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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

Background 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. Objective 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. Methods 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). Results 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. Conclusion 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.

Objective 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. Methods 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 . Results 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 4.898 kg, and 6.292 kg in G2. In both groups there was also a significantly decrease (p Conclusions Weight reduction is accompanied by favourable changes in lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

Resumen Objetivo Valorar el efecto de un programa de actividad fisica motivada sobre los parametros lipidicos mas relacionados con el exceso de peso (trigliceridos [TG] y colesterol de las lipoproteinas de alta densidad [cHDL]) en una intervencion para reducir peso en pacientes con sobrepeso y obesidad. Metodos Ensayo clinico, aleatorizado y controlado, con 2 brazos y un seguimiento de 12 meses. Los pacientes incluidos en el estudio fueron aleatorizados en 2 grupos de intervencion: intervencion motivacional de obesidad con enfermera entrenada previamente (G1), grupo motivacional, con apoyo de plataforma digital y programa de actividad fisica motivada (iwopi [G2]). Las variables antropometricas medidas fueron estatura, peso, indice masa corporal (IMC) y las analiticas, colesterol total, TG y cHDL. Resultados Han participado en el estudio 123 pacientes, de los que 61 fueron aleatorizados al G1 y 62 al G2. Todos los grupos disminuyeron significativamente el peso al final del estudio, siendo la disminucion en el G1 (−4,898 kg) y del G2 (−6,292 kg). Tambien todos los grupos disminuyeron significativamente (p Conclusiones La reduccion de peso se acompana de cambios favorables en los parametros lipidicos relacionados con el sobrepeso y la obesidad, siendo mas intensos cuanto mayor es la perdida de peso.

Introducción. La elección de los alimentos en época de confinamiento están influenciadas por múltiples factores como pueden ser la disponibilidad alimentaria que puede verse reducida y que constituyó uno de los principales retos a afrontar por los gobiernos en las pandemias pasadas, el estatus económico familiar que puede variar, así como el propio hecho del confinamiento que proporciona al grupo familiar de más tiempo para dedicar a la preparación de distintos platos pero también les sitúa en una situación que puede ser vivida como estresante y conducir a pautas distintas de consumo alimentario. Objetivo. Conocer el patrón dietético habitual, es decir previo al confinamiento recabando esta información en el momento en que se iniciaba aquel. Método. Estudio observacional transversal mediante encuesta alimentaria telemática anónima en línea que monitorizó la adherencia a la dieta mediterránea en tiempo real en 492 adultos de España en la pandemia por covid19 durante la segunda quincena del mes marzo 2020. Resultados. Nuestro estudio muestra que el grado de adherencia a la DM en la primera parte del confinamiento ha sido elevado, mostrando una puntuación de 10.0 ± 2.0 en el test de MEDAS y de 9.3± 2.1 en el PREDIMED modificado. En concreto en nuestro estudio un 77% de la población estudiada presenta una alta adherencia a la dieta mediterránea frente a moderada adherencia el 22,4%y baja el 5%. Conclusiones. Nuestro estudio refleja una alta adherencia de los participantes a la Dieta Mediterránea.

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.

Resumen Introduccion El colesterol no transportado por las lipoproteinas de alta densidad (c-no-HDL) esta adquiriendo relevancia en su participacion en la valoracion del riesgo cardiovascular y como diana terapeutica. El objetivo del presente estudio ha sido valorar la capacidad predictiva independiente, tanto del c-no-HDL como del colesterol de las lipoproteinas de baja densidad (cLDL), principal prioridad en las dislipidemias para reducir el riesgo cardiovascular (RCV), en la morbilidad de causa cardiovascular, en una muestra de origen poblacional. Metodos El diseno del estudio corresponde a una cohorte prospectiva en la que han participado 1.186 individuos en el grupo c-no-HDL y 1.177 en el grupo cLDL, seguidos durante 10,7 anos (DE = 2,2), los cuales no habian padecido ningun episodio cardiovascular (CV) previo. Las variables predictoras incluidas en el ajuste han sido: genero, edad, hipertension arterial, diabetes mellitus, estado de fumador y c-no-HDL en un grupo. En el otro grupo, formado por pacientes que presentaban niveles de trigliceridos ≤ 400 mg/dl, se sustituyo el c-no-HDL por el cLDL. Se calcularon curvas de supervivencia (Kaplan-Meier) y se aplicaron dos modelos de regresion de Cox, uno por cada grupo. Resultados El grupo c-no-HDL presento un 6,2% de episodios CV no mortales durante el seguimiento, y el grupo cLDL, un 6,0%. Despues del ajuste, por cada aumento de 30 mg/dl de c-no-HDL, la incidencia de nuevos episodios CV no mortales aumento un 31% (HR = 1,31; IC 95%: 1,06-1,61; p = 0,018) y en el grupo del cLDL un 27% (HR = 1,27; IC 95%: 0,97-1,61; p = 0,068). Conclusiones Tras un seguimiento de 10,7 anos, el c-no-HDL se ha mostrado en nuestra poblacion como un factor pronostico de enfermedad CV no mortal, pero no el cLDL, aunque su HR se encuentra proxima a la significacion estadistica.

