Comparative effect of different physical exercise training on exercise capacity and cardiac function in heart failure with preserved ejection fraction: a network meta-analysis-ExIC-FEp Study

AIMS

This network meta-analysis aimed to compare the effect of different types of physical exercise [endurance training, endurance/resistance training, and high-intensity interval training (HIIT)] on exercise capacity and cardiac function parameters in patients with heart failure with preserved ejection fraction.

METHODS AND RESULTS

A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different physical exercise training programmes on exercise capacity and cardiac function in heart failure with preserved ejection fraction. Comparative evaluation of the effect of exercise training type was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between exercise training types and controls/non-interventions. Eleven studies were included in the analysis showing that endurance training improves the main exercise capacity parameters (VO2peak, workload, exercise time, peak heart rate, VO2, and 6 min walk distance). Additionally, endurance/resistance training showed a significant effect on VO2peak, workload, early mitral annulus velocity, and early mitral/mitral annulus velocity ratio. Finally, HIIT showed a significant effect on VO2peak, VO2, and the early mitral/mitral annulus velocity ratio.

CONCLUSION

Our findings support the effect of three different types of physical exercise on exercise capacity, mainly VO2peak. Additionally, endurance/resistance training and HIIT could reverse left ventricular remodelling in patients with heart failure with preserved ejection fraction.

REGISTRATION

PROSPERO: CRD42021276111.

Are Physical Activity Interventions Effective in Improving Health-Related Quality of Life in Children and Adolescents? A Systematic Review and Meta-Analysis

CONTEXT

Physical activity (PA) interventions improve well-being and positive mental health in children and adolescents, but the results of previous systematic reviews included participants with chronic medical conditions and did not accurately assess the multidimensional nature of health-related quality of life (HRQoL).

OBJECTIVE

The aims of this meta-analysis were to (1) evaluate the effects of PA interventions on several domains of HRQoL in healthy <18-year-olds and (2) examine the effectiveness of interventions on HRQoL according to whether they were successful in increasing PA, the type of intervention delivered, and the duration of the intervention.

DATA SOURCES

PubMed (Medline), EMBASE, the Cochrane Library, SCIELO, SPORTDiscus, and PEDro databases were systematically searched from inception to September 30, 2022.

STUDY SELECTION

Experimental studies that examined the effectiveness of PA interventions on HRQoL participants aged <18 years.

STUDY DESIGN

Systematic review with meta-analysis and meta-regression.

LEVEL OF EVIDENCE

Level 1.

METHODS

Random-effects models were used to calculate pooled effect size (ES) for total HRQoL score and its dimensions. Subgroup analyses were conducted to examine the effect of PA program characteristics.

RESULTS

A total of 17 studies were included. Pooled ES (95% CI) estimations were as follows: 0.179 (0.045, 0.002) for total HRQoL score, 0.192 (0.077, 0.306) for physical well-being, 0.158 (0.080, 0.237) for psychological well-being, 0.118 (0.044, 0.192) for autonomy and parent relation, 0.135 (0.043, 0.227) for social support and peers, and 0.129 (-0.013, 0.270) for school environment. Subgroup analyses suggested there were no differences in the effectiveness of the interventions by category of PA increase or by type and duration of intervention.

CONCLUSION

Exercise interventions are an effective strategy for improving overall HRQoL and its most significant domains in children and adolescents.

Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis

Background

Multicomponent physical exercise is the most recommended type of physical intervention in older adults. Experimental data suggest the relevance of the muscle-brain axis and the relationship between muscle contraction and release of brain-derived neurotrophic factor, however, the impact of this relationship on cognition remains unclear, especially in people with diagnosis of cognitive impairment. This study assesses the effect of multicomponent physical exercise on global cognition in people with mild cognitive impairment or dementia.

Methods

Randomized controlled trials published until January 2021 were searched across three electronic databases (PubMed, Scopus, and Cochrane Database). Data about exercises included in the multicomponent intervention (endurance, strength, balance, or flexibility), the inclusion of aerobic exercise, and the change in global cognition were extracted. The effect size was represented as a standardized mean difference. Risk of bias was assessed by the RoB2 tool.

