Gut microbiota and its relationship with early vascular ageing in a Spanish population (MIVAS study)

BACKGROUND

Gut microbiota and its by-products are increasingly recognized as having a decisive role in cardiovascular diseases. The aim is to study the relationship between gut microbiota and early vascular ageing (EVA).

METHODS

A cross-sectional study was developed in Salamanca (Spain) in which 180 subjects aged 45-74 years were recruited. EVA was defined by the presence of at least one of the following: carotid-femoral pulse wave velocity (cf-PWV), cardio-ankle vascular index (CAVI) or brachial-ankle pulse wave velocity (ba-PWV) above the 90th percentile of the reference population. All other cases were considered normal vascular ageing (NVA).

MEASUREMENTS

cf-PWV was measured by SphygmoCor® System; CAVI and ba-PWV were determined by Vasera 2000® device. Gut microbiome composition in faecal samples was determined by 16S rRNA Illumina sequencing.

RESULTS

Mean age was 64.4 ± 6.9 in EVA group and 60.4 ± 7.6 years in NVA (p < .01). Women in EVA group were 41% and 53% in NVA. There were no differences in the overall composition of gut microbiota between the two groups when evaluating Firmicutes/Bacteriodetes ratio, alfa diversity (Shannon Index) and beta diversity (Bray-Curtis). Bilophila, