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Resumen Objetivos El conocimiento sobre la incidencia de enfermedad coronaria en nuestro pais es escaso y sus fuentes poco comparables. Fue nuestro objetivo determinar la incidencia de cardiopatia isquemica en una cohorte poblacional con un seguimiento de 7 anos y el riesgo asociado a los factores de riesgo cardiovascular clasicos. Metodos Estudio de cohortes prospectivo en una muestra poblacional de 2833 sujetos, seleccionada por metodo aleatorio simple entre ciudadanos de 25 a 79 anos del Area de Salud Don Benito – Villanueva de la Serena (Badajoz), tasa de respuesta 80,5%. Se recogieron todos los episodios de angina de pecho, infarto de miocardio letal y no letal en individuos sin antecedentes previos de enfermedad cardiovascular. Se calcularon las incidencias acumuladas y las tasas de incidencia ajustadas por 100.000 personas-ano por sexo y global. Resultados De los 2833 participantes iniciales, se excluyeron 103 por antecedentes de enfermedad cardiovascular y 61 por perdidas, completando el seguimiento 2669 (94,2%). La mediana de seguimiento fue de 6,9 anos (RI 6,5 - 7,5), 56,4% mujeres; se registraron 59 eventos. La tasa de incidencia global de cardiopatia isquemica fue 327 casos/100.000 personas-ano correspondiendo 470 casos/100.000 al sexo masculino y 211 casos/100.000 personas-ano al femenino. Los factores de riesgo cardiovascular clasicos que se asociaron con mayor riesgo de presentar eventos en el seguimiento fueron la dislipemia y la HTA, ademas del sexo masculino y la edad. Conclusiones La incidencia de cardiopatia isquemica en la poblacion urbano-rural de Extremadura, es elevada. Los factores de riesgo cardiovascular clasicos mas fuertemente asociados a su aparicion fueron la dislipemia, y la hipertension arterial.

Resumen Introduccion y objetivos Comparar el rendimiento de distintas funciones de riesgo cardiovascular propuestas para Espana, a partir del seguimiento de una cohorte poblacional de Extremadura, con el fin de proporcionar pruebas que respalden su uso. Metodos Se aplicaron las funciones REGICOR y FRESCO CI para la prediccion de la cardiopatia isquemica, la SCORE para paises de bajo riesgo y para personas mayores, y la FRESCO ECV para el riesgo cardiovascular total. La validez se analizo mediante la prueba de bondad de ajuste de Hosmer-Lemeshow y la discriminacion, con el indice C de Harrell. Se calculo la proporcion de participantes en cada categoria de riesgo. Resultados Cohorte inicial de 2.833 personas. Se analizo a 2.669 tras excluir a 103 por antecedentes de enfermedad cardiovascular y a 61 que se perdieron. Seguimiento medio 6,9 anos (rango 6,1-8,1). Se registraron 59 eventos coronarios, 45 cerebrovasculares y 23 otras muertes cardiovasculares. La razon entre casos esperados/observados fue REGICOR: 1,04 (0,81-1,5), FRESCO CI: 0,82 (0,62-1,21), SCORE: 1,75 (1,23-2,69) y FRESCO ECV: 0,79 (0,63-1,03). La prueba de Hosmer-Lemeshow mostro diferencias para SCORE (p = 0,012) y FRESCO ECV (p = 0,005). El indice C fue para REGICOR: 0,77, FRESCO CI: 0,79, SCORE: 0,87 y FRESCO ECV: 0,82. SCORE categorizo como riesgo alto-muy alto al 24,7% de la poblacion, por el 3,2, 5,3 y 10,5% de FRESCO CI, REGICOR y FRESCO ECV, respectivamente. Conclusiones Las funciones que predicen cardiopatia isquemica (REGICOR y FRESCO CI) presentaron mayor validez. SCORE sobrestimo de forma significativa el riesgo y clasifico como riesgo alto o muy alto el 25% de la poblacion estudiada. Introduction and objectives To compare the performance of different cardiovascular risk functions proposed for Spain based on the follow-up of a population cohort in Extremadura, in order to provide evidence to support their use. Methods The cardiovascular risk functions of REGICOR and FRESCO CHD were applied for the prediction of coronary heart disease, SCORE for low risk countries and older persons, and FRESCO CVD for overall cardiovascular risk. Validity was analysed using the Hosmer-Lemeshow goodness-of-fit test, and discrimination with the Harrell C index. The proportion of participants in each risk category was calculated. Results Of the initial cohort of 2833 subjects, 2669 were analysed after excluding 103 for history of cardiovascular disease, and 61 due to losses. The mean follow-up was 6.9 years (range 6.1-8.1), and 59 coronary events, 45 cerebrovascular events, and 23 other cardiovascular deaths were recorded. The ratio of expected/observed cases was REGICOR: 1.04 (0.81-1.5), FRESCO CHD: 0.82 (0.62-1.21), SCORE: 1.75 (1.23-2.69) and FRESCO CVD: 0.79 (0.63-1.03). The Hosmer-Lemeshow test showed differences for SCORE (P = .012) and FRESCO CVD (P = .005). The C index was REGICOR: 0.77, FRESCO CHD: 0.79, SCORE: 0.87, and FRESCO CVD: 0.82. SCORE classified 24.7% of the population as high-very high risk, by 3.2%, 5.3% and 10.5% of FRESCO CHD, REGICOR and FRESCO CVD, respectively. Conclusions The cardiovascular risk functions that predict coronary heart disease (REGICOR and FRESCO CHD) were more valid than the rest. SCORE significantly overestimated the risk and classified approximately 25% of the test population as high or very high risk.

The present work has been financed by: Carlos III Health Institute [PI071218 National Plan for Scientific Research 2004-07 (Funded the medical staff for 3 years and material for the extraction of samples and indirect costs of the project) EMER 07/046 Grants for emerging research groups (Funding of personnel: nurse, doctor and technician) -INT 07/289 Grants for intensification of personal care research (Funded a researcher for 6 months)], Fundesalud [Integral Plan Grant for Cardiovascular Diseases in Extremadura (Funded a lab technician during patient enrolment)] and Junta de Extremadura and European Union (ERDF) [GR18076 Aid to Research Groups 2018 (Funded a research support technician)]., Background: The Mediterranean Diet (MD) is recognized as heart-healthy, but the economic cost associated with this type of diet has scarcely been studied. The objective of the present study is to explore the cost and adherence of a low-income region population to the MD and its relationship with income. Methods: A population-based study was carried out on 2,833 subjects between 25 and 79 years of age, 54% women, selected at random from the municipalities of Vegas Altas, La Siberia and La Serena in the province of Badajoz, Extremadura (Spain). Average monthly cost of each product included in the MD was computed and related to adherence to the MD using the Panagiotakos Index and average disposable income. Results: The monthly median cost was 203.6€ (IQR: 154.04-265.37). Food-related expenditure was higher for men (p, Instituto de Salud Carlos III PI071218 EMER 07/046 INT 07/289, Fundesalud [Integral Plan Grant for Cardiovascular Diseases in Extremadura] Junta de Extremadura, European Commission GR18076

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute - Spain Background Cardiovascular diseases are the leading cause of death in developed countries. In this context, the Mediterranean diet (MD) is widely recognized as cardioprotective, although its implementation cost has been little studied and rarely employed as an argument for debate. Although previous Spanish studies have corroborated a higher monetary cost associated with increased adherence to the MD, there exist large disparities among studies, and none of them has related the cost of MD to available income, which is highly relevant for assessing the degree of affordability by families. Purpose The aim of this study is twofold. First, to estimate the cost and degree of adherence of the MD in a population of Extremadura. Second, to provide evidence on the cost of the MD in relation to available incomes. Methods A population study including 2.833 subjects between 25 and 79 years old (54% women), randomly selected from Don Benito-Villanueva de la Serena (Badajoz, Spain). Diet questionnaire contained 175 food items and 7 items related to alcoholic beverages. Consumption frequencies were translated in terms of grams or millilitres. Price for each item was obtained using price supermarket comparators from the same geographical area. Total monthly cost was obtained using monthly quantities consumed and the price of each category. Final cost was related to Panagiotakos adherence degree and to available income. Data of available income was obtained from the Income Tax Statistics by municipality. Results Median monthly cost was EUR 203.63 (IQR 154.04-265.37): 216.91 for men and 191.22 for women. Median monthly cost per age cohort showed an inverted U-shape, with a maximum in the 45-54 years-old cohort (EUR 212.1; IQR 155.47-274.63) and a minimum for the 75-79 years-old cohort (EUR 179; IQR 130.21-224.99). Median monthly cost was very similar for primary, secondary and higher educational levels (208.18, 206.57 and 205.70, respectively), but 14% lower for those without primary studies. MD cost was lower in rural compared with urban areas (188 versus 223 euros, respectively) The percentage of population showing a high MD adherence was 59% whereas the percentage with a low adherence was 12%. The cost associated with a high MD adherence was EUR 228.38. The average cost represents 14% of the available income, ranging from 10.5% for the group with low MD adherence, to 15.72% for the group with a high adherence. Conclusions Higher adherence to the MD can reach almost 20% of the available income. This can lead to low-income families opting for cheaper, energy-dense, and consequently, less healthy dietary patterns. Emphasis should be placed on education strategies to recreate the MD at an affordable price or to introduce changes to consumer taxes (VAT) that favor DM pattern.

Background and Aims To evaluate the relationship between chronic kidney disease (CKD) diagnosed by the hematocrit, urea and gender (HUGE) equation and the incidence of major adverse cardiovascular events and cardiovascular mortality in a sample of Spanish general population. Method The sample consisted of 2,668 subjects (mean age, 50.6±14.5 years; 54.6% were female). Of them, 55 patients have a HUGE score > 0. The median follow-up was 81 (75-89) months. Serum creatinine, urea and haematocrit were analyzed after overnight fast. The HUGE formula score was calculated for all subjects. Results Event-free survival was 98.4 % at three years and 97.1% at five years of follow-up for patients with a HUGE score < 0. For patients with a estimated HUGE score higher than 0 survival was 88.9% at three years and 87.0 at five years of follow-up. (p Conclusion A significantly increased cardiovascular risk was associated to the diagnosis of CKD through HUGE formula. This effect on survival could be detected despite of a very small sample of CKD patients. This relationship was close to those obtained using MDRD estimated GFR in a bigger sample of patients. HUGE formula may be a useful tool for diagnosing CKD and to evaluate the cardiovascular risk of these patients.

Background Heart failure (HF) is a global pandemic, and the cause of the greater health expenditure on hospitalization. Purpose To determine, in patients admitted due to decompensated heart failure (dHF), the predictors of in-hospital and late all-cause mortality. Methods Retrospective and longitudinal observational study of consecutive patients admitted with a diagnosis of dHF in a General Hospital between 2000–2015. Primary objective was in-hospital and late mortality. Results A total of 3705 patients were included (76.9 + 10.1 years, 54.1% women). Diabetes was present in 1611 (43.5%) patients, hypertension in 3210 (86.6%), active smoking in 221 (6%), COPD in 989 (26.7%), neoplasms in 415 (11.2%), chronic renal failure (CRF) in 628 (17%), previous myocardial infarction (pMI) in 449 (12.1%), stroke in 416 (11.2%), previous heart failure (pHF) in 1015 (27.4%), atrial fibrillation in 1672 (45.1%). A total of 239 (6.5%) lived in a nursing home (NH). The rate of 6-months readmission due to heart failure was 473 (12.8%). The in-hospital all-cause mortality rate was 9.3% (345). During a median follow-up of 930 days (RI 230–2611), 2165 (58.4%) patients died. The following variables were independent predictors of in-hospital mortality (Odds ratio, 95% CI): age 1.03 (1.02–1.05), basal creatinine 1.18 (1.01–1.39) and urea 1.014 (1.011–1.018) (model AUC 0.78 (0.75–0.81)). We identified the following predictors of late mortality (Hazard ratio, 95% CI): age 1,029 (1,022–1,035), diabetes mellitus 1,13 (1,02–1,25), COPD 1,15 (1,03–1,28), neoplasms 1,17 (1,008–1,361), pMI 1.19 (1.02–1.38), pHF 1.25 (1.12–1.39), NH 1.24 (1.03–1.49), readmission 1.73 (1.51–1.97), urea 1.003 (1.001–1.005) (model AUC 0.73 (0.71–0.75)). Conclusions In-hospital mortality was significantly associated with age and markers of renal function, while for late mortality the predictors were comorbidities, hospital readmissions and living in a nursing home.

