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Via M, Pera G, Forés R, Costa-Garrido A, Heras A, Baena-Díez JM, Pedrosa E, Clemente IC, Lamonja-Vicente N, Mataró M, Torán-Montserrat P, Alzamora MT. Genetic Variants at the 9p21.3 Locus Are Associated with Risk for Non-Compressible Artery Disease: Results from the ARTPER Study. Genes (Basel) 2023; 15:2. [PMID: 38275585 PMCID: PMC10815029 DOI: 10.3390/genes15010002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Peripheral artery disease (PAD) and non-compressible artery disease (NCAD) constitute predictors of subclinical atherosclerosis easily assessed through the ankle brachial index (ABI). Although both diseases show substantial genetic influences, few genetic association studies have focused on the ABI and PAD, and none have focused on NCAD. To overcome these limitations, we assessed the role of several candidate genes on the ABI, both in its continuous distribution and in the clinical manifestations associated to its extreme values: PAD and NCAD. We examined 13 candidate genomic regions in 1606 participants from the ARTPER study, a prospective population-based cohort, with the ABI assessed through ultrasonography. Association analyses were conducted independently for individuals with PAD (ABI < 0.9) or with NCAD (ABI > 1.4) vs. healthy participants. After including potential covariates and correction for multiple testing, minor alleles in the genetic markers rs10757278 and rs1333049, both in the 9p21.3 region, were significantly associated with a decreased risk of NCAD. Associations with the ABI showed limited support to these results. No significant associations were detected for PAD. The locus 9p21.3 constitutes the first genetic locus associated with NCAD, an assessment of subclinical atherosclerosis feasible for implementation in primary healthcare settings that has been systematically neglected from genetic studies.
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Affiliation(s)
- Marc Via
- Brainlab-Grup de Recerca en Neurociència Cognitiva, Departament de Psicologia Clínica i Psicobiologia, Institut de Neurociències, Universitat de Barcelona, 08035 Barcelona, Spain;
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain;
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
| | - Rosa Forés
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet, Direcció d’Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, 08921 Santa Coloma de Gramenet, Spain
| | - José Miguel Baena-Díez
- Centre d’Atenció Primària la Marina, Direcció d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08038 Barcelona, Spain;
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain
| | - Edurne Pedrosa
- IGTP-HUGTP Biobank, Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain;
| | - Inmaculada C. Clemente
- Brainlab-Grup de Recerca en Neurociència Cognitiva, Departament de Psicologia Clínica i Psicobiologia, Institut de Neurociències, Universitat de Barcelona, 08035 Barcelona, Spain;
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain;
| | - Noemí Lamonja-Vicente
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
- Departament de Psicologia Clínica i Psicobiologia, Institut de Neurociències, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Maria Mataró
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain;
- Departament de Psicologia Clínica i Psicobiologia, Institut de Neurociències, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Pere Torán-Montserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
| | - M. Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain; (G.P.); (R.F.); (A.C.-G.); (A.H.); (N.L.-V.); (P.T.-M.); (M.T.A.)
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet, Direcció d’Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, 08921 Santa Coloma de Gramenet, Spain
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Chacón C, Arteaga I, Martínez-Escudé A, Ruiz Rojano I, Lamonja-Vicente N, Caballeria L, Ribatallada Diez AM, Schröder H, Montraveta M, Bovo MV, Ginés P, Pera G, Diez-Fadrique G, Pachón-Camacho A, Alonso N, Graupera I, Torán-Monserrat P, Expósito C. Clinical epidemiology of non-alcoholic fatty liver disease in children and adolescents. The LiverKids: Study protocol. PLoS One 2023; 18:e0286586. [PMID: 37831682 PMCID: PMC10575486 DOI: 10.1371/journal.pone.0286586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/18/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is rapidly increasing alongside overweight and obesity, not only in adults but also in children and adolescents. It is unknown what impact the development of NAFLD in childhood may have in later life. The importance of early detection and treatment lies in its potential for progression to cirrhosis, liver cancer and liver-related death, as well as its associated extrahepatic comorbidities. Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is an effective, non-invasive and safe diagnostic method to estimate the degree of fibrosis and steatosis in the liver, but little is known about its applicability in the paediatric population. AIMS 1) To assess the prevalence of significant liver fibrosis (Liver Stiffness Measurement (LSM) ≥6.5 kPa) using VCTE, and that of non-alcoholic fatty liver disease (≥225 dB/m) using CAP in children and adolescents. 2) To determine the optimal cut-off points of the CAP to achieve maximum concordance with the Magnetic Resonance Imaging (MRI) findings in the diagnosis of mild, moderate and severe NAFLD in children and adolescents. METHODS Cross-sectional population-based study which will include 2,866 subjects aged between 9 and 16 years. Participants will undergo: anamnesis, physical examination, blood extraction, VCTE, MRI and questionnaires on socio-demographic data, personal and family medical history and lifestyle assessment. APPLICABILITY AND RELEVANCE The study aims to establish the foundations for the use of VCTE in children and adolescents in order to achieve early diagnosis of NAFLD. Moreover, it will serve to understand in further detail the disease and to identify the risk groups of children and adolescents who may be at risk of developing it. Ultimately, this will help determine to which subgroups of the population we need to target resources for prevention and early detection of this entity, as well as possible intervention for its treatment. TRIAL REGISTRATION The LiverKids study is registered on Clinicaltrials.gov (NCT05526274).
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Affiliation(s)
- Carla Chacón
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- PhD Programme in Medicine and Translational Research, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ingrid Arteaga
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Centre d’Atenció Primària Palaudàries, Institut Català de la Salut, Lliçà d’Amunt, Barcelona, Spain
| | - Alba Martínez-Escudé
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Centre d’Atenció Primària La Llagosta, Institut Català de la Salut, La Llagosta, Barcelona, Spain
| | - Irene Ruiz Rojano
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Centre d’Atenció Primària Dr. Barraquer, Institut Català de la Salut, Sant Adrià del Besos, Barcelona, Spain
| | - Noemí Lamonja-Vicente
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
| | - Llorenç Caballeria
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Ana María Ribatallada Diez
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Centre d’Atenció Primària Serraparera, Institut Català de la Salut, Cerdanyola del Vallès, Barcelona, Spain
| | - Helmut Schröder
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Montraveta
- Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Maria Victoria Bovo
- Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Pere Ginés
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
- Liver Unit, Hospital Clínic de Barcelona, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
| | - Galadriel Diez-Fadrique
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
| | - Alba Pachón-Camacho
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Graupera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
- Liver Unit, Hospital Clínic de Barcelona, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, Mataró, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord (USR Metro-Nord), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Barcelona, Spain
- Grup de Recerca en Malalties Hepàtiques a l’Atenció Primària (GRemHAp), IDIAP Jordi Gol, USR Metro-Nord, Mataró, Barcelona, Spain
- Centre d’Atenció Primària Badia del Vallès, Institut Català de la Salut, Badia del Vallès, Barcelona, Spain
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3
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Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E, Pera G, Grgurevic I, Caballeria L, Piano S, van Kleef L, Reichert M, Roulot D, Pericàs JM, Schattenberg JM, Tsochatztis EA, Guha IN, Garcia-Retortillo M, Hernández R, Hoyo J, Fuentes M, Expósito C, Martínez A, Such P, Madir A, Detlefsen S, Tonon M, Martini A, Ma AT, Pich J, Bonfill E, Juan M, Soria A, Carol M, Gratacós-Ginès J, Morillas RM, Toran P, Navarrete JM, Torrejón A, Fournier C, Llorca A, Arslanow A, de Koning HJ, Cucchietti F, Manns M, Newsome PN, Hernáez R, Allen A, Angeli P, de Knegt RJ, Karlsen TH, Galle P, Wong VWS, Fabrellas N, Castera L, Krag A, Lammert F, Kamath PS, Ginès P. Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study. Lancet 2023; 402:988-996. [PMID: 37572680 DOI: 10.1016/s0140-6736(23)01174-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Liver cirrhosis is a major cause of death worldwide. Cirrhosis develops after a long asymptomatic period of fibrosis progression, with the diagnosis frequently occurring late, when major complications or cancer develop. Few reliable tools exist for timely identification of individuals at risk of cirrhosis to allow for early intervention. We aimed to develop a novel score to identify individuals at risk for future liver-related outcomes. METHODS We derived the LiverRisk score from an international prospective cohort of individuals from six countries without known liver disease from the general population, who underwent liver fibrosis assessment by transient elastography. The score included age, sex, and six standard laboratory variables. We created four groups: minimal risk, low risk, medium risk, and high risk according to selected cutoff values of the LiverRisk score (6, 10, and 15). The model's discriminatory accuracy and calibration were externally validated in two prospective cohorts from the general population. Moreover, we ascertained the prognostic value of the score in the prediction of liver-related outcomes in participants without known liver disease with median follow-up of 12 years (UK Biobank cohort). FINDINGS We included 14 726 participants: 6357 (43·2%) in the derivation cohort, 4370 (29·7%) in the first external validation cohort, and 3999 (27·2%) in the second external validation cohort. The score accurately predicted liver stiffness in the development and external validation cohorts, and was superior to conventional serum biomarkers of fibrosis, as measured by area under the receiver-operating characteristics curve (AUC; 0·83 [95% CI [0·78-0·89]) versus the fibrosis-4 index (FIB-4; 0·68 [0·61-0·75] at 10 kPa). The score was effective in identifying individuals at risk of liver-related mortality, liver-related hospitalisation, and liver cancer, thereby allowing stratification to different risk groups for liver-related outcomes. The hazard ratio for liver-related mortality in the high-risk group was 471 (95% CI 347-641) compared with the minimal risk group, and the overall AUC of the score in predicting 10-year liver-related mortality was 0·90 (0·88-0·91) versus 0.84 (0·82-0·86) for FIB-4. INTERPRETATION The LiverRisk score, based on simple parameters, predicted liver fibrosis and future development of liver-related outcomes in the general population. The score might allow for stratification of individuals according to liver risk and thus guide preventive care. FUNDING European Commission under the H20/20 programme; Fondo de Investigación Sanitaria de Salud; Instituto de Salud Carlos III; Spanish Ministry of Economy, Industry, and Competitiveness; the European Regional Development Fund; and the German Ministry of Education and Research (BMBF).
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Affiliation(s)
- Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Adrià Juanola
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | | | - Maja Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Isabel Graupera
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Elisa Pose
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Llorenç Caballeria
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Laurens van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Mathias Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
| | - Juan M Pericàs
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Emmanuel A Tsochatztis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London, London, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | - Rosario Hernández
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Jordi Hoyo
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Matilde Fuentes
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Alba Martínez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Patricia Such
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | - Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Marta Tonon
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Martini
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Ann T Ma
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Judith Pich
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Eva Bonfill
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Marta Juan
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Anna Soria
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Marta Carol
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Rosa M Morillas
- Liver Unit, Hospital Germans Trias i Pujol, IGTP, Badalona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - J M Navarrete
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | - Antoni Torrejón
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | | | | | - Anita Arslanow
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Michael Manns
- Health Sciences, Hannover Medical School MHH, Hannover, Germany
| | - Phillip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Rubén Hernáez
- Division of Gastroenterology and Hepatology, Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alina Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Tom H Karlsen
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany; Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany; Hannover Medical School, Hannover, Germany
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Pere Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.
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Graupera I, Thiele M, Ma AT, Serra-Burriel M, Pich J, Fabrellas N, Caballeria L, de Knegt RJ, Grgurevic I, Reichert M, Roulot D, Schattenberg JM, Pericas JM, Angeli P, Tsochatzis EA, Guha IN, Garcia-Retortillo M, Morillas RM, Hernández R, Hoyo J, Fuentes M, Madir A, Juanola A, Soria A, Juan M, Carol M, Diaz A, Detlefsen S, Toran P, Pera G, Fournier C, Llorca A, Newsome PN, Manns M, de Koning HJ, Serra-Burriel F, Cucchietti F, Arslanow A, Korenjak M, van Kleef L, Falcó JL, Kamath PS, Karlsen TH, Castera L, Lammert F, Krag A, Ginès P. Correction: LiverScreen project: study protocol for screening for liver fibrosis in the general population in European countries. BMC Public Health 2023; 23:923. [PMID: 37217864 DOI: 10.1186/s12889-023-15867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Isabel Graupera
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maja Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Ann T Ma
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judit Pich
- Clinical Trial Unit, Hospital Clínic, 08036, Barcelona, Spain
| | - Núria Fabrellas
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Llorenç Caballeria
- Unitat de Suport a La Recerca Metropolitana Nord, Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de La Salut, Barcelona, Spain
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Mathias Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg, Mainz, Germany
| | - Juan M Pericas
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University-Teaching Hospital of Padova, Padua, Italy
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London (UCL), London, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research University Mainz Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | - Rosa M Morillas
- Liver Unit, Hospital Germans Trias I Pujol, IGTP, Badalona, Spain
| | - Rosario Hernández
- Institut Catala de La Salut (ICS), BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Jordi Hoyo
- Institut Catala de La Salut (ICS), BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Matilde Fuentes
- Institut Catala de La Salut (ICS), BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Adrià Juanola
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Soria
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marta Juan
- Clinical Trial Unit, Hospital Clínic, 08036, Barcelona, Spain
| | - Marta Carol
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Alba Diaz
- Department of Pathology, Centre of Biomedical Diagnosis, Hospital Cínic, Barcelona, Spain
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital (OUH), University of Southern Denmark, Odense, Denmark
| | - Pere Toran
- Unitat de Suport a La Recerca Metropolitana Nord, Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de La Salut, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a La Recerca Metropolitana Nord, Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de La Salut, Barcelona, Spain
| | | | | | - Phillip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Michael Manns
- Health Sciences, Hannover Medical School MHH, Hannover, Germany
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Anita Arslanow
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg, Mainz, Germany
| | | | - Laurens van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany
- Hannover Medical School (MHH), Hannover, Germany
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Pere Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain.
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Martínez-Sánchez N, Palasí A, Pera G, Martínez LM, Albaladejo R, Torán P. [Interarm blood pressure difference: Concordance between two methods of automatic simultaneous measurement and between visits reproducibility]. Aten Primaria 2022; 54:102514. [PMID: 36423568 PMCID: PMC9681639 DOI: 10.1016/j.aprim.2022.102514] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE An increased interarm blood pressure difference (IAD) (≥10mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre. DESIGN Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. SITE: Parets del Vallès primary care centre (Barcelona). PARTICIPANTS General population aged 35-74 years. INTERVENTIONS AND MAIN MEASUREMENTS One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological. RESULTS Concordance for IAD expressed continuously was low: CCL=0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k=-0.03 (-0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL=0.19 (0.03-0.34) and k=-0.02 (-0.16-0.12) and for WBP™ CCL=0.14 (-0.01-0.29) and k=0.49 (0.33-0.64). CONCLUSIONS Concordance between two automatic oscillometers in the simultaneous IAD measurement was low. Reproducibility between visits was also low for both methods.
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Affiliation(s)
- Nuria Martínez-Sánchez
- Centro de Atención Primaria Parets, Institut Català de la Salut, Parets del Vallès, Barcelona, España,Autor para correspondencia.
| | - Antonio Palasí
- Servicio de Neurología, Hospital Universitario Vall d́Hebron, Barcelona, España
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Barcelona, España
| | | | - Raquel Albaladejo
- Centro de Atención Primaria Pinetons, Institut Català de la Salut, Ripollet, Barcelona, España
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Barcelona, España
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Graupera I, Thiele M, Serra-Burriel M, Caballeria L, Roulot D, Wong GLH, Fabrellas N, Guha IN, Arslanow A, Expósito C, Hernández R, Aithal GP, Galle PR, Pera G, Wong VWS, Lammert F, Ginès P, Castera L, Krag A. Low Accuracy of FIB-4 and NAFLD Fibrosis Scores for Screening for Liver Fibrosis in the Population. Clin Gastroenterol Hepatol 2022; 20:2567-2576.e6. [PMID: 34971806 DOI: 10.1016/j.cgh.2021.12.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [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: 06/09/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fibrosis-4 (FIB-4) and the nonalcoholic fatty liver disease fibrosis score (NFS) are the 2 most popular noninvasive blood-based serum tests proposed for widespread fibrosis screening. We therefore aimed to describe the accuracy of FIB-4 and NFS to detect elevated liver stiffness as an indicator of hepatic fibrosis in low-prevalence populations. METHODS This study included a total of 5129 patients with concomitant measurement of FIB-4, NFS, and liver stiffness measurement (LSM) by Fibroscan (Echosens, France) from 5 independent population-based cohorts from Spain, Hong Kong, Denmark, England, and France; 3979 participants from the general population and 1150 from at-risk cohorts due to alcohol, diabetes, or obesity. We correlated LSM with FIB-4 and NFS, and calculated pre- and post-test predictive values of FIB-4 and NFS to detect elevated LSM at 8 kPa and 12 kPa cutoffs. The mean age was 53 ± 12 years, the mean body mass index was 27 ± 5 kg/m2, and 2439 (57%) were women. One in 10 patients (552; 11%) had liver stiffness ≥8 kPa, but 239 of those (43%) had a normal FIB-4, and 171 (31%) had normal NFS. The proportion of false-negatives was higher in at-risk patients than the general population. FIB-4 was false-negative in 11% of diabetic subjects, compared with 2.5% false-negatives with NFS. Waist circumference outperformed FIB-4 and NFS for detecting LSM ≥8 kPa in the general population. Almost one-third (28%-29%) of elevated FIB-4/NFS were false-positive in both the general population and at-risk cohorts. CONCLUSIONS FIB-4 and NFS are suboptimal for screening purposes due to a high risk of overdiagnosis and a non-negligible percentage of false-negatives, especially in patients with risk factors for chronic liver disease. Waist circumference emerged as a potential first step to identify patients at risk for liver fibrosis in the general population.
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Affiliation(s)
- Isabel Graupera
- Liver Unit Hospital Clínic. Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Department for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Llorenç Caballeria
- USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Dominique Roulot
- Department of Hepatology, AP-HP, Hopital Avicenne, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona; Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Anita Arslanow
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Carmen Expósito
- USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Rosario Hernández
- CAP La Marina, Institut Català de la Salut de Barcelona, Barcelona, Spain
| | - Guruprasad Padur Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Guillem Pera
- USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Pere Ginès
- Liver Unit Hospital Clínic. Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Laurent Castera
- Hôpital Beaujon; Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France; Université Paris VII, Inserm Umr 1149, Centre de Recherche Sur L'inflammation, Paris, France
| | - Aleksander Krag
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Department for Clinical Research, University of Southern Denmark, Odense, Denmark
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Bermudo-Gallaguet A, Ariza M, Dacosta-Aguayo R, Agudelo D, Camins-Vila N, Boldó M, Carrera Ò, Vidal S, Ferrer-Uris B, Busquets A, Via M, Pera G, Cáceres C, Gomis M, García-Molina A, Tormos JM, Arrabé A, Diez G, Durà Mata MJ, Torán-Monserrat P, Soriano-Raya JJ, Domènech S, Perera-Lluna A, Erickson KI, Mataró M. Effects and mechanisms of mindfulness training and physical exercise on cognition, emotional wellbeing, and brain outcomes in chronic stroke patients: Study protocol of the MindFit project randomized controlled trial. Front Aging Neurosci 2022; 14:936077. [PMID: 36248000 PMCID: PMC9557300 DOI: 10.3389/fnagi.2022.936077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPost-stroke cognitive and emotional complications are frequent in the chronic stages of stroke and have important implications for the functionality and quality of life of those affected and their caregivers. Strategies such as mindfulness meditation, physical exercise (PE), or computerized cognitive training (CCT) may benefit stroke patients by impacting neuroplasticity and brain health.Materials and methodsOne hundred and forty-one chronic stroke patients are randomly allocated to receive mindfulness-based stress reduction + CCT (n = 47), multicomponent PE program + CCT (n = 47), or CCT alone (n = 47). Interventions consist of 12-week home-based programs five days per week. Before and after the interventions, we collect data from cognitive, psychological, and physical tests, blood and stool samples, and structural and functional brain scans.ResultsThe effects of the interventions on cognitive and emotional outcomes will be described in intention-to-treat and per-protocol analyses. We will also explore potential mediators and moderators, such as genetic, molecular, brain, demographic, and clinical factors in our per-protocol sample.DiscussionThe MindFit Project is a randomized clinical trial that aims to assess the impact of mindfulness and PE combined with CCT on chronic stroke patients’ cognitive and emotional wellbeing. Furthermore, our design takes a multimodal biopsychosocial approach that will generate new knowledge at multiple levels of evidence, from molecular bases to behavioral changes.Clinical trial registrationwww.ClinicalTrials.gov, identifier NCT04759950.
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Affiliation(s)
- Adrià Bermudo-Gallaguet
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Mar Ariza
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Rosalia Dacosta-Aguayo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Daniela Agudelo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Neus Camins-Vila
- Institut Nacional d’Educació Física de Catalunya, University of Barcelona, Barcelona, Spain
| | - Maria Boldó
- Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Òscar Carrera
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Sandra Vidal
- Germans Trias i Pujol Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Blai Ferrer-Uris
- Institut Nacional d’Educació Física de Catalunya, University of Barcelona, Barcelona, Spain
| | - Albert Busquets
- Institut Nacional d’Educació Física de Catalunya, University of Barcelona, Barcelona, Spain
| | - Marc Via
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
- Germans Trias i Pujol Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Meritxell Gomis
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Badalona, Spain
| | - José María Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ana Arrabé
- Nirakara Lab, Mindfulness and Cognitive Science Extraordinary Chair, Universidad Complutense de Madrid, Madrid, Spain
| | - Gustavo Diez
- Nirakara Lab, Mindfulness and Cognitive Science Extraordinary Chair, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria José Durà Mata
- Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
- Germans Trias i Pujol Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan José Soriano-Raya
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Sira Domènech
- Institut de Diagnòstic per la Imatge, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alexandre Perera-Lluna
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- B2SLab, Departament d’Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- *Correspondence: Maria Mataró,
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8
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Biarnés-Martínez M, Fàbregas M, Coma E, Pera G, Fina F, Rivera-Arco A, Guiriguet C, Méndez-Boo L, Medina M. [SARS-CoV-2 infection in occupational settings in Catalonia.]. Rev Esp Salud Publica 2022; 96:e202205040. [PMID: 35506485] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE The aim of this paper was to estimate the SARS-CoV-2 infection incidence regarding the occupation in Catalonia, globally and in the different waves of the pandemic. METHODS We performed a retrospective cohort study. We included all people between 16 and 65 years old with an occupation identified from the sick leave recorded in the primary care electronic health records of the Institut Català de la Salut (ICS) (total n=2,199,745 people). The study period was from March 1st, 2020 to September 16th, 2021. RESULTS Healthcare workers had the highest incidence, with an age and sex adjusted cumulative rate of 27.7% [95% CI: 27.3%-28.1%]: 29.4% in nursing assistants, 27.3% in medical professions and 26.3% in nursing professionals; followed by the elementary occupations group with an adjusted incidence of 16.9% [95% CI: 16.7%-17%], such as the agricultural laborers (23% [95% CI: 21%-25.1%]) and rural occupations (19.1% [95% CI: 18.3%-19.8%) -especially during the 2020 summer period-, the domestic employees (20.5% [95% CI: 18.9%-22.2%]) and cleaning professionals (17.5% [95% CI: 17.2%-17.9%]). CONCLUSIONS Healthcare workers are the hardest hit during the pandemic. On the other hand, the less qualified professions have high incidences, highlighting the different inequities in access to telework, working conditions and other social determinants of health.
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Affiliation(s)
- Marta Biarnés-Martínez
- Unidad Docente de Medicina Preventiva y Salud Pública Parc de Salut Mar. Universitat Pompeu Fabra. Agència de Salut Pública de Barcelona. Barcelona. España
| | - Mireia Fàbregas
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Ermengol Coma
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord. Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol. Barcelona. España
| | - Francesc Fina
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Alejandro Rivera-Arco
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Carolina Guiriguet
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Manuel Medina
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
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Alzamora MT, Forés R, Serra N, Martinez E, Pera G, Seda G, Lopez Palencia J, Gomis M, Heras Tébar A, Valverde M, Garnacho MV, Torán P. Supervised physical activity in patients with symptomatic peripheral arterial disease: protocol for a randomized clinical trial (ARTPERfit Study). BMJ Open 2022; 12:e054352. [PMID: 35477870 PMCID: PMC9047770 DOI: 10.1136/bmjopen-2021-054352] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is a marker of cardiovascular morbidity, causing disability, loss of mobility and poor quality of life, manifesting clinically in the form of intermittent claudication (IC). Physical exercise increases the distance walked and improves quality of life. The aim of our study will be increased walking distance prolonging the time of onset of pain in patients with symptomatic PAD (IC). METHODS AND ANALYSIS This study will be performed in Mataró Hospital's vascular surgery service and School of Health Sciences, TecnoCampus. This population comes from 15 primary healthcare centres ofNorth Barcelona, Spain (450 000 inhabitants).This study will be a four-group parallel, longitudinal, randomised controlled trial, blind to analysis.The main primary outcome of this study will be the improvement in pain-free walking distance. Others primary objectives are and improvement in functional status, quality of life and Ankle-Brachial Index (ABI). Secondary outcomes will be the analysis of cardiorespiratory fitness, evaluation of muscle fitness, determine the maintenance of primary objectives at 6 and 12 months.We will be included 124 patients (31 per group). The changes of the outcome (Barthel, SF-12, VascQOL-6, ABI) of the three intervention groups vs the control group at 3, 6 and 12 months will be compared, both continuously (linear regression) and categorically (logistic regression). A person who has not performed at least 75% of the training will be considered to have not completed the intervention. ETHICS AND DISSEMINATION The study will be conducted according to the Declaration of Helsinki . It was approved by the Ethics Committee of the Research Institute Primary Health IDIAP Jordi Gol (20/035 P),Barcelona 6 October 2020. Informed consent will be obtained from all patients before the start of the study. We will disseminate results through academic papers and conference presentations. TRIAL REGISTRATION NUMBER NCT04578990.
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Affiliation(s)
- Maria Teresa Alzamora
- Family Medicine Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Spain
- USR Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
| | - Rosa Forés
- USR Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
- Family Medicine Riu Nord-Riu Sud. Santa Coloma de Gramenet, Institut Català de la Salut, Barcelona, Spain
| | - Noemi Serra
- Universitat Pompeu Fabra Escola Superior Politècnica del TecnoCampus, Mataro, Spain
| | | | - Guillem Pera
- USR Metropolitana Nord. Mataró, IDIAP Jordi Gol, Barcelona, Spain
| | - Gemma Seda
- Institut Catala De La Salut, Barcelona, Spain
| | | | - Manuel Gomis
- Universitat Pompeu Fabra Escola Superior Politècnica del TecnoCampus, Mataro, Spain
| | - Antonio Heras Tébar
- USR Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
- Primary Healthcare Center Riu Nord-Riu SUD, Institut Catala De La Salut, Barcelona, Spain
| | - Marta Valverde
- Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | | | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
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Castells-Sánchez A, Roig-Coll F, Dacosta-Aguayo R, Lamonja-Vicente N, Torán-Monserrat P, Pera G, García-Molina A, Tormos JM, Montero-Alía P, Heras-Tébar A, Soriano-Raya JJ, Cáceres C, Domènech S, Via M, Erickson KI, Mataró M. Molecular and Brain Volume Changes Following Aerobic Exercise, Cognitive and Combined Training in Physically Inactive Healthy Late-Middle-Aged Adults: The Projecte Moviment Randomized Controlled Trial. Front Hum Neurosci 2022; 16:854175. [PMID: 35529777 PMCID: PMC9067321 DOI: 10.3389/fnhum.2022.854175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022] Open
Abstract
Behavioral interventions have shown promising neuroprotective effects, but the cascade of molecular, brain and behavioral changes involved in these benefits remains poorly understood. Projecte Moviment is a 12-week (5 days per week—45 min per day) multi-domain, single-blind, proof-of-concept randomized controlled trial examining the cognitive effect and underlying mechanisms of an aerobic exercise (AE), computerized cognitive training (CCT) and a combined (COMB) groups compared to a waitlist control group. Adherence was > 80% for 82/109 participants recruited (62% female; age = 58.38 ± 5.47). In this study we report intervention-related changes in plasma biomarkers (BDNF, TNF-α, HGF, ICAM-1, SDF1-α) and structural-MRI (brain volume) and how they related to changes in physical activity and individual variables (age and sex) and their potential role as mediators in the cognitive changes. Our results show that although there were no significant changes in molecular biomarker concentrations in any intervention group, changes in ICAM-1 and SDF1-α were negatively associated with changes in physical activity outcomes in AE and COMB groups. Brain volume changes were found in the CCT showing a significant increase in precuneus volume. Sex moderated the brain volume change in the AE and COMB groups, suggesting that men may benefit more than women. Changes in molecular biomarkers and brain volumes did not significantly mediate the cognitive-related benefits found previously for any group. This study shows crucial initial molecular and brain volume changes related to lifestyle interventions at early stages and highlights the value of examining activity parameters, individual difference characteristics and using a multi-level analysis approach to address these questions.
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Affiliation(s)
- Alba Castells-Sánchez
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Francesca Roig-Coll
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Rosalía Dacosta-Aguayo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
- *Correspondence: Rosalía Dacosta-Aguayo,
| | - Noemí Lamonja-Vicente
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
- Department of Medicine, Universitat de Girona, Girona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Alberto García-Molina
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Badalona, Spain
| | - José Maria Tormos
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Pilar Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Antonio Heras-Tébar
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Juan José Soriano-Raya
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Sira Domènech
- Institut de Diagnòstic per la Imatge, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Marc Via
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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Vallès Fernández R, Vedia Urgell C, García Vicente JA, Pera G. EL TRATAMIENTO PREVIO CON ANTICOAGULANTE ORAL NO ES UN FACTOR PROTECTOR DE EVENTO TROMBOEMBOLICO EN PACIENTES CON COVID-19. Aten Primaria 2022; 54:102371. [PMID: 35636020 PMCID: PMC9050580 DOI: 10.1016/j.aprim.2022.102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Roser Vallès Fernández
- Servicio de Atención Primaria Barcelonès Nord i Maresme. Institut Català de la Salut, Barcelona, España.
| | - Cristina Vedia Urgell
- Servicio de Atención Primaria Barcelonès Nord i Maresme. Institut Català de la Salut, Barcelona, España
| | | | - Guillem Pera
- Unitat de Suport a la Recerca. Dirección Atención Primaria Metropolitana Nord. Institut Català de la Salut. IDIAP Jordi Gol i Gurina, Barcelona, España
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12
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Julián MT, Ballesta S, Pera G, Pérez-Montes de Oca A, Soldevila B, Caballería L, Morillas R, Expósito C, Martínez–Escudé A, Puig-Domingo M, Franch-Nadal J, Torán P, Cusi K, Julve J, Mauricio D, Alonso N. Abdominal obesity and dsyglycemia are risk factors for liver fibrosis progression in NAFLD subjects: A population-based study. Front Endocrinol (Lausanne) 2022; 13:1051958. [PMID: 36714592 PMCID: PMC9880071 DOI: 10.3389/fendo.2022.1051958] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate longitudinal changes in the liver stiffness measurement (LSM) in the general adult population without known liver disease and to describe its association with metabolic risk factors, with a special focus on subjects with non-alcoholic fatty liver disease (NAFLD) and dysglycemia. MATERIAL AND METHODS A longitudinal adult population-based cohort study was conducted in Catalonia. LSM was measured by transient elastography (TE) at baseline and follow-up (median: 4.2 years). Subgroup with NAFLD and dysglycemia were analyzed. Moderate-to-advanced liver fibrosis was defined as LSM ≥8.0 kPa and LSM ≥9.2 kPa respectively. RESULTS Among 1.478 subjects evaluated, the cumulative incidence of LSM ≥8.0 kPa and ≥9.2 kPa at follow-up was 2.8% and 1.9%, respectively. This incidence was higher in NAFLD (7.1% for LSM ≥8.0 kPa and 5% for LSM ≥9.2 kPa) and dysglycemia (6.2% for LSM ≥8.0 kPa and 4.7% for LSM ≥9.2 kPa) subgroups. In the global cohort, the multivariate analyses showed that dysglycemia, abdominal obesity and atherogenic dyslipidemia were significantly associated with progression to moderate-to-advanced liver fibrosis. Female sex was negatively associated. In subjects with NAFLD, abdominal obesity and dysglycemia were associated with changes in LSM to ≥8.0 kPa and ≥9.2 kPa at follow-up. A decline in LSM value to <8 kPa was observed in 64% of those subjects with a baseline LSM ≥8.0 kPa. CONCLUSIONS In this population study, the presence of abdominal obesity and dysglycemia were the main risk metabolic factors associated with moderate-to-advanced liver fibrosis development over time in general populations as well as in subjects with NAFLD.
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Affiliation(s)
- María Teresa Julián
- Department of Endocrinology and Nutrition, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Sílvia Ballesta
- Department of Endocrinology and Nutrition, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Spain
| | | | - Berta Soldevila
- Department of Endocrinology and Nutrition, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Llorenç Caballería
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Rosa Morillas
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
- Hepatology Department, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Alba Martínez–Escudé
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Spain
- Primary Care, Centre d’Atenció Primària La Llagosta, Institut Català de la Salut, Barcelona, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Franch-Nadal
- Center for Biomedical Research on Diabetes and Associated Metabolic diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism. University of Florida, Gainesville, FL, United States
| | - Josep Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau; Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dídac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau; Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Faculty of Medicine, University of Vic, Central University of Catalonia, Vic, Spain
- *Correspondence: Núria Alonso, ; Dídac Mauricio,
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Núria Alonso, ; Dídac Mauricio,
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Pérez-Montes de Oca A, Julián MT, Pera G, Caballería L, Morillas R, Torán P, Expósito C, Franch-Nadal J, Mauricio D, Alonso N. Dysglycemia in young women attenuates the protective effect against fatty liver disease. Front Endocrinol (Lausanne) 2022; 13:971864. [PMID: 36479218 PMCID: PMC9720265 DOI: 10.3389/fendo.2022.971864] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sexual dimorphism has been reported in non-alcoholic fatty liver disease (NAFLD), similar to the sex differences evident with cardiovascular disease. Type 2 diabetes mellitus (T2D) significantly increases the risk and severity of NAFLD, but there is scarce information on whether T2D or altered glucose metabolism can modify the prevalence of NAFLD in men and women of reproductive age. PURPOSE To investigate the relationship between age, sex and NAFLD in subjects with and without dysglycemia. MATERIALS AND METHODS We analyzed 2,790 patients. NAFLD was characterized using established diagnostic criteria: one or more positive results on the fatty liver index and hepatic ultrasound. Liver fibrosis (liver stiffness measurement [LSM] ≥8.0 kPa) was assessed by Fibroscan®. For analysis purposes, we included both T2D and prediabetes under the predefined condition of dysglycemia. RESULTS The global prevalence of NAFLD was higher in men than in women (50% and 34%; P<0.001), and the prevalence increased with age in both sexes. Older women (≥ 50 years) had a higher prevalence than younger women (<50 years), both in the overall cohort and in non-dysglycemic subjects. In dysglycemic subjects, the prevalence of NAFLD was slightly higher in men (68% vs 61%, p=0.021); in younger subjects, there were no differences in the prevalence of NAFLD between men and women (68% vs 64%, respectively; p=0.635). We found an interaction between dysglycemia and female sex (odds ratio [OR] 1.6 95% confidence interval [CI] 1.0-2.4, p=0.030), and between and age ≥50 years (OR 0.6, 95% CI 0.3-1.0, p=0.046). The global prevalence of LSM ≥8.0 kPa was higher in men compared with women (8% vs 4%; p< 0.001). This prevalence increased with age, mainly in men. We did not find any association between liver fibrosis and age and gender. CONCLUSIONS While the global prevalence of NAFLD is higher in men than in women across all ages, younger women with dysglycemia have a similar risk of developing NAFLD as men of a similar age. Therefore, the presence of dysglycemia may erase the protective effect of female sex against fatty liver disease.
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Affiliation(s)
- Alejandra Pérez-Montes de Oca
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Teresa Julián
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Llorenç Caballería
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Rosa Morillas
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
- Hepatology Department, Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Josep Franch-Nadal
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Didac Mauricio
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- *Correspondence: Didac Mauricio, ; Nuria Alonso,
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Didac Mauricio, ; Nuria Alonso,
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Ruiz-Comellas A, Pera G, Baena-Díez JM, Mundet Tudurí X, Heras A, Forés-Raurell R, Torán-Montserrat P, Alzamora-Sas MT. [Relationship between physical activity during leisure time and progression of ankle-brachial index]. Gac Sanit 2021; 36:317-323. [PMID: 34417057 DOI: 10.1016/j.gaceta.2021.06.006] [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] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population. METHOD Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI) <0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI. RESULTS The mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot. CONCLUSIONS In our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk.
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Affiliation(s)
- Anna Ruiz-Comellas
- Centre d'Atenció Primària Sant Joan de Vilatorrada, Institut Català de la Salut, Sant Joan de Vilatorrada, Barcelona, España; Unitat de Suport a la Recerca de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España.
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, España
| | | | - Xavier Mundet Tudurí
- Unitat de Suport a la Recerca Barcelona-Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, España; Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
| | - Rosa Forés-Raurell
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, España; Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
| | - Pere Torán-Montserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, España
| | - María Teresa Alzamora-Sas
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, España; Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
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15
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Pose E, Pera G, Torán P, Gratacós-Ginès J, Avitabile E, Expósito C, Díaz A, Graupera I, Rubio AB, Ginès P, Fabrellas N, Caballeria L. Interaction between metabolic syndrome and alcohol consumption, risk factors of liver fibrosis: A population-based study. Liver Int 2021; 41:1556-1564. [PMID: 33595176 DOI: 10.1111/liv.14830] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/28/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Alcohol and metabolic syndrome (MS) coexist frequently as cofactors of liver disease. Previous studies suggest a deleterious effect of MS in advanced alcohol-related liver disease (ArLD). However, it is unknow whether MS can increase the risk of liver fibrosis in early stages of ArLD. The aim of this study was to investigate the effect of MS on liver fibrosis in subjects with alcohol consumption from a population-based cohort. METHODS The number of subjects include 1760(58%) of 3014 who were randomly selected from the community consumed alcohol and were classified as current drinkers, divided in moderate (n = 1222) or high-risk drinkers (n = 275) (>21 units/week men, >14 units/week women for high-risk drinkers), or former drinkers (n = 263). Liver fibrosis was estimated by measuring liver stiffness(LS) with transient elastography (TE). RESULTS Prevalence of significant LS using cutoff values of TE of 8 and 9.1kPa was increased in high-risk compared with moderate or former drinkers and lifetime abstainers. In subjects with alcohol consumption, LS was associated with male gender, AST, ALT, years of consumption, and MS. In high-risk drinkers, MS and intensity of consumption were the only factors associated with significant LS (OR 3.7 and 4.6 for LS ≥ 8 kPa and 3.9 and 9.2 kPa for LS ≥ 9.1 kPa, respectively). Presence of significant liver fibrosis in the liver biopsy was higher among high-risk as compared with moderate or former drinkers. CONCLUSION MS increases the risk of liver fibrosis in subjects with alcohol consumption. Among high-risk drinkers, only MS and consumption of high amount of alcohol are associated with risk of liver fibrosis.
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Affiliation(s)
- Elisa Pose
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Guillem Pera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
| | - Pere Torán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
| | | | - Emma Avitabile
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Carmen Expósito
- Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
| | - Alba Díaz
- Pathological Department, Hospital Clínic, Barcelona, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ana B Rubio
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Llorenç Caballeria
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
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16
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Castells-Sánchez A, Roig-Coll F, Lamonja-Vicente N, Torán-Monserrat P, Pera G, Montero P, Dacosta-Aguayo R, Bermudo-Gallaguet A, Bherer L, Erickson KI, Mataró M. Sex Matters in the Association between Physical Activity and Fitness with Cognition. Med Sci Sports Exerc 2021; 53:1252-1259. [PMID: 33394900 DOI: 10.1249/mss.0000000000002570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The benefits from physical activity (PA) and cardiorespiratory fitness (CRF) on normal age-related cognitive decline might be sex dependent. Our aim was to explore the relationship between different types of PA, CRF, and cognition and to identify the mediating effects of CRF in the association between PA and cognition in women and men. METHODS We recruited 115 healthy adults 50-70 yr of age. We obtained demographic, cognitive, and PA status data based on the Projecte Moviment protocol. We calculated cognitive domains by grouping z-sample scores. We obtained self-reported total energy expenditure during the last month and grouped it into sportive PA (S-PA) and nonsportive PA (NS-PA). CRF was estimated using the Rockport 1-Mile Walk Test. We applied regression models and mediation analyses in a final sample of 104 individuals (65 women and 39 men). RESULTS In the total sample, CRF was positively associated with executive function, verbal memory, and attention-speed. S-PA was positively related to executive function and attention-speed, whereas NS-PA was unrelated to cognitive domains. Greater amounts of S-PA were associated with executive function and attention-speed for both women and men. Higher CRF was associated with executive function, memory, language, and attention-speed only in men. Mediation analyses showed that CRF was a significant mediator of the positive effects of S-PA on executive function and attention-speed in men but not in women. CONCLUSIONS Both women and men show cognitive benefits from greater S-PA, but not from NS-PA. However, there were sex differences in the mediating effects of CRF in this relationship, showing that CRF was mediating these benefits only in men.
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Affiliation(s)
| | - Francesca Roig-Coll
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, SPAIN
| | | | - Pere Torán-Monserrat
- Primary Healthcare Research Support Unit Metropolitana Nord, ICS-IDIAP Jordi Gol, Mataró, SPAIN
| | - Guillem Pera
- Primary Healthcare Research Support Unit Metropolitana Nord, ICS-IDIAP Jordi Gol, Mataró, SPAIN
| | - Pilar Montero
- Primary Healthcare Research Support Unit Metropolitana Nord, ICS-IDIAP Jordi Gol, Mataró, SPAIN
| | - Rosalia Dacosta-Aguayo
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, SPAIN
| | - Adrià Bermudo-Gallaguet
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, SPAIN
| | | | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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17
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Julián MT, Pera G, Soldevila B, Caballería L, Julve J, Puig-Jové C, Morillas R, Torán P, Expósito C, Puig-Domingo M, Castelblanco E, Franch-Nadal J, Cusi K, Mauricio D, Alonso N. Atherogenic dyslipidemia, but not hyperglycemia, is an independent factor associated with liver fibrosis in subjects with type 2 diabetes and NAFLD: a population-based study. Eur J Endocrinol 2021; 184:587-596. [PMID: 33606661 DOI: 10.1530/eje-20-1240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the prevalence and risks factors associated with the presence of liver fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) with and without type 2 diabetes mellitus (T2D). DESIGN AND METHODS This study was part of a population-based study conducted in the Barcelona metropolitan area among subjects aged 18-75 years old. Secondary causes of steatosis were excluded. Moderate-to-advanced liver fibrosis was defined as a liver stiffness measurement (LSM) ≥ 8.0 kPa assessed by transient elastography. RESULTS Among 930 subjects with NAFLD, the prevalence of moderate-to-advanced liver fibrosis was higher in subjects with T2D compared those without (30.8% vs 8.7%). By multivariable analysis, one of the main factors independently associated with increased LSM in subjects with NAFLD was atherogenic dyslipidemia but only in those with T2D. The percentage of subjects with LSM ≥ 8.0 kPa was higher in subjects with T2D and atherogenic dyslipidemia than in those with T2D without atherogenic dyslipidemia both for the cut-off point of LSM ≥8.0 kPa (45% vs 24% P = 0.002) and ≥13 kPa (13% vs 4% P = 0.020). No differences were observed in the prevalence of LSM ≥8.0 kPa regarding glycemic control among NAFLD-diabetic subjects. CONCLUSIONS Factors associated with moderate-to-advanced liver fibrosis in NAFLD are different in subjects with and without T2D. Atherogenic dyslipidemia was associated with the presence of moderate-to-advanced liver fibrosis in T2D with NAFLD but not in non-diabetic subjects. These findings highlight the need for an active search for liver fibrosis in subjects with T2D NAFLD and atherogenic dyslipidemia.
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Affiliation(s)
- María Teresa Julián
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d'Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Berta Soldevila
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Llorenç Caballería
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d'Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Josep Julve
- Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Puig-Jové
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Rosa Morillas
- Centro d'Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
- Hepatology Department, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d'Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
- Centro d'Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Esmeralda Castelblanco
- Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Franch-Nadal
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, USA
| | - Didac Mauricio
- Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Faculty of Medicine, University of Vic, Central University of Catalonia, Vic, Spain
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
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18
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Martínez-Escudé A, Pera G, Rodríguez L, Arteaga I, Expósito-Martínez C, Torán-Monserrat P, Caballería L. Risk of Liver Fibrosis According to TSH Levels in Euthyroid Subjects. J Clin Med 2021; 10:jcm10071350. [PMID: 33805893 PMCID: PMC8037170 DOI: 10.3390/jcm10071350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/24/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022] Open
Abstract
Alterations in thyroid function may contribute to the development of liver fibrosis especially in subjects with non-alcoholic fatty liver disease. This study aimed to investigate the risk of liver fibrosis according to low-normal thyroid function in the general population. We performed a descriptive cross-sectional study in subjects from 18–75 years randomly selected from 16 primary health care centers from 2017–2019. Each subject underwent clinical evaluation, physical examination, blood analysis and transient hepatic elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with fibrosis. We included 1096 subjects (60 ± 11 years; 61% women); 70% had strict-normal thyroid function and 30% had low-normal thyroid function. Low-normal thyroid function was associated with a higher liver stiffness (LS) values: 5.2 vs. 4.8 kPa (p = 0.001) and a greater prevalence of fibrosis: 6.1 vs. 3% (p = 0.016) and 4.3 vs. 2.1% (p = 0.044) for the cut-off points of ≥8.0 kPa and ≥9.2 kPa, respectively. After adjustment for potential confounding factors, the risk of fibrosis in subjects with low-normal thyroid function was OR 1.54 (p = 0.213). In conclusion, low-normal thyroid function is associated with higher LS values and a greater risk of liver fibrosis in the general population, being dependent on other metabolic factors.
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Affiliation(s)
- Alba Martínez-Escudé
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centre d’Atenció Primària La Llagosta, Institut Català de la Salut, 08120 La Llagosta, Barcelona, Spain
- Correspondence: ; Tel.: +34-93-741-5338
| | - Guillem Pera
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Lluís Rodríguez
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centre d’Atenció Primària Rocafonda-Palau, Institut Català de la Salut, 08303 Mataró, Barcelona, Spain
| | - Ingrid Arteaga
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centre d’Atenció Primària Santa Eulàlia, Institut Català de la Salut, 08187 Santa Eulàlia de Ronçana, Barcelona, Spain
| | - Carmen Expósito-Martínez
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centre d’Atenció Primària Sabadell Centre, Institut Català de la Salut, 08201 Sabadell, Barcelona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Llorenç Caballería
- Unitat de Suport a la Recerca (USR) Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), 08303 Mataró, Barcelona, Spain; (G.P.); (L.R.); (I.A.); (C.E.-M.); (P.T.-M.); (L.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
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19
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Castells-Sánchez A, Roig-Coll F, Dacosta-Aguayo R, Lamonja-Vicente N, Sawicka AK, Torán-Monserrat P, Pera G, Montero-Alía P, Heras-Tebar A, Domènech S, Via M, Erickson KI, Mataró M. Exercise and Fitness Neuroprotective Effects: Molecular, Brain Volume and Psychological Correlates and Their Mediating Role in Healthy Late-Middle-Aged Women and Men. Front Aging Neurosci 2021; 13:615247. [PMID: 33776741 PMCID: PMC7989549 DOI: 10.3389/fnagi.2021.615247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Although exercise is known to have a neuroprotective effect in aging, the mediators underlying the exercise-cognition association remain poorly understood. In this paper we aimed to study the molecular, brain, and behavioral changes related to physical activity and their potential role as mediators. Methods: We obtained demographic, physical activity outcomes [sportive physical activity and cardiorespiratory fitness (CRF)], plasma biomarkers (TNF-α, ICAM-1, HGF, SDF1-α, and BDNF), structural-MRI (brain volume areas), psychological and sleep health (mood, depressive and distress symptoms, and sleep quality), and multi-domain cognitive data from 115 adults aged 50-70 years. We conducted linear regression models and mediation analyses stratifying results by sex in a final sample of 104 individuals [65 women (age = 56.75 ± 4.96) and 39 men (age = 58.59 ± 5.86)]. Results: Women engaging in greater amounts of exercising showed lower TNF-α levels and greater dorsolateral prefrontal cortex and temporal lobe volumes. Men engaging in greater amounts of exercise showed greater temporal lobe volumes. CRF levels were not related to any of the analyzed outcomes in women but in men higher CRF was associated with lower TNF-α, HGF and ventricle volumes, greater volume of temporal and parietal lobes and fewer depressive symptoms and better mood. In men, reduced TNF-α and HGF levels mediated brain and cognitive CRF-related benefits. Conclusion: Our results show that exercise is a promising approach for influencing inflammation and brain volume and also contributes to ongoing discussions about the physiological mediators for the association between CRF and cognition in men.
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Affiliation(s)
- Alba Castells-Sánchez
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Francesca Roig-Coll
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Rosalia Dacosta-Aguayo
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Noemí Lamonja-Vicente
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Angelika K Sawicka
- Applied Cognitive Neuroscience Lab, Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Pilar Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Antonio Heras-Tebar
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Sira Domènech
- Institut de Diagnòstic per la Imatge, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Marc Via
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria Mataró
- Departament of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
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20
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Lamonja-Vicente N, Dacosta-Aguayo R, López-Olóriz J, Prades-Senovilla L, Roig-Coll F, Castells-Sánchez A, Soriano-Raya JJ, Clemente I, Miralbell J, Barrios M, López-Cancio E, Cáceres C, Arenillas JF, Millán M, Torán P, Pera G, Fores R, Alzamora MT, Mataró M, Via M. Sex-Specific Protective Effects of APOE ε2 on Cognitive Performance. J Gerontol A Biol Sci Med Sci 2021; 76:41-49. [PMID: 32992326 DOI: 10.1093/gerona/glaa247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Apolipoprotein E (APOE) has an important role in the multiple trajectories of cognitive aging. However, environmental variables and other genes mediate the impact of APOE on cognition. Our main objective was to analyze the effect of APOE genotype on cognition and its interactions and relationships with sex, age, lipid profile, C-reactive protein, and Brain-derived neurotrophic factor (BDNF) genotype in a sample of 648 healthy participants over 50 years of age with a comprehensive neuropsychological assessment. Our results showed that APOE ε2 carriers performed better in the Verbal Memory (p = .002) and Fluency Domains (p = .001). When we studied the effect of sex, we observed that the beneficial effect of APOE ε2 on the normalized values of these cognitive domains occurred only in females (β = 0.735; 95% confidence interval, 0.396-1.074; p = 3.167·10-5 and β = 0.568; 95% confidence interval, 0.276-0.861; p = 1.853·10-4, respectively). Similarly, the sex-specific effects of APOE ε2 were further observed on lipidic and inflammation biomarkers. In the whole sample, APOE ε2 carriers showed significantly lower levels of total cholesterol, low-density lipoprotein cholesterol, and C-reactive protein. These differences were found only among females. Furthermore, total cholesterol and low-density lipoprotein cholesterol mediated the protective effect of APOE ε2 on cognition in the whole sample and total cholesterol in females, providing candidate physiological mechanisms for the observed genetic effects. Our results show that the neuroprotective role of APOE ε2 in cognition varies with sex and that the lipidic profile partially mediates this protection. Age-related cognitive and functional decline is a continuous biological process with different cognitive trajectories (1). Complex interactions between heritability, environmental influence, and cognitive functions in aging have been highlighted (2). In particular, genetic differences explain around 15%-25% of the variance in life expectancy (3). Therefore, the identification of susceptibility genes and their biological effects on cognitive aging is required to establish interindividual differences in this process and promote early personalized interventions to delay cognitive decline and minimize the financial burden of aging in the health care system.
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Affiliation(s)
- Noemí Lamonja-Vicente
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Rosalia Dacosta-Aguayo
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Jorge López-Olóriz
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Unidad de Trastornos del Aprendizaje (UTA), Fundación Josep Finestres (FJF), Barcelona, Spain
| | - Laia Prades-Senovilla
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesca Roig-Coll
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Alba Castells-Sánchez
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Juan José Soriano-Raya
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Inmaculada Clemente
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Júlia Miralbell
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Maite Barrios
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona, Spain
| | - Elena López-Cancio
- Departamento de Neurología, Unidad de Ictus Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Cynthia Cáceres
- Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Francisco Arenillas
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.,Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid-Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Mónica Millán
- Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Rosa Fores
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marc Via
- Department of Clinical Psychology and Psychobiology, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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21
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Roig-Coll F, Castells-Sánchez A, Lamonja-Vicente N, Torán-Monserrat P, Pera G, García-Molina A, Tormos JM, Montero-Alía P, Alzamora MT, Dacosta-Aguayo R, Soriano-Raya JJ, Cáceres C, Erickson KI, Mataró M. Effects of Aerobic Exercise, Cognitive and Combined Training on Cognition in Physically Inactive Healthy Late-Middle-Aged Adults: The Projecte Moviment Randomized Controlled Trial. Front Aging Neurosci 2020; 12:590168. [PMID: 33192485 PMCID: PMC7664521 DOI: 10.3389/fnagi.2020.590168] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Lifestyle interventions are promising strategies to promote cognitive health in aging. Projecte Moviment examines if aerobic exercise (AE), computerized cognitive training (CCT), and their combination (COMB) improves cognition, psychological health, and physical status compared to a control group. We assessed the moderating role of age and sex and the mediating effects of cardiorespiratory fitness (CRF), physical activity (PA), and psychological health on intervention-related cognitive benefits. Methods This was a 12-week multi-domain, single-blind, proof-of-concept randomized controlled trial (RCT). 96 healthy adults aged 50-70 years were assigned to AE, CCT, COMB, and a wait-list control group. The per protocol sample, which completed the intervention with a level of adherence > 80%, consisted of 82 participants (62% female; age = 58.38 ± 5.47). We assessed cognition, psychological health, CRF, and energy expenditure in PA at baseline and after the intervention. We regressed change in each outcome on the treatment variables, baseline score, sex, age, and education. We used PROCESS Macro to perform the mediation and moderation analyses. Results AE benefited Working Memory (SMD = 0.29, p = 0.037) and Attention (SMD = 0.33, p = 0.028) including the Attention-Speed (SMD = 0.31, p = 0.042) domain, compared to Control. COMB improved Attention (SMD = 0.30, p = 0.043), Speed (SMD = 0.30, p = 0.044), and the Attention-Speed (SMD = 0.30, p = 0.041) domain. CTT group did not show any cognitive change compared to Control. Sportive PA (S-PA) and CRF increased in AE and COMB. Age and sex did not moderate intervention-related cognitive benefits. Change in S-PA, but not in CRF, significantly mediated improvements on Attention-Speed in AE. Conclusion A 12-week AE program improved Executive Function and Attention-Speed in healthy late-middle-aged adults. Combining it with CCT did not provide further benefits. Our results add support to the clinical relevance of even short-term AE as an intervention to enhance cognition and highlight the mediating role of change in S-PA in these benefits. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT03123900.
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Affiliation(s)
- Francesca Roig-Coll
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Alba Castells-Sánchez
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Noemí Lamonja-Vicente
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Maria Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Rosalía Dacosta-Aguayo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Juan José Soriano-Raya
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States.,Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
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22
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García-Sierra RM, Badia Perich E, Manresa Dominguez JM, Moreno Millan N, Sabaté Cintas V, Romero Martínez M, Moreno Gabriel E, Pera G, Seda Gombau G, Montellà Jordana N, Violan Fors C, Argerich González MJ, Bonet Simó JM, Prat Gil N, Torán Monserrat P. [Descriptive study of the health service workers of a Primary Care Department confined by Covid-19.]. Rev Esp Salud Publica 2020; 94:e202009106. [PMID: 32880381] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE The Covid-19 pandemic is testing the resistance of health systems, the preservation of health professionals is a priority in processes of this type. The professionals' exposure to suspicious contacts often requires their confinement. The objective was to know the epidemiological characteristics of the primary care professionals who required confinement. METHODS The research was carried out in the North Metropolitan Primary Care Area of Barcelona, from February 17 to May 3, 2020. 1,418 professionals who required confinement due to the epidemic by Covid-19 participated. The reasons for confinement, symptomatology, the confinement time and the results of PCR tests results were recorded. Univariate descriptive analysis was performed. RESULTS 78.8% of the professionals were women and the mean age was 45.2 years. 67.8% were doctors and nurses, in the remaining 32.2% there were different healthcare and non-care professionals. 64.1% of the sample presented symptoms compatible with Covid-19. Participants described multiple symptoms during confinement. 1,050 diagnostic RT- PCR tests were performed, being positive in 323 cases, of which 33 were in asymptomatic people. CONCLUSIONS The impact of the epidemic by Covid-19 is anticipated in health personnel compared to the general population. The distribution of symptoms in healthcare professionals is similar to that of other studies in the general population. Of the total number of professionals requiring isolation, 22.7% confirmed the diagnosis.
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Affiliation(s)
- Rosa Mª García-Sierra
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
- Departament d'Infermeria. Universitat Autònoma de Barcelona. Cerdanyola del Vallès. Barcelona
| | - Esther Badia Perich
- Àrea de Qualitat i Seguretat del Pacient. Direcció d'Atenció Primària Metropolitana Nord. Institut Català de la Salut. Sabadell. Barcelona
| | - Josep Mª Manresa Dominguez
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
- Departament d'Infermeria. Universitat Autònoma de Barcelona. Cerdanyola del Vallès. Barcelona
- Grup de Recerca Multidsciplinar en Salut i Societat (GREMSAS). Mataró. Barcelona
| | - Nemesio Moreno Millan
- Àrea de Metodologia i Avaluació. Direcció d'Atenció Primària Metropolitana Nord. Institut Català de la Salut. Sabadell. Barcelona
| | - Victòria Sabaté Cintas
- Àrea de Qualitat i Seguretat del Pacient. Direcció d'Atenció Primària Metropolitana Nord. Institut Català de la Salut. Sabadell. Barcelona
| | - Merche Romero Martínez
- Àrea d'Atenció a la Ciutadania. Direcció d'Atenció Primària Metropolitana Nord. Institut Català de la Salut. Sabadell. Barcelona
| | - Eduard Moreno Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
| | - Gemma Seda Gombau
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
- Grup de Recerca Multidsciplinar en Salut i Societat (GREMSAS). Mataró. Barcelona
| | - Núria Montellà Jordana
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Metropolitana Nord. Institut Català de la Salut. Cerdanyola del Vallès. Barcelona
| | - Concepció Violan Fors
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
| | - María José Argerich González
- Dirección de Atención Primaria Metropolitana Nord. CAP Sant Fèlix. Institut Català de la Salut. Sabadell. Barcelona
| | - Josep Mª Bonet Simó
- Dirección de Atención Primaria Metropolitana Nord. CAP Sant Fèlix. Institut Català de la Salut. Sabadell. Barcelona
| | - Nuria Prat Gil
- Dirección de Atención Primaria Metropolitana Nord. CAP Sant Fèlix. Institut Català de la Salut. Sabadell. Barcelona
| | - Pere Torán Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord. Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mataró. Barcelona
- Grup de Recerca Multidsciplinar en Salut i Societat (GREMSAS). Mataró. Barcelona
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23
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Castells-Sánchez A, Roig-Coll F, Lamonja-Vicente N, Altés-Magret M, Torán-Monserrat P, Via M, García-Molina A, Tormos JM, Heras A, Alzamora MT, Forés R, Pera G, Dacosta-Aguayo R, Soriano-Raya JJ, Cáceres C, Montero-Alía P, Montero-Alía JJ, Jimenez-Gonzalez MM, Hernández-Pérez M, Perera A, Grove GA, Munuera J, Domènech S, Erickson KI, Mataró M. Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol. Front Aging Neurosci 2019; 11:216. [PMID: 31481889 PMCID: PMC6711364 DOI: 10.3389/fnagi.2019.00216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/14/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses. Methods One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention. Results Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample. Discussion Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900.
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Affiliation(s)
- Alba Castells-Sánchez
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Francesca Roig-Coll
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Noemí Lamonja-Vicente
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marina Altés-Magret
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Marc Via
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Maria Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Maite T Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Rosa Forés
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Rosalia Dacosta-Aguayo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Juan José Soriano-Raya
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Pilar Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Juan José Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Maria Mercedes Jimenez-Gonzalez
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Spain
| | - Maria Hernández-Pérez
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Alexandre Perera
- B2SLab, Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - George A Grove
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Josep Munuera
- Diagnostic Imaging Department, Fundació de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sira Domènech
- Institut de Diagnòstic per la Imatge, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
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24
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Alventosa-Zaidin M, Guix Font L, Benitez Camps M, Roca Saumell C, Pera G, Alzamora Sas MT, Forés Raurell R, Rebagliato Nadal O, Dalfó-Baqué A, Brugada Terradellas J. Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population. Eur J Gen Pract 2019; 25:109-115. [PMID: 31339387 PMCID: PMC6713172 DOI: 10.1080/13814788.2019.1639667] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/18/2022] Open
Abstract
Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.
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Affiliation(s)
- M Alventosa-Zaidin
- a Centre d'Atenció Primària Arenys de Mar, Servei d'atenció Primària Barcelonès Nord- Maresme, Institut Català de la Salut , Barcelona , Spain
| | - L Guix Font
- b Centre d'Atenció Primària Berga, Servei d'atenció Primària Bages- Berguedà-Solsonés, Institut Català de la Salut , Barcelona , Spain
| | - M Benitez Camps
- c Centre d'Atenció Primària Gòtic, Servei d'atenció Primària Barcelona Litoral, Institut Català de la Salut , Barcelona , Spain
| | - C Roca Saumell
- d Centre d'Atenció Primària El Clot, Servei d'atenció Primària Barcelona Dreta-Muntanya, Institut Català de la Salut , Barcelona , Spain.,e Faculty of Medicine, University of Barcelona , Barcelona , Spain
| | - G Pera
- f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain
| | - M Teresa Alzamora Sas
- f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,g Centre d'Atenció Primària Riu-Nord Riu-Sud Santa Coloma de Gramenet, Servei d'atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut , Barcelona , Spain
| | - R Forés Raurell
- f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,g Centre d'Atenció Primària Riu-Nord Riu-Sud Santa Coloma de Gramenet, Servei d'atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut , Barcelona , Spain
| | - O Rebagliato Nadal
- c Centre d'Atenció Primària Gòtic, Servei d'atenció Primària Barcelona Litoral, Institut Català de la Salut , Barcelona , Spain.,f Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain
| | - A Dalfó-Baqué
- c Centre d'Atenció Primària Gòtic, Servei d'atenció Primària Barcelona Litoral, Institut Català de la Salut , Barcelona , Spain
| | - J Brugada Terradellas
- e Faculty of Medicine, University of Barcelona , Barcelona , Spain.,h Departament de Cardiologia, Hospital Clínic de Barcelona , Barcelona , Spain
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Martínez Escudé A, Pera G, Arteaga I, Expósito C, Rodríguez L, Torán P, Caballeria L. Relationship between hypothyroidism and non-alcoholic fatty liver disease in the Spanish population. Med Clin (Barc) 2019; 154:1-6. [PMID: 31153607 DOI: 10.1016/j.medcli.2019.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/27/2018] [Revised: 02/24/2019] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in developed countries and is considered the hepatic component of metabolic syndrome (MetS). Recently hypothyroidism has been associated with NAFLD but has never been studied in Spain. OBJECTIVES To analyze the relationship between hypothyroidism (clinical and subclinical) and NAFLD. To determine the association between MetS with NAFLD and hypothyroidism. METHODS Cross-sectional, retrospective, population study in subjects ≥45 years from primary care centres in Catalonia included in the SIDIAP database. The data was collected between 2009 and 2013. VARIABLES socio-demographic data, comorbidities, toxic habits, physical examination, analytical tests and diagnosis of MetS. Descriptive analysis and application of statistical tests for the comparison of variables. RESULTS Sample of 10,116 individuals with a mean age of 61(10) and a predominance of females (63.6%). The prevalence of hypothyroidism was 9.1%, with no significant differences according to the presence of NAFLD (p=.631). Hypothyroidism was associated with higher triglyceride levels and a greater prevalence of obesity (p=.003). Greater alteration of AST was detected in individuals with elevated TSH (p=.012) and decreased levels of T4L (p=.037). Alterations in thyroid hormone levels were not associated with a higher prevalence of NAFLD (TSH p=.072 and T4L p=.447). Hypothyroidism was not considered a risk factor for the development of NAFLD (OR .75; 95% CI: .39-1.44; p=.38). CONCLUSIONS No association was found between hypothyroidism and NAFLD. Prospective studies are needed to clarify a possible relationship between these two diseases.
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Affiliation(s)
- Alba Martínez Escudé
- Centro de Atención Primaria La Llagosta, Instituto Catalán de la Salud, La Llagosta, Barcelona, España; Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España
| | - Guillem Pera
- Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Ingrid Arteaga
- Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Atención Primaria Santa Eulàlia, Instituto Catalán de la Salud, Santa Eulàlia de Ronçana, Barcelona, España
| | - Carmen Expósito
- Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Atención Primaria Sabadell Centro, Instituto Catalán de la Salud, Sabadell, Barcelona, España
| | - Lluís Rodríguez
- Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Pere Torán
- Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Llorenç Caballeria
- Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España.
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Alventosa-Zaidin M, Pera G, Roca Saumell C, Mengual Miralles N, Zamora Sanchez MV, Gros Garcia T, Guix Font L, Benitez Camps M, Francisco-Pascual J, Brugada Terradellas J. Diagnosis of right bundle branch block: a concordance study. BMC Fam Pract 2019; 20:58. [PMID: 31060516 PMCID: PMC6501399 DOI: 10.1186/s12875-019-0946-3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.
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Affiliation(s)
- M Alventosa-Zaidin
- Bon Pastor, Primary Healthcare Center, Catalan Health Institute, Barcelona, Catalonia, Spain.
| | - G Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
| | - C Roca Saumell
- EAP El Clot, Primary Healthcare Center, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - N Mengual Miralles
- EAP Ronda Cerdanya, Primary Healthcare Center, Catalan Health Institute, Mataró, Barcelona, Spain
| | - M V Zamora Sanchez
- EAP El Gòtic, Primary Healthcare Center, Catalan Health Institute, Barcelona, Spain
| | - T Gros Garcia
- EAP Ronda Cerdanya, Primary Healthcare Center, Catalan Health Institute, Mataró, Barcelona, Spain
| | - L Guix Font
- EAP Berga, Primary Healthcare Center, Catalan Health Institute, Berga, Barcelona, Spain
| | - M Benitez Camps
- EAP El Gòtic, Primary Healthcare Center, Catalan Health Institute, Barcelona, Spain
| | - J Francisco-Pascual
- Unity of arithmies. Servei de cardiologia. University Hospital Vall Hebrón, Research Institut, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - J Brugada Terradellas
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
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Planas-Ballvé A, Crespo AM, Aguilar LM, Hernández-Pérez M, Canento T, Dorado L, Alzamora MT, Torán P, Pera G, Muñoz-Ortiz L, Arenillas JF, Castañón M, Dávalos A, Millán M, López-Cancio E. The Barcelona-Asymptomatic Intracranial Atherosclerosis study: Subclinical intracranial atherosclerosis as predictor of long-term vascular events. Atherosclerosis 2019; 282:132-136. [PMID: 30731285 DOI: 10.1016/j.atherosclerosis.2019.01.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/09/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Symptomatic intracranial atherosclerosis (ICAS) is associated with a high risk of stroke recurrence and occurrence of other vascular events. However, ICAS has been poorly studied from its asymptomatic stage. The objective of our study was to determine if subclinical intracranial atherosclerosis is associated with long-term incident vascular events in Caucasians. METHODS The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) Study is a population-based study that enrolled 933 subjects with a moderate-high vascular risk and without history of stroke or coronary disease, and determined the prevalence of asymptomatic ICAS and associated risk factors. At baseline visit, carotid atherosclerosis and ICAS were screened by color-coded duplex ultrasound, and moderate-severe stenosis was confirmed by magnetic resonance angiography. At baseline, 8.9% of subjects had asymptomatic ICAS, of whom 3.3% were moderate-severe. In the longitudinal phase, subjects were prospectively followed-up to assess the incidence of a combined primary endpoint of vascular events (stroke, acute coronary syndrome and/or vascular death). RESULTS After 7.17 years of follow-up, there were 51 incident cerebrovascular events (16 transient ischemic attacks, 27 ischemic, 8 hemorrhagic strokes), 63 incident coronary events and 23 vascular deaths. After multivariate Cox regression analyses adjusted by age, sex, vascular risk and presence of carotid plaques, ICAS was an independent predictor for overall vascular events (HR 1.83 [1.10-3.03], p = 0.020), and moderate-severe intracranial stenosis was also an independent predictor for cerebrovascular events (HR 2.66 [1.02-6.94], p = 0.046). CONCLUSIONS Asymptomatic ICAS is independently associated with the incidence of future vascular events in our population. These findings might have implications for the development of primary prevention strategies.
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Affiliation(s)
- Anna Planas-Ballvé
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Ane Miren Crespo
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Lorena Martín Aguilar
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - María Hernández-Pérez
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Tamara Canento
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Laura Dorado
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - María T Alzamora
- Atención Primaria, ABS Nord-Riu Sud, Santa Coloma de Gramenet, Barcelona, Spain; Unitat de Suport a La Recerca (USR) Metropolitana Nord, IDIAP-J Gol, Mataró, Spain
| | - Pere Torán
- Unitat de Suport a La Recerca (USR) Metropolitana Nord, IDIAP-J Gol, Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a La Recerca (USR) Metropolitana Nord, IDIAP-J Gol, Mataró, Spain
| | - Laura Muñoz-Ortiz
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Juan F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Spain
| | - María Castañón
- Servicio de Neurología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Antoni Dávalos
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Mónica Millán
- Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Elena López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
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Caballería L, Pera G, Arteaga I, Rodríguez L, Alumà A, Morillas RM, de la Ossa N, Díaz A, Expósito C, Miranda D, Sánchez C, Prats RM, Urquizu M, Salgado A, Alemany M, Martinez A, Majeed I, Fabrellas N, Graupera I, Planas R, Ojanguren I, Serra M, Torán P, Caballería J, Ginès P. High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study. Clin Gastroenterol Hepatol 2018; 16:1138-1145.e5. [PMID: 29452268 DOI: 10.1016/j.cgh.2017.12.048] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [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: 12/11/2017] [Accepted: 12/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease. METHODS This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.
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Affiliation(s)
- Llorenç Caballería
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Ingrid Arteaga
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Lluís Rodríguez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Alba Alumà
- Biochemistry Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain
| | - Rosa Ma Morillas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Hepatology Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain
| | - Napoleón de la Ossa
- Pathological Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain
| | - Alba Díaz
- Pathological Department, Hospital Clínic, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Dolores Miranda
- Radiology Department, Institut Català de la Salut, Mataró, Barcelona, Spain
| | - Carmen Sánchez
- Radiology Department, Institut Català de la Salut, Santa Coloma Gramenet, Barcelona, Spain
| | - Rosa Ma Prats
- Radiology Department, Institut Català de la Salut, Santa Coloma Gramenet, Barcelona, Spain
| | - Marta Urquizu
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Angels Salgado
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Magda Alemany
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Alba Martinez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Irfan Majeed
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Núria Fabrellas
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Isabel Graupera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Liver Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Ramón Planas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Hepatology Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain
| | - Isabel Ojanguren
- Pathological Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain
| | - Miquel Serra
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Catalonia
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Juan Caballería
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Liver Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Pere Ginès
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Liver Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.
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Forés R, Alzamora MT, Pera G, Baena-Díez JM, Mundet-Tuduri X, Torán P. Correction: Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort. PLoS One 2018; 13:e0197139. [PMID: 29734376 PMCID: PMC5937770 DOI: 10.1371/journal.pone.0197139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0191283.].
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Real J, Serna MC, Giner-Soriano M, Forés R, Pera G, Ribes E, Alzamora M, Marsal JR, Heras A, Morros R. Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database. BMC Cardiovasc Disord 2018; 18:85. [PMID: 29739318 PMCID: PMC5941464 DOI: 10.1186/s12872-018-0822-4] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. METHODS Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009-2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). RESULTS Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. CONCLUSIONS Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients.
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Affiliation(s)
- Jordi Real
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Epidemiologia i Salut Pública, Universitat Internacional de Catalunya, Sant Cugat, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Catalina Serna
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Lleida, Spain
- Universitat de Lleida, Lleida, Spain
- Institut Català de la Salut, Lleida, Spain
| | - Maria Giner-Soriano
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Institut Català de la Salut, Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
| | - Rosa Forés
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet. Direcció d’Atenció Primària Metropolitana Nord. Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Esther Ribes
- Unitat de Farmàcia. Direcció d’Atenció Primària Lleida. Institut Català de la Salut, Lleida, Spain
| | - Maite Alzamora
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet. Direcció d’Atenció Primària Metropolitana Nord. Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Lleida, Spain
- Epidemiology Unit of the Cardiovascular Service, Hospital Universitari Vall d’Hebron, CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III Barcelona, Barcelona, Spain
| | - Antonio Heras
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet. Direcció d’Atenció Primària Metropolitana Nord. Institut Català de la Salut, Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Institut Català de la Salut, Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Plataforma SCReN (Spanish Clinical Research Network), Unidad de Investigación Clínica y Ensayos Clínicos (UICEC) IDIAPJGol, Barcelona, Spain
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Forés R, Alzamora MT, Pera G, Baena-Díez JM, Mundet-Tuduri X, Torán P. Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort. PLoS One 2018; 13:e0191283. [PMID: 29338049 PMCID: PMC5770061 DOI: 10.1371/journal.pone.0191283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 09/01/2017] [Accepted: 01/02/2018] [Indexed: 11/21/2022] Open
Abstract
Background The different cardiovascular risk prediction scales currently available are not sufficiently sensitive. Aim The aim of the present study was to analyze the contribution of the ankle-brachial index (ABI) added to the Framingham and REGICOR risk scales for the reclassification of cardiovascular risk after a 9-year follow up of a Mediterranean population with low cardiovascular risk. Design and setting A population-based prospective cohort study was performed in the province of Barcelona, Spain. Method A total of 3,786 subjects >49 years were recruited from 2006–2008. Baseline ABI was performed and cardiovascular risk was calculated with the Framingham and REGICOR scales. The participants were followed until November 2016 by telephone and review of the clinical history every 6 months to confirm the possible appearance of cardiovascular events. Results 2,716 individuals participated in the study. There were 126 incidental cases of first coronary events (5%) during follow up. The incidence of coronary events in patients with ABI <0.9 was 4-fold greater than that of subjects with a normal ABI (17.2/1,000 persons-year versus 4.8/1,000 persons-year). Improvement in the predictive capacity of REGICOR scale was observed on including ABI in the model, obtaining a net reclassification improvement of 7% (95% confidence interval 0%-13%) for REGICOR+ ABI. Framingham + ABI obtained a NRI of 4% (-2%-11%). Conclusion The results of the present study support the addition of the ABI as a tool to help in the reclassification of cardiovascular risk and to confirm the greater incidence of coronary events in patients with ABI < 0.9.
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Affiliation(s)
- Rosa Forés
- Centre d’Atenció Primària Riu Nord- Riu Sud Santa Coloma de Gramenet, Direcció d’Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- * E-mail:
| | - Maria Teresa Alzamora
- Centre d’Atenció Primària Riu Nord- Riu Sud Santa Coloma de Gramenet, Direcció d’Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - José Miguel Baena-Díez
- Centre d’Atenció Primària La Marina, Direcció d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Xavier Mundet-Tuduri
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
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Guiriguet C, Pera G, Castells A, Toran P, Grau J, Rivero I, Buron A, Macià F, Vela-Vallespín C, Vilarrubí-Estrella M, Marzo-Castillejo M. Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study. BMC Cancer 2017; 17:524. [PMID: 28784093 PMCID: PMC5547546 DOI: 10.1186/s12885-017-3516-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 03/06/2017] [Accepted: 07/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background There is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes. The aim of this study is to assess the effect of comorbidities on participation in the Barcelona population-based colorectal cancer screening programme (BCCSP). Methods Cross-sectional study carried out in ten primary care centres involved in the BCCSP. Individuals aged 50 to 69, at average risk of colorectal cancer, who were invited to participate in the first round of the faecal immunochemical test-based BCCSP were included (2011–2012). The main variable was participation in the BCCSP. Comorbidity was assessed by clinical risk group status. Other adjusting variables were age, sex, socioeconomic deprivation, visits to primary care, smoking, alcohol consumption and body mass index. Logistic regression models were used to test the association between participation in the programme and potential explanatory variables. The results were given as incidence rate ratios (IRR) and their 95% confidence intervals (CI). Results Of the 36,208 individuals included, 17,404 (48%) participated in the BCCSP. Participation was statistically significantly higher in women, individuals aged 60 to 64, patients with intermediate socioeconomic deprivation, and patients with more medical visits. There was a higher rate of current smoking, high-risk alcohol intake, obesity and individuals in the highest comorbidity categories in the non-participation group. In the adjusted analysis, only individuals with multiple minor chronic diseases were more likely to participate in the BCCSP (IRR 1.14; 95% CI [1.06 to 1.22]; p < 0.001). In contrast, having three or more dominant chronic diseases was associated with lower participation in the screening programme (IRR 0.76; 95% CI [0.65 to 0.89]; p = 0.001). Conclusions Having three or more dominant chronic diseases, was associated with lower participation in a faecal immunochemical test-based colorectal cancer screening programme, whereas individuals with multiple minor chronic diseases were more likely to participate. Further research is needed to explore comorbidity as a cause of non-participation in colorectal cancer screening programmes and which individuals could benefit most from colorectal cancer screening.
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Affiliation(s)
- Carolina Guiriguet
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain. .,Family Medicine Department, Catalan Institute of Health, Barcelona, Spain. .,Catalan Institute of Health, Gotic Primary Care Center, Passatge de la Pau, 1, 08002, Barcelona, Spain.
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Biomedical Research Networking Center Consortium in Hepatic and Digestive diseases (CIBEREHD), Barcelona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Irene Rivero
- Family Medicine Department, Catalan Institute of Health, Barcelona, Spain
| | - Andrea Buron
- Preventive Medicine and Epidemiology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Francesc Macià
- Preventive Medicine and Epidemiology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Carmen Vela-Vallespín
- Family Medicine Department, Catalan Institute of Health, Santa Coloma de Gramenet, Spain
| | | | - Mercedes Marzo-Castillejo
- Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà de Llobregat, Spain
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Alzamora MT, Forés R, Pera G, Baena-Díez JM, Heras A, Sorribes M, Valverde M, Muñoz L, Mundet X, Torán P. Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up. BMC Cardiovasc Disord 2016; 16:8. [PMID: 26758025 PMCID: PMC4710015 DOI: 10.1186/s12872-015-0170-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 03/11/2015] [Accepted: 12/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background To know the epidemiology (prevalence, incidence, progression and morbidity and mortality associated) of peripheral artery disease in general population and the factors associated with this progression is essential to know the evolution of atherosclerosis and develop preventive strategies. The aim of the study was to determine the incidence of PAD after 5 years of follow-up population-based cohort ARTPER, and the evolution of Ankle brachial Index (ABI) in this period. Methods Peripheral artery disease incidence analysis after 5 years of follow-up of 3786 subjects > 50 years old. Peripheral artery disease incident when the second cross section Ankle brachial Index was <0.9 in any of the lower limbs, with normal baseline (0.9 to 1.4). Results Between 2012 and 2013 2762 individuals (77 % participation) were re-examined . Finally analyzed 2256 subjects (after excluding pathological Ankle brachial Index) followed for 4.9 years (range 3.8 to 5.8 years), totalling 11,106 person-years. Peripheral artery disease 95 new cases were detected, representing an incidence of 4.3 % at 5 years and 8.6 per 1000 person-years (95 % CI 6.9 to 10.5) being higher in men (10.2, 95 % CI 7.4 to 13.5) than in women (7.5, 95 % CI 5.5 to 9.9). Linear correlation between the baseline Ankle brachial Index and the second cross section was low (r = 0.23). Conclusions The incidence of peripheral artery disease in ARTPER cohort was 8.6 cases per 1000 person-years, being higher in men, especially <65 years. The correlation between two measures Ankle brachial Index after 5 years of follow-up was low. One might consider whether Ankle brachial Index repeated measures could improve the correlation.
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Affiliation(s)
- Ma Teresa Alzamora
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, Spain. .,Research Unit Barcelonès Nord Maresme, ICS-IDIAP Jordi Gol, Barcelona, Spain.
| | - Rosa Forés
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, Spain.,Research Unit Barcelonès Nord Maresme, ICS-IDIAP Jordi Gol, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Guillem Pera
- Research Unit Barcelonès Nord Maresme, ICS-IDIAP Jordi Gol, Barcelona, Spain
| | | | - Antonio Heras
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, Spain
| | - Marta Sorribes
- Primary Healthcare Centre Numància, Institut Català de la Salut, Barcelona, Spain
| | - Marta Valverde
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Laura Muñoz
- Research Unit Barcelonès Nord Maresme, ICS-IDIAP Jordi Gol, Barcelona, Spain
| | - Xavier Mundet
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Research Unit Barcelona, ICS-IDIAP Jordi Gol, Barcelona, Spain
| | - Pere Torán
- Research Unit Barcelonès Nord Maresme, ICS-IDIAP Jordi Gol, Barcelona, Spain
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Ruiz Comellas A, Pera G, Baena Díez JM, Heras A, Alzamora Sas MT, Forés Raurell R, Torán Monserrat P, Mundet Tudurí X. [The relationship between physical activity in leasure time and the ankle-brachial index in a general Spanish population: The ARTPER study]. Med Clin (Barc) 2015; 145:419-26. [PMID: 25825220 DOI: 10.1016/j.medcli.2015.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/28/2014] [Revised: 12/28/2014] [Accepted: 01/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE High levels of daily physical activity have been shown to be linked to decreased functional impairment in peripheral artery disease (PAD) patients and positively related to the ankle brachial index (ABI) in subjects without PAD. The aim of this study was to examine the relationship between leisure time physical activity (LTPA) and the ABI in a general population. MATERIAL AND METHOD Baseline data from the ARTPER study cohort corresponding to 2,840 subjects>49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI<0.9 was taken to indicate PAD. Multivariate logistic regression analysis was performed to evaluate the independent association between LTPA and PAD. RESULTS Subjects with more LTPA were younger, female, less smokers, and suffered fewer PAD. Total activity, measured in metabolic energy turnover (MET) and the LTPA hours, was significantly higher in subjects without PAD (P<.001). There was an inverse relationship between LTPA and the risk of suffering PAD (odds ratio 0.56, 95% confidence interval 0.38-0.81 for those who expended 2,700 METs or more in 14 days) adjusting for confounding factors. CONCLUSIONS In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA.
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Affiliation(s)
- Anna Ruiz Comellas
- Centre d'Atenció Primària Sant Joan de Vilatorrada, Institut Català de la Salut, Sant Joan de Vilatorrada, Barcelona, España.
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Santa Coloma de Gramenet, Barcelona, España
| | | | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Santa Coloma de Gramenet, Barcelona, España; Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
| | - Maria Teresa Alzamora Sas
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Santa Coloma de Gramenet, Barcelona, España; Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
| | - Rosa Forés Raurell
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Santa Coloma de Gramenet, Barcelona, España; Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
| | - Pere Torán Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Santa Coloma de Gramenet, Barcelona, España
| | - Xavier Mundet Tudurí
- Unitat de Suport a la Recerca Barcelona-Ciutat, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
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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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Mortara L, Pera G, Monti E, Morbelli S, Minuto F, Sambuceti G, Giusti M. Efficacy of sorafenib and impact on cardiac function in patients with thyroid cancer: a retrospective analysis. J Endocrinol Invest 2014; 37:1099-108. [PMID: 25283887 DOI: 10.1007/s40618-014-0177-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Sorafenib has recently been recognized as an important standard option for the management of patients with differentiated thyroid cancer. Although data concerning cardiac safety are available in pan-tumor studies, no data are available on its use in everyday clinical practice in patients with thyroid cancer. METHODS In the off-label program of our institution, we enrolled 14 patients with different histological types of thyroid cancer suitable for treatment with sorafenib. Our aims were to evaluate cardiac safety factors-LVEF (left ventricular ejection fraction), heart rate and blood pressure-the cardiac markers NT-proBNP and troponin I, radiological response evaluated by CT and (18)FDG-PET (according to RECIST 1.1 criteria) and biomarker reduction (Eastern Cooperative Oncology Group Performance Status: ECOG PS) 0-2. RESULTS Patients with ECOG PS 2 accounted for 36%. After starting sorafenib, many patients displayed reduced or stabilized metabolic activity in target lesions (clinical benefit = 44%), radiologic reduction or stabilization (74%) and decreased cancer markers (90%). Lung metastases displayed the largest reductions in size. Median overall survival (OS) was 7 months and median progression-free survival (PFS) was 3 months. No sign of cardiotoxicity was observed in almost all patients. LVEF was altered in two patients and proved symptomatic in one. CONCLUSIONS Sorafenib seems to be effective in reducing disease progression in the early stages of treatment (3-6 months). Responses varied considerably according to the criteria investigated. Cardiac toxicities did not raise concerns and were in line with data reported in other malignancies. However, cardiac monitoring is recommended.
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Affiliation(s)
- L Mortara
- Endocrine Unit, IRCSS IST-San Martino University Hospital, 16132, Genoa, Italy,
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Giusti M, Mortara L, Machello N, Monti E, Pera G, Marenzana M. Utility of a Liquid Formulation of Levo-thyroxine in Differentiated Thyroid Cancer Patients. Drug Res (Stuttg) 2014; 65:332-6. [PMID: 25020105 DOI: 10.1055/s-0034-1384535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The goal of levo-thyroxine (L-T4) administration in differentiated thyroid cancer (DTC) is to suppress thyroid stimulating hormone (TSH) levels. The tolerability and efficacy of a new formulation of liquid L-T4 vs. the previous tablet formulation was evaluated in a cohort of 59 patients with cured DTC. The correlation between breakfast modality and therapy was also monitored. Hormonal and clinical evaluations were performed before and 70 days after patients were switched from tablet to liquid L-T4 formulation, without changes in daily dose. Breakfast habits were evaluated. The interval between L-T4 therapy and breakfast was recorded. Patient approval of L-T4 formulations was evaluated. 8% of patients dropped out owing to adverse events. The modality of L-T4 administration proved adequate under tablet and liquid formulation in 64% and 68% of patients who fully complied with the protocol. While significantly more patients found the tablet formulation more agreeable, at the end of the protocol subjective symptoms had diminished significantly and 73% requested to remain on the liquid formulation. No change in TSH, thyroid hormones or thyroglobulin was noted during the study. A balanced breakfast containing less than 4 g of alimentary fibre did not interfere with L-T4 therapy. Liquid L-T4 seems to be a valid alternative formulation in DTC patients, its initial dislike being outweighed by a significant reduction in subjective symptoms. Both tablet and liquid L-T4 therapy require monitoring over time. A continental breakfast containing less than 4 g of alimentary fibres seems to favour the absorption of L-T4, whether in tablet or liquid formulation.
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Affiliation(s)
- M Giusti
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - L Mortara
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - N Machello
- Service of Clinical Nutrition, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - E Monti
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - G Pera
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - M Marenzana
- Service of Clinical Nutrition, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Fernández-Andújar M, Doornink F, Dacosta-Aguayo R, Soriano-Raya JJ, Miralbell J, Bargalló N, López-Cancio E, Pérez de la Ossa N, Gomis M, Millán M, Barrios M, Cáceres C, Pera G, Forés R, Clemente I, Dávalos A, Mataró M. Remote thalamic microstructural abnormalities related to cognitive function in ischemic stroke patients. Neuropsychology 2014; 28:984-996. [PMID: 24885449 DOI: 10.1037/neu0000087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Ischemic stroke can lead to a continuum of cognitive sequelae, ranging from mild vascular cognitive impairment to vascular dementia. These cognitive deficits can be influenced by the disruption of cortico-subcortical circuits. We sought to explore remote thalamic microstructural abnormalities and their association with cognitive function after ischemic stroke. METHOD Seventeen patients with right hemispheric ischemic stroke and 17 controls matched for age, sex, and years of education were included. All participants underwent neurological, neuropsychological, and diffusion tensor image examination. Patients were assessed 3 months poststroke. Voxel-wise analysis was used to study thalamic diffusion differences between groups. Mean fractional anisotropy (FA) and mean diffusivity (MD) values in significant thalamic areas were calculated for each subject and correlated with cognitive performance. RESULTS Stroke patients showed lower FA values and higher MD values in specific areas of both the left and right thalamus compared with controls. In patients, decreased FA values were associated with lower verbal fluency performance in the right thalamus (R(2) = 0.45, β = 0.74) and the left thalamus (R(2) = 0.57, β = 0.77) after adjusting for diabetes mellitus. Moreover, increased MD values were associated with lower verbal fluency performance in the right thalamus (R(2) = 0.27, β = -0.54) after adjusting for diabetes mellitus. In controls, thalamic FA and MD values were not related to any cognitive function. CONCLUSION Our findings support the hypothesis that ischemic stroke lesions are associated with remote thalamic diffusion abnormalities, and that these abnormalities can contribute to cognitive dysfunction 3 months after a cerebrovascular event.
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Affiliation(s)
| | | | | | | | - Júlia Miralbell
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
| | - Núria Bargalló
- Image Research Platform, Institut d'Investigacions Biomèdiques August Pi i Sunyer
| | - Elena López-Cancio
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
| | | | - Meritxell Gomis
- Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona
| | - Mònica Millán
- Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona
| | - Maite Barrios
- Department of Methodology of Behavioral Sciences, University of Barcelona
| | - Cynthia Cáceres
- Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona
| | - Guillem Pera
- Primary Healthcare Research Support Unit Metropolitana Nord, Institut Universitari d'Investigació en Atenció Prima`ria Jordi Gol, Santa Coloma de Gramenet
| | - Rosa Forés
- Primary Healthcare Research Support Unit Metropolitana Nord, Institut Universitari d'Investigació en Atenció Prima`ria Jordi Gol, Santa Coloma de Gramenet
| | - Imma Clemente
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
| | - Antoni Dávalos
- Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona
| | - Maria Mataró
- Department of Psychiatry and Clinical Psychobiologyr, University of Barcelona
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Caballería L, Pera G, Bernad J, Canut S, Navarro E, Bruguera M. Strategies for the detection of hepatitis C viral infection in the general population. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.01.008] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arteaga I, Buezo I, Expósito C, Pera G, Rodríguez L, Alumà A, Auladell MA, Torán P, Caballería L. [Non-invasive markers of fibrosis in the diagnosis of non-alcoholic fatty liver disease]. Gastroenterol Hepatol 2014; 37:503-10. [PMID: 24746708 DOI: 10.1016/j.gastrohep.2014.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/06/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze the utility of three indices to predict hepatic fibrosis in the detection of non-alcoholic fatty liver disease (NAFLD) as a non-invasive method in primary care. DESIGN We performed a descriptive, cross-sectional, multicenter study with a populational base from 25 primary care centers in the province of Barcelona. PARTICIPANTS Healthy individuals aged 17 to 83 years randomly selected from the Primary Care Computer System. METHODS Medical history, physical examination, and blood analyses were used to determine the following predictive indices of fibrosis; HAIR (hypertension, alanine-aminotransferase, insulin resistance); Fatty Liver Index (FLI) (body mass index, gammaglutamyl-transpeptidase, triglycerides, abdominal perimeter) and Lipid Accumulation Product (LAP) (triglycerides, abdominal perimeter), and abdominal echography. RESULTS We included 702 individuals; 58% were women and the mean age was 53±14 years. The FLI was positive in 30.8%, HAIR was positive in 6.7%, and LAP was positive in 15.5%. Agreement among the three indices ranged from 63.1% to 84.9%, with kappa indices between 0.18 and 0.50. A total of 184 individuals met the echographic criteria of NAFLD, representing a prevalence of 26.29%. The prevalence of NAFLD in patients with positive FLI, HAIR and LAP indices was 46.8%, 68.1% and 56%, respectively. The index with the greatest sensitivity for NAFLD was tFLI≥60 with 84%. Specificity was highest for HAIR and LAP with 97% and 91%, respectively. CONCLUSIONS FLI, HAIR and LAP are highly prevalent and have been shown to be independent markers for the diagnosis of NAFLD. Because of the lack of concordance between the indices, different prevalences are obtained, thus requiring criteria to be unified in order to obtain a more useful index for the diagnosis of NAFLD.
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Affiliation(s)
- Ingrid Arteaga
- Centro de Atención Primara, Vall de Tenes, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España.
| | - Isabel Buezo
- Centro de Atención Primaria, Bufala-Canyet, Badalona, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Carmen Expósito
- Centro de Atención Primaria Sabadell 1A , Sabadell, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Lluís Rodríguez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Alba Alumà
- Servicio de Laboratorio Dr. Robert Badalona, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Badalona, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - M Antònia Auladell
- Centro de Atención Primaria Premià de Mar, Premià de Mar, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | - Llorenç Caballería
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
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Forés R, Alzamora MT, Pera G, Torán P, Urrea M, Heras A. [Concordance between 3 methods of measurement the ankle-brachial index to diagnose peripheral artery disease]. Med Clin (Barc) 2014; 143:335-40. [PMID: 24703416 DOI: 10.1016/j.medcli.2013.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 05/29/2013] [Revised: 09/27/2013] [Accepted: 10/03/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES To determine the concordance of the ankle-brachial index (ABI) determined by automatic measurements (sphygmomanometer Omron and the triple cuff device) using doppler as the gold-standard, computing as well as sensitivity and specificity. PATIENTS AND METHODS ARTPER population cohort subjects, classified as peripheral arterial disease (PAD) if ABI<0.9, calcified if ABI≥1.4 and healthy otherwise. To asses concordance we used kappa index using the 3 categories and the intraclass correlation coefficient (ICC) for ABI continuous values. RESULTS Eighty-eight participants, 52% women, 57-87 years. It was possible to calculate the ABI using doppler for 100%, 97% using Omron and 95% using triple. ABI means (standard deviation) were: doppler 1.089 (0.236), Omron 1.082 (0.110), triple 1.146 (0.134), with poor agreement (ICC doppler/Omron=0.27, doppler/triple=0.13, and triple/Omron=0.39). Categorizing ABI as PAD-healthy-calcified 13.6% (doppler), 6.8% (Omron) and 3.4% (triple) were PAD and 9.1% (doppler), 1.1% (Omron) and 9.1% (triple) were calcified. Kappa indexes were weak (doppler/Omron=0.22, doppler/triple=0.01, triple/Omron=0.17). Both triple and Omron were highly specific (97%) but had very low sensitivity (8 and 33%, respectively) compared to doppler. CONCLUSIONS Concordance of ABI automatic measurements as Omron and triple with doppler was poor, and they do not seem suitable for screening for PAD in primary care consultations.
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Affiliation(s)
- Rosa Forés
- Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Barcelona, España.
| | - Maria Teresa Alzamora
- Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Barcelona, España
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Barcelona, España
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Barcelona, España
| | - Magalí Urrea
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Barcelona, España
| | - Antonio Heras
- Centre d'Atenció Primària Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Barcelona, España
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Alzamora MT, Forés R, Pera G, Torán P, Heras A, Sorribes M, Baena-Diez JM, Urrea M, Alegre J, Viozquez M, Vela C. Ankle-brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort. BMC Cardiovasc Disord 2013; 13:119. [PMID: 24341531 PMCID: PMC3878485 DOI: 10.1186/1471-2261-13-119] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral arterial disease (PAD) of the lower limbs is a cardiovascular disease highly prevalent particularly in the asymptomatic form. Its prevalence starts to be a concern in low coronary risk countries like Spain. Few studies have analyzed the relationship between ankle-brachial index (ABI) and cardiovascular morbi-mortality in low cardiovascular risk countries like Spain where we observe significant low incidence of ischemic heart diseases together with high prevalence of cardiovascular risk factors. The objective of this study is to determine the relationship between pathological ABI and incidence of cardiovascular events (coronary disease, cerebrovascular disease, symptomatic aneurism of abdominal aorta, vascular surgery) and death in the >49 year population-based cohort in Spain (ARTPER). Methods Baseline ABI was measured in 3,786 randomly selected patients from 28 Primary Health Centers in Barcelona, distributed as: ABI<0.9 peripheral arterial disease (PAD), ABI ≥1.4 arterial calcification (AC), ABI 0.9-1.4 healthy; and followed during 4 years. Results 3,307 subjects were included after excluding those with previous vascular events. Subjects with abnormal ABI were older with higher proportion of men, smokers and diabetics. 260 people presented cardiovascular events (incidence 2,117/100,000 person-years) and 124 died from any cause (incidence 978/100,000 person-years). PAD had two-fold greater risk of coronary disease (adjusted hazard ratio (HR) = 2.0, 95% confidence interval (CI) 1.3-3.2) and increased risk of vascular surgery (HR = 5.6, 95%CI 2.8-11.5) and mortality (HR = 1.8, 95%CI 1.4-2.5). AC increased twice risk of cerebrovascular events (HR = 1.9, 95%CI 1.0-3.5) with no relationship with ischemic heart disease. Conclusions PAD increases coronary disease risk and AC cerebrovascular disease risk in low cardiovascular risk Mediterranean population. ABI could be a useful tool to detect patients at risk in Primary Health Care.
