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Artime E, Romera I, Díaz-Cerezo S, Delgado E. Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review. Diabetes Ther 2021; 12:1631-1659. [PMID: 33942247 PMCID: PMC8179862 DOI: 10.1007/s13300-021-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). The objectives of this systematic literature review were to identify and synthesize published data describing the epidemiology and mortality of CVD in the T2DM population and the associated economic burden. METHODS We conducted a systematic review searching the PubMed and MEDES databases from 2009 to 2019 using predefined selection criteria. Peer-reviewed observational studies reporting primary or secondary data on CVD prevalence, incidence, mortality, resource use and costs in patients with T2DM in Spain, written in English and Spanish, were included. Data were tabulated and summarized descriptively. RESULTS Of 706 articles identified, 52 were included in the review. Most studies were based on data from hospital discharge databases and registries. The reported prevalence of CVD among patients with T2DM ranged from 6.9 to 40.8%. The prevalence of coronary heart disease ranged from 4.7 to 37%, stroke from 3.5 to 19.6%, peripheral artery disease from 2.5 to 13.0%, and heart failure from 4.3 to 20.1%. In-hospital CVD mortality rates ranged from 5.6 to 10.8%. Direct costs due to CVD in hospitalized patients with T2DM were increased (> 50%) compared with patients without CVD. No studies analysed indirect costs of CVD in patients with T2DM. CONCLUSIONS The burden of CVD among patients with T2DM, combined with the elevated costs of care, highlights the importance of early prevention as part of integrated management of the disease to improve clinical and economic outcomes.
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Affiliation(s)
- Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain.
| | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, University of Oviedo, Oviedo, Spain
- Central University Hospital of Asturias, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Spanish Biomedical Research Network in Rare Diseases, Madrid, Spain
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Calvo-Hueros JI, Cañón-Barroso L, Morales-Gabardino JA, Buitrago F. Cardiovascular risk and validation of cardiovascular risk prediction functions in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (SPAIN). AN observational study. Prim Care Diabetes 2021; 15:115-120. [PMID: 32811775 DOI: 10.1016/j.pcd.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022]
Abstract
AIMS To analyse whether diabetes behaves as an equivalent of coronary risk and assess the performance of the original and REGICOR Framingham functions in a cohort of patients with type 2 diabetes observed for 10 years in primary care practices in Badajoz, Spain. METHODS Observational, longitudinal study. A total of 643 patients (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease were studied. We assessed the incidence of cardiovascular events and the patients' 10-year coronary risk predicted-values at the time of their recruitment. RESULT The actual incidence rate of coronary events was 14.5% (15.1% in women and 13.7% in men, p = 0.616). Patients who suffered coronary events were older (66.3 vs 63.6 years, p < 0.05), had higher total cholesterol (236.3 vs 219.5 mg/dl, p < 0.01), fasting plasma glucose levels (177.6 vs 159.8 mg/dl, p < 0.01), glycated haemoglobin (7.3 vs 6.7%, p < 0.05) and also higher prevalence of high blood pressure, dyslipidemia and chronic renal disease. The original Framingham equation overpredicted risk by 88%, whereas the REGICOR Framingham function underpredicted risk by 24%. CONCLUSIONS Diabetes in our cohort does not behave as a coronary heart disease equivalent and both the original and REGICOR Framingham coronary risk functions have little utility in a diabetic population.
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Affiliation(s)
| | | | | | - Francisco Buitrago
- Centro de Salud Universitario "La Paz", Unidad Docente de Medicina Familiar y Comunitaria, Facultad de Medicina, Universidad de Extremadura, Servicio Extremeño de Salud, Badajoz, Spain.
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3
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Gil-Terrón N, Cerain-Herrero MJ, Subirana I, Rodríguez-Latre LM, Cunillera-Puértolas O, Mestre-Ferrer J, Grau M, Dégano IR, Elosua R, Marrugat J, Ramos R, Baena-Díez JM, Salvador-González B. Riesgo cardiovascular en la disminución leve-moderada de la tasa de filtrado glomerular, diabetes y enfermedad coronaria en un área del sur de Europa. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Gil-Terrón N, Cerain-Herrero MJ, Subirana I, Rodríguez-Latre LM, Cunillera-Puértolas O, Mestre-Ferrer J, Grau M, Dégano IR, Elosua R, Marrugat J, Ramos R, Baena-Díez JM, Salvador-González B. Cardiovascular risk in mild to moderately decreased glomerular filtration rate, diabetes and coronary heart disease in a southern European region. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:212-218. [PMID: 30709697 DOI: 10.1016/j.rec.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Individuals with mild to moderately decreased estimated glomerular filtration rate (eGFR=30-59 mL/min/1.73 m2) are considered at high risk of cardiovascular disease (CVD). No studies have compared this risk in eGFR=30-59, diabetes mellitus (DM), and coronary heart disease (CHD) in regions with a low incidence of CHD. METHODS We performed a retrospective cohort study of 122 443 individuals aged 60-84 years from a region with a low CHD incidence with creatinine measured between January 1, 2010 and December 31, 2011. We identified hospital admissions due to CHD (myocardial infarction, angina) or CVD (CHD, stroke, or transient ischemic attack) from electronic medical records up to December 31, 2013. We estimated incidence rates and Cox regression adjusted subdistribution hazard ratio (sHR) including competing risks in patients with eGFR=30-59, DM and CHD, or combinations, compared with individuals without these diseases. RESULTS The median follow-up was 38.3 [IQR, 33.8-42.7] months. Adjusted sHR for CHD in individuals with eGFR=30-59, DM, eGFR=30-59 plus DM, previous CHD, CHD plus DM, and CHD plus eGFR=30-59 plus DM, were 1.34 (95%CI, 1.04-1.74), 1.61 (95%CI, 1.36-1.90), 1.96 (95%CI, 1.42-2.70), 4.33 (95%CI, 3.58-5.25), 7.05 (5.80-8.58) and 7.72 (5.72-10.41), respectively. The corresponding sHR for CVD were 1.25 (95%CI, 1.06-1.46), 1.56 (95%CI, 1.41-1.74), 1.83 (95%CI, 1.50-2.23), 2.86 (95%CI, 2.48-3.29), 4.54 (95%CI, 3.93-5.24), and 5.33 (95%CI, 4.31-6.60). CONCLUSIONS In 60- to 84-year-olds with eGFR=30-59, similarly to DM, the likelihood of being admitted to hospital for CHD and CVD was about half that of individuals with established CHD. Thus, eGFR=30-59 does not appear to be a coronary-risk equivalent. Individuals with CHD and DM, or eGFR=30-59 plus DM, should be prioritized for more intensive risk management.