To evaluate the screening power of the HUGE formula for the detection of chronic kidney disease (CKD) in a Spanish population sample obtained from the HERMEX study, a survey of cardiovascular risk factors carried out in the region of Extremadura, stratified by age.This was an observational, cross-sectional, population-based study. The final sample included 2,813 subjects selected from Health Care System records. Anthropometric data and cardiovascular risk factors were recorded. Hematocrit, urea, creatinine and microalbuminuria were analyzed, after which the HUGE formula was applied. Renal function, assessed as eGFR based on serum creatinine, was estimated following the MDRD-4 formula.Using the HUGE formula, the estimated prevalence of CKD was 2.2% (men 2.2%, women 2.1%). The prevalence of CKD increased with age (5.0% in persons aged 60- 70 years and 9.6% in individuals over 70 years of age, p0.001) whereas with the MDRD formula the prevalence values were 9.8% and 15.5% respectively. The HUGE formula was seen to be highly specific (0.99). CKD was more common in persons70 years, obese subjects, hypertensive patients, dyslipidemic subjects and those with microalbuminuria. Multivariate analysis revealed an independent negative association of CKD as the dependent variable with SBP, serum triglyceride levels and microalbuminuria.The HUGE formula allows the prediction of CKD in the general population to be honed without relying on serum creatinine levels. This method was found to have a higher specificity than the MDRD-4 formula. Moreover, it could reduce the excessively extensive diagnostic suspicion of CKD in women.

Diabetic nephropathy traditionally produces significant proteinuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. The current study evaluated the impact of diabetes mellitus on the prevalence of renal disease in general population.Data from of the HERMEX survey, an observational, cross sectional, population based study were used. The final sample included 2813 subjects (mean age 51.2 years, 53.5% female). Four hundred patients have diabetes. Urinary albumin excretion (UAE) rate was analyzed and glomerular filtration rate (GFR) was estimated using the CKD-EPI formula.Among participants without diabetes, 2.9%(2.2-3.6) had a GFR60 ml/min. Prevalence of abnormal UAE in population without diabetes was 3.3% (2.6-4.0). The global prevalence of renal disease was 5.6%(4.8-6.6). Prevalence of GFR60 ml/min in subjects with diabetes was 8.8%(6.4-11.9)(p0.001,Chi-square test). Prevalence of abnormal UAE in population with diabetes was 14.1%(7.7-19.8)(p0.001,Chi-square test). CKD prevalence was 20.3%(16.6-24.6)(p0.001,Chi-square test). The logistic regression analysis showed a positive independent association of CKD with age, high blood pressure and albuminuria. No significant relationship was found with diabetes mellitus CONCLUSIONS: CKD is more prevalent in population with diabetes. Nevertheless, most of patients with diabetes and CKD have no albuminuria. An increased cardiovascular burden seems to produce this clinical presentation.

