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Félix-Redondo FJ, Lozano Mera L, Alvarez-Palacios Arrighi P, Grau Magana M, Ramírez-Romero JM, Fernández-Bergés D. [Impact of cardiovascular risk factors in the Extremadura population: HERMEX cohort contributions for a preventive strategy]. Aten Primaria 2019; 52:3-13. [PMID: 30638699 PMCID: PMC6938985 DOI: 10.1016/j.aprim.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS Design, Cohort study. LOCATION Representative population sample of a health area of Extremadura (Spain) PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. MEASUREMENTS Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. OUTCOME VARIABLE First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy.
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Affiliation(s)
| | - Luis Lozano Mera
- Centro de Salud Urbano I, Servicio Extremeño de Salud, Mérida, Badajoz, España
| | - Paula Alvarez-Palacios Arrighi
- Unidad de Investigación Área de Salud Don Benito-Villanueva de la Serena. FUNDESALUD, Villanueva de la Serena, Badajoz, España
| | | | | | - Daniel Fernández-Bergés
- Unidad de Investigación Área de Salud Don Benito-Villanueva de la Serena. FUNDESALUD, Villanueva de la Serena, Badajoz, España
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de la Sierra A, Pintó X, Guijarro C, Miranda JL, Callejo D, Cuervo J, Subirà R, Rubio M. Prevalence, Treatment, and Control of Hypercholesterolemia in High Cardiovascular Risk Patients: Evidences from a Systematic Literature Review in Spain. Adv Ther 2015; 32:944-61. [PMID: 26499178 PMCID: PMC4635180 DOI: 10.1007/s12325-015-0252-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Indexed: 12/13/2022]
Abstract
Introduction Cardiovascular diseases (CVDs) represent a major Public Health burden. High serum cholesterol levels have been linked to major CV risk. The objectives of this study were to review the epidemiology of hypercholesterolemia in high risk CV patients from Spain, by assessing its prevalence, the proportion of diagnosed patients undergoing pharmacological treatment and the degree of attained lipid control. Methods A systematic literature review was carried out using Medline and two Spanish databases. Manuscripts containing information on hypercholesterolemia in several high CV risk groups [diabetes mellitus (DM), Systematic COronary Risk Evaluation (SCORE) risk >5, or documented CVD], published between January 2010 and October 2014, were included. Results Of the 1947 published references initially retrieved, a full-text review was done on 264 manuscripts and 120 were finally included. Prevalence of hypercholesterolemia ranged from 50 to 84% in diabetics, 30–60% in patients with DM or elevated SCORE risk, 64–74% with coronary heart disease, 40–70% in stroke patients, and 60–80% in those with peripheral artery disease. Despite the finding that most of them were on pharmacological treatment, acceptable control of serum lipids was very variable, ranging from 15% to 65%. Among those with heterozygous familial hypercholesterolemia, 95–100% received treatment but less than 50% achieved their therapeutic goals. Conclusions An elevated prevalence of hypercholesterolemia can be found in targeted groups at high CV risk. Although most patients are receiving pharmacological treatment, rates of lipid control continue to be low, both in primary and secondary prevention. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0252-y) contains supplementary material, which is available to authorized users.
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Gabriel R, Brotons C, Tormo MJ, Segura A, Rigo F, Elosua R, Carbayo JA, Gavrila D, Moral I, Tuomilehto J, Muñiz J. La ecuación ERICE: la nueva ecuación autóctona de riesgo cardiovascular para una población mediterránea envejecida y de bajo riesgo en España. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gabriel R, Brotons C, Tormo MJ, Segura A, Rigo F, Elosua R, Carbayo JA, Gavrila D, Moral I, Tuomilehto J, Muñiz J. The ERICE-score: the new native cardiovascular score for the low-risk and aged Mediterranean population of Spain. ACTA ACUST UNITED AC 2014; 68:205-15. [PMID: 25155342 DOI: 10.1016/j.rec.2014.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/18/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES In Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. METHODS Seven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11800 people (6387 women) representing 107915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. RESULTS Age was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic=0.789 in men and C=0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. CONCLUSIONS The ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain.
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Affiliation(s)
- Rafael Gabriel
- Unidad de Epidemiología Clínica, Instituto IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain; Red de Investigación Cardiovascular (RIC), Spain.
| | - Carlos Brotons
- Red de Investigación Cardiovascular (RIC), Spain; Unidad de Investigación, EAP Sardenya-IIB Sant Pau, Barcelona, Spain
| | - M José Tormo
- Servicio de Epidemiología, Conserjería de Sanidad de Murcia, Murcia, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Spain; Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain
| | - Antonio Segura
- Instituto de Ciencias de la Salud de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
| | - Fernando Rigo
- Grupo CORSAIB, IB-Salut, Palma de Mallorca, Islas Baleares, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Spain
| | - Roberto Elosua
- CIBER Epidemiología y Salud Pública, CIBERESP, Spain; Epidemiología Cardiovascular y Genética, IMIM (Instituto de Investigación Hospital del Mar), Barcelona, Spain
| | - Julio A Carbayo
- Unidad de Lípidos, Clínica Nuestra Señora del Rosario, Grupo de Enfermedades Vasculares de Albacete (GEVA), Albacete, Spain
| | - Diana Gavrila
- Servicio de Epidemiología, Conserjería de Sanidad de Murcia, Murcia, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Spain; Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain
| | - Irene Moral
- Unidad de Investigación, EAP Sardenya-IIB Sant Pau, Barcelona, Spain
| | - Jaakko Tuomilehto
- Unidad de Epidemiología Clínica, Instituto IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain; Red de Investigación Cardiovascular (RIC), Spain; University of Helsinki, Helsinki, Finland
| | - Javier Muñiz
- Unidad de Epidemiología Clínica, Instituto IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain; Red de Investigación Cardiovascular (RIC), Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
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An epidemiological study determining blood pressure in a Portuguese cohort: the Guimarães/Vizela study. J Hum Hypertens 2014; 29:190-7. [DOI: 10.1038/jhh.2014.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/08/2022]
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Marrugat J, Subirana I, Ramos R, Vila J, Marín-Ibañez A, Guembe MJ, Rigo F, Tormo Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, Baena-Díez JM, de la Cámara AG, Lapetra J, Grau M, Quesada M, Medrano MJ, González Diego P, Frontera G, Gavrila D, Aicua EA, Basora J, García JM, García-Lareo M, Gutierrez JA, Mayoral E, Sala J, D'Agostino R, Elosua R. Derivation and validation of a set of 10-year cardiovascular risk predictive functions in Spain: the FRESCO Study. Prev Med 2014; 61:66-74. [PMID: 24412897 DOI: 10.1016/j.ypmed.2013.12.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/26/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. METHOD Pooled analysis of 11 population-based Spanish cohorts (1992-2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. RESULTS The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. CONCLUSIONS The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.
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Affiliation(s)
- Jaume Marrugat
- Research Group on Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain.