Results

A total of 8 studies were included. The overall effect size suggested an effect of multicomponent exercise on global cognition. However, the subgroup analysis showed an effect only when aerobic exercise was included in the intervention. No effect when mild cognitive impairment and dementia were assessed separately was found.

Conclusion

This study suggests that multicomponent physical exercise could have an effect on global cognition in people with mild cognitive impairment or dementia only when aerobic exercise is included in the intervention. Our results support the inclusion of structured physical exercise programs in the management of people with cognitive impairment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03302-1.

Effect of physical activity on cognitive domains in dementia and mild cognitive impairment: overview of systematic reviews and meta-analyses

OBJECTIVE

To assess the effect of physical activity on cognitive domains in persons with dementia or mild cognitive impairment.

DESIGN

An overview of systematic reviews and meta-analyses of randomized controlled trials were performed.

METHODS

A literature search was performed in PubMed, Scopus, and Cochrane Database of Systematic Reviews databases up to February 2020. Data about the change in cognitive domains after physical activity intervention was extracted and plotted.

RESULTS

We included 11 meta-analyses in this overview. The most frequent type of physical activity for the intervention group was the aerobic exercise with a duration between 6 and 78 weeks. Global cognition was the most common form of assessing the cognitive function, follow of executive function, delayed recall, attention, and verbal fluency. We found a positive effect of physical activity on global cognition, executive function, and delayed recall, but no effect on verbal fluency, attention, and immediate recall.

CONCLUSION

Physical activity shows a positive effect on cognition in people with dementia and mild cognitive impairment, especially when it was assessed as global cognition. Positive effects on executive function and memory were also shown. This result confirms the relevance of physical activity in the treatment of persons with cognitive impairment.

Relationship between both cardiorespiratory and muscular fitness and health-related quality of life in children and adolescents: a systematic review and meta-analysis of observational studies

Background

No review to date has evaluated the association between physical fitness and health-related quality of life (HRQoL) in healthy children and adolescents. The aims of this systematic review and meta-analysis were to examine the relationship between both cardiorespiratory fitness (CRF) and muscular fitness (MF) and HRQoL in healthy subjects under 18 years of age and to describe the dimensions of HRQoL in which these relationships are more robust.

Methods

The Medline, Embase, Cochrane Library, SCIELO, SPORTDiscus and PEDro databases were systematically searched to collect observational studies that examined the relationship between CRF and HRQoL and between MF and HRQoL in participants under 18 years of age without any diagnosed medical condition. Pooled effect sizes (ES) were estimated for the associations between both CRF and MF and the various HRQoL dimensions.

Results

The pooled ES (95% CI) estimates for the relationship between CRF and HRQoL were as follows: 0.19 (0.10 to 0.27) for physical well-being, 0.19 (0.07 to 0.32) for psychological well-being, 0.20 (− 0.14 to 0.55) for perceived health status, 0.10 (0.00 to 0.20) for self-perception/self-esteem, 0.07 (− 0.05 to 0.19) for quality of family relationship, 0.14 (0.04 to 0.25) for quality of peer relationship, 0.17 (0.04 to 0.29) for everyday functioning at school and 0.20 (0.12 to 0.28) for total HRQoL score. The pooled ES (95% CI) estimates for the relationship between MF and HRQoL were: 0.25 (0.12 to 0.37) for physical well-being, 0.11 (0.04 to 0.17) for psychological well-being, 0.08 (0.01 to 0.15) for quality of family relationship, 0.14 (0.03 to 0.25) for quality of peer relationship, and 0.09 (0.03 to 0.14) for total HRQoL score.

Conclusions

Our data suggest that both CRF and MF are positively associated with HRQoL, mainly in physical, psychological and peer relationships. Moreover, CRF is positively associated with school dimensions and MF is positively associated with family relationships.

Trail registration Protocol PROSPERO registration number: CRD42015025823.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01766-0.

The Short-term Effect of Graded Motor Imagery on the Affective Components of Pain in Subjects with Chronic Shoulder Pain Syndrome: Open-Label Single-Arm Prospective Study

OBJECTIVE

To determine the short-term effect of graded motor imagery (GMI) on the affective components of pain and range of motion in subjects with chronic shoulder pain syndrome.

DESIGN

Open-label single-arm prospective study.