Introduction 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. Methods A prospective cohort study involving 1186 individuals in the non-HDL-C group and 1177 in the LDL-C group, followed for 10.7 years (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 400 mg/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. Results 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 30 mg/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 = 0.018) and in the LDL-C group by 27% (HR = 1.27, 95% CI: 0.97–1.61, p = 0.068). Conclusions After a follow-up of 10.7 years, 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.

Resumen Introduccion . La fibrilacion auricular (FA) es la arritmia cardiaca mas frecuente. En su manejo, es clave valorar la necesidad de anticoagulacion. Nuestro objetivo fue valorar en pacientes diagnosticados de FA no valvular si la indicacion de anticoagulacion es adecuada en funcion de la escala CHA2DS2-VASc y la adecuacion del rango del International Normalizad Ratio (INR) en los pacientes en tratamiento con antivitamina K. Metodos Estudio observacional, analitico transversal. Se seleccionaron 232 pacientes con diagnostico de FA no valvular. Se han analizado variables demograficas, variables de la escala CHA2DS2-VASc, tratamiento prescrito y valores de INR durante 6 meses consecutivos. La comparacion de variables se realizo con ji cuadrado y la tendencia lineal entre grupos por Mantel Haenzel, siendo calculadas las odds ratios. Resultados La prevalencia total de FA no valvular en el area fue 1,05%. El 88,4% presento un CHA2DS2-VASc ≥ 2. Un 71,1% de pacientes con fibrilacion auricular estaban anticoagulados, de los que el 58,2% tomaban farmacos antivitamina K. El 46,7% de los pacientes en tratamiento con acenocumarol presento un INR con un tiempo en rango terapeutico directo insuficiente. La prescripcion de antivitamina K en los pacientes con FA permanente fue superior que en pacientes con FA paroxistica (62,8 vs. 37,2%, p Conclusiones El control de la anticoagulacion oral con antivitamina K fue suboptimo pese a la adecuada adherencia de los pacientes. Los pacientes con FA paroxistica recibieron menos antivitamina-K que los de FA persistente/permanente.

Resumen Objetivo Valorar el efecto sobre los parametros lipidicos mas relacionados con el exceso de peso (trigliceridos [TG] y colesterol de las lipoproteinas de alta densidad [cHDL]) de una intervencion para reducir peso en pacientes con sobrepeso y obesidad. Metodos Ensayo clinico, aleatorizado y controlado, doble ciego, con 3 brazos y un seguimiento de 12 meses. Los pacientes incluidos en el estudio fueron aleatorizados en 3 grupos de intervencion: Intervencion motivacional de obesidad con enfermera entrenada previamente (G1), intervencion en consulta de menor intensidad, sin grupo motivacional, con apoyo de plataforma digital (G2) y un tercer grupo que recibia recomendacion de perder peso y seguimiento habitual (G3). Las variables antropometricas medidas fueron estatura, peso y perimetro de cintura abdominal y las analiticas, colesterol total, TG y cHDL). Resultados Han participado en el estudio 176 pacientes de los que 60 fueron aleatorizados al G1, 61 al G2 y 59 al G3. Todos los grupos disminuyeron significativamente el peso al final del estudio, siendo mas intensa la disminucion en el G1 (−5,6 kg), seguido del G2 (−4,3 kg) y del G3 (−1,7 kg), media en su conjunto: −3,9 kg. Tambien todos los grupos disminuyeron significativamente (p Conclusiones La reduccion de peso se acompana de cambios favorables en los parametros lipidicos relacionados con el sobrepeso y la obesidad, siendo mas intensos cuanto mayor es la perdida de peso.

