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Riesgo cardiovascular en la población anciana española. Escala de riesgo EPICARDIAN. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gabriel R, Muñiz J, Vega S, Moral I, Pérez Castro TR, Rodriguez-Salvanés F, Suárez C, Novella B, Brotons C. Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score. Rev Clin Esp 2021; 222:13-21. [PMID: 34565710 DOI: 10.1016/j.rceng.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular risk estimation in people over 70 years of age is problematic. Most scores have been created based on cohorts of middle-aged people, with an underrepresentation of older adults. The predictive power of classical cardiovascular risk factors declines with age. The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain. METHODS This work is a population-based cohort established in 1995. SETTING Three geographical areas of Spain (Madrid, Ávila, and Lugo). PARTICIPANTS 3,729 people older than 64 years with no cardiovascular diseases (CVD) at baseline. MEASUREMENTS Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were investigated annually and confirmed using the WHO-MONICA criteria. All participants were followed-up on until occurrence of a first CVD event, until death, or until December 31, 2015. RESULTS Age was the strongest predictor of CVD at 10 years in both men and women. In men, variables associated with CVD were high blood pressure treatment (HR: 1.35; 95% CI: 1.067-1.710), diabetes (HR: 1.359; 95% CI: 0.997-1.852), and smoking (HR: 1.207; 95% CI: 0.945-1.541) and in women, the variables were smoking (HR: 1.881; 95% CI: 1.356-2.609) and diabetes (HR: 1.285; 95% CI: 0.967-1.707). Total cholesterol did not increase the risk of CVD in men or women. However, total cholesterol levels >200 mg/dL were inversely associated with 10-year risk of CVD in men and women. CONCLUSIONS In elderly Spanish men, total CVD at 10 years is significantly increased by age, diabetes, and antihypertensive treatment and in elderly Spanish women by diabetes and smoking. Total cholesterol levels did not increase the risk of CVD, particularly in males.
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Affiliation(s)
- R Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain.
| | - J Muñiz
- Instituto Universitario de Ciencias de la Salud, Universidad de La Coruña, A Coruña, Spain
| | - S Vega
- Centro de Salud de Arévalo, SACyL, Arévalo, Ávila, Spain
| | - I Moral
- Unidad de Investigación, EAP Sardenya-IIB, Barcelona, Spain
| | - T R Pérez Castro
- Instituto Universitario de Ciencias de la Salud, Universidad de La Coruña, A Coruña, Spain
| | - F Rodriguez-Salvanés
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - C Suárez
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - B Novella
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - C Brotons
- Unidad de Investigación, EAP Sardenya-IIB, Barcelona, Spain
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Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort. Sci Rep 2021; 11:15245. [PMID: 34315938 PMCID: PMC8316319 DOI: 10.1038/s41598-021-94121-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).
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Vázquez-Oliva G, Zamora A, Ramos R, Marti R, Subirana I, Grau M, Dégano IR, Marrugat J, Elosua R. Tasas de incidencia y mortalidad, y letalidad poblacional a 28 días del infarto agudo de miocardio en adultos mayores. Estudio REGICOR. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Forcadell MJ, Vila-Córcoles A, de Diego C, Ochoa-Gondar O, Satué E. Incidence and mortality of myocardial infarction among Catalonian older adults with and without underlying risk conditions: The CAPAMIS study. Eur J Prev Cardiol 2018; 25:1822-1830. [PMID: 30019923 DOI: 10.1177/2047487318788396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Population-based data about the epidemiology of acute myocardial infarction is limited. This study investigated incidence and mortality of acute myocardial infarction in older adults with specific underlying chronic conditions and evaluated the influence of these conditions in developing acute myocardial infarction. DESIGN AND METHODS This was a population-based cohort study involving 27,204 individuals ≥ 60 years of age in Tarragona (Catalonia, Spain). Data on all cases of hospitalised acute myocardial infarction were collected from 1 December 2008-30 November 2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses and underlying conditions. Multivariable Cox regression analysis was used to calculate hazard ratios and to estimate the association between baseline conditions and risk of developing acute myocardial infarction. RESULTS The incidence of acute myocardial infarction was 475 per 100,000 person-years. Maximum rates appeared among individuals with history of coronary artery disease (2839 per 100,000), chronic severe nephropathy (1407 per 100,000), atrial fibrillation (1226 per 100,000), chronic heart disease (1149 per 100,000), history of stroke (1147 per 100,000) and diabetes mellitus (914 per 100,000). Thirty-day mortality was 15.3% overall, reaching 31.6% among patients over 80 years. In the multivariable analysis, history of coronary artery disease, age > 70 years, sex male, chronic heart disease, history of stroke, atrial fibrillation, diabetes mellitus and hypertension emerged as significantly associated with an increased risk of acute myocardial infarction. CONCLUSIONS The incidence and mortality of acute myocardial infarction remain considerable in our setting. Considering classical major risk factors, diabetes mellitus and hypertension were the underlying conditions most strongly associated with an increased risk in our study population.
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Affiliation(s)
- M José Forcadell
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain.,2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
| | - Angel Vila-Córcoles
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain.,2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
| | - Cinta de Diego
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain
| | - Olga Ochoa-Gondar
- 1 Primary Health Care Service 'Camp de Tarragona', Institut Catala de la Salut, Spain.,2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
| | - Eva Satué
- 2 Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Spain
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Vázquez-Oliva G, Zamora A, Ramos R, Marti R, Subirana I, Grau M, Dégano IR, Marrugat J, Elosua R. Acute Myocardial Infarction Population Incidence and Mortality Rates, and 28-day Case-fatality in Older Adults. The REGICOR Study. ACTA ACUST UNITED AC 2017; 71:718-725. [PMID: 29174866 DOI: 10.1016/j.rec.2017.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Our aims were to determine acute myocardial infarction (AMI) incidence and mortality rates, and population and in-hospital case-fatality in the population older than 74 years; variability in clinical characteristics and AMI management of hospitalized patients, and changes in the incidence and mortality rates, case-fatality, and management by age groups from 1996 to 1997 and 2007 to 2008. METHODS A population-based AMI registry in Girona (Catalonia, Spain) including individuals with suspected AMI older than 34 years. RESULTS The incidence rate increased with age from 169 and 28 cases/100 000 per year in the group aged 35 to 64 years to 2306 and 1384 cases/100 000 per year in the group aged 85 to 94 years, in men and women, respectively. Population case-fatality also increased with age, from 19% in the group aged 35 to 64 years to 84% in the group aged 85 to 94 years. A lower population case-fatality was observed in the second period, mainly explained by a lower in-hospital case-fatality. The use of invasive procedures and effective drugs decreased with age but increased in the second period in all ages up to 84 years. CONCLUSIONS Acute myocardial infarction incidence, mortality, and case-fatality increased exponentially with age. There is still a gap in the use of invasive procedures and effective drugs between younger and older patients.
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Affiliation(s)
- Gabriel Vázquez-Oliva
- Departament de Cardiologia, Hospital Sant Joan de Déu, Fundació Althaia, Manresa, Barcelona, Spain; Facultat de Medicina, Universitat de Girona, Girona, Spain
| | - Alberto Zamora
- Facultat de Medicina, Universitat de Girona, Girona, Spain; Unitat de Risc Vascular, Hospital de Blanes, Corporació de Salut del Maresme i la Selva, Blanes, Girona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Rafel Ramos
- Facultat de Medicina, Universitat de Girona, Girona, Spain; Grup de Recerca ISV, Unitat de Recerca en Atenció Primària, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain; Atenció Primària, Serveis Atenció Primària, Institut Català de la Salut (ICS), Girona, Spain
| | - Ruth Marti
- Grup de Recerca ISV, Unitat de Recerca en Atenció Primària, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Isaac Subirana
- Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - María Grau
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - Irene R Dégano
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Central de Cataluña, Vic, Barcelona, Spain
| | - Jaume Marrugat
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
| | - Roberto Elosua
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Grup de Epidemiologia i Genètica Cardiovascular, Grup del estudi REGICOR (REgistre GIroní del COR). IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Central de Cataluña, Vic, Barcelona, Spain.
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Elkhader BA, Abdulla AA, Ali Omer MA. Correlation of Smoking and Myocardial Infarction Among Sudanese Male Patients Above 40 Years of Age. Pol J Radiol 2016; 81:138-40. [PMID: 27081418 PMCID: PMC4818030 DOI: 10.12659/pjr.894068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/24/2015] [Indexed: 02/02/2023] Open
Abstract
To find an association between smoking and the development of myocardial infarction in male patients above forty years of age presenting at the echocardiology department of Sudan heart center Khartoum. A prospective cohort study was carried out at the echocardiography department of Sudan Heart Center in Khartoum-Sudan between July 2012 and June 2014. The study population comprised a total of 168 adult male patients who underwent cardiac ultrasound scanning. Out of a total of 144 cases, 65% (94) of patients were smokers, 74% of the 94 cases smoked for more than 10 years, and 26% of the 94 cases smoked for less than 10 years. With this study it was concluded that smoking is a risk factor for the development of myocardial infarction. This study showed that patients with myocardial infarction are more likely to have a past history of smoking.
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Affiliation(s)
- Bahaaedin A Elkhader
- College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Alsafi A Abdulla
- College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Mohammed A Ali Omer
- College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan; Department of Radiologic Technology, College of Applied Medical Sciences, Qassim University, Buraidah, Sudan
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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] [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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López-Suárez A, Bascuñana-Quirell A, Elvira-González J, Beltrán-Robles M, Aboza-Lobatón A, Solís-Díaz R. Incidencia poblacional de enfermedad cardiovascular y mortalidad en los adultos de 50-75 años. Rev Clin Esp 2013; 213:278-84. [DOI: 10.1016/j.rce.2013.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/22/2013] [Accepted: 01/27/2013] [Indexed: 11/30/2022]
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Suárez AL, Bascuñana-Quirell A, Elvira-González J, Beltrán-Robles M, Aboza-Lobatón A, Solís-Díaz R. Community-based incidence rate of cardiovascular disease and mortality in 50–75-year-old adults. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sicras-Mainar A, Fernández de Bobadilla J, Navarro-Artieda R, Rejas-Gutiérrez J. [All-cause mortality and incidence of major cardiovascular events in hypertensive patients with ASCOT-type profile in a Spanish population setting]. Aten Primaria 2010; 42:420-30. [PMID: 20116891 DOI: 10.1016/j.aprim.2009.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 09/25/2009] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Mediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects. METHODS A retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects. RESULTS A total of 11,104 were included in the analysis; 68.0+/-11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8-1.9) and 1.6 (0.9-2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8-2.8), p<0.001], as well as in ASCOT-LLA subjects [1.8 (1.3-2.4), p<0.001]. CONCLUSIONS Hypertensive patients on treatment with ASCOT-type profile are more likely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain.
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Affiliation(s)
- Antoni Sicras-Mainar
- Dirección de Planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, España.
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Vila-Corcoles A, Hospital-Guardiola I, Ochoa-Gondar O, de Diego C, Salsench E, Raga X, Fuentes-Bellido CM. Rationale and design of the CAPAMIS study: effectiveness of pneumococcal vaccination against community-acquired pneumonia, acute myocardial infarction and stroke. BMC Public Health 2010; 10:25. [PMID: 20085658 PMCID: PMC2822825 DOI: 10.1186/1471-2458-10-25] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 01/19/2010] [Indexed: 11/20/2022] Open
Abstract
Background The 23-valent polysaccharide pneumococcal vaccine (PPV-23) is recommended for elderly and high-risk people, although its effectiveness is controversial. Some studies have reported an increasing risk of acute vascular events among patients with pneumonia, and a recent case-control study has reported a reduction in the risk of myocardial infarction among patients vaccinated with PPV-23. Given that animal experiments have shown that pneumococcal vaccination reduces the extent of atherosclerotic lesions, it has been hypothesized that PPV-23 could protect against acute vascular events by an indirect effect preventing pneumonia or by a direct effect on oxidized low-density lipoproteins. The main objective of this study is to evaluate the clinical effectiveness of PPV-23 in reducing the risk of pneumonia and acute vascular events (related or nonrelated with prior pneumonia) in the general population over 60 years. Methods/Design Cohort study including 27,000 individuals 60 years or older assigned to nine Primary Care Centers in the region of Tarragona, Spain. According to the reception of PPV-23 before the start of the study, the study population will be divided into vaccinated and nonvaccinated groups, which will be followed during a consecutive 30-month period. Primary Care and Hospitals discharge databases will initially be used to identify study events (community-acquired pneumonia, hospitalisation for acute myocardial infarction and stroke), but all cases will be further validated by checking clinical records. Multivariable Cox regression analyses estimating hazard ratios (adjusted for age, sex and comorbidities) will be used to estimate vaccine effectiveness. Discussion The results of the study will contribute to clarify the controversial effect of the PPV-23 in preventing community-acquired pneumonia and they will be critical in determining the posible role of pneumococcal vaccination in cardiovascular prevention.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Service of Tarragona-Valls, Institut Catalá de la Salut, Tarragona, Spain
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Gabriel R, Alonso M, Reviriego B, Muñiz J, Vega S, López I, Novella B, Suárez C, Rodríguez-Salvanés F. Ten-year fatal and non-fatal myocardial infarction incidence in elderly populations in Spain: the EPICARDIAN cohort study. BMC Public Health 2009; 9:360. [PMID: 19778417 PMCID: PMC2761893 DOI: 10.1186/1471-2458-9-360] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 09/24/2009] [Indexed: 11/24/2022] Open
Abstract
Background In Spain, more than 85% of coronary heart disease deaths occur in adults older than 65 years. However, coronary heart disease incidence and mortality in the Spanish elderly have been poorly described. The aim of this study is to estimate the ten-year incidence and mortality rates of myocardial infarction in a population-based large cohort of Spanish elders. Methods A population-based cohort of 3729 people older than 64 years old, free of previous myocardial infarction, was established in 1995 in three geographical areas of Spain. Any case of fatal and non-fatal myocardial infarction was investigated until December 2004 using the "cold pursuit method", previously used and validated by the the WHO-MONICA project. Results Men showed a significantly (p < 0.001) higher cumulative incidence of myocardial infarction (7.2%; 95%CI: 5.94-8.54) than women (3.8%; 95%CI: 3.06-4.74). Although cumulative incidence increased with age (p < 0.05), gender-differences tended to narrow. Adjusted incidence rates were higher in men (957 per 100 000 person-years) than in women (546 per 100 000 person-years) (p < 0.001) and increased with age (p < 0.001). The increase was progressive in women but not in men. Adjusted mortality rates were also higher in men than in women (p < 0.001), being three times higher in the age group of ≥ 85 years old than in the age group of 65-74 years old (p < 0.001). Conclusion Incidence of fatal and non-fatal myocardial infarction is high in the Spanish elderly population. Men show higher rates than women, but gender differences diminish with age.
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Affiliation(s)
- Rafael Gabriel
- Unidad de Investigación, Red RECAVA, Hospital Universitario La Paz, Madrid, Spain.
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