SETTING

The Physical Therapy Laboratory, Universidad de las Americas.

SUBJECTS

One hundred seven patients with chronic shoulder pain syndrome.

METHODS

The subjects received a six-week GMI program based on laterality training, imagined movements, and mirror therapy. We assessed pain intensity using a visual analog scale (VAS), fear of movement was assessed using the Tampa Scale of Kinesiophobia (TSK), and catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The patient's flexion active range of motion (AROM) was also recorded.

RESULTS

At the end of treatment, the VAS showed a decrease of 4.2 cm (P < 0.001, Cohen's d = 3.3), TSK showed a decrease of 17.0 points (P < 0.001, Cohen's d = 2.8), catastrophizing showed a decrease of 19.2 points (P < 0.001, Cohen's d = 3.2), and shoulder flexion AROM showed an increment of 30.3º (P < 0.000, Cohen's d = 1.6).

CONCLUSIONS

We conclude that a short-term GMI program improves the affective components of pain and shoulder flexion AROM in patients with chronic shoulder pain syndrome.

Rationale and methods of a randomized clinical trial to compare specific exercise programs versus home exercises in patients with subacromial impingement syndrome

BACKGROUND

Subacromial impingement syndrome (SIS) is a common clinical condition with a multifactorial etiology. Currently, there is a great variety of therapeutic exercise modalities aimed at treating SIS. Based on alterations of the glenohumeral and/or dysfunctional scapular kinematics associated with SIS, we hypothesize that the implementation of a specific exercise program with special focus on the correction of muscle deficits should be more effective than nonspecific exercises performed at home. This article describes the rationale and methods of study aimed at testing the effectiveness of specific exercise programs versus home exercises in patients with SIS.

METHOD/DESIGN

Ninety-four patients between the ages of 18 and 50 years referred to the Physical Therapy department of the Clinical Hospital San Borja Arriaran in Chile will be randomized to 2 treatment arms. The intervention group will receive a program of specific exercises with a duration of 12 weeks, taking as a reference the algorithm of clinical decision proposed by a panel of experts. The control group will receive a program of nonspecific exercises to perform at home. Three evaluations will be performed: before the initiation of treatment, and at the 12-week and 1-year follow-up. The primary outcome measure will be the shoulder function by the Constant-Murley questionnaire, and the secondary outcome measures will be the upper extremity function by the Disabilities of the Arm, Shoulder and Hand questionnaire, and pain by the visual analog scale.

DISCUSSION

This article reports the design of a randomized clinical trial aimed at assessing the effectiveness of a specific exercise program versus home exercises in patients with SIS.

TRIAL REGISTRATION

Brazilian registry of clinical trials UTN number U1111-1204-0268. Registered 27 September 2017.

Milk and Dairy Product Consumption and Cardiovascular Diseases: An Overview of Systematic Reviews and Meta-Analyses

Milk and dairy products containing milk fat are major food sources of saturated fatty acids, which have been linked to increased risk of cardiovascular-related clinical outcomes such as cardiovascular disease (CVD), coronary heart disease (CHD), and stroke. Therefore, current recommendations by health authorities advise consumption of low-fat or fat-free milk. Today, these recommendations are seriously questioned by meta-analyses of both prospective cohort studies and randomized controlled trials (RCTs) reporting inconsistent results. The present study includes an overview of systematic reviews and meta-analyses of follow-up studies, an overview of meta-analyses involving RCTs, and an update on meta-analyses of RCTs (2013-2018) aiming to synthesize the evidence regarding the influence of dairy product consumption on the risk of major cardiovascular-related outcomes and how various doses of different dairy products affect the responses, as well as on selected biomarkers of cardiovascular disease risk, i.e., blood pressure and blood lipids. The search strategies for both designs were conducted in the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception to April 2018. From the 31 full-text articles retrieved for cohort studies, 17 met the eligibility criteria. The pooled risk ratio estimated for the association between the consumption of different dairy products at different dose-responses and cardiovascular outcomes (CVD, CHD, and stroke) showed a statistically significant negative association with RR values <1, or did not find evidence of significant association. The overview of 12 meta-analyses involving RCTs as well as the updated meta-analyses of RCTs did not result in significant changes on risk biomarkers such as systolic and diastolic blood pressure and total cholesterol and LDL cholesterol. Therefore, the present study states that the consumption of total dairy products, with either regular or low fat content, does not adversely affect the risk of CVD.

EVIDENT Smartphone App, a New Method for the Dietary Record: Comparison With a Food Frequency Questionnaire

BACKGROUND

More alternatives are needed for recording people's normal diet in different populations, especially adults or the elderly, as part of the investigation into the effects of nutrition on health.

OBJECTIVE

The aim of this study was to compare the estimated values of energy intake, macro- and micronutrient, and alcohol consumption gathered using the EVIDENT II smartphone app against the data estimated with a food frequency questionnaire (FFQ) in an adult population aged 18 to 70 years.

METHODS

We included 362 individuals (mean age 52 years, SD 12; 214/362, 59.1% women) who were part of the EVIDENT II study. The participants registered their food intake using the EVIDENT app during a period of 3 months and through an FFQ. Both methods estimate the average nutritional composition, including energy intake, macro- and micronutrients, and alcohol. Through the app, the values of the first week of food recording, the first month, and the entire 3-month period were estimated. The FFQ gathers data regarding the food intake of the year before the moment of interview.

RESULTS

The intraclass correlation for the estimation of energy intake with the FFQ and the app shows significant results, with the highest values returned when analyzing the app's data for the full 3-month period (.304, 95% CI 0.144-0.434; P<.001). For this period, the correlation coefficient for energy intake is .233 (P<.001). The highest value corresponds to alcohol consumption and the lowest to the intake of polyunsaturated fatty acids (r=.676 and r=.155; P<.001), respectively. The estimation of daily intake of energy, macronutrients, and alcohol presents higher values in the FFQ compared with the EVIDENT app data. Considering the values recorded during the 3-month period, the FFQ for energy intake estimation (Kcal) was higher than that of the app (a difference of 408.7, 95% CI 322.7-494.8; P<.001). The same is true for the other macronutrients, with the exception g/day of saturated fatty acids (.4, 95% CI -1.2 to 2.0; P=.62).

CONCLUSIONS

The EVIDENT app is significantly correlated to FFQ in the estimation of energy intake, macro- and micronutrients, and alcohol consumption. This correlation increases with longer app recording periods. The EVIDENT app can be a good alternative for recording food intake in the context of longitudinal or intervention studies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02016014; http://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/760i8EL8Q).

Role of Physical Activity and Fitness in the Characterization and Prognosis of the Metabolically Healthy Obesity Phenotype: A Systematic Review and Meta-analysis

The aims of the present article are to systematically review and meta-analyze the existing evidence on: 1) differences in physical activity (PA), sedentary behavior (SB), cardiorespiratory fitness (CRF) and muscular strength (MST) between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO); and 2) the prognosis of all-cause mortality and cardiovascular disease (CVD) mortality/morbidity in MHO individuals, compared with the best scenario possible, i.e., metabolically healthy normal-weight (MHNW), after adjusting for PA, SB, CRF or MST. Our systematic review identified 67 cross-sectional studies to address aim 1, and 11 longitudinal studies to address aim 2. The major findings and conclusions from the current meta-analysis are: 1) MHO individuals are more active, spend less time in SB, and have a higher level of CRF (yet no differences in MST) than MUO individuals, suggesting that their healthier metabolic profile could be at least partially due to these healthier lifestyle factors and attributes. 2) The meta-analysis of cohort studies which accounted for PA (N = 10 unique cohorts, 100% scored as high-quality) support the notion that MHO individuals have a 24-33% higher risk of all-cause mortality and CVD mortality/morbidity compared to MHNW individuals. This risk was borderline significant/non-significant, independent of the length of the follow-up and lower than that reported in previous meta-analyses in this topic including all type of studies, which could be indicating a modest reduction in the risk estimates as a consequence of accounting for PA. 3) Only one study has examined the role of CRF in the prognosis of MHO individuals. This study suggests that the differences in the risk of all-cause mortality and CVD mortality/morbidity between MHO and MHNW are largely explained by differences in CRF between these two phenotypes.

Reliability and validity of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ-SP) in school-age children

BACKGROUND

Sleep disorders in schoolchildren are a common problem worldwide, and when are not adequately diagnosed and treated, their negative impact on daytime functioning may be significant. The aim of this study was to evaluate the psychometric properties of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ).

METHODS

Participants were 286 school-aged children from a community-based sample, aged 4 to 7 years. The sleep behaviour was evaluated using the CSHQ and actigraphy (ActiSleep monitor). The CSHQ was adapted to the Spanish language. The internal consistency of the questionnaire and the test-retest reliability between scores at baseline and three-weeks-later were estimated. Associations between CSHQ items and accelerometer sleep quality indicators were used as indicators of concurrent validity.

RESULTS

Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.81, and 0.81 for the full scale; the intraclass correlation coefficients ranged from 0.56 to 0.81. A moderate correlation was observed in sleep latency and awakenings measurements using both parents' reported sleep habits (CSHQ-SP) and sleep quality indicators (ActiSleep).

CONCLUSIONS

The CSHQ-SP has demonstrated adequate psychometric properties, and it serves as a useful instrument for clinical and research setting.

Rationale and methods of a randomised cross-over cluster trial to assess the effectiveness of MOVI-KIDS on preventing obesity in pre-schoolers

BACKGROUND

Childhood obesity has become an alarming worldwide increasing public health problem. The earlier adiposity rebound occurs, the greater the risk of becoming obese during puberty and adolescence. It has been speculated about the potential influence of vigorous physical activity on modifying the age of onset of adiposity rebound. Moreover, studies aimed to evaluate the effectiveness of physical activity interventions programs on reducing adiposity and other cardiovascular risk factors in children younger than 6 years are scarce. This paper describes the rationale and methods of a study aimed to test the effectiveness of a two-years multidimensional pre-school intervention on preventing obesity and improving physical fitness during the adiposity rebound period.

METHODS/DESIGN

Twenty-one schools from the provinces of Cuenca and Ciudad Real, Spain, were randomised to an intervention and a control arm. In the first academic year, children in third grade of pre-school and first grade of primary school in the intervention group received the physical activity intervention (MOVI-KIDS). After an academic year schools were crossed over to the alternative arm. According to the socio-ecological model, the intervention included children, their parents and teachers, and the school environment where MOVI-KIDS was conducted. MOVI-KIDS consisted of: i) three-h/week sessions of recreational non-competitive physical activity in after-school time; ii) educational materials to parents and teachers about physical activity benefits and sedentary lifestyle risks; and iii) modifications in the playground to promote physical activity during recess. Baseline and post-intervention outcomes are going to be measured in both arms three times, at the beginning and at the end of first academic year, and at the end of the second academic year. Primary outcomes included body mass index, waist circumference, triceps skinfold thickness, percentage of both body fat and fat-free mass, and blood pressure. Secondary end points were physical activity, fitness, and carotid intima-media thickness.

DISCUSSION

This paper reports the design of a randomised cross-over cluster trial aimed at assessing the effectiveness of the multidimensional physical activity intervention (MOVI-KIDS) during two years in pre-school children.

TRIAL REGISTRATION

Clinical trials.gov: NCT01971840 . (Date of registration: Initial Release: 10/07/2013; Record Verification: 23/10/2013).

Validity of the Connor Davidson Resilience scale (CD-RISC) in people from 60-to-75 years old

The aim of this study was to evaluate the psychometric properties of the Spanish version of the CD-RISC in community dwelling older people, and compare its factorial structure with the original one. We used the following scales: CD-RISC (resilience), PSS (perceived stress), the mental component of the SF-12, GDS (Geriatric Depression) and MOS (social support). It was finally a scale with three dimensions including 17 items. Convergent validity was performed to test whether the means of the variables used are significantly associated with resilience and global scores of Spanish version of CD-RISC scale were directly correlated with the scores of MOS and mental component of SF-12, and inversely related with the scores of PSS and GDS scales. In conclusion the Spanish CD-RISC scale includes 17 items divided into three dimensions, shows acceptable psychometric properties and correlates with social support, perceived stress, depression and mental component of quality of life.

Bicycling to school is associated with improvements in physical fitness over a 6-year follow-up period in Swedish children

OBJECTIVE

To examine whether modes of commuting to school at baseline and changes in commuting were related to 6-year changes in cardiorespiratory fitness in youth.