Objective 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. Methods 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). Results The study includes 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 (−5.6 kg), followed by G2 (−4.3 kg), and G3 (−1.7 kg), with an overall mean loss of −3.9 kg. There was also a significant decrease ( p Conclusions Weight reduction is accompanied by favourable changes in the lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

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.

Resumen Objetivo. El envejecimiento implica padecer enfermedades crónicas y ansiedad. Los objetivos han sido relacionar la ansiedad con las enfermedades cardiovasculares (ECV) y sus factores de riesgo (FRCV). También con la actividad física (AF) y el consumo de alcohol y tabaco. Método. Estudio observacional y analítico, transversal. Participaron 27 voluntarios (16 mujeres) mayores de 65 años. La ansiedad se valoró con la escala de Hamilton. El resto de variables mediante encuesta estructurada. Se utilizó estadística descriptiva y análisis bivariante. Resultados. Edad media 75,3 años. Ansiedad media 10,4. Los bebedores presentaron una ansiedad de 6,7 frente a 15,9 en los no bebedores (p=0,004). La media de ansiedad somática fue 3,1 en los que hacían otro tipo de AF frente a 4,3 en los que no (p=0,025). Conclusiones. No se ha encontrado relación entre la ansiedad y las ECV y sus FRCV. Tampoco con el consumo de tabaco. Sí con el consumo de alcohol y la AF.

Summary: Obesity and overweight are significant public health problems, worldwide. Hence, there is the importance of developing and applying strategies that reduce weight in this population. We set out to evaluate the effectiveness of obesity intervention with three different approaches—one of them with a platform that promotes physical activity. Methods: Randomized, controlled, parallel clinical trial that compared three arms, multicenter study in overweight or obese patients, with a 12-month follow-up. The patients were randomized into three groups: Intervention in the primary care center with intervention G1: Control group, which received the usual recommendations of losing weight following the SEEDO 2000 (Sociedad Espanola para el Estudio de la Obesidad) Consensus, G2: Motivational intervention of obesity (IMOAP) with a trained nurse and small periodic work groups, and G3: IMOAP adding the use of a digital platform to record physical activity, monitors it, and, in turn, favors the practice of this (aka iwopi: the concept that physical activity has a positive impact beyond the activity). Variables collected included: weight, height, body mass index (BMI), waist circumference, lipid parameters, blood pressure, and glycosylated hemoglobin. After the interventions, clinical relevance indicators were studied. Relative risk (RR), absolute risk reduction (ARR), relative risk reduction (RRR), and number needed to treat (NNT), both for intention to treat and for biological efficacy. Results: Cholesterol levels in three groups were reduced. The BMI showed a general average reduction. Total cholesterol levels were reduced in all groups, with the largest decrease in G3. Triglyceride levels were significantly reduced in two groups. Glycosylated hemoglobin showed a slight decrease that did not reach a statistically significant value. Conclusions: The digital health platform that stimulates physical activity added to an interventionist motivation in patients with overweight or obesity is a significant additional benefit in terms of weight loss results, BMI reduction, and lipid profile in patients affected by overweight or obesity, and a most effective cost.

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.

The degree of Architecture at the University of Alicante (UA) started in 1996-1997, coinciding almost with the beginning of the prodigious decade 1997-2006 and producing their first architects 2002-2003. The School did not miss either this period of euphoria and or the crisis of 2008. The main objective of this study is to know what the architects from the first eleven graduations of the School are working on and how. Specifically, the architects participating in the study are graduates from the academic year 2002-2003 until 2012-2013 both inclusive, being the outbreak of the crisis within this period. The study tries to elucidate the new and traditional professional exits and working conditions of the UA Architecture graduates, seeking a differential that can characterize them com-pared to the rest of Spanish architecture schools. The research starts from a triple-concern: the one from the seniors in the face of the uncertainty that the crisis poses; the curiosity to understand and explain how the profession is being transformed; and the institutional responsibility for adapting curricula to current needs. To this end, a representative percentage of the group has been surveyed online (135 out of 497 people); their results have been statistically processed, they have been expressed in tables and figures, and they have been discussed, concluding that there is at least one activity, the design, characterizes the UA architects in their professional work, their satisfaction is more than sufficient and the recognition of their work reaches more than half of the respondents.

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.

Resumen Es conocida la enorme contribucion que ha hecho y sigue haciendo la novela Don Quijote de la Mancha, de Miguel de Cervantes, a la literatura universal. Un libro de esta categoria, presenta para su estudio dimensiones multiples. Una de ellas es la nutricion. El principal objetivo de este estudio ha sido valorar y exponer la alimentacion citada en el Quijote y en tiempos de Cervantes en los nutrientes que la constituyen, y comparar la nutricion realizada en La Mancha con la realizada en Cataluna. El calculo de los nutrientes de la parte intermedia del itinerario, situada principalmente en Aragon, no ha sido objeto de este estudio. Ademas se ha comprobado si estos nutrientes seguian las recomendaciones actuales de la Sociedad Espanola de Arteriosclerosis y otros consensos.

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.

Resumen Objetivo Evaluar la consecucion del objetivo de colesterol LDL segun la guia europea de prevencion cardiovascular de 2007 en pacientes dislipidemicos atendidos en las unidades de lipidos y riesgo vascular de la Sociedad Espanola de Arteriosclerosis (SEA). Diseno Estudio observacional, longitudinal, retrospectivo, multicentrico, nacional que incluyo de forma consecutiva a pacientes de ambos sexos mayores de 18 anos de edad remitidos por dislipidemia y riesgo vascular. Se recogio la informacion de la historia clinica correspondiente a 2 consultas realizadas en la unidad de lipidos. Resultados Se incluyeron 1.828 pacientes procedentes de 43 unidades de lipidos. En la primera consulta seguian tratamiento farmacologico hipolipemiante 846 (46,3%) pacientes. En la ultima visita hubo un incremento significativo de todos los farmacos hipocolesterolemiantes, excepto un decremento en el acido nicotinico. El 65,3% de los pacientes con enfermedad vascular establecida y el 50,4% de los pacientes diabeticos tenian una concentracion de colesterol LDL Conclusion El presente estudio indica una mejora en el grado de consecucion del objetivo terapeutico en colesterol LDL respecto a los estudios previos realizados en otros ambitos asistenciales, asi como un aumento sustancial en la prescripcion de las estatinas en monoterapia y asociadas a ezetimiba en una poblacion dislipidemica atendida en las unidades de lipidos y riesgo vascular de la SEA. Sin embargo, la efectividad del tratamiento de la hipercolesterolemia tiene aun un amplio margen de mejora.

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.

The new cardiovascular risk markers are a group of tools that can be considered useful in the reclassification of patients at intermediate-risk, since the use of risk scales of cardiovascular disease that are based on atherosclerosis, such as the Framingham, REGICOR, SCORE, etc., risk scores, do not fully explain the appearance of these diseases. The detection of these patients would imply a stronger control of the classic risk factors, and therefore we can expect a decrease in the appearance of clinical manifestations of atherosclerotic disease, still the leading cause of death in developed countries. In this article we review the markers involved in the development of atherosclerosis, with particular scrutiny on those that can modify the risk stratification of patients, especially those at intermediate-risk.

Resumen Antecedentes y objetivo La resistencia a la insulina (RI) se ha relacionado directamente con la obesidad, especialmente la obesidad central, y con otros factores de riesgo cardiovascular (FRCV). La cuantificacion de la RI de forma directa es dificil en la practica clinica, por lo que se han desarrollado metodos indirectos como el indice homeostasis model assessment (HOMA). El objetivo de este estudio fue valorar la asociacion existente entre la RI, medida por indice HOMA, con diferentes medidas antropometricas y algunos FRCV. Material y metodos Se trata de un estudio observacional transversal realizado en una muestra de poblacion general mayor de 18 anos de la provincia de Albacete. El tamano muestral fue de 678 sujetos. Se realizaron encuesta, exploracion fisica y analitica a los participantes. Las medidas de obesidad valoradas fueron indice de masa corporal, perimetro de cintura y diametro sagital abdominal. El analisis de datos se realizo con el programa SPSS 15.0. Resultados Los valores medios de las medidas de obesidad fueron mayores en varones que en mujeres y aumentan con la edad. La prevalencia de RI fue del 39,8%. Todas las medidas antropometricas evaluadas, el descenso del colesterol unido a lipoproteinas de alta densidad (HDL) y el aumento del colesterol no unido a HDL se asocian de manera independiente con el riesgo de presentar RI. Conclusiones Existe una clara relacion entre diferentes medidas antropometricas y la RI en poblacion general. Tambien hay relacion entre las alteraciones del perfil lipidico y el riesgo de presentar RI.