| | - Isaac Subirana
- Research Group on Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain
| | - Rafel Ramos
- Unitat de Recerca d'Atenció Primària, Instituto de Investigación en Atención Primaria Jordi Gol. Instituto de Investigación de Girona, Spain
| | - Joan Vila
- Research Group on Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain
| | | | - María Jesús Guembe
- Grupo de Investigación Riesgo Vascular en Navarra (RIVANA), Departamento de Salud, Gobierno de Navarra, Pamplona, Spain; Servicio de Investigación, Innovación y Formación, Departamento de Salud, Gobierno de Navarra, Pamplona, Spain
| | - Fernando Rigo
- Grupo Cardiovascular de Baleares de la REDIAP IBSALUT, Palma de Mallorca, Spain
| | - María José Tormo Díaz
- CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain; Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, Spain
| | - Conchi Moreno-Iribas
- CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain; Grupo de Investigación Riesgo Vascular en Navarra (RIVANA), Departamento de Salud, Gobierno de Navarra, Pamplona, Spain; Instituto de Salud Pública de Navarra, Departamento de Salud, Gobierno de Navarra, Pamplona, Spain
| | - Joan Josep Cabré
- Unitat de Recerca d'Atenció Primària, Institut Català de la Salut, Tarragona-Reus, Spain
| | - Antonio Segura
- Instituto de Ciencias de la Salud, Consejería de Salud y Asuntos Sociales, Junta de Comunidades de Castilla - La Mancha, Talavera de la Reina, Spain
| | | | - Agustín Gómez de la Cámara
- CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain; Unidad de Investigación Clínica, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - José Lapetra
- Centro de Salud Universitario "San Pablo", Distrito Sanitario Atención Primaria Sevilla, Servicio Andaluz de Salud, Sevilla, Spain; CIBER de Fisiopatología de la Obesidad y la Nutrición, CIBEROBN FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain
| | - María Grau
- Research Group on Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
| | - Miquel Quesada
- Unitat de Recerca d'Atenció Primària, Instituto de Investigación en Atención Primaria Jordi Gol. Instituto de Investigación de Girona, Spain
| | - María José Medrano
- Instituto de Salud Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
| | - Paulino González Diego
- Grupo de Investigación Riesgo Vascular en Navarra (RIVANA), Departamento de Salud, Gobierno de Navarra, Pamplona, Spain
| | - Guiem Frontera
- Grupo Cardiovascular de Baleares de la REDIAP IBSALUT, Palma de Mallorca, Spain
| | - Diana Gavrila
- CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain; Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, Spain
| | - Eva Ardanaz Aicua
- CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain; Grupo de Investigación Riesgo Vascular en Navarra (RIVANA), Departamento de Salud, Gobierno de Navarra, Pamplona, Spain; Instituto de Salud Pública de Navarra, Departamento de Salud, Gobierno de Navarra, Pamplona, Spain
| | - Josep Basora
- Unitat de Recerca d'Atenció Primària, Institut Català de la Salut, Tarragona-Reus, Spain; CIBER de Fisiopatología de la Obesidad y la Nutrición, CIBEROBN FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain
| | - José María García
- Instituto de Ciencias de la Salud, Consejería de Salud y Asuntos Sociales, Junta de Comunidades de Castilla - La Mancha, Talavera de la Reina, Spain
| | | | | | - Eduardo Mayoral
- CIBER de Fisiopatología de la Obesidad y la Nutrición, CIBEROBN FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain; Plan Integral de Diabetes de Andalucía, Servicio Andaluz de Salud, Sevilla, Spain
| | - Joan Sala
- Department of Cardiology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - Roberto Elosua
- Research Group on Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP FEDER-ERDF Instituto de Salud Carlos III, Madrid, Spain
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Félix-Redondo FJ, Grau M, Baena-Díez JM, Dégano IR, de León AC, Guembe MJ, Alzamora MT, Vega-Alonso T, Robles NR, Ortiz H, Rigo F, Mayoral-Sanchez E, Tormo MJ, Segura-Fragoso A, Fernández-Bergés D. Prevalence of obesity and associated cardiovascular risk: the DARIOS study. BMC Public Health 2013; 13:542. [PMID: 23738609 PMCID: PMC3695785 DOI: 10.1186/1471-2458-13-542] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 05/29/2013] [Indexed: 12/28/2022] Open
Abstract