METHODS

A total of 262 (142 girls) Swedish children (9 years at entry) were measured at baseline (1998/9) and follow-up (2004/5). Mode of commuting to school was assessed by questionnaire and fitness by a maximal bicycle test.

RESULTS

At baseline, 34% of children used passive modes of commuting (e.g., car, motorcycle, bus, train), 54% walked, and 12% bicycled to school. Six years later the percentage of bicyclists increased 19% and the percentage of walkers decreased 19%. On average, children who bicycled to school increased their fitness 13% (p=0.03) more than those who used passive modes and 20% (p=0.002) more than those who walked. Children who used passive modes or walked at baseline and bicycled to school at 6 years later increased their fitness 14% (p=0.001) more than those who remained using passive modes or walking at follow-up.

CONCLUSIONS

Implementing initiatives that encourage bicycling to school may be a useful strategy to increase cardiorespiratory fitness of children.

Self-reported and measured cardiorespiratory fitness similarly predict cardiovascular disease risk in young adults

We aimed to (a) examine the validity and reliability of the International FItness Scale (IFIS) in Spanish young adults and (b) compare the capacity of self-reported vs measured fitness to predict cardiovascular disease (CVD) risk. The study comprised 276 participants (18-30 years). Fitness level (overall and specific components) was both self-reported (IFIS) and measured using standard fitness tests. Total and trunk fat was assessed by dual-energy X-ray absorptiometry. We computed a previously validated metabolic syndrome score. A separate sample of 181 of same age and characteristics fulfilled IFIS twice for reliability purposes. The results of the present study support the validity and reliability of self-reported fitness, as measured by IFIS, in Spanish young adults. Our data also suggest that not only measured cardiorespiratory fitness but also self-reported cardiorespiratory fitness predicts CVD risk, as assessed by adiposity and metabolic syndrome indicators. The associations for muscular fitness (both reported and measured) differed depending on how it was expressed (i.e., absolute vs relative terms). Self-reported fitness, as assessed by IFIS, can be a good alternative when physical fitness cannot be measured in large surveys.

Stability of the factorial structure of metabolic syndrome from childhood to adolescence: a 6-year follow-up study

Background

Metabolic syndrome (MS) is a clustering of cardiometabolic risk factors that is considered a predictor of cardiovascular disease, type 2 diabetes and mortality. There is no consistent evidence on whether the MS construct works in the same way in different populations and at different stages in life.

Methods

We used confirmatory factor analysis to examine if a single-factor-model including waist circumference, triglycerides/HDL-c, insulin and mean arterial pressure underlies metabolic syndrome from the childhood to adolescence in a 6-years follow-up study in 174 Swedish and 460 Estonian children aged 9 years at baseline. Indeed, we analyze the tracking of a previously validated MS index over this 6-years period.

Results

The estimates of goodness-of-fit for the single-factor-model underlying MS were acceptable both in children and adolescents. The construct stability of a new model including the differences from baseline to the end of the follow-up in the components of the proposed model displayed good fit indexes for the change, supporting the hypothesis of a single factor underlying MS component trends.

Conclusions

A single-factor-model underlying MS is stable across the puberty in both Estonian and Swedish young people. The MS index tracks acceptably from childhood to adolescence.

[Carotid intima-media thickness in diabetics and hypertensive patients]

The aims of this study are to describe the mean values of carotid intima-media thickness and how it increases with age, and to compare carotid injury in diabetics and hypertensive patients with that of controls. We included 562 subjects (121 diabetics, 352 hypertensive patients, 89 controls). The mean intima-media thickness was 0.781 mm in diabetics, 0.738 mm in hypertensive patients and 0.686 mm in controls. The difference in intima-media thickness between diabetics and controls and between hypertensive patients and controls, adjusted for age, was 0.040 and 0.026 mm, respectively. We observed an increase in intima-media thickness of 0.005 mm in diabetics and of 0.005 mm in controls with every additional year of age. We found carotid damage in 23% of the diabetics, 12% of the hypertensive patients and 3.4% of the controls. In conclusion, the intima-media thickness is greater in diabetics, but the annual increase in the thickness is greater in hypertensive patients. Full English text available from:www.revespcardiol.org.