Background and objective 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. Materials and methods 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. Results 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. Conclusions A clear association exists between different anthropometrical measures and IR in the general population. There is also an association between lipid profile changes and the risk of experiencing IR.

Resumen Introduccion El objetivo del estudio ha sido valorar la capacidad predictiva del indice tobillo-brazo (ITB) en la mortalidad por todas las causas y en el criterio compuesto de valoracion morbilidad de causa cardiovascular (CV) y mortalidad total en una muestra de origen poblacional. Metodos Estudio de cohortes prospectivo en el que han participado 1.143 individuos seguidos durante 10,8 anos (DE = 2,2) libres de eventos CV. El ITB se estratifico en 2 niveles: menos de 0,9 y entre 0,9 y 1,4. Las variables predictoras incluidas en el ajuste fueron: sexo, edad (corte en 50 anos), hipertension arterial, diabetes mellitus, obesidad, hipercolesterolemia (corte en 200 mg/dl), cociente cHDL/trigliceridos, fumador e hiperfibrinogenemia. Se calcularon curvas de supervivencia (Kaplan-Meier) y se aplico un modelo de regresion de Cox. Resultados La edad media de los participantes (56,8% mujeres) fue de 47,1 anos (DE = 17,4), rango 18-91 anos. Un 6,9% de la muestra presento un ITB menor de 0,9. Tras el ajuste, un ITB menor de 0,9 presento para la mortalidad por todas las causas una hazard ratio (HR) de 1,90, intervalo de confianza (IC) del 95%: 1,10-3,26, y para el combinado morbilidad CV y mortalidad por todas las causas una HR de 1,69 (IC del 95%: 1,07-2,67). Conclusiones Un ITB

Objective: to assess the relationship between different colorectal cancer (CC) risk factors in the province of Al- bacete, Spain Subjects And Methods: the study was designed to be population-based, observational, analytical, descriptive and cross- sectional and used a questionnaire. The study area included the Primary Care Health Centres in the province of Albacete. We compared two previously assessed areas, one with a high CC incidence and the other with a low CC incidence, along with the factors that could influence these differences. We used a questionnaire to collect personal and consumer habit data in relation to CC. We did bivariate and multivariate (logistic regression) statistical analyses. The predictor variables considered in this model were age, gender, body mass index (BMI), level of education, intensity of physical activity, presence or absence of a disease, smoking habit (packs per year), alcohol intake, number of defeca- tions per week, being on a diet, intake frequencies (IF) of pasta and rice, IF of eggs or omelette, IF of white fish, IF of blue fish, IF of pulses, IF of vegetables and salads, fruit, cold meats, meat, water intake and relatives with cancer. Results: The high CC incidence areas presented an incidence between 26.9 and 30.2 cases per 100,000 citizens per year, while the rates of the low incidence areas were between 5.1 and 6.5. A total of 417 people participated (56.8% women), of whom 245 (58.8%) came from the low CC incidence area (41.2% men) and 172 (41.2%) were from the high CC incidence area (45.9% men). After adjusting the model in the logistic regression analysis, the variables related to high cancer inci- dence were alcohol intake, odds ratio (OR) 1,79 (CI: 1.8-2.96; P=0.024 eating eating pasta and rice more than two days per week: OR 2.23 (CI: 1.33-3.72; P=0.002); eating eggs and/or omelette more than two days per week: OR 2.68 (CI: 1.49-4.80; P=0.001), and drinking more than two litres of water per day: OR 2.87 (CI: 1.51-5.46; P=0.001. Frequent physical exercise related with a low CC incidence: OR 3.38 (CI: 1.30-8.84; P=0.013). Conclusions: In this study, the highest CC incidence is associated with alcohol intake and a high intake of water, pasta and rice, and eggs. Doing physical exercise regularly has a protective effect.

