density lipoprotein [HDL-C]) of an intervention to reduce weight in overweight and obese patients.A randomised, controlled, double blind clinical trial, with three groups, and a follow-up of 12 months. Patients included in the study were randomised into three intervention groups: Obesity motivational intervention group with previously trained nurse (G1), lower intensity consultation, non-motivational group, with digital platform support (G2), and a third group that received a recommendation to lose weight and usual follow-up (G3). The anthropometric variables measured were height, weight, and abdominal/waist circumference, and laboratory results, total cholesterol, TG and HDL cholesterol).The study include 176 patients, of whom 60 were randomised to G1, 61 to G2, and 59 to G3. All groups significantly decreased body weight at the end of the study, with a decrease in G1 (-5.6kg), followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean loss of -3.9kg. There was a also significant decrease (P.05) in total cholesterol and TG, and an increased HDL-C. These changes were more marked in the G1 group (the group that lost more weight). The clinical relevance indicators that were significant were: in the case of TG: G1/G3: relative risk: 1.42 (95% CI: 1.11-1.80); relative risk reduction: 41.7% (11.4-80.2); absolute risk reduction: 25% (9.2-40.8) and NNT: 5 (3-11). In the case of G1/G2 HDL-C: relative risk: 1.32 (1.07-1.63); relative risk reduction: 32.2% (7.4-62.6); absolute risk reduction: 21.1% (6.4-35.8) and NNT: 5 (3-16).Weight reduction is accompanied by favorable changes in the lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

Background 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. Materials and Methods This prospective cohort study used stratified and randomized two-stage sampling. Obesity [body mass index (BMI) ≥30 kg/m2] 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. Results 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/m2 yielded a hazard ratio for all-cause mortality of 1.94 (95% CI: 1.11–3.42) in comparison to non-obese subjects (BMI

ObjetivoObservar diferencias entre las mediciones clínicas y las automediciones de presión arterial (AMPA) domiciliarias.DiseñoEstudio descriptivo realizado en la población general censal.EmplazamientoAtención primaria.ParticipantesMediante muestreo aleatorio estratificado se seleccionó una muestra de 1.411 sujetos≥18 años.MétodosUna enfermera adiestrada realizó 3 mediciones de PA en la consulta (PAC) y entrenó a los pacientes o sus familiares para la realización de AMPA; hicieron 12 en un día. Las mediciones de la PAC y la AMPA domiciliaria se realizaron con un aparato electrónico (OMRON 705CP).ResultadosCompletaron 12 AMPA un total de 1.184 sujetos (52% mujeres) con una edad media de 47,6±17,2 años. De ellos, 195 eran hipertensos conocidos.Se diagnosticó efecto de bata blanca en un 14,9% de los normotensos, un 22,3% de los hipertensos tratados y un 57,6% de los sujetos con sospecha de hipertensión clínica aislada. Se diagnosticó posible hipertensión clínica aislada en el 10% de los sujetos no hipertensos y posible normotensión de bata blanca en el 2,3% de los no tratados y en el 4,7% de los hipertensos tratados. Un 20,7% de los hipertensos tratados mal controlados en la consulta fue considerado como seudorrefractario (el 11,4% al final del intervalo de dosificación).Un 77% de los sujetos se hizo las automediciones a sí mismo, y un 89% de ellos consideró fácil su realización.ConclusiónLa incorporación de la automedición domiciliaria en la práctica clínica diaria podría evitar un 20-30% de posibles errores en el diagnóstico y seguimiento de los pacientes hipertensos.ObjectiveTo find differences between measurements of clinical blood pressure and self-monitored home blood pressure measurement (HBPM).DesignDescriptive study developed in a general population census.SettingPrimary care.SubjectsA total of 1411 subjects ≥18 years old were selected by stratified randomized sampling.MethodsA skilled nurse made 3 clinical blood pressure (CBP) measurements, and trained patients or their relatives in HBPM, doing 12 in one day. CBP and HBPM employed an electronic device (OMRON 705CP).ResultsA total of 12 HBPM from 1184 subjects (52% women) were completed, with a mean age of 47.6 (SD, 17.2); 195 subjects were known to have hypertension.Whitecoat effect was diagnosed in 14.9% of subjects with normal pressure, 22.3% of hypertense patients treated and 57.6% of subjects with suspicion of isolated clinical hypertension. Possible isolated clinical hypertension was diagnosed in 10% of subjects without hypertension.White Coat normal pressure was found in 2.3% of untreated subjects and 4.7% of subjects with treated hypertension. 20.7% of subjects with hypertension poorly controlled in the clinic were considered pseudo-refractory (11.4% at the end of dosage interval). 77% of subjects conducted HBPM on their own and 89% thought it easy to do so.ConclusionIncorporation of HBPM into daily medical practice could avoid 20%-30% of possible mistakes in diagnosis and monitoring of hypertense patients.

It is known that Miguel de Cervantes's novel 'Don Quixote de La Mancha' has done and is still doing a great contribution to the universal literature. A book that has reached such category and grows in number of its readers, shows multiple dimensions for its study. One of them is nutrition. One of the aims of this study has been to value and expound, according to their own nutrients, the kinds of food cited in 'The Quixote' and in the times of Cervantes. This has allowed the comparison made between ways of nutrition in La Mancha and in Catalonia, as well as the regions situated at the beginning and end of the itinerary covered by its main characters Don Quixote and Sancho Panza. The evaluation of the nutrients in the middle part of the itinerary, placed mainly in Aragón, has not been considered in this study. Another purpose has been to check if these nutrients followed the current recommendations of the Spanish Society of Arteriosclerosis and other valid agreements at the moment.

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.

Inflammation is present in every stage of the atherosclerosis process, therefore, inflammation hallmarks such as the fibrinogen can be related to the complications in which it intervenes, mortality is one of them. The objective of this study is to assess the association of the fibrinogen with all-cause mortality in men from general population sample obtained by random sampling in the Spanish region of Albacete.A total of 506men without cardiovascular events with 10.6years (SD=2.3) of follow-up, volunteered to participate in a prospective cohort study. The assessment of the fibrinogen as a predictor variable has been calculated after adjusting it by age, hypertension, diabetes mellitus, obesity, total cholesterol, HDL-cholesterol/triglycerides ratio, and smoking habit applying a Cox regression model. The adjustment has been made by adding the fibrinogen to the model, as a qualitative variable (400 and ≥400mg/dl).The average age of the participants was 46.6years old (DE=16.8). After the adjustment, the hyperfibrinogenemia (≥400mg/dl) showed a hazard ratio (HR) for all-cause mortality of 1.85 (95%CI: 1.05-3.26) and for cardiovascular mortality HR=2.69 (95%CI: 1.09-6.63).In men without cardiovascular events of our study, fibrinogen was showed as an independent predictor of all-cause mortality and cardiovascular mortality.

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.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.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%).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.

Insulin resistance (IR) has been directly related to obesity, particularly central obesity, and to other cardiovascular risk factors (CVRFs). Direct IR quantification is difficult in clinical practice, and indirect methods such as HOMA (homeostasis model assessment) have therefore been developed. The aim of this study was to assess the association of IR, as measured by HOMA, with different anthropometric measures and some CVRFs.A cross-sectional, observational study was carried out in a general population sample older than 18 years in the province of Albacete, Spain. Sample size was 678 subjects. Participants completed a survey and underwent physical examinations and laboratory tests. Obesity measures included body mass index, waist perimeter, and sagittal abdominal diameter. Data analysis was performed using SPSS 15.0 software.Mean values of obesity measures were higher in males as compared to females and increased with age. IR prevalence was 39.8%. All assessed anthropometric measures, decreased HDL (high density lipoprotein) cholesterol and increased non-HDL cholesterol were independently associated to the risk of IR.A clear association exists between different anthropometrical measures and IR in the general population. There is also an association between lipid profile cahnges and the risk of experiencing IR.

BackgroundThe question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity.MethodsThe cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated.ResultsThe mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (PConclusionsThe results support the proposal for "reclassification" of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe.