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Martínez D, Bergillos S, Corominas L, Comas-Cufí M, Calle E. Seamless integration of sewer system topology and tree location data: An algorithm to diagnose the potential impact of tree roots on pipes and propose rearrangement solutions. Heliyon 2024; 10:e23382. [PMID: 38169737 PMCID: PMC10758799 DOI: 10.1016/j.heliyon.2023.e23382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Wastewater networks are subject to several threats leading to wastewater leakages and public health hazards. External elements such as natural factors and human activities are common causes of wastewater leakages and require more in-depth analysis. Prevention and rehabilitation work is essential to secure wastewater networks and avoid pipe failures. This work presents a new algorithm that allows for the seamless integration of sewer topology and tree location data to diagnose the potential impact of tree roots on pipes. The algorithm also proposes tree rearrangement options that balance the cost of tree rearrangement with the cost of pipe repair. The paper also showcases a real-world case study in the city of Girona to evaluate the performance of the presented algorithms for a specific case focusing on tree roots as a natural factor. Results show that it is possible to optimally rearrange a number of the trees with the greatest impact, significantly minimizing pipe failures and wastewater leakages (82% risk reduction with only rearranging a 12% of the most impactful trees). The rearrangement solution not only protects the environment and prevents public health hazards, but also achieves a positive economic payback during the operational period of the pipes, saving up to 1.33M€ for a tree rearrangement of 7%. The presented methodology is applicable to other natural or human factors.
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Affiliation(s)
- David Martínez
- Institute of Informatics and Applications, University of Girona, Maria Aurèlia Capmany 61 (Edifici PIV), 17003, Girona, Spain
| | - Sergi Bergillos
- Institute of Informatics and Applications, University of Girona, Maria Aurèlia Capmany 61 (Edifici PIV), 17003, Girona, Spain
| | - Lluís Corominas
- Catalan Institute for Water Research, Emily Grahit 101, 17003, Girona, Spain
| | - Marc Comas-Cufí
- Institute of Informatics and Applications, University of Girona, Maria Aurèlia Capmany 61 (Edifici PIV), 17003, Girona, Spain
| | - Eusebi Calle
- Institute of Informatics and Applications, University of Girona, Maria Aurèlia Capmany 61 (Edifici PIV), 17003, Girona, Spain
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Eizaguirre S, Sabater G, Belda S, Calderón JC, Pineda V, Comas-Cufí M, Bonnin M, Orriols R. Long-term respiratory consequences of COVID-19 related pneumonia: a cohort study. BMC Pulm Med 2023; 23:439. [PMID: 37951891 PMCID: PMC10638724 DOI: 10.1186/s12890-023-02627-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/31/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Our aims were to describe respiratory sequelae up to 12 months after discharge in COVID-19 patients with severe pneumonia requiring non-invasive respiratory support therapies. METHODS This study was undertaken at University Hospital Doctor Josep Trueta (Girona, Spain) between March 2020 and June 2020. Three months after discharge, we evaluated their dyspnoea and performed Saint George's respiratory questionnaire, pulmonary function tests, blood test, 6-min walking test, and a high-resolution CT (HRCT). At the six and 12-month follow-up, we repeated all tests except for pulmonary function, 6-min walking test, and HRCT, which were performed only if abnormal findings had been previously detected. RESULTS Out of the 94 patients recruited, 73% were male, the median age was 62.9 years old, and most were non-smokers (58%). When comparing data three and 12 months after discharge, the percentage of patients presenting dyspnoea ≥ 2 decreased (19% vs 7%), the quality-of-life total score improved (22.8% vs 18.9%; p = 0.019), there were less abnormal results in the pulmonary function tests (47% vs 23%), the 6-min walking test distance was enhanced (368.3 m vs 390.7 m, p = 0.020), ground glass opacities findings waned (51.6% vs 11.5%), and traction bronchiectasis increased (5.6% vs 15.9%). Only age showed significant differences between patients with and without pulmonary fibrotic-like changes. CONCLUSION Most patients improved their clinical condition, pulmonary function, exercise capacity and quality of life one year after discharge. Nonetheless, pulmonary fibrotic-like changes were observed during the follow-ups.
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Affiliation(s)
- Saioa Eizaguirre
- Department of Respiratory, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Gladis Sabater
- Department of Respiratory, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Sònia Belda
- Department of Respiratory, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Juan Carlos Calderón
- Department of Respiratory, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Victor Pineda
- Department of Radiology, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Department of Computer Science, Mathematics and Statistics, University of Girona, Girona, Catalonia, Spain
| | - Marc Bonnin
- Department of Respiratory, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Ramon Orriols
- Department of Respiratory, Dr. Josep, Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Catalonia, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
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Ramos R, Alves-Cabratosa L, Blanch J, Pèlach À, Albert L, Salomó Q, Cabarrocas S, Comas-Cufí M, Martí-Lluch R, Ponjoan A, Garcia-Gil M, de Cambra S, d'Anta A, Balló E, Alum A, Aleixandre RN. SARS-CoV-2 transmission risk screening for safer social events: a non-randomised controlled study. Sci Rep 2022; 12:12794. [PMID: 35896583 PMCID: PMC9326423 DOI: 10.1038/s41598-022-16905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
There is an ongoing debate on the implementation of the COVID-19 passport throughout Europe. We sought to build and test a feasible prevention strategy to ensure low SARS-CoV transmission risk in public events. We conducted a non-randomised controlled study. The intervention group obtained a confidential digital certificate of very low capacity for transmitting SARS-CoV-2 and attended socio-cultural events in Girona (Spain) between 1 April and 21 May 2021. The primary care services and a network of pharmacies cooperated in providing the certification. A group of non-attendees was randomly selected from pseudonymised health records as controls. We estimated the incidences of SARS-CoV-2 infection and recorded the challenges in the process. Follow-up was complete for 1351 participants, who were matched with 4050 controls. Mean age of the study population was 31.1 years, and 53% of participants were women. Incidence rates of SARS-CoV infection at 14 days in the group of attendees and non-attendees were 15.9 and 17.7 per 100,000 person-days, respectively; the difference between incidences was − 1.8 (95% CI − 22.8, 19.3). Implementation problems were minor, and 89.2% of respondents to a survey were satisfied with the process. The incidence rate of SARS-CoV-2 infection was not different in the intervention and control groups. These results are in favour of establishing a COVID-19 certificate to attend public events, and connote feasibility of implementation at a population level.
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Affiliation(s)
- Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain. .,Department of Medical Sciences, School of Medicine, Campus Salut, Universitat de Girona, Girona, Catalonia, Spain. .,Biomedical Research Institute of Girona (IdIBGi), Salt, Girona, Catalonia, Spain.
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain
| | - Àlex Pèlach
- Centre Blockchain de Catalunya, Parc Científic i Tecnològic de la Universitat de Girona, Girona, Catalonia, Spain
| | - Laura Albert
- Col·legi de Farmacèutics de Girona, Girona, Catalonia, Spain
| | - Quirze Salomó
- Centre Blockchain de Catalunya, Parc Científic i Tecnològic de la Universitat de Girona, Girona, Catalonia, Spain
| | | | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain.,Computer Science, Applied Mathematics and Statistics Department, Universitat de Girona, Girona, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain.,Biomedical Research Institute of Girona (IdIBGi), Salt, Girona, Catalonia, Spain
| | - Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain.,Biomedical Research Institute of Girona (IdIBGi), Salt, Girona, Catalonia, Spain
| | - Maria Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain
| | - Salomé de Cambra
- Centre Blockchain de Catalunya, Parc Científic i Tecnològic de la Universitat de Girona, Girona, Catalonia, Spain
| | - Albert d'Anta
- Centre Blockchain de Catalunya, Parc Científic i Tecnològic de la Universitat de Girona, Girona, Catalonia, Spain
| | - Elisabet Balló
- Department of Medical Sciences, School of Medicine, Campus Salut, Universitat de Girona, Girona, Catalonia, Spain.,Unitat de Qualitat i Seguretat del Pacient, Atenció Primària, Institut Català de la Salut, Girona, Catalonia, Spain
| | - Albert Alum
- Unitat de Qualitat i Seguretat del Pacient, Atenció Primària, Institut Català de la Salut, Girona, Catalonia, Spain
| | - Rosa Núria Aleixandre
- Col·legi de Farmacèutics de Girona, Girona, Catalonia, Spain.,Consell de Col·legis Farmacèutics de Catalunya, Barcelona, Catalonia, Spain.,Consell Social Universitat de Girona, Girona, Catalonia, Spain
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Castillo-Cano B, Martín-Pérez M, Llorente-García A, Montero-Corominas D, Comas-Cufí M, Martín-Merino E. Assessment of thyroiditis risk associated with HPV vaccination among girls aged 9-18 years: A time-varying cohort study. Vaccine 2022; 40:4816-4826. [PMID: 35792023 DOI: 10.1016/j.vaccine.2022.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have suggested a relationship between human papillomavirus vaccine and autoimmune diseases, including thyroiditis. Thus, we aimed to evaluate the risk of thyroiditis associated with HPV vaccination among girls using the Primary Care Database For Pharmacoepidemiological Research (BIFAP) in Spain. METHODS In this retrospective cohort study, girls in BIFAP aged 9-18 years from 2007 to 2016, free of past thyroiditis and HPV vaccination, were included. Hazard Ratios (HRs; 95% CI) of thyroiditis were calculated within exposed periods (up to 2 years of vaccination) and post-exposed periods (from 2 years after vaccination onwards) compared with non-exposed periods, overall, by dose and by type of vaccine, adjusted for potential confounders collected at different times. In a post-hoc analysis, we moved back the thyroiditis date (30 days) as a theoretical delay in diagnosis. RESULTS Out of the 388,411 girls included in the cohort, 153,924 were vaccinated against HPV and 480 thyroiditis (253 autoimmune) cases were identified (334 non-exposed; 103 exposed; 43 post-exposed). Adjusted HR was 1.18 [95% CI: 0.79-1.76] for exposed (1.25 [0.77-2.04] for bi- and 1.15 [0.76-1.76] for quadri-valent vaccines) and 1.26 [0.74-2.14] for post-exposed periods. HR was 1.50 [0.87-2.59] for the 1st dose, 1.13 [0.66-1.91] for the 2nd and 1.11 [0.71-1.72] for the 3rd one. When the diagnosis date was moved back, the risk was 1.14 [0.76-1.70] for exposed period, being 1.80 [0.86-3.76] and 1.40 [0.74-2.66] after 1st dose of bi- and quadri-valent, respectively. CONCLUSIONS We did not observe an increased risk of thyroiditis following HPV vaccination (whether bi- or quadri-valent). Even though the point estimate was higher after 1st HPV vaccination dose than after subsequent doses, a dose-effect was not confirmed. Results remained similar after applying a lag time.
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Affiliation(s)
- Belén Castillo-Cano
- Division of Pharmacoepidemiology and Pharmacovigilance. Spanish Agency of Medicines and Medical Devices (AEMPS), 28022, Madrid, Spain
| | - Mar Martín-Pérez
- Division of Pharmacoepidemiology and Pharmacovigilance. Spanish Agency of Medicines and Medical Devices (AEMPS), 28022, Madrid, Spain
| | - Ana Llorente-García
- Division of Pharmacoepidemiology and Pharmacovigilance. Spanish Agency of Medicines and Medical Devices (AEMPS), 28022, Madrid, Spain
| | - Dolores Montero-Corominas
- Division of Pharmacoepidemiology and Pharmacovigilance. Spanish Agency of Medicines and Medical Devices (AEMPS), 28022, Madrid, Spain
| | - Marc Comas-Cufí
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Elisa Martín-Merino
- Division of Pharmacoepidemiology and Pharmacovigilance. Spanish Agency of Medicines and Medical Devices (AEMPS), 28022, Madrid, Spain.
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Ponjoan A, Blanch J, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Cirach M, Nieuwenhuijsen M, Garcia-Gil MDM, Ramos R. Impact of residential greenness on myocardial infarction in the population with diabetes: A sex-dependent association? Environ Res 2022; 205:112449. [PMID: 34883080 DOI: 10.1016/j.envres.2021.112449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/04/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
Living in urban areas with abundant greenness might provide health benefits in general population. Literature suggests that sex/gender plays a role in the association between greenness and health outcomes. But the impact of greenness in populations with moderate to high cardiovascular risk, such as persons with diabetes, is still unknown. Our aim was to evaluate the relationship between urban greenness and myocardial infarction incidence in persons with type 2 diabetes in Barcelona (Catalonia, Spain), and seek potential gender/sex differences in this association. This retrospective cohort study is based on data from the System for the Development of Research in Primary Care (SIDIAP database). We used Cox models to estimate if a 0.01 increase in Normalized Difference Vegetation Index (NDVI) at census tract level was associated to reduced risk of developing a myocardial infarction. Models were adjusted by demographic and clinical characteristics at individual level, and by environmental and socioeconomic variables at census tract level. Amongst 41,463 persons with diabetes and 154,803.85 person-years of follow-up, we observed 449 incident cases of acute myocardial infarction. For each 0.01 increment in NDVI the risk of developing a myocardial infarction decreased by 6% (Hazard Ratio, HR = 0.94; 95%CI, 0.89-0.99) in the population with diabetes. When stratifying by sex, we observed a significant association only in men (HR = 0.91; 95%CI, 0.86-0.97). People with diabetes living in urban greener areas might benefit from reduced cardiovascular risk, specially men. We observed sex/gender disparities, which could be related to different exposures and activities performed in green spaces between men and women. Further studies are needed to confirm sex/gender disparities between greenness exposure and cardiovascular outcomes. Our findings contribute to improve the health of people with diabetes who should be recommended to spent time and exercise in green areas.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain; Girona Biomedical Research Institute (IDIBGI), Dr.Trueta University Hospital, 17190, Girona, Catalonia, Spain.
| | - Jordi Blanch
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain.
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain.
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain; Girona Biomedical Research Institute (IDIBGI), Dr.Trueta University Hospital, 17190, Girona, Catalonia, Spain.
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain.
| | - Marta Cirach
- ISGlobal, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain.
| | - Mark Nieuwenhuijsen
- ISGlobal, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain.
| | - María Del Mar Garcia-Gil
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain.
| | - Rafel Ramos
- Vascular Health Research Group (ISV)-Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), 17002, Girona, Catalonia, Spain; Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Catalonia, Spain.
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Alves-Cabratosa L, Comas-Cufí M, Blanch J, Martí-Lluch R, Ponjoan A, Castro-Guardiola A, Hurtado-Ganoza A, Pérez-Jaén A, Rexach-Fumaña M, Faixedas-Brunsoms D, Gispert-Ametller MA, Guell-Cargol A, Rodriguez-Batista M, Santaularia-Font F, Orriols R, Bonnin-Vilaplana M, Calderón López JC, Sabater-Talaverano G, Queralt Moles FX, Rodriguez-Requejo S, Avellana-Revuelta E, Balló E, Fages-Masmiquel E, Sirvent JM, Lorencio C, Morales-Pedrosa JM, Ortiz-Ballujera P, Ramos R. Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data. JMIR Public Health Surveill 2022; 8:e30006. [PMID: 34797774 PMCID: PMC8734611 DOI: 10.2196/30006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. OBJECTIVE We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. METHODS This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. RESULTS The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. CONCLUSIONS Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition.
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Affiliation(s)
- Lia Alves-Cabratosa
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Girona, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Girona, Spain
| | - Jordi Blanch
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Girona, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Girona, Spain
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Anna Ponjoan
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Girona, Spain
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Antoni Castro-Guardiola
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Internal Medicine Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
| | - Abelardo Hurtado-Ganoza
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Internal Medicine Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Ana Pérez-Jaén
- Internal Medicine Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Maria Rexach-Fumaña
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Internal Medicine Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Delfi Faixedas-Brunsoms
- Technical Secretariat, Institut Assistència Sanitària, Girona, Spain
- Technical Secretariat, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Maria Angels Gispert-Ametller
- Department of Medical Sciences, University of Girona, Girona, Spain
- Emergency Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Anna Guell-Cargol
- Emergency Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | | | | | - Ramon Orriols
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Pneumology Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Pneumology Department, Hospital Santa Caterina de Salt, Salt, Spain
- CIBER of Respiratory Diseases, Barcelona, Spain
| | - Marc Bonnin-Vilaplana
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Pneumology Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Pneumology Department, Hospital Santa Caterina de Salt, Salt, Spain
| | - Juan Carlos Calderón López
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Pneumology Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Pneumology Department, Hospital Santa Caterina de Salt, Salt, Spain
| | - Gladis Sabater-Talaverano
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Pneumology Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Pneumology Department, Hospital Santa Caterina de Salt, Salt, Spain
| | | | - Sara Rodriguez-Requejo
- Atenció Primària, Institut Català de la Salut, Girona, Spain
- Atenció Primària, Institut d'Assistència Sanitària, Girona, Spain
| | - Esteve Avellana-Revuelta
- Atenció Primària, Institut Català de la Salut, Girona, Spain
- Atenció Primària, Institut d'Assistència Sanitària, Girona, Spain
| | - Elisabet Balló
- Department of Medical Sciences, University of Girona, Girona, Spain
- Atenció Primària, Institut Català de la Salut, Girona, Spain
| | | | - Josep-Maria Sirvent
- Intensive Care Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Carol Lorencio
- Intensive Care Department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | | | | | - Rafel Ramos
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Girona, Spain
- Institut d'Investigació Biomèdica de Girona, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Atenció Primària, Institut Català de la Salut, Girona, Spain
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Alves-Cabratosa L, Comas-Cufí M, Martí-Lluch R, Ponjoan A, Ramos R. Ankle-brachial index and the risk of hemorrhagic stroke. Eur J Intern Med 2021; 94:112-114. [PMID: 34763981 DOI: 10.1016/j.ejim.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Lia Alves-Cabratosa
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol I Gurina, Carrer Maluquer Salvador, 11, Girona, Catalonia 17002, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol I Gurina, Carrer Maluquer Salvador, 11, Girona, Catalonia 17002, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol I Gurina, Carrer Maluquer Salvador, 11, Girona, Catalonia 17002, Spain; Girona Biomedical Research Institute, Carrer Dr. Castany s/n, Salt, Girona, Catalonia 17190, Spain
| | - Anna Ponjoan
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol I Gurina, Carrer Maluquer Salvador, 11, Girona, Catalonia 17002, Spain; Girona Biomedical Research Institute, Carrer Dr. Castany s/n, Salt, Girona, Catalonia 17190, Spain
| | - Rafel Ramos
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol I Gurina, Carrer Maluquer Salvador, 11, Girona, Catalonia 17002, Spain; Girona Biomedical Research Institute, Carrer Dr. Castany s/n, Salt, Girona, Catalonia 17190, Spain; Department of Medical Sciences, University of Girona, Carrer Emili Grahit, 77, Girona, Catalonia 17003, Spain; Primary Care Services, Catalan Institute of Health, Carrer de Santa Clara, 35, Girona, Catalonia 17001, Spain.
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8
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Fages-Masmiquel E, Ponjoan A, Blanch J, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Garcia-Gil MM, Ramos R. [The effect of age and sex on factors associated with dementia]. Rev Neurol 2021; 73:409-415. [PMID: 34877643 DOI: 10.33588/rn.7312.2021301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is currently no cure for dementia and its prevention is considered to be crucial. The aim is to analyse the association between risk factors and dementia, and how this varies according to age and sex. PATIENTS AND METHODS This cross-sectional study includes 1,048,956 people aged 65 and over. Data were obtained from the SIDIAP pseudonymised clinical database. The response variable was dementia and cases were identified using a validated algorithm. Exposure to the following risk factors was assessed: smoking, coronary heart disease, cerebrovascular disease, heart failure, peripheral arterial disease, alcoholism, high blood pressure, hyperlipidaemia, diabetes, hyperthyroidism, Parkinson's disease, depressive disorder and rurality. Logistic regression models were estimated to assess the association between risk factors and dementia, and they were stratified by age, sex and both jointly. RESULTS The association between a medical history of cerebrovascular disease, Parkinson, depressive disorder or hyperthyroidism and dementia was more pronounced in men. The inverse association between coronary heart disease, heart failure or smoking and dementia was significant only in women. A stronger association was observed in younger age groups for most risk factors, but hypertension, coronary heart disease, heart failure or smoking were negatively associated among the older age groups. CONCLUSION Sex and age both condition the association between risk factors and dementia. We recommend promoting effective control of cardiovascular risk factors in order to prevent dementia.
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Affiliation(s)
| | - A Ponjoan
- Universitat Autònoma de Barcelona, Bellaterra, España.,Institut Català de la Salut, Girona, España.,Fundació Institut Universitari per la Recerca a l´Atenció Primària de Salut Jordi Gol i Gurina, Girona, España.,Institut d´investigació Biomèdica de Girona Josep Trueta, Girona, España
| | - J Blanch
- Fundació Institut Universitari per la Recerca a l´Atenció Primària de Salut Jordi Gol i Gurina, Girona, España
| | - L Alves-Cabratosa
- Fundació Institut Universitari per la Recerca a l´Atenció Primària de Salut Jordi Gol i Gurina, Girona, España
| | - R Martí-Lluch
- Universitat Autònoma de Barcelona, Bellaterra, España.,Institut d´Investigació Biomèdica de Girona Dr. Josep Trueta , Girona, España
| | - M Comas-Cufí
- Fundació Institut Universitari per la Recerca a l´Atenció Primària de Salut Jordi Gol i Gurina , Girona, España
| | - M M Garcia-Gil
- Fundació Institut Universitari per la Recerca a l´Atenció Primària de Salut Jordi Gol i Gurina, Girona, España
| | - R Ramos
- Institut Català de la Salut, Girona, España.,Fundació Institut Universitari per la Recerca a l´Atenció Primària de Salut Jordi Gol i Gurina, Girona, España.,Universitat de Girona, Girona, España
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9
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Mayneris-Perxachs J, Russo MF, Ramos R, de Hollanda A, Arxé AA, Rottoli M, Arnoriaga-Rodríguez M, Comas-Cufí M, Bartoletti M, Verrastro O, Gudiol C, Fages E, Giménez M, Gil ADG, Bernante P, Tinahones F, Carratalà J, Pagotto U, Hernández-Aguado I, Fernández-Aranda F, Meira F, Castro Guardiola A, Mingrone G, Fernández-Real JM. Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain. Front Endocrinol (Lausanne) 2021; 12:741248. [PMID: 34795637 PMCID: PMC8593102 DOI: 10.3389/fendo.2021.741248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19. METHODS Consecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms. RESULTS As expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels. CONCLUSIONS Blood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.
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Affiliation(s)
- Jordi Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Maria Francesca Russo
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Rafel Ramos
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Ana de Hollanda
- Department of Endocrinology & Nutrition, Hospital Clínic Barcelona, Diabetes Unit, Barcelona, Spain
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Arola Armengou Arxé
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Matteo Rottoli
- Department of Surgery, Diabetology and Otolaryngology, Surgery of the Alimentary Tract and Centre for the Study and Research of Treatment for Morbid Obesity, Bologna, Italy
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - María Arnoriaga-Rodríguez
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - Ornella Verrastro
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Department of Oncology, Institut Català d’Oncologia (ICO) Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Fages
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Marga Giménez
- Department of Endocrinology & Nutrition, Hospital Clínic Barcelona, Diabetes Unit, Barcelona, Spain
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Ariadna de Genover Gil
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Paolo Bernante
- Department of Surgery, Diabetology and Otolaryngology, Surgery of the Alimentary Tract and Centre for the Study and Research of Treatment for Morbid Obesity, Bologna, Italy
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Malaga, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Uberto Pagotto
- Endocrinology and Prevention and Care of Diabetes Unit, Department of Medical and Surgical Sciences, Sant’ Orsola Policlinic, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain
- Department of Epidemiology, Centro de Investigación Biomédica en Red (CIBER) Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Fernández-Aranda
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Fernanda Meira
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Department of Infectious Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Antoni Castro Guardiola
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Geltrude Mingrone
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
- Department of Internal Medicine, King’s College London, London, United Kingdom
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- *Correspondence: José Manuel Fernández-Real,
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Dégano IR, Ramos R, García-Gil M, Zamora A, Comas-Cufí M, Francés A, Garcia-Elias A, Marrugat J. Three-year events and mortality in cardiovascular disease patients without lipid-lowering treatment. Eur J Prev Cardiol 2020; 27:2102-2104. [DOI: 10.1177/2047487319862103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Irene Roman Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Spain
- CIBERCV of Cardiovascular Diseases, Instituto de Salud Carlos III (ISCIII), Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain
- Institut Català de la Salut, Spain
- Department of Medical Sciences, University of Girona, Spain
- Biomedical Research Institute, Institut Català de la Salut, Spain
| | - Maria García-Gil
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain
| | - Alberto Zamora
- Department of Medical Sciences, University of Girona, Spain
- Lipid and Atherosclerosis Unit and Department of Internal Medicine, Hospital de Blanes, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain
| | - Albert Francés
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Spain
- CIBERCV of Cardiovascular Diseases, Instituto de Salud Carlos III (ISCIII), Spain
- Hospital del Mar, Spain
| | | | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Spain
- CIBERCV of Cardiovascular Diseases, Instituto de Salud Carlos III (ISCIII), Spain
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11
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Ponjoan A, Blanch J, Alves-Cabratosa L, Martí Lluch R, Comas-Cufí M, Parramon D, García-Gil MM, Ramos R, Petersen I. Extreme diurnal temperature range and cardiovascular emergency hospitalisations in a Mediterranean region. Occup Environ Med 2020; 78:62-68. [PMID: 33051384 DOI: 10.1136/oemed-2019-106245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/03/2020] [Accepted: 08/08/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The impact of extreme diurnal temperature range (DTR) on cardiovascular morbidity in Mediterranean regions remains uncertain. We aimed to analyse the impact of extreme low DTR (stable temperature) or high DTR (changeable temperature) on cardiovascular hospitalisations in Catalonia (Southern Europe). METHODS We conducted a self-controlled case series study using whole-year data from the System for the Development of Research in Primary Care database and 153 weather stations from the Catalan Meteorological Service. The outcome was first emergency hospitalisation. Monthly DTR percentiles were used to define extreme DTR as low (DTR <the 5th percentile) and high (DTR>95th percentile). We assessed two effects: same-day (1-day exposure, coinciding with the extreme DTR episode) and cumulative (3-day exposure, adding two subsequent days). Incidence rate ratios (IRR) were calculated adjusted by age, season and air pollution. Stratified analyses by gender, age or cardiovascular type and regions are provided. RESULTS We computed 121 206 cardiovascular hospitalisations from 2006 to 2013. The IRR was 1.032 (95% CI 1.005 to 1.061) for same day and 1.024 (95% CI 1.006 to 1.042) for cumulative effects of extreme high DTR. The impact was significant for stroke and heart failure, but not for coronary heart disease. Conversely, extreme low DTR did not increase cardiovascular hospitalisations. CONCLUSIONS Extreme high DTR increased the incidence of cardiovascular hospitalisations, but not extreme low DTR. Same-day effects of extreme high DTR were stronger than cumulative effects. These findings contribute to better understand the impact of outdoor temperature on health, and to help defining public health strategies to mitigate such impact.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain .,Department of Vascular Health, Biomedical Research Institute Girona (IDIBGI), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain
| | - Ruth Martí Lluch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain.,Department of Vascular Health, Biomedical Research Institute Girona (IDIBGI), Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain.,Centre d'Atenció Primària Santa Clara. Gerència d'Àmbit d'Atenció Primària Girona, Institut Català de la Salut, Girona, Catalunya, Spain
| | - Maria M García-Gil
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Girona, Catalonia, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, London, UK.,Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Denmark
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Casellas-Robert M, Lim C, Lopez-Ben S, Lladó L, Salloum C, Codina-Font J, Comas-Cufí M, Ramos E, Figueras J, Azoulay D. Laparoscopic Liver Resection for Hepatocellular Carcinoma in Child-Pugh A Patients With and Without Portal Hypertension: A Multicentre Study. World J Surg 2020; 44:3915-3922. [PMID: 32661688 DOI: 10.1007/s00268-020-05687-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) may improve outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) and portal hypertension (PHT). The aim of this study was to compare the short-term outcomes after LLR for HCC in cirrhotic patients with and without PHT. METHODS This multicentric study included 96 HCC patients who underwent LLR. Clinically significant portal hypertension (CSPH) was defined by a hepatic venous pressure gradient ≥10 mmHg. Short-term outcomes and liver-specific complications including post-hepatectomy liver failure (PHLF), ascites and encephalopathy were compared between patients with and without CSPH. RESULTS Thirty-one patients (32%) had CSPH. The CSPH group had higher post-operative morbidity (52% vs. 15%; p < 0.001), PHLF (10% vs. 0%; p = 0.03) and encephalopathy (10% vs. 0%; p = 0.03). There was no difference in terms of post-operative ascites between the two groups (CSPH: 16% vs. no CPSH: 8%, p = 0.28). The length of stay was longer in patients with CSPH than in those without CSPH (6 vs. 4 days; p < 0.001). CONCLUSIONS The laparoscopic approach is feasible in selected HCC patients with CSPH, at the price of significant increases in liver-specific complications and length of stay.
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Affiliation(s)
- Margarida Casellas-Robert
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Av de França s/n, 17007, Girona, Catalonia, Spain.
| | - Chetana Lim
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Santiago Lopez-Ben
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Av de França s/n, 17007, Girona, Catalonia, Spain
| | - Laura Lladó
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Chady Salloum
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Jaume Codina-Font
- Department of Interventional Radiology, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Department of Computer Science, Applied Mathematics and Statistics, Universitat de Girona, Girona, Catalonia, Spain.,Research Unit in Primary Care, Catalan Institute of Health, Barcelona, Catalonia, Spain.,The Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | - Emilio Ramos
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Joan Figueras
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Av de França s/n, 17007, Girona, Catalonia, Spain
| | - Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France.,Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, Garcia-Gil M, Ramos R. Is it time to use real-world data from primary care in Alzheimer's disease? Alzheimers Res Ther 2020; 12:60. [PMID: 32423489 PMCID: PMC7236302 DOI: 10.1186/s13195-020-00625-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The analysis of real-world data in clinical research is rising, but its use to study dementia subtypes has been hardly addressed. We hypothesized that real-world data might be a powerful tool to update AD epidemiology at a lower cost than face-to-face studies, to estimate the prevalence and incidence rates of AD in Catalonia (Southern Europe), and to assess the adequacy of real-world data routinely collected in primary care settings for epidemiological research on AD. METHODS We obtained data from the System for the Development of Research in Primary Care (SIDIAP) database, which contains anonymized information of > 80% of the Catalan population. We estimated crude and standardized incidence rates and prevalences (95% confidence intervals (CI)) of AD in people aged at least 65 years living in Catalonia in 2016. RESULTS Age- and sex-standardized prevalence and incidence rate of AD were 3.1% (95%CI 2.7-3.6) and 4.2 per 1000 person-years (95%CI 3.8-4.6), respectively. Prevalence and incidence were higher in women and in the oldest people. CONCLUSIONS Our incidence and prevalence estimations were slightly lower than the recent face-to-face studies conducted in Spain and higher than other analyses of electronic health data from other European populations. Real-world data routinely collected in primary care settings could be a powerful tool to study the epidemiology of AD.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Primary Care Services, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Primary Care Services, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - María Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain.
- IDIAPJGol, c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain.
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Alves-Cabratosa L, Comas-Cufí M, Ponjoan A, Garcia-Gil M, Martí-Lluch R, Blanch J, Elosua-Bayes M, Parramon D, Camós L, Guzmán L, Ramos R. Levels of ankle-brachial index and the risk of diabetes mellitus complications. BMJ Open Diabetes Res Care 2020; 8:8/1/e000977. [PMID: 32144131 PMCID: PMC7059529 DOI: 10.1136/bmjdrc-2019-000977] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to compare the association of categorized ankle-brachial index (ABI) with mortality and complications of diabetes in persons with no symptoms of peripheral arterial disease (PAD) and in primary cardiovascular disease prevention. RESEARCH DESIGN AND METHODS This is a retrospective cohort study of persons with type 2 diabetes aged 35-85 years, from 2006 to 2011. Data were obtained from the Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAPQ). Participants had an ABI measurement that was classified into six categories. For each category of ABI, we assessed the incidence of mortality; macrovascular complications of diabetes: acute myocardial infarction (AMI), ischemic stroke, and a composite of these two; and microvascular complications of this metabolic condition: nephropathy, retinopathy, and neuropathy. We also estimated the HRs for these outcomes by ABI category using Cox proportional hazards models. RESULTS Data from 34 689 persons with type 2 diabetes were included. The mean age was 66.2; 51.5% were men; and the median follow-up was 6.0 years. The outcome with the highest incidence was nephropathy, with 24.4 cases per 1000 person-years in the reference category of 1.1≤ABI≤1.3. The incidences in this category for mortality and AMI were 15.4 and 4.1, respectively. In the Cox models, low ABI was associated with increased risk and was significant from ABI lower than 0.9; below this level, the risk kept increasing steeply. High ABI (over 1.3) was also associated with significant increased risk for most outcomes. CONCLUSIONS The studied categories of ABI were associated with different risks of type 2 diabetes complications in persons asymptomatic for PAD, who were in primary cardiovascular prevention. These findings could be useful to optimize preventive interventions according to the ABI category in this population.
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Affiliation(s)
| | | | - Anna Ponjoan
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- IDIBGI, Girona, Catalunya, Spain
| | | | - Ruth Martí-Lluch
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- IDIBGI, Girona, Catalunya, Spain
| | - Jordi Blanch
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
| | | | - Dídac Parramon
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain
| | - Lourdes Camós
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain
| | - Lidia Guzmán
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
| | - Rafel Ramos
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain
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15
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Ramos R, Masana L, Comas-Cufí M, García-Gil M, Martí-Lluch R, Ponjoan A, Plana N, Alves-Cabratosa L, Marrugat J, Elosua R, Dégano IR, Gomez-Marcos MA, Zamora A. Derivation and validation of SIDIAP-FHP score: A new risk model predicting cardiovascular disease in familial hypercholesterolemia phenotype. Atherosclerosis 2019; 292:42-51. [PMID: 31759248 DOI: 10.1016/j.atherosclerosis.2019.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Assessment of individual cardiovascular risk, distinguishing primary and secondary prevention, would improve the clinical management of the population with familial hypercholesterolemia. We aimed to develop and validate two risk functions to predict incident and recurrent atherosclerotic cardiovascular disease (ASCVD) in a primary care-based population with familial hypercholesterolemia phenotype (FHP), and to compare their predictive capacity with that of the SpAnish Familial hypErcHolEsterolemiA cohoRT (SAFEHEART) risk equation (SAFEHEART-RE). METHODS Data from the Catalan primary care system database (SIDIAP) of patients ≥18 years old with FHP in 2006-2013 were used to develop and validate two risk functions to predict incident and recurrent ASCVD. A validation dataset was also used to compare the model predictive capacity to that of SAFEHEART-RE. RESULTS The new model (SIDIAP-FHP) included age, diabetes, smoking, sex (male), hypertension, and baseline low-density lipoprotein cholesterol in the primary prevention cohort and age, diabetes, smoking, and disease characteristics (progressive, recent, polyvascular, or included myocardial infarction) in the secondary prevention cohort. The models demonstrated a fair fit: C-Statistic: 0.71 (95%CI:0.68-0.75) in primary prevention and 0.65 (95%CI:0.60-0.70) in secondary prevention (higher than that of SAFEHEART-RE: 0.64 [95%CI:0.60-0.68] and 0.55 [95%CI:0.51-0.59], respectively; both p < 0.01). The Brier scores obtained with the SIDIAP-FHP score were significantly lower than that obtained with SAFEHEART-RE in both the primary and secondary prevention cohorts. CONCLUSIONS The SIDIAP-FHP score provides accurate ASCVD risk estimates for primary and secondary prevention in the FHP population, with better predictive capacity than that of SAFEHEART-RE in this general population, especially in persons with previous ASCVD.
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Affiliation(s)
- Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain.
| | - Luís Masana
- Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Research Unit, "Sant Joan" University Hospital, Internal Medicine Department, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain
| | - Maria García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain
| | - Ruth Martí-Lluch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain
| | - Anna Ponjoan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain
| | - Núria Plana
- Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Research Unit, "Sant Joan" University Hospital, Internal Medicine Department, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain
| | - Jaume Marrugat
- Registre Gironí del COR (REGICOR) Group, Municipal Institute for Medical Research (IMIM), Barcelona, Spain; CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Catalonia, Spain
| | - Roberto Elosua
- CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Catalonia, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain; Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - Irene R Dégano
- Registre Gironí del COR (REGICOR) Group, Municipal Institute for Medical Research (IMIM), Barcelona, Spain; CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Catalonia, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Mauel A Gomez-Marcos
- . Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, The Alamedilla Health Center, Salamanca, Spain; Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Zamora
- Department of Medical Sciences, School of Medicine, University of Girona, Spain; Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Unit, Blanes Hospital, Girona, Spain; Laboratory of Translational Medicine (Translab), School of Medicine, University of Girona, Spain
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16
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Coll-de-Tuero G, Comas-Cufí M, Rodríguez-Poncelas A, Barrot-de-la Puente J, Blanch J, Figa-Vaello J, Barceló MA, Saez M. Prognostic Value of the Estimated Glomerular Filtration Rate Decline in Hypertensive Patients Without Chronic Kidney Disease. Am J Hypertens 2019; 32:890-899. [PMID: 30794282 DOI: 10.1093/ajh/hpz029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Our objective of this study was to determine if rate of estimated glomerular filtration rate (eGFR) decline and its intensity was associated with cardiovascular risk and death in patients with hypertension whose baseline eGFR was higher than 60 ml/minute/1.73 m2. METHODS This study comprised 2,516 patients with hypertension who had had at least 2 serum creatinine measurements over a 4-year period. An eGFR reduction of ≥10% per year has been deemed as high eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end points were coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, and death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. RESULTS A total of 2,354 patients with low rate of eGFR decline and 149 with high rate of eGFR decline were analyzed. The adjusted model shows that a -10% rate of eGFR decline per year is associated with a higher risk of the primary end point (HR 1.9; 95% CI 1.1-3.5; P = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95% CI 1.2-4.2; P < 0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were serum creatinine (OR 3.35; P < 0.001), gender, women (OR 15.3; P < 0.001), tobacco user (OR 1.9; P < 0.002), and pulse pressure (OR 0.99; P < 0.05). CONCLUSIONS A rate of eGFR decline equal to or higher than -10% per year is a marker of cardiovascular risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marc Comas-Cufí
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Antonio Rodríguez-Poncelas
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Joan Barrot-de-la Puente
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Jordi Blanch
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Josep Figa-Vaello
- MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Maria A Barceló
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Marc Saez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
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17
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, García-Gil M, Ramos R. How well can electronic health records from primary care identify Alzheimer's disease cases? Clin Epidemiol 2019; 11:509-518. [PMID: 31456649 PMCID: PMC6620769 DOI: 10.2147/clep.s206770] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/24/2019] [Indexed: 12/03/2022] Open
Abstract
Background Electronic health records (EHR) from primary care are emerging in Alzheimer’s disease (AD) research, but their accuracy is a concern. We aimed to validate AD diagnoses from primary care using additional information provided by general practitioners (GPs), and a register of dementias. Patients and methods This retrospective observational study obtained data from the System for the Development of Research in Primary Care (SIDIAP). Three algorithms combined International Statistical Classification of Diseases (ICD-10) and Anatomical Therapeutic Chemical codes to identify AD cases in SIDIAP. GPs evaluated dementia diagnoses by means of an online survey. We linked data from the Register of Dementias of Girona and from SIDIAP. We estimated the positive predictive value (PPV) and sensitivity and provided results stratified by age, sex and severity. Results Using survey data from the GPs, PPV of AD diagnosis was 89.8% (95% CI: 84.7–94.9). Using the dataset linkage, PPV was 74.8 (95% CI: 73.1–76.4) for algorithm A1 (AD diagnoses), and 72.3 (95% CI: 70.7–73.9) for algorithm A3 (diagnosed or treated patients without previous conditions); sensitivity was 71.4 (95% CI: 69.6–73.0) and 83.3 (95% CI: 81.8–84.6) for algorithms A1 (AD diagnoses) and A3, respectively. Stratified results did not differ by age, but PPV and sensitivity estimates decreased amongst men and severe patients, respectively. Conclusions PPV estimates differed depending on the gold standard. The development of algorithms integrating diagnoses and treatment of dementia improved the AD case ascertainment. PPV and sensitivity estimates were high and indicated that AD codes recorded in a large primary care database were sufficiently accurate for research purposes.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona , Bellaterra, Catalonia, Spain.,Girona Biomedical Research Institute (IDIBGI) , Girona, Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI) , Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Primary Care Services, Catalan Health Institute (ICS), Girona, Catalonia, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona , Bellaterra, Catalonia, Spain.,Girona Biomedical Research Institute (IDIBGI) , Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Primary Care Services, Catalan Health Institute (ICS), Girona, Catalonia, Spain
| | - María García-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain
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18
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Garcia-Gil M, Comas-Cufí M, Ramos R, Martí R, Alves-Cabratosa L, Parramon D, Prieto-Alhambra D, Baena-Díez JM, Salvador-González B, Elosua R, Dégano IR, Marrugat J, Grau M. Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study. J Cardiovasc Pharmacol Ther 2019; 24:542-550. [PMID: 31248268 DOI: 10.1177/1074248419857071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. AIM To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. METHODS A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. RESULTS Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). CONCLUSIONS Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.
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Affiliation(s)
- Maria Garcia-Gil
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Marc Comas-Cufí
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Rafel Ramos
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain.,3 Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalonia, Spain.,4 Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Ruth Martí
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain.,5 Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain
| | - Lia Alves-Cabratosa
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Dídac Parramon
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Daniel Prieto-Alhambra
- 6 Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,7 GREMPAL (Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor) Research Group, IDIAJGol and CIBERFes, Universitat Autònoma de Barcelona and Instituto Carlos III, Barcelona, Spain
| | - Jose Miguel Baena-Díez
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,9 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalunya, Spain.,10 MACAP Renal Research Group, Research Unit in Primary Care, Barcelona, Spain.,11 La Marina Primary Care Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Betlem Salvador-González
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,12 Florida Sud Primary Care Centre, Primary Care Services, Costa Ponent, Catalan Institute of Health, Catalunya, Spain
| | - Roberto Elosua
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene R Dégano
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jaume Marrugat
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María Grau
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,14 Universitat de Barcelona, Catalonia, Spain
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, Garcia-Gil M, Ramos R. Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care. Clin Epidemiol 2019; 11:217-228. [PMID: 30881138 PMCID: PMC6407519 DOI: 10.2147/clep.s186590] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Updated estimates of incidence and prevalence of dementia are crucial to ensure adequate public health policy. However, most of the epidemiological studies in the population in Spain were conducted before 2010. This study assessed the validity of dementia diagnoses recorded in electronic health records contained in a large primary-care database to determine if they could be used for research purposes. Then, to update the epidemiology of dementia in Catalonia (Spain), we estimated crude and standardized prevalence and incidence rates of dementia in Catalonia in 2016. Methods The System for the Development of Research in Primary Care (SIDIAP) database contains anonymized information for >80% of the Catalan population. Validity of dementia codes in SIDIAP was assessed in patients at least 40 years old by asking general practitioners for additional evidence to support the diagnosis. Crude and standardized incidence and prevalence (95% CI) in people aged ≥65 years were estimated assuming a Poisson distribution. Results The positive predictive value of dementia diagnoses recorded in SIDIAP was estimated as 91.0% (95% CI 87.5%–94.5%). Age-and sex-standardized incidence and prevalence of dementia were 8.6/1,000 person-years (95% CI 8.0–9.3) and 5.1% (95% CI 4.5%–5.7%), respectively. Conclusion SIDIAP contains valid dementia records. We observed incidence and prevalence estimations similar to recent face-to-face studies conducted in Spain and higher than studies using electronic health data from other European populations.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Santa Clara Primary Care Health Center, Catalan Health Institute, Girona, Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Santa Clara Primary Care Health Center, Catalan Health Institute, Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - María Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain,
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20
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Ramos R, Comas-Cufí M, Martí-Lluch R, Balló E, Ponjoan A, Alves-Cabratosa L, Blanch J, Marrugat J, Elosua R, Grau M, Elosua-Bayes M, García-Ortiz L, Garcia-Gil M. Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study. BMJ 2018; 362:k3359. [PMID: 30185425 PMCID: PMC6123838 DOI: 10.1136/bmj.k3359] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess whether statin treatment is associated with a reduction in atherosclerotic cardiovascular disease (CVD) and mortality in old and very old adults with and without diabetes. DESIGN Retrospective cohort study. SETTING Database of the Catalan primary care system (SIDIAP), Spain, 2006-15. PARTICIPANTS 46 864 people aged 75 years or more without clinically recognised atherosclerotic CVD. Participants were stratified by presence of type 2 diabetes mellitus and as statin non-users or new users. MAIN OUTCOME MEASURES Incidences of atherosclerotic CVD and all cause mortality compared using Cox proportional hazards modelling, adjusted by the propensity score of statin treatment. The relation of age with the effect of statins was assessed using both a categorical approach, stratifying the analysis by old (75-84 years) and very old (≥85 years) age groups, and a continuous analysis, using an additive Cox proportional hazard model. RESULTS The cohort included 46 864 participants (mean age 77 years; 63% women; median follow-up 5.6 years). In participants without diabetes, the hazard ratios for statin use in 75-84 year olds were 0.94 (95% confidence interval 0.86 to 1.04) for atherosclerotic CVD and 0.98 (0.91 to 1.05) for all cause mortality, and in those aged 85 and older were 0.93 (0.82 to 1.06) and 0.97 (0.90 to 1.05), respectively. In participants with diabetes, the hazard ratio of statin use in 75-84 year olds was 0.76 (0.65 to 0.89) for atherosclerotic CVD and 0.84 (0.75 to 0.94) for all cause mortality, and in those aged 85 and older were 0.82 (0.53 to 1.26) and 1.05 (0.86 to 1.28), respectively. Similarly, effect analysis of age in a continuous scale, using splines, corroborated the lack of beneficial statins effect for atherosclerotic CVD and all cause mortality in participants without diabetes older than 74 years. In participants with diabetes, statins showed a protective effect against atherosclerotic CVD and all cause mortality; this effect was substantially reduced beyond the age of 85 years and disappeared in nonagenarians. CONCLUSIONS In participants older than 74 years without type 2 diabetes, statin treatment was not associated with a reduction in atherosclerotic CVD or in all cause mortality, even when the incidence of atherosclerotic CVD was statistically significantly higher than the risk thresholds proposed for statin use. In the presence of diabetes, statin use was statistically significantly associated with reductions in the incidence of atherosclerotic CVD and in all cause mortality. This effect decreased after age 85 years and disappeared in nonagenarians.
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Affiliation(s)
- Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health, Catalonia, Spain
| | - Ruth Martí-Lluch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- Institut d'Investigació Biomèdica de Girona (IdIBGi), Catalonia, Spain
| | - Elisabeth Balló
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Anna Ponjoan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- Institut d'Investigació Biomèdica de Girona (IdIBGi), Catalonia, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health, Catalonia, Spain
| | - Jordi Blanch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health, Catalonia, Spain
| | - Jaume Marrugat
- Registre Gironí del COR Group (REGICOR); Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
- CIBER of Cardiovascular Diseases, Barcelona, Catalonia, Spain
| | - Roberto Elosua
- Registre Gironí del COR Group (REGICOR); Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
- CIBER of Cardiovascular Diseases, Barcelona, Catalonia, Spain
| | - María Grau
- Registre Gironí del COR Group (REGICOR); Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
- CIBER of Cardiovascular Diseases, Barcelona, Catalonia, Spain
| | - Marc Elosua-Bayes
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health, Catalonia, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca, Primary Care Research Unit, the Alamedilla Health Center, Castilla and León Health Service-SACYL, and Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Maria Garcia-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalonia, Spain
- ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health, Catalonia, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Spain
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21
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Rodriguez-Poncelas A, Coll-de-Tuero G, Blanch J, Comas-Cufí M, Saez M, Barceló MA. Prediabetes is associated with glomerular hyperfiltration in a European Mediterranean cohort study. J Nephrol 2018; 31:743-749. [PMID: 30151699 DOI: 10.1007/s40620-018-0524-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glomerular hyperfiltration is well recognized as an early renal alteration in subjects with diabetes mellitus. However, what is not well-known is whether hyperfiltration also occurs in the early stages of hyperglycaemia, for instance in prediabetes. Identifying subjects with glomerular hyperfiltration from among those with prediabetes might be helpful to implement preventive and therapeutic strategies. This study aimed to investigate the association of prediabetes with glomerular hyperfiltration and its associated variables. METHODS A representative sample of 9238 people aged ≥ 30 years and whose entire clinical and laboratory data were available, were included in this study. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS After adjustment for age, gender, body mass index, systolic blood pressure and diastolic blood pressure, cholesterol, log (triglycerides), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum uric acid, smoking status, hypertension, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, fasting plasma glucose (FPG) was found to be independently positively associated with eGFR. The hazard ratios (95% confidence interval) for hyperfiltration were 1.61 (1.28-2.03) and 2.30 (1.89-2.79) for prediabetes and diabetes, respectively, when compared with participants with normoglycemia. CONCLUSION Prediabetes was associated with glomerular hyperfiltration. Longitudinal studies are needed to investigate whether hyperfiltration in prediabetes is associated with a later decline in eGFR.
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Affiliation(s)
| | - Gabriel Coll-de-Tuero
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain.,Department of Medical Sciences, University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jordi Blanch
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain
| | - Marc Comas-Cufí
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain
| | - Marc Saez
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain.
| | - Maria Antònia Barceló
- METHARISC Group, USR Girona, IdIAP Gol i Gorina, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain
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22
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Elosua-Bayés M, Martí-Lluch R, García-Gil MDM, Camós L, Comas-Cufí M, Blanch J, Ponjoan A, Alves-Cabratosa L, Elosua R, Grau M, Marrugat J, Ramos R. Asociación de los factores de riesgo cardiovascular y estilos de vida clásicos con el índice vascular corazón-tobillo en población general mediterránea. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Comas-Cufí M, Martín-Fernández JA, Mateu-Figueras G. Merging the components of a finite mixture using posterior probabilities. STAT MODEL 2017. [DOI: 10.1177/1471082x17735919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methods in parametric cluster analysis commonly assume data can be modelled by means of a finite mixture of distributions. However, associating each mixture component to one cluster is frequently misleading because different mixture components can overlap, and then, associated clusters can overlap too suggesting a unique cluster. A number of approaches have already been proposed to construct the clusters by merging components using the posterior probabilities. This article presents a generic approach for building a hierarchy of mixture components that integrates and generalizes some techniques proposed earlier in the literature. Using this proposal, two new techniques based on the log-ratio of posterior probabilities are introduced. Moreover, to decide the final number of clusters, two new methods are presented. Simulated and real datasets are used to illustrate this methodology.
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Affiliation(s)
- Marc Comas-Cufí
- Department of Computer Science, Applied Mathematics and Statistics, Polytechnic School, University of Girona, Spain
| | - Josep A Martín-Fernández
- Department of Computer Science, Applied Mathematics and Statistics, Polytechnic School, University of Girona, Spain
| | - Glòria Mateu-Figueras
- Department of Computer Science, Applied Mathematics and Statistics, Polytechnic School, University of Girona, Spain
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24
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Alves-Cabratosa L, García-Gil M, Comas-Cufí M, Ponjoan A, Martí-Lluch R, Parramon D, Blanch J, Elosua-Bayes M, Ramos R. Statins and new-onset atrial fibrillation in a cohort of patients with hypertension. Analysis of electronic health records, 2006-2015. PLoS One 2017; 12:e0186972. [PMID: 29073212 PMCID: PMC5658105 DOI: 10.1371/journal.pone.0186972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/11/2017] [Indexed: 01/01/2023] Open
Abstract
Hypertension is the most prevalent risk factor for new-onset atrial fibrillation (AF). But few studies have addressed the effect of statins on the incidence of this arrhythmia in patients with hypertension. This study aimed to evaluate the effect of statins on new-onset of this arrhythmia in a hypertensive population, accounting for AF risk. Data from the Information System for the Development of Research in Primary Care was used to recruit a retrospective cohort of ≥55-year-old hypertensive individuals with no ischemic vascular disease, in 2006–2007, followed up through 2015. The effect of initiating statin treatment on new-onset atrial fibrillation was assessed with Cox proportional hazards models adjusted by the propensity score of receiving statin treatment, in the overall study population and stratified by AF risk. Of 100 276 included participants, 9814 initiated statin treatment. The AF incidence per 1000 person-years (95% confidence interval) was 12.5 (12.3–12.8). Statin use associated with a significant (9%) reduction in AF incidence. Differences in absolute AF incidence were higher in the highest AF risk subgroup, and the estimated number needed to treat to avoid one case was 720. The relative effect was poor, similar across groups, and non-significant, as was the association of statins with adverse effects. We found a limited protective effect of statins over new-onset AF in this hypertensive population with no ischemic vascular disease. If there is no further indication, hypertensive patients would not benefit from statin use solely for AF primary prevention.
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Affiliation(s)
- Lia Alves-Cabratosa
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
| | - Maria García-Gil
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
| | - Anna Ponjoan
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
- Institut d’Investigació Biomèdica de Girona (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Catalonia, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
- Translab Research Group. Department of Medical Sciences, School of Medicine, University of Girona, Girona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
- Primary Care Services, Girona. Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
| | - Marc Elosua-Bayes
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group of Girona (ISV-Girona). Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Catalonia, Spain
- Institut d’Investigació Biomèdica de Girona (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Catalonia, Spain
- Primary Care Services, Girona. Catalan Institute of Health (ICS), Girona, Catalonia, Spain
- * E-mail:
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25
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Elosua-Bayés M, Martí-Lluch R, García-Gil MDM, Camós L, Comas-Cufí M, Blanch J, Ponjoan A, Alves-Cabratosa L, Elosua R, Grau M, Marrugat J, Ramos R. Association of Classic Cardiovascular Risk Factors and Lifestyles With the Cardio-ankle Vascular Index in a General Mediterranean Population. ACTA ACUST UNITED AC 2017; 71:458-465. [PMID: 29079281 DOI: 10.1016/j.rec.2017.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/04/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES The cardio-ankle vascular index (CAVI) assesses arterial stiffness. We aimed to describe the distribution of CAVI in a Mediterranean population, to determine the proportion of CAVI ≥ 9 by sex and coronary risk level, and to assess the association of CAVI with classic cardiovascular risk factors and lifestyle patterns. METHODS This cross-sectional study was based on the population of Girona province. The CAVI was measured using the VaSera VS-1500. RESULTS Of 2613 individuals included in this study, the prevalence of CAVI ≥ 9 was 46.8% in men and 36.0% in women and significantly increased with coronary risk: from 21.1% and 24.8%, respectively to 76.7%, in the low-risk group, and 61.9% in the high-risk group. The CAVI increased with age in both sexes, being higher in men across all age groups. In men, CAVI ≥ 9 was associated with hypertension (OR, 2.70; 95%CI, 1.90-3.87) and diabetes (OR, 2.38; 95%CI, 1.52-3.78), body mass index (BMI) ≤ 25 to < 30 (OR, 0.44; 95%CI, 0.27-0.72) and BMI ≥ 30 (OR, 0.28; 95%CI, 0.14-0.58), and physical activity (OR, 0.66; 95%CI, 0.47-0.92). In women, CAVI ≥ 9 was associated with hypertension (OR, 2.22; 95%CI, 1.59-3.09), hypercholesterolemia (OR, 1.40; 95%CI, 1.01-1.94), and BMI ≥ 30 (OR, 0.38; 95%CI, 0.20-0.71). CONCLUSIONS The CAVI increases with age and is higher in men than in women. This index is associated with classic risk factors and coronary risk. It could be a good predictive biomarker, but further follow-up studies are required to assess its added value to cardiovascular risk stratification.
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Affiliation(s)
- Marc Elosua-Bayés
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Ruth Martí-Lluch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain; Institut d'Investigació Biomèdica de Girona (IdIBGi), ICS, Girona, Spain
| | - María Del Mar García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain
| | - Lourdes Camós
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain
| | - Jordi Blanch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain
| | - Anna Ponjoan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain; Institut d'Investigació Biomèdica de Girona (IdIBGi), ICS, Girona, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain
| | - Roberto Elosua
- Registre Gironí del Cor (REGICOR) Grupo de Investigación en Epidemiología y Genética Cardiovascular (EGEC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - María Grau
- Registre Gironí del Cor (REGICOR) Grupo de Investigación en Epidemiología y Genética Cardiovascular (EGEC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - Jaume Marrugat
- Registre Gironí del Cor (REGICOR) Grupo de Investigación en Epidemiología y Genética Cardiovascular (EGEC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain.
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Unitat de Recerca en Atenció Primària, Serveis en Atenció Primària, Institut Català de Salut (ICS), Girona, Spain; Institut d'Investigació Biomèdica de Girona (IdIBGi), ICS, Girona, Spain; Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain.
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Baena-Díez JM, Garcia-Gil M, Comas-Cufí M, Ramos R, Prieto-Alhambra D, Salvador-González B, Elosua R, Dégano IR, Peñafiel J, Grau M. Association between chronic immune-mediated inflammatory diseases and cardiovascular risk. Heart 2017; 104:119-126. [PMID: 28847852 DOI: 10.1136/heartjnl-2017-311279] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine the association between chronic immune-mediated diseases (rheumatoid arthritis, systemic lupus erythematosus or the following chronic immune-mediated inflammatory diagnoses groups: inflammatory bowel diseases, inflammatory polyarthropathies, systemic connective tissue disorders and spondylopathies) and the 6-year coronary artery disease, stroke, cardiovascular disease incidence and overall mortality; and to estimate the population attributable fractions for all four end-points for each chronic immune-mediated inflammatory disease. METHODS Cohort study of individuals aged 35-85 years, with no history of cardiovascular disease from Catalonia (Spain). The coded diagnoses of chronic immune-mediated diseases and cardiovascular diseases were ascertained and registered using validated codes, and date of death was obtained from administrative data. Cox regression models for each outcome according to exposure were fitted to estimate HRs in two models 1 : after adjustment for sex, age, cardiovascular risk factors and 2 further adjusted for drug use. Population attributable fractions were estimated for each exposure. RESULTS Data were collected from 991 546 participants. The risk of cardiovascular disease was increased in systemic connective tissue disorders (model 1: HR=1.38 (95% CI 1.21 to 1.57) and model 2: HR=1.31 (95% CI 1.15 to 1.49)), rheumatoid arthritis (HR=1.43 (95% CI 1.26 to 1.62) and HR=1.31 (95% CI 1.15 to 1.49)) and inflammatory bowel diseases (HR=1.18 (95% CI 1.06 to 1.32) and HR=1.12 (95% CI 1.01 to 1.25)). The effect of anti-inflammatory treatment was significant in all instances (HR=1.50 (95% CI 1.24 to 1.81); HR=1.47 (95% CI 1.23 to 1.75); HR=1.43 (95% CI 1.19 to 1.73), respectively). The population attributable fractions for all three disorders were 13.4%, 15.7% and 10.7%, respectively. CONCLUSION Systemic connective tissue disorders and rheumatoid arthritis conferred the highest cardiovascular risk and population impact, followed by inflammatory bowel diseases.
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Affiliation(s)
- Jose Miguel Baena-Díez
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,La Marina Primary Care Centre and Primary Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Maria Garcia-Gil
- Primary Care Research Institute Jordi Gol, Girona, Spain.,Research Unit in Primary Care, Primary Care Services Girona, Catalan Institute of Health (ICS), Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Marc Comas-Cufí
- Primary Care Research Institute Jordi Gol, Girona, Spain.,Research Unit in Primary Care, Primary Care Services Girona, Catalan Institute of Health (ICS), Girona, Spain
| | - Rafel Ramos
- Primary Care Research Institute Jordi Gol, Girona, Spain.,Research Unit in Primary Care, Primary Care Services Girona, Catalan Institute of Health (ICS), Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Biomedical Research Institute, Girona, Spain
| | - Daniel Prieto-Alhambra
- Musculoskeletal Diseases Research Group (GREMPAL), Primary Care Research Institute Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Musculoskeletal Pharmaco- and Device Epidemiology, University of Oxford, Oxford, UK
| | - Betlem Salvador-González
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Florida Sud Primary Care Centre and Primary Care Research Institute Jordi Gol, Catalan Institute of Health, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Judith Peñafiel
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - María Grau
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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Martí-Lluch R, Garcia-Gil MDM, Camós L, Comas-Cufí M, Elosua-Bayés M, Blanch J, Ponjoan A, Alves-Cabratosa L, Elosua R, Grau M, Marrugat J, Ramos R. Differences in cardio-ankle vascular index in a general Mediterranean population depending on the presence or absence of metabolic cardiovascular risk factors. Atherosclerosis 2017; 264:29-35. [PMID: 28756313 DOI: 10.1016/j.atherosclerosis.2017.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/08/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The main aim of this study is to describe the differences in the cardio-ankle vascular index (CAVI) in individuals with metabolic cardiovascular risk factors or a previous history of vascular diseases (WCVRF) compared to healthy individuals (free of risk factors and previous history of vascular diseases; FCVRF) in a general Mediterranean population. The secondary aim is to describe the proportion of CAVI≥9 depending on the cardiovascular risk category in both CVRF groups by sex. METHODS The study is a descriptive analysis of 2613 participants randomly selected in the Girona province (Catalonia, Spain). RESULTS CAVI mean differences between sexes and age categories in both CVRF groups followed the same pattern, the FCVRF group (men 25.2%; women 14.4%) in turn had a lower prevalence of CAVI≥9 than the WCVRF group (men 57.9%; women 51.8%). The percentage of men and women with CAVI≥9 with low risk was 13.9% and 11.3% in the FCVRF group, and 31.8% and 42.0% in the WCVRF group; with moderate risk, it was 55.8% and 10.0% in the FCVRF group and 60.3% and 49.0% in the WCVRF group. CONCLUSIONS In both sexes, FCVRF groups had a lower prevalence of CAVI≥9 as well as lower mean CAVI scores, across all 10 year-age categories from 40 to 69 years, than WCVRF groups. Moreover, CAVI≥9 was frequent in individuals with low and moderate coronary risk in the WCVRF group but also in the FCVRF group. These results suggest that CAVI assessment to detect asymptomatic arteriosclerosis could be a useful tool to improve cardiovascular risk stratification.
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Affiliation(s)
- Ruth Martí-Lluch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain; Biomedical Research Institute, Girona (IdIBGi). ICS, Catalunya, Spain
| | - Maria Del Mar Garcia-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain
| | - Lourdes Camós
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain
| | - Marc Elosua-Bayés
- ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain
| | - Jordi Blanch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain
| | - Anna Ponjoan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain; Biomedical Research Institute, Girona (IdIBGi). ICS, Catalunya, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain
| | - Roberto Elosua
- Registre Gironí del COR (REGICOR) Group; Cardiovascular Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - María Grau
- Registre Gironí del COR (REGICOR) Group; Cardiovascular Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; University of Barcelona, Spain
| | - Jaume Marrugat
- Registre Gironí del COR (REGICOR) Group; Cardiovascular Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain.
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona. Institut Català de la Salut (ICS), Catalunya, Spain; Biomedical Research Institute, Girona (IdIBGi). ICS, Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain.
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Zamora A, Masana L, Comas-Cufí M, Vila À, Plana N, García-Gil M, Alves-Cabratosa L, Marrugat J, Roman I, Ramos R. Familial hypercholesterolemia in a European Mediterranean population-Prevalence and clinical data from 2.5 million primary care patients. J Clin Lipidol 2017; 11:1013-1022. [PMID: 28826564 DOI: 10.1016/j.jacl.2017.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/18/2017] [Accepted: 05/24/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH), the most frequent hereditary cause of premature coronary heart disease (CHD), is underdiagnosed and insufficiently treated. OBJECTIVES The objectives of the study were to estimate the prevalence of the FH phenotype (FH-P) and to describe its clinical characteristics in a Mediterranean population. METHODS Data were obtained from the Catalan primary care system's clinical records database (Catalan acronym: SIDIAP). Patients aged >7 years with at least 1 low-density lipoprotein cholesterol measurement recorded between 2006 and 2014 (n = 2,554,644) were included. Heterozygous FH-P and homozygous FH-P were defined by untreated low-density lipoprotein cholesterol plasma concentrations. The presence of cardiovascular diseases and risk factors was defined by coded medical records from primary care and hospital discharge databases. RESULTS The age- and sex-standardized prevalence of heterozygous FH-P and homozygous FH-P were 1/192 individuals and 1/425,774 individuals, respectively. In the group aged 8 to 18 years, 0.46% (95% confidence interval: 0.41-0.52) had FH-P; overall prevalence was 0.58% (95% confidence interval: 0.58-0.60). Among patients with FH-P aged >18 years, cardiovascular disease prevalence was 3.5 times higher than in general population, and CHD prevalence in those aged 35 to 59 years was 4.5 times higher than in those without FH-P. Lipid-lowering therapy was lacking in 13.5% of patients with FH-P, and only 31.6% of men and 22.7 of women were receiving high or very high-intensity lipid-lowering therapy. CONCLUSION Prevalence of FH-P was higher than expected, but underdiagnosed and suboptimally treated, especially in women. Moreover, treatment started late considering the high CHD incidence associated with this condition.
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Affiliation(s)
- Alberto Zamora
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Spain; Laboratory of Translational Medicine (Translab), School of Medicine, University of Girona, Girona, Spain; Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Unit, Blanes Hospital, Girona, Spain
| | - Luís Masana
- Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Research Unit, "Sant Joan" University Hospital, and Internal Medicine Department, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Girona, Catalan Institute of Health (ICS), Catalonia, Spain
| | - Àlex Vila
- Lipids and Arteriosclerosis Unit, Figueres Hospital, Girona, Spain
| | - Núria Plana
- Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Research Unit, "Sant Joan" University Hospital, and Internal Medicine Department, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Maria García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Girona, Catalan Institute of Health (ICS), Catalonia, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Girona, Catalan Institute of Health (ICS), Catalonia, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Irene Roman
- Cardiovascular Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Rafel Ramos
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Girona, Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain.
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Ponjoan A, Blanch J, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, del Mar Garcia-Gil M, Ramos R, Petersen I. Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: a self-controlled case series study. Environ Health 2017; 16:32. [PMID: 28376798 PMCID: PMC5379535 DOI: 10.1186/s12940-017-0238-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/20/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cold spells and heatwaves increase mortality. However little is known about the effect of heatwaves or cold spells on cardiovascular morbidity. This study aims to assess the effect of cold spells and heatwaves on cardiovascular diseases in a Mediterranean region (Catalonia, Southern Europe). METHODS We conducted a population-based retrospective study. Data were obtained from the System for the Development of Research in Primary Care and from the Catalan Meteorological Service. The outcome was first emergency hospitalizations due to coronary heart disease, stroke, or heart failure. Exposures were: cold spells; cold spells and 3 or 7 subsequent days; and heatwaves. Incidence rate ratios (IRR) and 95% confidence intervals were calculated using the self-controlled case series method. We accounted for age, time trends, and air pollutants; results were shown by age groups, gender or cardiovascular event type. RESULTS There were 22,611 cardiovascular hospitalizations in winter and 17,017 in summer between 2006 and 2013. The overall incidence of cardiovascular hospitalizations significantly increased during cold spells (IRR = 1.120; CI 95%: 1.10-1.30) and the effect was even stronger in the 7 days subsequent to the cold spell (IRR = 1.29; CI 95%: 1.22-1.36). Conversely, cardiovascular hospitalizations did not increase during heatwaves, neither in the overall nor in the stratified analysis. CONCLUSIONS Cold spells but not heatwaves, increased the incidence of emergency cardiovascular hospitalizations in Catalonia. The effect of cold spells was greater when including the 7 subsequent days. Such knowledge might be useful to develop strategies to reduce the impact of extreme temperature episodes on human health.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Girona Biomedical Research Institute (IDIBGi), c/ del Dr. Castany, s/n, Salt, Girona, 17190 Catalonia Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Girona Biomedical Research Institute (IDIBGi), c/ del Dr. Castany, s/n, Salt, Girona, 17190 Catalonia Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Centre d’Atenció Primària Santa Clara, Gerència d’Àmbit d’Atenció Primària Girona, Institut Català de la Salut, Girona, Spain
| | - María del Mar Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Spain
| | - Irene Petersen
- Department of Primary Care and Population Health, University College of London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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García-Gil M, Parramon D, Comas-Cufí M, Martí R, Ponjoan A, Alves-Cabratosa L, Blanch J, Petersen I, Elosua R, Grau M, Salvador B, Ramos R. Role of renal function in cardiovascular risk assessment: A retrospective cohort study in a population with low incidence of coronary heart disease. Prev Med 2016; 89:200-206. [PMID: 27287663 DOI: 10.1016/j.ypmed.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 05/18/2016] [Accepted: 06/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early-stage chronic kidney disease (CKD), a marker of cardiovascular risk, is susceptible to therapeutic intervention but need further study in populations with low incidence of coronary heart disease (CHD). Incorporating glomerular filtration rate (GFR) could improve cardiovascular risk prediction in these patients. OBJECTIVE To determine if decreased GFR is associated with increased risk of cardiovascular morbidity and all-cause mortality and to analyse GFR effect on cardiovascular risk prediction in a population with low CHD incidence. METHODS Retrospective, observational, population-based study of 1,081,865 adults (35-74years old). Main exposure variable: GFR. OUTCOMES CHD, cerebrovascular disease, cardiovascular diseases, all-cause mortality. Association between GFR categories of CKD (G1-G5) and outcomes was tested with Cox survival models. G1 was defined as the reference category. Predictive value of GFR was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. RESULTS Beginning at stage-3a CKD, increased risk was observed for coronary (HR 1.27 (95%CI 1.14-1.43)), cerebrovascular (HR 1.19 (95%CI 1.06-1.34)), cardiovascular (HR 1.23 (95%CI 1.13-1.34)) and all-cause mortality risk (HR 1.17 (95%CI 1.07-1.27)). GFR did not increase discrimination and reclassification indices significantly for any outcome. CONCLUSION In general population with low CHD incidence and stage-3 CKD, impaired GFR was associated with increased risk of all cardiovascular diseases studied and all-cause mortality, but adding GFR values did not improve cardiovascular risk calculation. Despite a four-fold higher rate of CHD incidence at GFR G3a compared to G1, this represents moderate cardiovascular risk in our context.
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Affiliation(s)
- Maria García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Dídac Parramon
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Ruth Martí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain
| | - Anna Ponjoan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Jordi Blanch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Irene Petersen
- University College London, Department of Primary Care and Population Health, Rowland Hill Street, London NW3 2PF, UK
| | - Roberto Elosua
- Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - María Grau
- Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Betlem Salvador
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; MACAP Renal Research Group, Research Unit in Primary Care, Primary Care Services, Costa Ponent. Catalan Institute of Health, Catalunya, Spain
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain.
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Ramos R, Comas-Cufí M, Alves-Cabratosa L, García-Gil M. Reply: Peripheral Artery Disease and Atrial Fibrillation: The Dangerous Combination. J Am Coll Cardiol 2016; 68:238. [PMID: 27386783 DOI: 10.1016/j.jacc.2016.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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Ramos R, García-Gil M, Comas-Cufí M, Quesada M, Marrugat J, Elosua R, Sala J, Grau M, Martí R, Ponjoan A, Alves-Cabratosa L, Blanch J, Bolíbar B. Statins for Prevention of Cardiovascular Events in a Low-Risk Population With Low Ankle Brachial Index. J Am Coll Cardiol 2016; 67:630-640. [DOI: 10.1016/j.jacc.2015.11.052] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 11/16/2022]
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Alves-Cabratosa L, García-Gil M, Comas-Cufí M, Martí R, Ponjoan A, Parramon D, Blanch J, Ramos R. Diabetes and new-onset atrial fibrillation in a hypertensive population. Ann Med 2016; 48:119-27. [PMID: 26939743 DOI: 10.3109/07853890.2016.1144930] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The association of diabetes with new-onset atrial fibrillation (AF) remains controversial. Hypertension may partly explain the risk association ascribed to diabetes. We studied the role and characteristics of diabetes in hypertensive patients with no ischemic vascular disease. METHODS Records of 262,892 persons from the Information System for the Development of Research in Primary Care in Catalonia (Spain) were examined from July 2006 to December 2011. Included participants were ≥55-years-old and hypertensive with no ischemic heart disease, stroke, or peripheral artery disease. We used Cox proportional hazards regression to model incidences in the diabetic and non-diabetic subgroups of our population, and among diabetic patients, diabetes duration and pharmacological treatment, hemoglobin A1C, and body mass index. RESULTS New-onset AF incidence in diabetic patients was 13.3 per 1000 person-years (mean follow-up: 4.3 years). In non-diabetic patients, it was 10.4 per 1000 person-years (mean follow-up: 4.1 years). Diabetes hazard ratio (HR) for new-onset AF was 1.11 (95% confidence interval (CI): 1.06-1.16). Diabetic patients also diagnosed with obesity had an HR of 1.41 (95% CI: 1.22-1.64). CONCLUSION Diabetes was modestly associated with new-onset AF in hypertensive patients with no ischemic vascular disease. Among diabetic patients, only obesity reached significance in its association with this arrhythmia.
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Affiliation(s)
- Lia Alves-Cabratosa
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain
| | - Maria García-Gil
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain ;,b Translab Research Group, Department of Medical Sciences , School of Medicine, University of Girona , Girona , Spain
| | - Marc Comas-Cufí
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain
| | - Ruth Martí
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain ;,c Girona Biomedical Research Institute (IdibGi), Dr. Trueta University Hospital , Catalonia , Spain
| | - Anna Ponjoan
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain ;,c Girona Biomedical Research Institute (IdibGi), Dr. Trueta University Hospital , Catalonia , Spain
| | - Dídac Parramon
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain ;,d Primary Care Services, Girona, Catalan Institute of Health (ICS) , Catalonia , Spain
| | - Jordi Blanch
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain
| | - Rafel Ramos
- a Vascular Health Research Group (ISV)-Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) , Catalonia , Spain ;,b Translab Research Group, Department of Medical Sciences , School of Medicine, University of Girona , Girona , Spain ;,d Primary Care Services, Girona, Catalan Institute of Health (ICS) , Catalonia , Spain
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García-Gil M, Blanch J, Comas-Cufí M, Daunis-i-Estadella J, Bolíbar B, Martí R, Ponjoan A, Alves-Cabratosa L, Ramos R. Patterns of statin use and cholesterol goal attainment in a high-risk cardiovascular population: A retrospective study of primary care electronic medical records. J Clin Lipidol 2016; 10:134-42. [DOI: 10.1016/j.jacl.2015.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/17/2015] [Accepted: 10/10/2015] [Indexed: 12/19/2022]
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Agüero F, González-Zobl G, Baena-Díez JM, Dégano IR, Garcia-Gil M, Alzamora MT, Marrugat J, Comas-Cufí M, Pera G, Elosua R, Ramos R, Grau M. Prevalence of lower extremity peripheral arterial disease in individuals with chronic immune mediated inflammatory disorders. Atherosclerosis 2015; 242:1-7. [PMID: 26160040 DOI: 10.1016/j.atherosclerosis.2015.06.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/03/2015] [Accepted: 06/26/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the prevalence of lower extremity peripheral artery disease (PAD) and to assess whether age-associated progression in ankle-brachial index (ABI) differs between individuals with chronic immune-mediated inflammatory diseases (CIID) and the general population. METHODS Pooled analysis with data from individuals aged 50 years and older with ABI measurements, obtained from population-based cross-sectional studies conducted in Catalonia (Spain). Information on three CIID diagnoses (i.e., inflammatory bowel disease, systemic connective tissue disorders, and inflammatory polyarthropathies and spondylopathies, considered as one entity for purposes of analysis) was obtained from electronic medical records. To ascertain the statistical association between PAD and CIID, logistic regression models were fitted and adjusted for age, sex, and cardiovascular risk factors. We tested the interaction between age and CIID diagnosis for ABI values. RESULTS We included 8799 individuals, 312 (3.6%) with CIID. The age-standardized prevalence of PAD was higher in the CIID group (12% vs. 6% in general population, p = 0.001), and the model adjusted for age, sex, and cardiovascular risk factors also showed higher risk in individuals with CIID [Odds Ratio (95% confidence interval) = 1.65 (1.15-2.38); p = 0.007]. The inflammatory polyarthropathies/spondylopathies diagnosis was significantly associated with PAD in the fully adjusted model [1.80 (1.18-2.75); p = 0.006]. The atherosclerotic process was accelerated in individuals with CIID, compared to the general population (p for interaction<0.001). CONCLUSION In individuals with CIID, age-standardized prevalence of PAD was significantly higher than in the general population and the atherosclerotic process was accelerated. However, only inflammatory polyarthropathies/spondylopathies was associated with significant risk of PAD.
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Affiliation(s)
- Fernando Agüero
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Spain
| | - Griselda González-Zobl
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; L'Anoia Health Consortium, Igualada, Barcelona, Spain; Pompeu-Fabra University, Barcelona, Spain
| | - Jose M Baena-Díez
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; La Marina Primary Care Centre, Barcelona, Spain; CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Irene R Dégano
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Garcia-Gil
- Research Unit of Family Medicine Girona, Primary Care Research Institute Jordi Gol, Girona, Spain
| | - María Teresa Alzamora
- Riu Nord-Riu Sud Primary Care Centre Santa Coloma de Gramenet, Barcelona, Spain; Research Unit Metropolitana Nord, Primary Care Research Institute Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marc Comas-Cufí
- Research Unit of Family Medicine Girona, Primary Care Research Institute Jordi Gol, Girona, Spain
| | - Guillem Pera
- Research Unit Metropolitana Nord, Primary Care Research Institute Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Rafel Ramos
- Research Unit of Family Medicine Girona, Primary Care Research Institute Jordi Gol, Girona, Spain
| | - María Grau
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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Alves-Cabratosa L, García-Gil M, Comas-Cufí M, Ponjoan A, Martí R, Parramon D, Blanch J, Ramos R. Incident atrial fibrillation hazard in hypertensive population: a risk function from and for clinical practice. Hypertension 2015; 65:1180-6. [PMID: 25847950 DOI: 10.1161/hypertensionaha.115.05198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/13/2015] [Indexed: 11/16/2022]
Abstract
Determining the risk of atrial fibrillation within the hypertensive population without ischemic vascular disease would aid in decision making on preventive approaches. Accordingly, we aimed to estimate the risk of incident atrial fibrillation in this population. We conducted an historical cohort study between July 1, 2006, and December 31, 2011, using anonymized longitudinal patient information from primary care and hospital discharge records contained in the System for the Development of Research in Primary Care database. We included 255 440 hypertensive patients, aged ≥55 years at the time of study entry. Individuals with previous atrial fibrillation, ischemic heart disease, stroke, and peripheral artery disease were excluded. To build the incident atrial fibrillation risk function, a derivation and a validation cohort were defined, representing 60% and 40% of the entire database, respectively, and a Cox proportional hazards model was fitted. Atrial fibrillation incidence was 7.24 per 1000 person-years (95% confidence interval, 7.08-7.40). The final model included age, weight, total cholesterol, heart failure, valvular heart disease, and antihypertensive treatment. Its concordance index (standard error) was 0.769 (0.004) and 0.768 (0.005) in the derivation and validation datasets, respectively. This research provides a tool, built with variables from daily clinical practice, that can be readily used in the primary care setting to predict atrial fibrillation incidence in the hypertensive population without ischemic vascular disease. The tool may help tailor individualized diagnostic and preventive care decisions.
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Affiliation(s)
- Lia Alves-Cabratosa
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Maria García-Gil
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Marc Comas-Cufí
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Anna Ponjoan
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Ruth Martí
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Dídac Parramon
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Jordi Blanch
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.)
| | - Rafel Ramos
- From the Vascular Health Research Group of Girona (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain (L.A.-C., M.G.-G., M.C.-C., A.P., R.M., D.P., J.B., R.R.); Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain (M.G.-G., R.R.); Epidemiology and Vascular Health Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain (A.P., R.M.); Primary Care Services, Girona, Spain (D.P., R.R.); and Catalan Institute of Health (ICS), Catalonia, Spain (D.P., R.R.).
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Garcia-Gil M, Elorza JM, Banque M, Comas-Cufí M, Blanch J, Ramos R, Méndez-Boo L, Hermosilla E, Bolibar B, Prieto-Alhambra D. Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study. PLoS One 2014; 9:e109706. [PMID: 25329578 PMCID: PMC4203762 DOI: 10.1371/journal.pone.0109706] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. OBJECTIVE To study the association between deprivation and incidence of common cancer types in a Southern European region. METHODS Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. RESULTS SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11-1.45]), prostate (0.74 [0.69-0.80]), and breast (0.76 [0.71-0.81]) cancer. CONCLUSIONS Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.
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Affiliation(s)
- Maria Garcia-Gil
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Catalunya, Spain
| | - Josep-Maria Elorza
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Marta Banque
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Marc Comas-Cufí
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Jordi Blanch
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Rafel Ramos
- Primary Care Services, Girona, Spain, and Catalan Institute of Health (ICS), Catalunya, Spain
| | - Leonardo Méndez-Boo
- Primary Care Information System, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Eduardo Hermosilla
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Bonaventura Bolibar
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Daniel Prieto-Alhambra
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Ponjoan A, García-Gil MM, Martí R, Comas-Cufí M, Alves-i-Cabratosa L, Sala J, Marrugat J, Elosua R, de Tuero GC, Grau M, Ramos R. Derivation and validation of BOREAS, a risk score identifying candidates to develop cold-induced hypertension. Environ Res 2014; 132:190-196. [PMID: 24792416 DOI: 10.1016/j.envres.2014.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Blood pressure increases in cold periods, but its implications on prevalence of hypertension and on individual progression to hypertension remain unclear. Our aim was to develop a pre-screening test for identifying candidates to suffer hypertension only in cold months among non-hypertensive subjects. METHODS We included 95,277 subjects registered on a primary care database from Girona (Catalonia, Spain), with ≥ 3 blood pressure measures recorded between 2003 and 2009 and distributed in both cold (October-March) and warm (April-September) periods. We defined four blood pressure patterns depending on the presence of hypertension through these periods. A Cox model determined the risk to develop vascular events associated with blood pressure patterns. A logistic regression distinguished those nonhypertensive individuals who are more prone to suffer cold-induced hypertension. Validity was assessed on the basis of calibration (using Brier score) and discrimination (using the area under the receiver operating characteristics). RESULTS In cold months, the mean systolic blood pressure increased by 3.3 ± 0.1 mmHg and prevalence of hypertension increased by 8.2%. Cold-induced hypertension patients were at higher vascular events risk (Hazard ratio=1.44 [95% Confidence interval 1.15-1.81]), than nonhypertensive individuals. We identified age, diabetes, body mass index and prehypertension as the major contributing factors to cold-induced hypertension onset. DISCUSSION Hypertension follows a seasonal pattern in some individuals. We recommend screening for hypertension during the cold months, at least in those nonhypertensive individuals identified as cold-induced hypertensive by this assessment tool.
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Affiliation(s)
- A Ponjoan
- Research Unit, Family Medicine, Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain; Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain
| | - M M García-Gil
- Research Unit, Family Medicine, Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain; Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Translab Research Group. Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - R Martí
- Research Unit, Family Medicine, Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain; Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain
| | - M Comas-Cufí
- Research Unit, Family Medicine, Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain
| | - L Alves-i-Cabratosa
- Research Unit, Family Medicine, Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain
| | - J Sala
- Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain; Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Translab Research Group. Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - J Marrugat
- Research on Inflammatory and Cardiovascular Disorders Program (RICAD), Lipids and Cardiovascular Epidemiology Research Group (ULEC) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - R Elosua
- Research on Inflammatory and Cardiovascular Disorders Program (RICAD), Lipids and Cardiovascular Epidemiology Research Group (ULEC) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - G Coll de Tuero
- Translab Research Group. Department of Medical Sciences, School of Medicine, University of Girona, Spain; Research Unit, Healthcare Institute (IAS), Salt, Girona, Spain
| | - M Grau
- Research on Inflammatory and Cardiovascular Disorders Program (RICAD), Lipids and Cardiovascular Epidemiology Research Group (ULEC) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - R Ramos
- Research Unit, Family Medicine, Girona. Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalonia, Spain; Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Catalonia, Spain; Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Translab Research Group. Department of Medical Sciences, School of Medicine, University of Girona, Spain.
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Grau M, Baena-Díez JM, Félix-Redondo FJ, Fernández-Berges D, Comas-Cufí M, Forés R, Marrugat J, Ramos R. Estimating the risk of peripheral artery disease using different population strategies. Prev Med 2013; 57:328-33. [PMID: 23769902 DOI: 10.1016/j.ypmed.2013.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/03/2013] [Accepted: 06/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study is to compare the clinical performance of different strategies, REASON, PREVALENT, Inter-Society Consensus (ISC), and the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines, in the selection of candidates for peripheral artery disease (PAD) screening using ankle-brachial index (ABI). METHOD Our work is a population-based cross-sectional study conducted in Extremadura (Spain) in 2007-2009. Participants were ≥50years old and free of cardiovascular disease. ABI and cardiovascular risk factors were measured. RESULT In total, 1288 individuals (53% women), with a mean age of 63years (standard deviation (SD) 9) were included. The prevalence of ABI <0.9 was 4.9%. REASON risk score identified 53% of the sample to screen with sensitivity of 87.3%, quite similar to that identified in ISC and ACC/AHA strategies (both 90.5%), and specificity of 48.3%, higher than that of the ISC (30.9%) and ACC/AHA (31.1%) strategies. Although the Youden index was 0.4 for both REASON and PREVALENT risk scores, the latter's sensitivity was 60.3%, almost 30 points less than all other strategies. CONCLUSION REASON risk score was the strategy with the highest clinical performance and efficiency, with sensitivity of 87.3% and specificity higher than that of the ISC and ACC/AHA strategies. Although very specific, the PREVALENT strategy had low sensitivity making it difficult to be implemented as a screening tool.
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Affiliation(s)
- Maria Grau
- Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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