Current predictive models for cardiovascular disease based on points systems use the baseline situation of the risk factors as independent variables. These models do not take into account the variability of the risk factors over time. Predictive models for other types of disease also exist that do consider the temporal variability of a single biological marker in addition to the baseline variables. However, due to their complexity these other models are not used in daily clinical practice. Bearing in mind the clinical relevance of these issues and that cardiovascular diseases are the leading cause of death worldwide we show the properties and viability of a new methodological alternative for constructing cardiovascular risk scores to make predictions of cardiovascular disease with repeated measures of the risk factors and retaining the simplicity of the points systems so often used in clinical practice (construction, statistical validation by simulation and explanation of potential utilization). We have also applied the system clinically upon a set of simulated data solely to help readers understand the procedure constructed.

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.

Fundamento: Establecer estrategias de prevencion de la enfermedad cardiovascular implica conocer su epidemiologia y evolucion en el tiempo. El objetivo del estudio es conocer las prevalencias de los factores de riesgo y del riesgo cardiovascular en dos momentos de seguimiento de una poblacion general adulta. Metodos: Dentro de un estudio longitudinal y prospectivo con poblacion general seleccionada al azar seguida durante 12 anos (1992-94 a 2004-2006) se hacen dos analisis trasversales al inicio y en el ultimo corte de seguimiento. La poblacion objeto de estudio fueron personas mayores de 18 anos censadas en la provincia de Albacete. Muestreo aleatorio, estratificado y bietapico. Tamano muestral 2.121 y 1.577 sujetos en cada uno de los cortes. Se hizo anamnesis, exploracion fisica, medida de presion arterial, electrocardiograma y extraccion de sangre venosa. Las variables estudiadas fueron: edad, sexo, antecedentes personales y familiares, factores de riesgo y riesgo cardiovascular global. Resultados: En el primer examen acudieron a la cita 1.322 sujetos (edad media 48,2 anos. 53,6% mujeres) y 997 en el segundo (edad media 52,8 anos. 56,7% mujeres). Hubo un aumento en la prevalencia de hipertension (32,7% a 41,2%) diabetes mellitus (9,8 a 11,4%), obesidad (27,8 a 34,3%) e hipercolesterolemia (47,5 a 53,5%), una disminucion de fumadores (32,6 a 23,7%), de valores medios de presion arterial (132/81 a 129/73 mmHg), glucemia (100,8 a 92,8 mg/dl) y col-LDL (128,7 a 116,7 mg/dl) y un descenso del riesgo cardiovascular con Framingham (10,8% a 8,2%) y Score (2,3% a 1,6%). Conclusiones: En los ultimos anos se observa un aumento en la prevalencia de factores de riesgo (hipertension, diabetes e hipercolestrerolemia), un mejor control de los mismos, una menor prevalencia de fumadores y menor riesgo cardiovascular en la poblacion.

Las crisis hipertensivas constituyen un motivo frecuente de consulta en los servicios de urgencias. Aproximadamente un 1-2% de los pacientes hipertensos desarrollarán una crisis hipertensiva en algún momento de su vida. El presente trabajo pretende revisar las guías clínicas de referencia más actuales, en el manejo de esta patología, con el fin de poder plantear unas recomendaciones clínicas. El tema de estudio suele estar incluido en los documentos de consenso que sobre el manejo de la hipertensión arterial se han publicado, los cuales son muy similares en cuanto a contenidos y recomendaciones. Las guías clínicas evaluadas son muy similares en cuanto a contenidos y recomendaciones, incluyendo casi todas, un apartado de introducción, clasificación, definiciones, y manejo general, diferenciando entre urgencias y emergencias hipertensivas dependiendo de la ausencia o presencia de lesión aguda de órganos diana de la hipertensión arterial. Son escasos los ensayos clínicos aleatorizados publicados que han comparado diferentes fármacos o estrategias de manejo de las crisis hipertensivas. Se han encontrado guías sobre el manejo de la hipertensión arterial que sustentan sus recomendaciones en niveles de evidencia, pero no se han encontrado guías similares para las crisis hipertensivas, con excepción del manejo de la pre-eclampsia/eclampsia.