Incidence of T2DM and the role of baseline glycaemic status as a determinant in a metropolitan population in northern Madrid (Spain)

AIM

To estimate the incidence of T2DM and assess the effect of pre-T2DM (isolated impaired fasting glucose [iIFG], isolated impaired glucose tolerance [iIGT] or both) on progress to T2DM in the adult population of Madrid.

METHODS

Population-based cohort comprising 1,219 participants (560 normoglycaemic and 659 preT2DM [418 iIFG, 70 iIGT or 171 IFG-IGT]). T2DM was defined based on fasting plasma glucose or HbA1c or use of glucose-lowering medication. We used a Cox model with normoglycaemia as reference category.

RESULTS

During 7.26 years of follow-up, the unadjusted incidence of T2DM was 11.21 per 1000 person-years (95 %CI, 9.09-13.68) for the whole population, 5.60 (3.55-8.41) for normoglycaemic participants and 16.28 (12.78-20.43) for pre-T2DM participants. After controlling for potential confounding factors, the baseline glycaemic status was associated with higher primary effect on developing T2DM was iIGT (HR = 3.96 [95 %CI, 1.93-8.10]) and IFG-IGT (3.42 [1.92-6.08]). The HR for iIFG was 1.67 (0.96-2.90). Obesity, as secondary effect, was strongly significantly associated (HR = 2.50 [1.30-4.86]).

CONCLUSIONS

Our incidence of T2DM is consistent with that reported elsewhere in Spain. While baseline iIGT and IFG-IGT behaved a primary effect for progression to T2DM, iIFG showed a trend in this direction.

All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease

Background

Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population.

Methods

We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression).

Results

Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01).

Conclusions

In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02893-z.

Toward a new clinical classification of patients with familial hypercholesterolemia: One perspective from Spain

The introduction of singular therapies, such as proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), to lower high cholesterol levels requires better classification of patients eligible for intensive lipid lowering therapy. According to the European Medicines Administration, PCSK9i are recommended in primary prevention only in familial hypercholesterolemia (FH) patients. Therefore, an FH diagnosis is not simply an academic issue, because it has many clinical implications. The bases of a diagnosis of FH are not entirely clear. The availability of genetic testing, including large genome-wide association analyses and whole genome studies, has shown that some patients with a clinical diagnosis of definite FH have no mutations in the genes associated with the disease. This fact does not exclude the very high cardiovascular risk of these patients, and an early and intensive lipid lowering therapy is recommended in all FH patients. Because an FH diagnosis is a cornerstone for decisions about therapies, a precise definition of FH is urgently required. This is an expert consensus document from the Spanish Atherosclerosis Society. We propose the following classification: familial hypercholesterolemia syndrome integrated by (1) heterozygous familial hypercholesterolemia: patients with clinically definite FH and a functional mutation in one allele of the LDLR, ApoB:100, and PCSK9 genes; (2) homozygous familial hypercholesterolemia: mutations affect both alleles; (3) polygenic familial hypercholesterolemia: patients with clinically definite FH but no mutations associated with FH are found (to be distinguished from non-familial, multifactorial hypercholesterolemia); (4) familial hypercholesterolemia combined with hypertriglyceridemia: a subgroup of familial combined hyperlipidaemia patients fulfilling clinically definite FH with associated hypertriglyceridemia.

Functional analysis of new variants at the low-density lipoprotein receptor associated with familial hypercholesterolemia

Familial hypercholesterolemia is an autosomal dominant disease of lipid metabolism caused by defects in the genes LDLR, APOB, and PCSK9. The prevalence of heterozygous familial hypercholesterolemia (HeFH) is estimated between 1/200 and 1/250. Early detection of patients with FH allows initiation of treatment, thus reducing the risk of coronary heart disease. In this study, we performed in vitro characterization of new LDLR variants found in our patients. Genetic analysis was performed by Next Generation Sequencing using a customized panel of 198 genes in DNA samples of 516 subjects with a clinical diagnosis of probable or definitive FH. All new LDLR variants found in our patients were functionally validated in CHO-ldlA7 cells. The LDLR activity was measured by flow cytometry and LDLR expression was detected by immunofluorescence. Seven new variants at LDLR were tested: c.518 G>C;p.(Cys173Ser), c.[684 G>T;694 G>T];p.[Glu228Asp;Ala232Ser], c.926C>A;p.(Pro309His), c.1261A>G;p.(Ser421Gly), c.1594T>A;p.(Tyr532Asn), and c.2138delC;p.(Thr713Lysfs*17). We classified all variants as pathogenic except p.(Ser421Gly) and p.(Ala232Ser). The functional in vitro characterization of rare variants at the LDLR is a useful tool to classify the new variants. This approach allows us to confirm the genetic diagnosis of FH, avoiding the classification as "uncertain significant variants", and therefore, carry out cascade family screening.

