El lugar de fallecimiento de las personas ancianas en Cataluña

STUDY OBJECTIVE

To describe the place of death of the elderly and to analyze the factors associated with death occurring in an acute care hospital.

DESIGN

Cross-sectional interview of a randomized sample of individuals aged 65 or over who died during the year 1998. Three to four months after the death of the elderly subject, the main caregiver was interviewed about the socio-demographic characteristics, chronic conditions, functional and cognitive status, and use of health services in the months previous to the death, as well as the place where death occurred and their preferences on this site.

SETTING

Six areas of Catalonia, Spain, differing in the level of health and end of life social services.

PARTICIPANTS

584 caregivers (78.6% response rate).

MAIN RESULTS

Mean age of the deceased elderly was 81.4 (+/- 8) and half of them were females. 52% (95% CI: 47.5-55.7) had died in acute care hospitals. 35% of the caregivers of those dying at an acute hospital reported that they would have preferred another place for death. After adjustment, variables associated with dying in acute care hospitals were: living in an area with lower availability of social and health services for the end of life (OR: 2.8; 95% CI: 1.4-5.5) and suffering from chronic obstructive pulmonary disease (OR: 1.7; 95% CI: 1.1-2.5).

CONCLUSIONS

Acute hospitals are the predominant place of death in Catalonia, Spain. The place of death seems to be more closely influenced by the availability of end-of-life care services. There is a clear preference for dying at an alternative place to acute hospitals.

Effect of apoE genotype on the hypolipidaemic response to pravastatin in an outpatient setting

BACKGROUND

Considerable variability exists in the plasma lipid and lipoprotein response to statin treatment due, in part, to genetic factors. The gene for apolipoprotein E (ApoE) is polymorphic and the different genotypes modulate baseline lipid levels. The objective of the present study was to evaluate the effect of the apoE genotype on the lipoprotein response to pravastatin treatment in an outpatient population followed-up in several different clinics across Spain. Subjects and methods. Subjects (n=401; 56% female; mean age 57 years), who were hypercholesterolaemic despite a diet poor in saturated fat and cholesterol, were treated according to NCEP-ATP II guidelines. Plasma lipids and lipoproteins were measured centrally before and after 16 weeks of treatment with 20 mg day-1 of pravastatin.

RESULTS

ApoE genotype distributions were 3.2% with varepsilon2/3, 73.1% with varepsilon3/3 and 22.4% with varepsilon3/4 or varepsilon4/4. ApoE genotype did not have any effect on baseline lipid levels except on triglycerides such that the carriers of the varepsilon2 allele had concentrations significantly greater than those subjects with varepsilon3/3 genotype and carriers of the varepsilon4 allele after adjustment for age, gender and body mass index (BMI) (P < 0.001). Once adjusted for age, gender, BMI and baseline lipid levels, the apoE polymorphism did not significantly influence the plasma lipid and lipoprotein response to pravastatin.

CONCLUSION

ApoE genotype appears not to influence the hypolipidaemic effect of pravastatin in patients monitored in a general outpatient setting.

[Apolipoprotein E polymorphism and coronary disease]

BACKGROUND

Apolipoprotein E (Apo E) plays an important role in atherogenesis. Apo E is polymorphic with three codominant alleles: *2, *3 and *4. Inthis study we evaluated the association between *4 allele and coronary heart disease in hypercholesterolemic subjects from Spain.

SUBJECTS AND METHOD

We selected 389 subjects (56% women, mean age 57 years) with hypercholesterolemia who had been on a 6-weeks low fat, low cholesterol diet. Measurement of lipid and lipoprotein concentrations and determination of apoE genotype were carried out in a centralized laboratory.

RESULTS

ApoE distribution was as follows: *2/*33%, *3/*3 75%, *3/*4 20%, *4/*4 1% and *2/*41%. Subjects were grouped into *4 (n = 83) or no *4 (n = 303) according to the presence or absence of the *4 allele. Three *2/*4 cases were excluded. Prevalence of coronary artery disease was 15.7% in *4 and 6.9% in no *4 (OR 2.49, 95% CI 1.19-5.22). The relationship persisted significant after correction for age, sex, cardiovascular risk factors and serum concentrations of total cholesterol, HDL-cholesterol and triglycerides by multiple logistic regression analysis (OR2.56, 95% CI 1.03-6.39).Conclusión:In Spain, *4 carriers have a higher prevalence of coronary artery disease than no analysis *4 carriers.