Background To estimate the prevalence of overweight and obesity in the Spanish population as measured with body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) and to determine the associated cardiovascular risk factors. Methods Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. Participants aged 35–74 years were asked about the history of cardiovascular diseases, hypertension, diabetes and hypercholesterolemia. Height, weight, WC, blood pressure, glycaemia, total cholesterol, low-density and high-density lipoprotein cholesterol and coronary risk were measured. The prevalence of overweight (BMI 25–29.9 kg/m2), general obesity (BMI ≥30 kg/m2), suboptimal WC (≥ 80 cm and < 88 in women, ≥ 94 and < 102 in men), abdominal obesity (WC ≥88 cm ≥102 cm in women and men, respectively) and WHtR ≥0.5 was estimated, standardized for the European population. Results We included 28,743 individuals. The prevalence of overweight and suboptimal WC was 51% and 30% in men and 36% and 22% in women, respectively; general obesity was 28% in both sexes and abdominal obesity 36% in men and 55% in women. The prevalence of WHtR ≥0.5 was 89% and 77% in men and women, respectively. All cardiovascular risk factors were significantly associated with abnormal increased values of BMI, WC and WHtR. Hypertension showed the strongest association with overweight [OR = 1.99 (95% confidence interval 1.81-2.21) and OR = 2.10 (1.91-2.31)]; suboptimal WC [OR = 1.78 (1.60-1.97) and OR = 1.45 (1.26-1.66)], with general obesity [OR = 4.50 (4.02-5.04), and OR = 5.20 (4.70-5.75)] and with WHtR ≥0.5 [OR = 2.94 (2.52-3.43), and OR = 3.02 (2.66-3.42)] in men and women respectively, besides abdominal obesity in men only [OR = 3.51 (3.18-3.88)]. Diabetes showed the strongest association with abdominal obesity in women [OR = 3,86 (3,09-4,89). Conclusions The prevalence of obesity in Spain was high. Overweight, suboptimal WC, general, abdominal obesity and WHtR ≥0.5 was significantly associated with diabetes, hypertension, hypercholesterolemia and coronary risk. The use of lower cut-off points for both BMI and particularly WC and could help to better identify the population at risk and therefore achieve more effective preventive measures.
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Affiliation(s)
| | - María Grau
- Grupo de Epidemiología y Genética Cardiovascular, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
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Gavrila D, Salmerón D, Egea-Caparrós JM, Huerta JM, Pérez-Martínez A, Navarro C, Tormo MJ. Prevalence of metabolic syndrome in Murcia Region, a southern European Mediterranean area with low cardiovascular risk and high obesity. BMC Public Health 2011; 11:562. [PMID: 21752307 PMCID: PMC3152535 DOI: 10.1186/1471-2458-11-562] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 07/14/2011] [Indexed: 12/14/2022] Open
Abstract
Background Metabolic syndrome (MS) is associated with subsequent appearance of diabetes and cardiovascular disease. As compared to other Spanish regions, Murcia (southern Spain) registers increased obesity as well as cardiovascular morbidity and mortality. The aim of this study was to assess the prevalence of MS and its components, awareness of obesity as a health risk and associated lifestyles. Methods A population-based, cross-sectional study was conducted in 2003, covering a sample of 1555 individuals 20 years and over. MS was defined according to the Revised National Cholesterol Education Program Adult Treatment Panel III (R-ATPIII), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. Both low (94/80) and high (102/88) waist circumference (WC) thresholds were considered. Results Prevalence of MS was 27.2% (95%CI: 25.2-29.2), 32.2% (95%CI: 30.1-34.3) and 33.2% (95%CI: 31.2-35.3) according to the R-ATPIII, IDF and JIS94/80 respectively. It increased with age until reaching 52.6% (R-ATPIII) or 60.3% (JIS94/80) among persons aged 70 years and over, and was higher in persons with little or no formal education (51.7% R-ATPIII, 57.3% JIS94/80). The most common risk factors were hypertension (46.6%) and central obesity (40.7% and 66.1% according to high and low WC cut-off points respectively). Although most persons were aware that obesity increased health risks, regular exercise was very unusual (13.0% centrally obese, 27.2% non-centrally obese). Adherence to dietary recommendations was similar among centrally obese and non-centrally obese subjects. Conclusions Prevalence of MS is high in our population, is comparable to that found in northern Europe and varies with the definition used. Adherence to preventive recommendations and to adequate weight promotion is very low. In the absence of a specific treatment for MS, integrated intervention based on a sustained increase in physical activity and changes in diet should be reinforced.
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Affiliation(s)
- Diana Gavrila
- Department of Epidemiology, Regional Authority for Health & Consumer Affairs (Consejería de Sanidad y Consumo), Murcia, Spain.
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Stompór T, Napora M, Olszewski A. Renoprotective effects of benazepril: current perspective. Expert Rev Cardiovasc Ther 2011; 9:663-673. [DOI: 10.1586/erc.11.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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