Spanish Consensus on Physical Health in Patients with Bipolar Disorder

Background and objective:

Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.

The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.

Methods:

After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.

Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.

Results:

The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.

Conclusion:

The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.

Spanish Consensus on Physical Health in Patients with Bipolar Disorder

Background and objective:

Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.

The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.

Methods:

After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.

Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.

Results:

The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.

Conclusion:

The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.

Nutritional, Metabolic and Endocrine Disorders in Patients with Bipolar Disorder: A Systematic Review

Objective:

To evaluate the frequency of nutritional, metabolic and endocrine disorders in patients with bipolar disorder (BD).

Methods:

A Medline search (up to January 2008) in and manual review of reference lists of relevant primary articles and review articles. All studies in Spanish or English, all study designs, BD diagnosis by any criteria, with a sample size of ≥ 30 patients, and which reported any measure of frequency measure or association.

Results:

Thirty studies were identified: 18 (60%) cross-sectional and 12 (40%) retrospective cohort; 2 (6.7%) population- based; and 2 (6.7%) random sampling. The frequency of obesity in patients with BD was higher than that of the general population (n=4, 19-53% vs 9-14%), of other medical populations (n=1, 4.6% vs 1.1%) and of patients with schizophrenia (n=1, 11.6% vs 9.9%). The frequency of diabetes in patients with BD was higher than (n=5, 6-26% vs 2-16%) or similar to (n=2, 3.5-4.3% vs 3.4-4.8%) that of the general population; higher than that of other medical samples (n=2, 1.8-4.4% vs 0.6-2.2%) and similar to that in of patients with schizophrenia (n=1, 17.7% vs 17.6%). The frequency of dyslipidaemia was higher than that found in a medical sample (n=1, 0.9% vs 0.3%) and in patients with schizophrenia (n=1, 27% vs 23%). The frequency of hypothyroidism was higher than that of a medical sample (n=1, 10% vs 3%).

Conclusion:

BD appears to be associated with obesity. It may also be associated with dyslipidaemia and hypothyroidism. Data on the association between BD and diabetes are inconclusive.

Gynaecological and Obstetric Comorbidities in Patients with Bipolar Disorder: A Systematic Review

Objective:

To synthesize the available knowledge on gynaecological and obstetric comorbidities in patients with bipolar disorder (BD).

Methods:

Relevant studies were identified by a MEDLINE search from 1966 to January 2008, and supplemented by a manual review of reference lists of the articles identified and previous review articles. We included studies with any design, in patients with BD as diagnosed by any criteria, with sample size ≥30 patients, and reporting any measure of frequency or association as regards the comorbidities. When available, priority was given to comparative studies.

Results:

We identified 4 studies: 3 were comparative; 1 was cross-sectional and 3 were retrospective cohort studies; 1 was population-based study; and 4 used a convenience sample. A retrospective study reported an increased risk of pregnancy complications in patients with BD (OR1.23, 95%CI 1.06-1.44) but not of labor/delivery or neonatal complications; as compared to controls, patients with BD had an increased risk of placenta previa (OR2.04, 95% CI 1.11-3.73), antepartum hemorrhage (OR 1.66, 95%CI 1.15-2.39), and drug side-effects (OR 3.94, 95%CI 1.46-10.62). In another retrospective study, patients with BD had an increased risk of endometriosis (OR: 1.93, 95%CI 1.37-2.70), inflammatory disease of ovary (OR 2.17, 95%CI 1.84-2.57), and disorders of menstruation (OR 1.79, 95%CI 1.56-2.05). In a cross-sectional study, gynaecological disorders were more common in patients with BD than in patients with schizophrenia (4% vs 1.3%).