Resumen Antecedentes y objetivos La fibrilacion auricular es la arritmia cronica mas comun. El proposito de este estudio fue determinar la prevalencia de la fibrilacion auricular y su relacion con los factores de riesgo cardiovascular en Espana. Metodologia Estudio transversal a partir de un analisis agrupado de 17.291 individuos aleatorizados reclutados en 6 estudios poblacionales. Resultados La prevalencia de fibrilacion auricular fue de 1,5%. (intervalo de confianza 95%: 1,3-1,7%). Los hombres tuvieron mayor prevalencia que las mujeres (1,9 vs. 1,1%, respectivamente). La prevalencia de fibrilacion auricular se incremento progresivamente con la edad: 0,05% en los menores de 45 anos, 0,5% entre los 45-59 anos, 2,3% entre los 60-74 anos, y 6,3% en los mayores de 75 anos. El porcentaje de individuos que recibia tratamiento anticoagulante fue de 74,3%. Los factores de riesgo asociados significativamente con la arritmia fueron: edad mayor de 60 anos (odds ratio [OR]: 7,6; IC 95%: 5,1-11,2), sexo masculino (OR : 1,8; IC 95%: 1,4-2,4), hipertension arterial (OR : 1,6; IC 95%: 1,2-2,1), obesidad (OR : 1,5; IC 95%: 1,2-2,1), y antecedentes de enfermedad coronaria (OR : 1,9; IC 95%: 1,3-3,0). Conclusion La fibrilacion auricular es una enfermedad frecuente en los individuos de mayor edad mientras que su prevalencia es baja en individuos menores de 60 anos. La mayoria de los individuos con fibrilacion auricular estaban bajo tratamiento anticoagulante. Los factores de riesgo para padecer esta arritmia fueron la edad, el sexo masculino, la hipertension, la obesidad y los antecedentes de enfermedad coronaria.

Background and objectives Atrial fibrillation (AF) is the most common type of arrhythmia. The purpose of this study was to determine the prevalence of atrial fibrillation and its relationship with cardiovascular risk factors in Spain. Methodology Cross-sectional study based on a grouped analysis of 17,291 randomized individuals recruited in 6 population studies. Results The prevalence of atrial fibrillation was 1.5% (95% CI: 1.3–1.7%). Men had a greater prevalence of the disease than women (1.9 vs. 1.1%, respectively). The prevalence of atrial fibrillation progressively increased with age: 0.05% for patients younger than 45 years, 0.5% for those between 45 and 59 years of age, 2.3% for those between 60 and 74 years of age and 6.3% for those older than 75 years. The percentage of individuals who underwent anticoagulant treatment was 74.3%. The risk factors significantly associated with arrhythmia were ages older than 60 years (odds ratio [OR]: 7.6; 95% CI: 5.1–11.2), the male sex (OR: 1.8; 95% CI: 1.4–2.4), arterial hypertension (OR: 1.6; 95% CI: 1.2–2.1), obesity (OR: 1.5; 95% CI: 1.2–2.1) and a history of coronary artery disease (OR: 1.9; 95% CI: 1.3–3.0). Conclusion Atrial fibrillation is a common disease in elderly individuals, while its prevalence is low in individuals younger than 60 years. Most individuals with atrial fibrillation were on anticoagulant treatment. The risk factors for this type of arrhythmia are age, the male sex, hypertension, obesity and a history of coronary artery disease.

Objective:To evaluate the relationship between chronic kidney disease (CKD) defined through estimated glomerular filtration rate (GFR) and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population.Design and method:The s

HERMEX is a population-based study, which tries to evaluate the prevalence of cardiovascular risk factors in the population of Extremadura, Spain. This report provides the data concerning albuminuria in the elderly people recruited in the survey. 3,402 subjects were randomly selected from the database of the Health Care System of Extremadura. The final sample included 2,813 subjects (mean age 51.2 years, 53.5 % female). Urinary albumin excretion rate (UAER) in the first morning urine sample was analyzed. Albuminuria was diagnosed when UAER (albumin-to-creatinine ratio) was ≥22 mg/g in men or ≥31 mg/g in women. The prevalence of abnormal UAER in the elderly population was 10.9 % (microalbuminuria: 8.9 %; overt proteinuria: 1.8 %). The younger subjects showed a lower prevalence of microalbuminuria (3.4 %, p