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Affiliation(s)
- Neus Gil-Terrón
- Centre Atenció Primària El Pla-Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, Spain; Grup de Recerca Malaltia Cardiovascular en Atenció Primària (MACAP) Renal Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
| | - M Jesús Cerain-Herrero
- Grup de Recerca Malaltia Cardiovascular en Atenció Primària (MACAP) Renal Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Àrea Bàsica de Salut Can Vidalet, Servei d'Atenció Primària Baix Llobregat Centre, Direcció Atenció Primària Costa de Ponent, Institut Català de la Salut. Cornellà de Llobregat, Barcelona, Spain
| | - Isaac Subirana
- Grup de Recerca en Genètica i Epidemiologia Cardiovascular, Registre Gironí del Cor (REGICOR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa M Rodríguez-Latre
- Grup de Recerca Malaltia Cardiovascular en Atenció Primària (MACAP) Renal Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, Spain
| | - Oriol Cunillera-Puértolas
- Grup de Recerca Malaltia Cardiovascular en Atenció Primària (MACAP) Renal Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Cornellà de Llobregat, Barcelona, Spain
| | - Jordi Mestre-Ferrer
- Grup de Recerca Malaltia Cardiovascular en Atenció Primària (MACAP) Renal Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Centre d'Atenció Primària Les Sínies, Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Molins de Rei, Barcelona, Spain
| | - Maria Grau
- Grup de Recerca en Genètica i Epidemiologia Cardiovascular, Registre Gironí del Cor (REGICOR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Irene R Dégano
- Grup de Recerca en Genètica i Epidemiologia Cardiovascular, Registre Gironí del Cor (REGICOR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Roberto Elosua
- Grup de Recerca en Genètica i Epidemiologia Cardiovascular, Registre Gironí del Cor (REGICOR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jaume Marrugat
- Grup de Recerca en Genètica i Epidemiologia Cardiovascular, Registre Gironí del Cor (REGICOR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Direcció d'Atenció Primària Girona, Institut Català de la Salut, Girona, Spain
| | - José Miguel Baena-Díez
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Centre Atenció Primària Marina, Servei d'Atenció Primària Litoral Esquerre, Direcció d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Betlem Salvador-González
- Grup de Recerca Malaltia Cardiovascular en Atenció Primària (MACAP) Renal Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Grup de Recerca en Genètica i Epidemiologia Cardiovascular, Registre Gironí del Cor (REGICOR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Àrea Bàsica de Salut Florida Sud, Servei d'Atenció Primària Delta del Llobregat, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain.
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Riesgo de mortalidad total y cardiovascular según la clasificación propuesta por las guías KDIGO en pacientes con diabetes tipo 2. Med Clin (Barc) 2019; 153:263-269. [DOI: 10.1016/j.medcli.2019.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/15/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022]
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6
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Chang LH, Hwu CM, Chu CH, Won JGS, Chen HS, Lin LY. UPSTROKE TIME PER CARDIAC CYCLE IS ASSOCIATED WITH CARDIOVASCULAR PROGNOSIS IN TYPE 2 DIABETES. Endocr Pract 2019; 25:1109-1116. [PMID: 31241364 DOI: 10.4158/ep-2019-0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Upstroke time per cardiac cycle (UTCC) in the lower extremities has been found to be predictive of cardiovascular mortality in the general population. Therefore, the purpose of the study was to test the associations between increasing UTCC and outcomes in patients with type 2 diabetes. Methods: A total of 452 patients with type 2 diabetes (age, 67.5 ± 8.6 years; male, 54%) registered in a share-care program participated in the study at an outpatient clinic in Taipei Veterans General Hospital across a mean of 5.8 years. Primary outcomes were all-cause mortality hospitalization for coronary artery disease, stroke, revascularization, amputation, and diabetic foot syndrome. Secondary end-point outcome was all-cause mortality. Results: Increment of UTCC associations with primary and secondary outcomes were undertaken prior to baseline characteristic adjustments. A UTCC of 20.1% exhibited the greatest area under curve (AUC), sensitivity, and specificity balance to predict composite events in receiver operating curves (AUC, 0.63 [P = .001]; sensitivity, 67.7%; specificity, 54.9%). Sixty-four composite events and 17 deaths were identified from medical records. UTCC ≥20.1% was associated with the occurrence of composite events and an increased risk of mortality. For composite events, an adjusted hazard ratio (HR) of 2.45 and 95% confidence interval (CI) of 1.38 to 4.35 (P = .002) were calculated. For all-cause mortality, an adjusted HR of 1.91 and 95% CI of 0.33 to 10.99 (P = .467) were calculated. Conclusion: Increasing UTCC was associated with cardiovascular outcomes in patients with type 2 diabetes. Therefore, UTCC is advocated as a noninvasive screening tool for ambulatory patients with type 2 diabetes. Abbreviations: CAD = coronary artery disease; CI = confidence interval; eGFR = estimated glomerular filtration rate; HR = hazard ratio; PAD = peripheral artery disease; UTCC = upstroke time per cardiac cycle.