Conclusion:

Although the information is scanty, available data suggest that patients with BD might have an increased risk of gynaecological and obstetric comorbidities/complications.

[Prevalence of peripheral artery disease evaluated by ankle brachial index in patients with metabolic syndrome. MERITO I study]

INTRODUCTION

Patients with Metabolic Syndrome have high cardiovascular morbidity and mortality rate above that expected when using accepted scales for risk stratification. Ankle brachial index (ABI) is an available, straightforward and reproducible method for the detection of peripheral vascular disease and for improving risk stratification in this population. Our study aimed to evaluate the prevalence of low ABI in patients with metabolic syndrome older than 50 years and to study the risk factors associated with its development.

PATIENTS AND METHODS

1519 subjects between 50 and 85 years, 935 of them with metabolic syndrome (Adult Treatment Panel III [ATP III] criteria), in primary prevention, without symptoms of intermittent claudication and who gave their consent to have an ABI measurement in internal medicine offices were included in the study. Cardiovascular risk factors were evaluated in all participants. An ABI < 0.9 was considered low.

RESULTS

The prevalence of a low ABI in subjects with metabolic syndrome was 27.7 (95% CI: 24.8-30.5). Factors associated with low and a pathological ABI were age, higher serum creatinine levels and presence of proteinuria. After multivariate adjustment, only age (OR: 1.07; 95% CI: 1.04-1.09) and active tobacco use (OR: 1.45; 95% CI: 1.10-1.92) continued to be significant.

CONCLUSION

Prevalence of a low ABI is elevated in subjects with metabolic syndrome without known cardiovascular disease and related with age and active tobacco use.

[Lipid control in secondary prevention: multicenter observational study in primary care]

OBJECTIVE

To assess the implementation of pharmacological and non-pharmacological treatment in coronary patients followed in primary care.

DESIGN

Observational prospective study of 6 months of follow-up.

SETTING

Primary care centers all over Spain.

PARTICIPANTS

Men and women, between 18 and 75 years old, diagnosed in the last 3 years of myocardial infarction, stable angina, and unstable angina, with cholesterol levels higher than the lipid therapeutical goal recommended by the Guía de Prevención Cardiovascular del Programa de Actividades y de Promoción de la Salud de la Sociedad Española de Medicina de Familia y Comunitaria. Patients were recruited between february of 1998 and july of 1999, and were followed for 6 months.

OUTCOME MEASUREMENTS

Total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, weight, height, body mass index, systolic and diastolic blood pressure (SBP and DBP).

RESULTS

4464 patients were included, mean age of 59 years (range, 20-96), 60% men. At 6 months, 66% of the patients had a cholesterol level higher than 200 mg/dL, 55% had LDL-C higher than 130 mg/dL, and 11% had triglycerides higher than 190 mg/dL. At 6 months a reduction of 70 mg/dL of total cholesterol, of 52 mg/dL of triglycerides, and of 51 mg/dL of LDL-C, and an increase of 4 mg/dL of HDL-Cholesterol was observed. Also, SBP and DBP were reduced 5 mm Hg and 3 mm Hg.

CONCLUSIONS

Although a clear improved was observed in the control of lipids and other risk factors, there is still a considerable potential to raise standards in secondary prevention of coronary patients followed in primary care concerning control of cardiovascular risk factors, particularly total cholesterol and lipid fractions.

Successful zidovudine therapy for HIV-related severe thrombocytopenia. Report of a sustained remission

Five patients, two homosexuals and three drug abusers, with HIV-related severe thrombocytopenia, four of whom had also bleeding episodes, experienced a full remission of thrombocytopenia after 1,200 mg/day zidovudine treatment. None of the patients had acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Platelet counts began an upward trend at the end of the 3rd week and reached values higher than 140 x 10(9)/l towards the end of the 8th week of treatment. Patient's platelets remained stable after more than 4 months of active treatment. This is the first report of zidovudine-induced long-term remission of HIV-associated severe thrombocytopenia.