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Affiliation(s)
- Maria Teresa Alzamora
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Spain.
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Miralbell J, López-Cancio E, López-Oloriz J, Arenillas JF, Barrios M, Soriano-Raya JJ, Galán A, Cáceres C, Alzamora M, Pera G, Toran P, Dávalos A, Mataró M. Cognitive Patterns in Relation to Biomarkers of Cerebrovascular Disease and Vascular Risk Factors. Cerebrovasc Dis 2013; 36:98-105. [DOI: 10.1159/000352059] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 05/07/2013] [Indexed: 11/19/2022] Open
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López-Olóriz J, López-Cancio E, Arenillas JF, Hernández M, Jiménez M, Dorado L, Barrios M, Soriano-Raya JJ, Miralbell J, Cáceres C, Forés R, Pera G, Dávalos A, Mataró M. Asymptomatic cervicocerebral atherosclerosis, intracranial vascular resistance and cognition: the AsIA-neuropsychology study. Atherosclerosis 2013; 230:330-5. [PMID: 24075765 DOI: 10.1016/j.atherosclerosis.2013.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 05/04/2013] [Revised: 07/28/2013] [Accepted: 08/07/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Carotid atherosclerosis has emerged as a relevant contributor to cognitive impairment and dementia whereas the role of intracranial stenosis and vascular resistance in cognition remains unknown. This study aims to assess the association of asymptomatic cervicocerebral atherosclerosis and intracranial vascular resistance with cognitive performance in a large dementia-free population. METHODS The Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) Neuropsychology Study included 747 Caucasian subjects older than 50 with a moderate-high vascular risk (assessed by REGICOR score) and without history of neither symptomatic vascular disease nor dementia. Extracranial and transcranial color-coded duplex ultrasound examination was performed to assess carotid intima-media thickness (IMT), presence of carotid plaques (ECAD group), intracranial stenosis (ICAD group), and middle cerebral artery pulsatility index (MCA-PI) as a measure of intracranial vascular resistance. Neuropsychological assessment included tests in three cognitive domains: visuospatial skills and speed, verbal memory and verbal fluency. RESULTS In univariate analyses, carotid IMT, ECAD and MCA-PI were associated with lower performance in almost all cognitive domains, and ICAD was associated with poor performance in some visuospatial and verbal cognitive tests. After adjustment for age, sex, vascular risk score, years of education and depressive symptoms, ECAD remained associated with poor performance in the three cognitive domains and elevated MCA-PI with worse performance in visuospatial skills and speed. CONCLUSIONS Carotid plaques and increased intracranial vascular resistance are independently associated with low cognitive functioning in Caucasian stroke and dementia-free subjects. We failed to find an independent association of intracranial large vessel stenosis with cognitive performance.
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Affiliation(s)
- Jorge López-Olóriz
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, 08035 Barcelona, Spain; Institute for Brain, Cognition and Behavior (IR3C), Universitat de Barcelona, 08035 Barcelona, Spain
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Ruiz Comellas A, Pera G, Baena Díez JM, Mundet Tudurí X, Alzamora Sas T, Elosua R, Torán Monserrat P, Heras A, Forés Raurell R, Fusté Gamisans M, Fàbrega Camprubí M. [Validation of a Spanish Short Version of the Minnesota Leisure Time Physical Activity Questionnaire (VREM)]. Rev Esp Salud Publica 2013; 86:495-508. [PMID: 23223762 DOI: 10.4321/s1135-57272012000500004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this study is to develop and validate a shorter version (VREM) of the Spanish version of the Minnesota leisure time Physical Activity Questionnaire (CAFM), in order to have a shorter physical activity questionnaire to be used in Primary Care. METHODS Descriptive study of validation of a new physical activity measurement questionnaire. 200 patients older than 50, who visited one of 5 primary care centers in Barcelona for any reason were selected, with age-sex Catalonia's distribution. Two phases: first, VREM construction through items reduction. Second, validity of VREM against CAFM (gold standard) and test-retest reliability of VREM were analyzed, using kappa index and the intraclass correlation coefficient (ICC). RESULTS 6 items were included in the VREM: Walking, Gardening, Sport/dancing, Climbing stairs, Shopping walking and Cleaning house. The interview using VREM lasted 5 minutes (standard deviation 2). Agreement between both questionnaires, using 4 levels of physical activity, was 95.5% (kappa=0.93). Test-retest reliability of the questionnaire was 92.5% (kappa=0.88). Using a continuous outcome in metabolic energy turnover (MET), VREM also proved to be valid and reliable (ICC=0.95 and ICC=0.96 respectively). CONCLUSION This short version of CAFM has shown good validity and reliability in people ≥50 years.
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Affiliation(s)
- Anna Ruiz Comellas
- Centre d´Atenció Primària Sant Joan de Vilatorrada, Institut Catalá de la Salut (ICS), Sant Joan de Vilatorrada, Barcelona, España.
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de la Poza Abad M, Mas Dalmau G, Moreno Bakedano M, González González AI, Canellas Criado Y, Hernández Anadón S, Rotaeche del Campo R, Torán Monserrat P, Negrete Palma A, Pera G, Borrell Thió E, Llor C, Little P, Alonso Coello P. Rationale, design and organization of the delayed antibiotic prescription (DAP) trial: a randomized controlled trial of the efficacy and safety of delayed antibiotic prescribing strategies in the non-complicated acute respiratory tract infections in general practice. BMC Fam Pract 2013; 14:63. [PMID: 23682979 PMCID: PMC3682866 DOI: 10.1186/1471-2296-14-63] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/10/2013] [Indexed: 11/13/2022]
Abstract
Background Respiratory tract infections are an important burden in primary care and it’s known that they are usually self-limited and that antibiotics only alter its course slightly. This together with the alarming increase of bacterial resistance due to increased use of antimicrobials calls for a need to consider strategies to reduce their use. One of these strategies is the delayed prescription of antibiotics. Methods Multicentric, parallel, randomised controlled trial comparing four antibiotic prescribing strategies in acute non-complicated respiratory tract infections. We will include acute pharyngitis, rhinosinusitis, acute bronchitis and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (mild to moderate). The therapeutic strategies compared are: immediate antibiotic treatment, no antibiotic treatment, and two delayed antibiotic prescribing (DAP) strategies with structured advice to use a course of antibiotics in case of worsening of symptoms or not improving (prescription given to patient or prescription left at the reception of the primary care centre 3 days after the first medical visit). Discussion Delayed antibiotic prescription has been widely used in Anglo-Saxon countries, however, in Southern Europe there has been little research about this topic. The DAP trial wil evaluate two different delayed strategies in Spain for the main respiratory infections in primary care. Trial registration This trial is registered with ClinicalTrials.gov, number http://NCT01363531.
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Caballería L, Arteaga I, Pera G, Rodríguez L, Alumà A, Auladell MA, Torán P. [Risk factors associated with non-alcoholic fatty liver disease: a case-control study]. Med Clin (Barc) 2013; 141:233-9. [PMID: 23601740 DOI: 10.1016/j.medcli.2012.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 07/18/2012] [Revised: 10/29/2012] [Accepted: 11/08/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES To establish the factors associated with the presence of non-alcoholic fatty liver disease (NAFLD) and evaluate the influence of each component constituting the metabolic syndrome (MS) and the risk of developing NAFLD. PATIENTS AND METHODS We performed a multicenter, population-based, observational, analytical study of cases and controls. A case was defined as any patient fulfilling the inclusion criteria and presenting NAFLD by abdominal echography for any reason. A control was randomly selected for each case, from the same health center and of the same age and sex. All the cases underwent anamnesis, physical examination, complete biochemical analyses and determination of MS according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. All the controls also underwent an abdominal echography. RESULTS We included 327 cases and 377 controls with a mean age of 56 ± 12 years for the cases and of 55 ± 13 years for the controls (range: 17 and 80 years); 52.0% of the cases were males and 49.1% of males were controls. The risk factors associated with NAFLD were obesity (odds ratio [OR] 3.82, 95% confidence interval [95% CI] 2.19-6.66), MS (OR 1.73, 95% CI 1.09-2.75), insulin resistance (OR 3.65, 95% CI 2.18-6.12), and an increase in alanine aminotransferase (ALT) (OR 4.72, 95% CI 2.58-8.61) and gamma glutamyl transferase values (GGT) (OR 1.95, 95% CI 1.14-3.34). The components of the MS best predicting NAFLD were hyperglycemia (OR 1.65, 95% CI1.06-2.56) and triglyceride values (OR 1.75, 95% CI1.13-2.72). CONCLUSIONS The independent variables associated with NAFLD were obesity, insulin resistance and elevated ALT and GGT. The components of MS best predicting NAFLD were hyperglycemia and an increase in triglyceride values.
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Affiliation(s)
- Llorenç Caballería
- Centre d'Atenció Primària Premià de Mar, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Premià de Mar, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
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López-Cancio E, Dorado L, Millán M, Reverté S, Suñol A, Massuet A, Galán A, Alzamora MT, Pera G, Torán P, Dávalos A, Arenillas JF. The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) study: prevalence and risk factors. Atherosclerosis 2011; 221:221-5. [PMID: 22245037 DOI: 10.1016/j.atherosclerosis.2011.12.020] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/01/2011] [Accepted: 12/14/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The ongoing population-based Barcelona-Asymptomatic Intracranial Atherosclerosis (Barcelona-AsIA) study is a prospective study that plans to investigate the natural history of asymptomatic intracranial atherosclerosis (AsIA) in a Caucasian-Mediterranean population, which remains unknown until now. The present study aims to determine the prevalence of AsIA and associated risk factors in the final study cohort. METHODS Crossover, population-based study of a representative sample (randomly selected from our reference population) older than 50 with a moderate-high vascular risk assessed by the vascular equation REGICOR and prior history of neither stroke nor ischemic heart disease. Anthropometric, demographic, clinical data and blood samples were collected at baseline. All individuals underwent a complete extracranial and transcranial color-coded duplex (TCCD) examination. TCCD criteria were used to identify and classify the degree of intracranial stenoses. RESULTS A total of 933 subjects (64% men, mean age 66.3 years) were included in the study. One or more intracranial stenoses were detected at baseline in 80 subjects (8.6%) of whom 31 (3.3%) had moderate-severe lesions. The higher the REGICOR scores the greater the prevalence of AsIA (6.6%, 10.2% and 25% for REGICOR scores 5-9, 10-14 and ≥15, p<0.001). Diabetes (OR 2.95; 95% CI (1.68-5.18); p<0.001), age (OR 1.05; 95% CI (1.02-1.08); p=0.001) and hypertension (OR 1.78; 95% CI (1.02-3.13); p=0.04) were independently associated with any degree of AsIA, while diabetes (OR 2.85; 95% CI (1.16-6.96); p=0.02) and age kept independently associated with moderate-severe AsIA. CONCLUSION The prevalence of AsIA and moderate-severe AsIA in stroke-free Caucasians with a moderate-high vascular risk were 8.6% and 3.3% respectively. Diabetes and age were independently associated with moderate-severe AsIA.
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Affiliation(s)
- E López-Cancio
- Department of Neurosciences, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
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Miralbell J, Soriano JJ, Spulber G, López-Cancio E, Arenillas JF, Bargalló N, Galán A, Barrios MT, Cáceres C, Alzamora MT, Pera G, Kivipelto M, Wahlund LO, Dávalos A, Mataró M. Structural brain changes and cognition in relation to markers of vascular dysfunction. Neurobiol Aging 2011; 33:1003.e9-17. [PMID: 22014619 DOI: 10.1016/j.neurobiolaging.2011.09.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 09/05/2011] [Accepted: 09/10/2011] [Indexed: 10/16/2022]
Abstract
The aim was to investigate the relationship between blood markers of vascular dysfunction with brain microstructural changes and cognition. Eighty-six participants from the Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) neuropsychology study were included. Subjects were 50-65 years old, free from dementia and without history of vascular disease. We assessed correlations of blood levels of inflammatory biomarkers (C-reactive protein [CRP] and resistin) and fibrinolysis inhibitors (plasminogen activator inhibitor-1 [PAI-1] and A-lipoprotein (Lp (a)) with fractional anisotropy (FA) measurements of diffusion tensor images (DTI), regional gray matter (GM) volumes and performance in several cognitive domains. Increasing levels of C-reactive protein and PAI-1 levels were associated with white matter (WM) integrity loss in corticosubcortical pathways and association fibers of frontal and temporal lobes, independently of age, sex and vascular risk factors. PAI-1 was also related to lower speed and visuomotor/coordination. None of the biomarkers were related to gray matter volume changes. Our findings suggest that inflammation and dysregulation of the fibrynolitic system may be involved in the pathological mechanisms underlying the WM damage seen in cerebrovascular disease and subsequent cognitive impairment.
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Affiliation(s)
- Julia Miralbell
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
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Puig-Girbau MN, Lladó-Blanch MM, Seco-Salcedo MC, Gómez-Saldaña A, Medina-Peralta M, Riera-Torres R, Pera G. Evaluación de una intervención educativa grupal en el control de pacientes con riesgo cardiovascular. Enfermería Clínica 2011; 21:238-47. [PMID: 21723176 DOI: 10.1016/j.enfcli.2011.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 04/08/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Affiliation(s)
- M Núria Puig-Girbau
- EAP Llefià-Badalona, Institut Català de la Salut, Badalona, Barcelona, España.
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