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Baena-Díez JM, Peñafiel J, Subirana I, Ramos R, Elosua R, Marín-Ibañez A, Guembe MJ, Rigo F, Tormo-Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, García-Lareo M, Gómez de la Cámara A, Lapetra J, Quesada M, Marrugat J, Medrano MJ, Berjón J, Frontera G, Gavrila D, Barricarte A, Basora J, García JM, Pavone NC, Lora-Pablos D, Mayoral E, Franch J, Mata M, Castell C, Frances A, Grau M. Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis. Diabetes Care 2016; 39:1987-1995. [PMID: 27493134 DOI: 10.2337/dc16-0614] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/27/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODS We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTS We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONS Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.
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Affiliation(s)
- Jose Miguel Baena-Díez
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Judit Peñafiel
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Isaac Subirana
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Rafel Ramos
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.,Univeristy of Girona, Girona, Spain
| | - Roberto Elosua
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - María Jesús Guembe
- Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.,Knowledge Planning, Evaluation and Management, Health Department, Navarra Government, Pamplona, Spain
| | - Fernando Rigo
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
| | - María José Tormo-Díaz
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.,Murcian Health Departament, Murcia, Spain.,University of Murcia, Murcia, Spain.,Murcian Institute of Biomedical Research, Murcia, Spain
| | - Conchi Moreno-Iribas
- Navarre Public Health Institute, Pamplona, Spain.,Research Network for Health Services in Chronic Disease, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Joan Josep Cabré
- Primary Care Center Sant Pere Centre and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Antonio Segura
- Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain
| | - Manel García-Lareo
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Agustín Gómez de la Cámara
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - José Lapetra
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.,Primary Care Division, Department of Family Medicine, Primary Care Center San Pablo, Sevilla, Spain
| | - Miquel Quesada
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain
| | - Jaume Marrugat
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Jesús Berjón
- Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Guiem Frontera
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
| | - Diana Gavrila
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Health and Consumers Department, Murcia Government, Murcia, Spain
| | - Aurelio Barricarte
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Navarre Public Health Institute, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Josep Basora
- Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Jose María García
- Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain
| | - Natalia C Pavone
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - David Lora-Pablos
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - Eduardo Mayoral
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.,Diabetes Strategy, Andalusia Health Service, Seville, Spain
| | - Josep Franch
- Primary Care Center Raval Sud and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Diabetes and Associated Metabolic Diseases, Madrid, Spain
| | - Manel Mata
- Primary Care Center La Mina and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Conxa Castell
- Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Albert Frances
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | - María Grau
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain .,University of Barcelona, Barcelona, Spain
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[Baseline characteristics and clinical management of the first 3,000 patients enrolled in the IBERICAN study (Identification of the Spanish population at cardiovascular and renal risk)]. Semergen 2016; 43:493-500. [PMID: 27567214 DOI: 10.1016/j.semerg.2016.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the prevalence and incidence of cardiovascular risk factors in Spain, as well as cardiovascular events, in Spanish adult population attended in primary care. METHODOLOGY IBERICAN is a longitudinal, observational, multicenter study in which patients aged 18 to 85years attended in primary care health center in Spain are being included. The obtained cohort will be followed annually for at least 5years. The estimated final sample is 7,000 patients. The baseline characteristics of the second cut (n=3,042) are presented. RESULTS The mean age of the subjects included is 57.9±14.6 years, and 55.5% are women. 54.9% live in urban habitat, and 57.3% have primary education. 50.3% had dyslipidemia, 47.4% hypertension, 29.7% physical inactivity, 28.2% abdominal obesity and 19% diabetes mellitus. The degree of control of hypertension, dyslipidemia and type2 diabetes was 58.5%, 25.8% and 75.9%. 28.2% have criteria for metabolic syndrome. 15.6% of patients had previous cardiovascular disease. 7.8% have a history of coronary heart disease, a glomerular filtration rate <60ml/min (CKD-EPI) 8.4%, microalbuminuria 9.6%, atrial fibrillation 5.5%, stroke 4.6%, and heart failure 2.9%. CONCLUSIONS Although the population treated in primary care is relatively young, the high prevalence of risk factors, their poor control and the existence of previous cardiovascular disease will determine the impact on the prognosis of the cohort.
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Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2013.03.009] [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] Open
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10
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Royo-Bordonada MA, Lobos Bejarano JM, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles RM, Maiques A, Lizcano Á, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines. Neurologia 2016; 31:195-207. [PMID: 23969295 DOI: 10.1016/j.nrl.2013.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 11/20/2022] Open
Abstract
Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.
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Affiliation(s)
| | | | | | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria, España
| | - A Pérez
- Sociedad Española de Diabetes, España
| | | | | | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria, España
| | - Á Lizcano
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria, España
| | - V Lizarbe
- Ministerio de Sanidad, Servicios Sociales e Igualdad, España
| | | | - F Fornés Ubeda
- Sociedad Española de Medicina y Seguridad en el Trabajo, España
| | - R Elosua
- Sociedad Española de Epidemiología, España
| | | | | | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria, España
| | - A Cordero
- Sociedad Española de Cardiología, España
| | | | | | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA, España
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Pedro-Botet J, Chillarón JJ, Benaiges D, Flores-Le Roux JA. [Cardiovascular prevention in diabetes mellitus: A multifactorial challenge]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 28:154-63. [PMID: 26655375 DOI: 10.1016/j.arteri.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 12/21/2022]
Abstract
Patients with type2 diabetes mellitus have a high to very high cardiovascular risk, and often have other associated risk factors, such as hypertension, obesity and dyslipidaemia. Cardiovascular disease is the leading cause of morbidity and mortality in this population. An integrated control of all risk factors in patients with diabetes is essential for minimising the risk of macrovascular complications. Given the benefits of the multifactorial intervention strategies for cardiovascular prevention in diabetic patients, a review is presented on the therapeutic goals established for each risk factor in diabetes and the benefits of their control.
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Affiliation(s)
- Juan Pedro-Botet
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Juan J Chillarón
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - David Benaiges
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Juana A Flores-Le Roux
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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12
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Gimeno-Orna JA, Blasco-Lamarca Y, Campos-Gutierrez B, Molinero-Herguedas E, Lou-Arnal LM, García-García B. Risk of mortality associated to chronic kidney disease in patients with type 2 diabetes mellitus: a 13-year follow-up. Nefrologia 2015; 35:487-92. [PMID: 26306974 DOI: 10.1016/j.nefro.2015.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/17/2015] [Accepted: 05/11/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Our aim was to assess the usefulness of glomerular filtration rate (GFR) and urinary albumin excretion (UAE) to predict the risk of mortality in patients with type 2 diabetes mellitus. MATERIAL AND METHODS This is a prospective cohort study in patients with type 2 diabetes mellitus. Clinical end-point was mortality rate. GFR was measured in ml/min/1.73 m2 and stratified in 3 categories (≥60; 45-59; <45); UAE was measured in mg/24hours and was also stratified in 3 categories (<30; 30-300; >300). Mortality rates were reported per 1000 patient-years. Cox regression models were used to predict mortality risk associated with combined GFR and UAE. The predictive power was estimated with C-Harrell statistic. RESULTS A total of 453 patients (39.3% males), aged 64.9 (SD 9.3) years were included; mean diabetes duration was 10.4 (SD 7.5) years. Median follow-up was 13 years. Total mortality rate was 39.5/1000. The progressive increase in mortality in the successive categories of GFR and UAE was statistically significant (P<.001). In a multivariable analysis, UAE (HR30-300=1.02 and HR>300=2.83; X2=11.6; P =.003) and GFR (HR45-59=1.34 and HR<45=1.84; X2=6.4; P =.041) were independent predictors for mortality, with no significant interaction. Simultaneous inclusion of GFR and UAE improved the predictive power of models (C-Harrell 0.741 vs. 0.726; P =.045). CONCLUSIONS GFR and UAE are independent predictors for mortality in type 2 diabetic patients and do not show a statistically significant interaction.
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Affiliation(s)
| | - Yolanda Blasco-Lamarca
- Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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13
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Amor AJ, Masana L, Soriguer F, Goday A, Calle-Pascual A, Gaztambide S, Rojo-Martínez G, Valdés S, Gomis R, Ortega E. Estimación del riesgo cardiovascular en España según la guía europea sobre prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Franch-Nadal J, Roura-Olmeda P, Benito-Badorrey B, Rodriguez-Poncelas A, Coll-de-Tuero G, Mata-Cases M. Metabolic control and cardiovascular risk factors in type 2 diabetes mellitus patients according to diabetes duration. Fam Pract 2015; 32:27-34. [PMID: 25194144 DOI: 10.1093/fampra/cmu048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Control of glycaemic levels as well as cardiovascular risk factors (CVRF) is essential to prevent the onset of complications associated with type 2 diabetes mellitus (T2DM). AIM To describe the degree of glycaemic control and CVRF in relation to diabetes duration. PATIENTS AND METHODS Multicentre cross-sectional study in T2DM patients seen in primary care centres during 2007. VARIABLES Demographical and clinical characteristics, antidiabetic treatments and development of disease complications. Diabetes duration classification: 0-5, 6-10, 11-20 and >20 years. Logistic regression models were used in the analysis. RESULTS A total of 3130 patients; 51.5% males; mean age: 68±11.7 years; mean diabetes duration:7.0 (±5.6) years, median: 5 (interquartile range:3-9) years; mean HbA1c: 6.84 (±1.5), were analyzed. There has been a progressive decline in HbA1c levels (HbA1c > 7% in 25.8% of patients during the first 5 years and 51.8% after 20 years). Blood pressure values remained relatively stable throughout disease duration. The mean value of low density lipoprotein (LDL) experienced a slight decline with the progression of the disease, but due to the significant increase of cardiovascular disease (CVD) after 20 years of duration, less patients reached the recommended target (LDL < 100mg/dl) in secondary prevention. Logistic regression model controlling for age, sex and CVD showed that diabetes duration was related to glycaemic control (odds ratio: 1.066, 95% confidence interval: 1.050-1.082 per year) but not to blood pressure or LDL control. CONCLUSIONS The degree of glycaemic control and the risk factors in relation to the duration of T2DM followed different patterns. Diabetes duration was associated with a poorer glycaemic control but in general had a limited role in blood pressure control or lipid profile.
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Affiliation(s)
- Josep Franch-Nadal
- Primary Care Center Raval Sud, Barcelona, Spain; Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, Barcelona, Spain;
| | | | | | | | - Gabriel Coll-de-Tuero
- PCC Anglés, Girona, Spain; Research Unit, Healthcare Institute, Girona, Spain; Translab. Departament of Medical Sciences, University of Girona, Girona, Spain and
| | - Manel Mata-Cases
- Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, Barcelona, Spain; PCC La Mina, Sant Adrià de Besòs, Barcelona, Spain
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Amor AJ, Masana L, Soriguer F, Goday A, Calle-Pascual A, Gaztambide S, Rojo-Martínez G, Valdés S, Gomis R, Ortega E. Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. ACTA ACUST UNITED AC 2014; 68:417-25. [PMID: 25444376 DOI: 10.1016/j.rec.2014.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/13/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES There are no nationwide, population-based studies in Spain assessing overall cardiovascular risk. We aimed to describe cardiovascular risk and achievement of treatment goals following the 2012 European Guidelines on cardiovascular disease prevention strategy. We also investigated clinical characteristics (non-classical risk factors) associated with moderate risk. METHODS Participants (n=2310, 58% women) aged 40 to 65 years from a national population-based study (Di@bet.es Study) were identified. First, a priori high/very-high risk individuals were identified. Next, total cardiovascular risk (Systematic Coronary Risk Evaluation equation including high-density lipoprotein cholesterol) was used to assess risk of a priori non-high risk individuals. Variables independently associated with moderate versus low-risk were investigated by multiple logistic regression analysis. RESULTS Age-and-sex standardized (direct method) percentages of high/very-high, moderate, and low-risk were 22.8%, 43.5%, and 33.7%, respectively. Most men were at moderate (56.2%), while 55.4% of women were at low risk. Low-density lipoprotein cholesterol (< 70,<100, < 115 mg/dL) and blood pressure (<140/90 mmHg) goals for very-high, high and moderate risk were met in 15%, 26% and 46%, and 77%, 68% and 85% of the individuals, respectively. Body mass index, high triglycerides concentrations, diastolic blood pressure, and low Mediterranean diet adherence (in women) were independently associated with moderate (versus low) risk. CONCLUSIONS Cardiovascular risk in Spain is mainly moderate in men and low in women. Achievement of treatment goals in high-risk individuals should be improved. The prevalence of non-classical cardiovascular risk factors is elevated in subjects at moderate risk, an important aspect to consider in a population-based strategy to decrease cardiovascular disease in the most prevalent group.
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Affiliation(s)
- Antonio Jesús Amor
- Servicio de Endocrinología y Nutrición, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo, Hospital Universitario Sant Joan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | - Federico Soriguer
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Albert Goday
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, Spain
| | - Alfonso Calle-Pascual
- Servicio de Endocrinología y Nutrición, Hospital Universitario San Carlos , Madrid, Spain
| | - Sonia Gaztambide
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Grupo de Investigación de Diabetes, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Vizcaya, Spain
| | - Gemma Rojo-Martínez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Sergio Valdés
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Ramón Gomis
- Servicio de Endocrinología y Nutrición, Hospital Clínic, IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Emilio Ortega
- Servicio de Endocrinología y Nutrición, Hospital Clínic, IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
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Piniés JA, González-Carril F, Arteagoitia JM, Irigoien I, Altzibar JM, Rodriguez-Murua JL, Echevarriarteun L. Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: the Basque Country Prospective Complications and Mortality Study risk engine (BASCORE). Diabetologia 2014; 57:2324-33. [PMID: 25212259 DOI: 10.1007/s00125-014-3370-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/14/2014] [Indexed: 12/28/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to construct a model for predicting CHD and cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes in a southern European region. External validation of two other cardiovascular risk models and internal validation of our model were assessed. METHODS We studied 65,651 people attending a primary care setting in the Basque Country Health Service. A 10-year prospective population-based cohort study was performed with 777 patients newly diagnosed with type 2 diabetes older than 24 years in a Sentinel Practice Network. Cardiovascular risk factors, CVD events and mortality were registered. Coefficients for the significant predictors of CHD and CVD were estimated using Cox models. We assessed the discrimination and calibration of the UK Prospective Diabetes Study risk engine (UKPDS-RE), the Framingham Risk Score-Regicor Study (FRS-RS) and the cardiovascular risk model we developed. RESULTS The incidence rate per 1,000 patients/year was calculated for microvascular and cardiovascular complications, and death. Age, the ratio of non-HDL- to HDL-cholesterol, HbA1c, systolic blood pressure and smoking were significant predictors of cardiovascular events. A risk model was developed using these predictors. The UKPDS-RE and FRS-RS showed inadequate discrimination (Uno's C statistics 0.62 and 0.58, respectively) and calibration (24% overestimation and 51% underestimation, respectively) for predicting CHD risk. The internal discrimination and calibration of the developed model were acceptable for predicting fatal/non-fatal 2- and 5-, but not 10-year CHD and CVD risk. CONCLUSIONS/INTERPRETATION This study is the first southern European validated population-derived model for predicting 5-year fatal/non-fatal CHD and CVD risk in patients with newly diagnosed type 2 diabetes.
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Affiliation(s)
- José A Piniés
- Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza-Basque Country Health Service, Baracaldo, Bizkaia, Spain
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Chillarón JJ, Roux JAFL, Benaiges D, Pedro-Botet J. Subclinical cardiovascular disease in type 2 diabetes mellitus: To screen or not to screen. World J Clin Cases 2014; 2:415-421. [PMID: 25232543 PMCID: PMC4163762 DOI: 10.12998/wjcc.v2.i9.415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/30/2014] [Accepted: 07/14/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) has risen in recent decades, and cardiovascular disease remains the leading cause of death in this population. Several clinical trials have demonstrated the benefit of tight control of risk factors on the incidence and mortality of cardiovascular disease. However, in clinical practice, few patients achieve the therapeutic goals. The current diagnostic procedures for subclinical cardiovascular disease in T2DM patients have not been shown to improve prognosis or mortality, probably because they do not categorize cardiovascular risk. Thus, clinical practice guidelines do not systematically recommend screening for subclinical atherosclerosis in these patients, although it is known that patients with extra-coronary atherosclerosis, microangiopathy and poorly-controlled cardiovascular risk factors are at high risk for cardiovascular disease. Improvements in the reliability of diagnostic tests, with fewer side effects and better cost efficiency, may better help to stratify cardiovascular risk in this group of patients, and further evaluation on this topic should be considered.
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Albert Fàbregas L, González-Clemente JM. Prevención cardiovascular primaria con estatinas en la diabetes mellitus tipo 2: ¿es hora de cambiar de estrategia? Med Clin (Barc) 2014; 142:358-9. [DOI: 10.1016/j.medcli.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/09/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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[Morbidity and mortality cardiovascular risk in dependence of type 2 diabetes duration]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:122-30. [PMID: 24461345 DOI: 10.1016/j.arteri.2013.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/09/2013] [Accepted: 11/24/2013] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study was aimed to assess the prognostic importance of diabetes duration to predict cardiovascular risk in type 2 diabetic patients. METHODS Prospective cohort study with inclusion of type 2 diabetic patients. Follow-up lasted until the appearance of a cardiovascular event, until death or until 2012. Patients were classified into 5 groups in accordance to diabetes duration and baseline cardiovascular disease (CVD): group 1: ≤ 5 years without CVD; group 2: 6-10 years without CVD; group 3: 11-15 years without CVD; group 4: >15 years without CVD; group 5: baseline CVD independently of diabetes duration. CVD rates were expressed per 1000 patients-year and compared by Kaplan-Meier analysis and Log Rank Test. The predictive power of diabetes duration was evaluated by Cox regression. RESULTS 457 patients, aged 64.9 (DE 9.3) years (38.9% males), were included. Diabetes duration was 10.5 (DE 7.6) years. 125 cardiovascular events occurred during 12.3 years follow-up. Cardiovascular event rates were progressively increased from groups 1 to 5 (group 1: 14.1; group 2: 18.3; group 3: 19.6; group 4: 32.9; group 5: 53.5; p<0.0001, linear tendency). Diabetes duration superior to 15 years significantly increased cardiovascular risk of the patients (HR=1.97; 95%CI: 1.23-3.15; P=.004). CONCLUSIONS It could be useful to consider diabetes duration in order to stratify cardiovascular risk of type 2 diabetic patients.
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Aguilera E, Serra-Planas E, Granada ML, Alonso N, Pellitero S, Pizarro E, Reverter JL, Salinas I, Soldevila B, Mauricio D, Puig-Domingo M. Low prevalence of subclinical atherosclerosis in asymptomatic patients with type 1 diabetes in a European Mediterranean population. Diabetes Care 2014; 37:814-20. [PMID: 24135385 DOI: 10.2337/dc13-1453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the presence of early carotid and coronary atherosclerosis in asymptomatic patients with type 1 diabetes with no history of ischemic heart disease. RESEARCH DESIGN AND METHODS One hundred and fifty patients with type 1 diabetes (58% males; 38.6 ± 8.1 years, 20.4 ± 8.1 years of evolution; HbA1c 8.1 ± 2.3%; 52% nonsmokers; 26% retinopathy; 9% microalbuminuria) and 50 nondiabetic control subjects age and sex matched were studied. Carotid ultrasonography to determine common carotid artery intima-media thickness (c-IMT) and the presence of atheroma plaques and cardiac computed tomography for calcium analysis and quantification (coronary artery calcium score [CACS]) were performed. RESULTS Most patients with type 1 diabetes and control subjects displayed a CACS of 0 (82 vs. 92%). Patients with type 1 diabetes with CACS ≥1 were older and had higher HbA1c (44.5 ± 5.1 vs. 36.7 ± 8.1 years [P < 0.001] and 8.5 ± 1.1 vs. 7.8 ± 1.0% [P < 0.003], respectively) and longer evolution of diabetes (25.4 ± 9.2 vs. 19.3 ± 7.4 years, P < 0.005) and mean c-IMT (0.67 ± 0.18 vs. 0.53 ± 0.11 mm, P < 0.001) compared with patients with CACS of 0. Smoking (P < 0.02), nephropathy (P < 0.05), retinopathy (P < 0.05), and male sex (P < 0.03) were significantly and positively associated with CACS ≥1. Mean c-IMT was significantly higher in patients with type 1 diabetes (0.55 ± 0.14 vs. 0.48 ± 0.14 mm, P < 0.01), and 11% of them presented atheroma plaques (8% of control subjects). Multivariant logistic regression analysis showed that c-IMT was related to CACS (β = 6.87, P < 0.001). CONCLUSIONS A small percentage of patients with type 1 diabetes showed data suggestive of subclinical atherosclerosis. Universal screening of coronary disease in this population is not justified. Carotid ultrasonography may be useful for screening in the subset of patients with cardiovascular risk factors and long disease evolution.
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Affiliation(s)
- Eva Aguilera
- Endocrinology and Nutrition Unit, Department of Medicine, Institute of Research and Hospital Universitari Germans Trias i Pujol, Universitat Aut `onoma de Barcelona, Badalona, Spain.
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Akinpelu OV, Mujica-Mota M, Daniel SJ. Is type 2 diabetes mellitus associated with alterations in hearing? A systematic review and meta-analysis. Laryngoscope 2013; 124:767-76. [DOI: 10.1002/lary.24354] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/01/2013] [Accepted: 07/16/2013] [Indexed: 12/18/2022]
Affiliation(s)
| | - Mario Mujica-Mota
- Department of Otolaryngology-Head and Neck Surgery; The Montreal Children's Hospital; Montreal QC Canada
| | - Sam J. Daniel
- McGill Auditory Sciences Laboratory; McGill University; Montreal QC Canada
- Department of Otolaryngology-Head and Neck Surgery; The Montreal Children's Hospital; Montreal QC Canada
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Royo-Bordonada M, Lobos Bejarano J, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles R, Maiques A, Lizcano Á, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. Comentarios del Comité Español Interdisciplinario de Prevención Cardiovascular (CEIPC) a las Guías Europeas de Prevención Cardiovascular 2012. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Royo-Bordonada MA, Lobos Bejarano JM, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles RM, Maiques A, Lizcano A, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. [Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2013; 25:127-139. [PMID: 23726872 DOI: 10.1016/j.arteri.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.
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Abstract
Type 2 diabetes increases the risk of cardiovascular disease (CVD) from two- to four-fold. In our large Finnish population-based study published in 1998 subjects with medication for type 2 diabetes had as high a risk of fatal and nonfatal myocardial infarction (MI) during the 7- year follow-up as non-diabetic subjects with a prior MI, suggesting that type 2 diabetes is a CVD equivalent. In another large study, including all 3.3 million residents of Denmark, subjects requiring glucose-lowering therapy exhibited a CVD risk similar to that of non-diabetic subjects with a prior MI. Subsequent studies have not systematically replicated aforementioned results. Some studies have supported the concept that type 2 diabetes is a CVD equivalent only in some subgroups, and many studies have reported negative findings. This is likely to be due to many differences across the studies published, for example ethnicity, gender, age and other demographic factors of the populations involved, study design, validation of diabetes status and CVD events, statistical analyses (adjustments for confounding factors), duration of diabetes, and treatment of hyperglycemia among diabetic participants. Varying results reflect the fact that not all diabetic patients are at a similar risk for CVD. Therefore, CVD risk assessment and the tailoring of preventive measures should be done individually, taking into consideration each patient's long-term risk of developing cardiovascular events.
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Affiliation(s)
- Johanna Kuusisto
- Department of Medicine, Centre for Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, P.O.B. 1777, 70211 Kuopio, Finland.
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Rodríguez Poncelas A, Alemán Sánchez J, Álvarez Cosmea A, Serrano Cumplido A, Torres Baile J. Documento de consenso de la Red de Grupos de Estudio de la Diabetes en Atención Primaria de la Salud) sobre el tratamiento de la dislipidemia en la diabetes tipo 2 en prevención primaria. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2013.02.004] [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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Padrós G, Ferrer A, Formiga F, Almeda J, March MA, Pujol R. Dyslipidemia and ischemic cardiopathy associated with duration of diabetes mellitus in the oldest old: the OCTABAIX study. J Am Geriatr Soc 2012; 60:1594-6. [PMID: 22889033 DOI: 10.1111/j.1532-5415.2012.04087.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Magri CJ, Fava S. Should diabetes still be considered a coronary artery disease equivalent? J Cardiovasc Med (Hagerstown) 2012; 13:760-5. [PMID: 22885535 DOI: 10.2459/jcm.0b013e3283577295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diabetes is well established as a cardiovascular risk factor and is currently regarded as a coronary artery disease equivalent. However, some recent data have contradicted the concept. We review the currently available data and usefulness or otherwise of this concept. While the concept of coronary artery disease equivalence has served to highlight the importance of diabetes as a risk factor, it has a number of problems. We propose that it would be more useful to consider diabetes as a myocardial infarction risk equivalent. This is not only more precise and in line with the literature but also conveys better the message that patients with diabetes and one or more previous myocardial infarction(s) are at even higher risk.
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Affiliation(s)
- Caroline J Magri
- Department of Cardiology, Mater Dei Hospital, University of Malta, Malta
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Nakajima K, Matsuo S, Okuyama C, Hatta T, Tsukamoto K, Nishimura S, Yamashina A, Kusuoka H, Nishimura T. Cardiac event risk in Japanese subjects estimated using gated myocardial perfusion imaging, in conjunction with diabetes mellitus and chronic kidney disease. Circ J 2011; 76:168-75. [PMID: 22104035 DOI: 10.1253/circj.cj-11-0857] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac event risk is estimated using quantitative gated myocardial perfusion imaging (MPI) and clinical background in patients with ischemic heart disease. The aim of the present study was to calculate major cardiac event risk and tabulate it in the Heart Risk Table for clinical use of risk stratification. METHODS AND RESULTS Multivariate logistic regression was performed based on a multicenter prognostic database (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated Single-photon emission computed tomography [J-ACCESS investigation]) using MPI (n=2,395). The risk of major cardiac events (cardiac death, non-fatal myocardial infarction and heart failure requiring hospitalization) was estimated using age, ejection fraction (EF), estimated glomerular filtration rate (eGFR) and presence of diabetes mellitus (DM). Age-matched standard eGFR was determined in 77 subjects. Major cardiac event risk was calculated using the equation: risk (%/3 years)=1/(1+Exp(-(-4.699-0.0151×eGFR+0.7998×DM+0.0582×age+0.697×SSS-0.0359×EF))×100, where SSS refers to summed stress scores. Risk was determined without eGFR (the initial version) and using the present formula with eGFR (revised version), with consistent results. DM and chronic kidney disease were major determinants of cardiac events. CONCLUSIONS Cardiac event risk was estimated using MPI defect score and left ventricular EF in conjunction with eGFR and the presence of DM. The risk table might be used for risk evaluation in Japanese patients undergoing MPI.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
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Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS. Rev Esp Cardiol 2011; 64:766-73. [DOI: 10.1016/j.recesp.2011.04.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/29/2011] [Indexed: 12/11/2022]
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Riesgo vascular, diabetes e índice tobillo-brazo. Rev Esp Cardiol (Engl Ed) 2011; 64:729; author reply 729-30. [DOI: 10.1016/j.recesp.2011.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 11/21/2022]
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Valdivielso P, Mancera-Romero J, Sánchez-Chaparro MA. Vascular Risk, Diabetes and the Ankle-Brachial Index. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2011; 64:729. [DOI: 10.1016/j.rec.2011.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Nakajima K, Matsuo S, Okuda K, Wakabayashi H, Tsukamoto K, Nishimura T. Estimation of cardiac event risk by gated myocardial perfusion imaging and quantitative scoring methods based on a multi-center J-ACCESS database. Circ J 2011; 75:2417-23. [PMID: 21799273 DOI: 10.1253/circj.cj-11-0371] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) has been used to estimate cardiac event risk. The aim of the present study is to achieve stable risk estimation based on perfusion scoring and a multi-center prognostic database. METHODS AND RESULTS Multivariate logistic regression analysis was performed to estimate cardiac event risk based on a J-ACCESS study. A stress-MPI was performed in 45 patients with coronary artery disease (CAD) and in 25 non-CAD patients. Perfusion defect scoring of summed stress score (SSS) was performed by 5 methods: (1) visual scoring; (2) automatic scoring of 3 short-axis and 1 vertical long-axis slices; (3) visual modification of Method 2; (4) automatic polar map scoring based on a Japanese multi-center database; and (5) visual modification of Method 4. Agreement of SSS between 2 observers was good (r=0.87-0.97). Agreement of estimated cardiac event risk between observers and among 5 methods was very good (r=0.99-1.00). Regarding diagnostic accuracy for CAD, Method 5 showed optimal diagnostic yields (sensitivity 84%, accuracy 77%). CONCLUSIONS Estimation of cardiac event risk in conjunction with polar map segmentation and common normal databases resulted in stable risk values, and might be used for risk stratification in patients suspected of having CAD.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
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Benaiges D, Goday A, Ramon JM, Hernandez E, Pera M, Cano JF. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis 2011; 7:575-80. [PMID: 21546321 DOI: 10.1016/j.soard.2011.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/02/2011] [Accepted: 03/03/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Very few studies have compared laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) outcomes or analyzed improvement in cardiovascular risk (CVR) after bariatric surgery. None of the studies considered the Mediterranean population. Our primary objective was to compare the 10-year estimated CVR reduction achieved by LRYGB and LSG in Spanish subjects with severe obesity. The secondary objectives were to compare the techniques in terms of weight loss and co-morbidity improvement. The study was performed at a university hospital in Barcelona, Spain. METHODS A 12-month prospective cohort study of 140 consecutive patients (95 LRYGB and 45 LSG) compared the 2 surgical intervention groups to study the percentage of excess weight loss, resolution and improvement/resolution of co-morbidities, and effect on CVR using both the Framingham risk score (FRS) and the Registre Gironí del Cor (REGICOR) model. RESULTS At 12 months, the overall CVR decreased from 6.6% to 3.4% using the FRS and from 3.7% to 1.9% using the REGICOR score. Neither model found a difference between the 2 surgical intervention groups in decreased postoperative CVR risk, with a FRS of 3.4% ± 2.2% for LRYGB versus 3.3% ± 2.1% for LSG (P = .872) and a REGICOR score of 1.9% ± 1.5% versus 1.8% ± 1.6%, respectively (P = .813). No differences were observed in the percentage of excess weight loss or the resolution of type 2 diabetes mellitus and hypertension. The hypercholesterolemia improvement/resolution rate was lower in the LSG group than in the LRYGB group. CONCLUSION Bariatric surgery reduces the estimated CVR by one half at 1 year after surgery. Except for the less-improved cholesterol metabolism, LSG, a restrictive technique, proved to be equally as effective at 1 year of follow-up as LRYGB.
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital Universitari del Mar, Barcelona, Spain.
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Boyko EJ, Meigs JB. Does diabetes always confer coronary heart disease risk equivalent to a prior myocardial infarction?: implications for prevention. Diabetes Care 2011; 34:782-4. [PMID: 21357366 PMCID: PMC3041226 DOI: 10.2337/dc10-1958] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Edward J. Boyko
- From the Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington; the
- Department of Medicine, University of Washington, Seattle, Washington; and the
| | - James B. Meigs
- General Medicine Division, Harvard Medical School, Boston, Massachusetts
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Coll De Tuero G, Rodríguez Poncelas A. Estatinas y diabetes. HIPERTENSION Y RIESGO VASCULAR 2010. [DOI: 10.1016/j.hipert.2010.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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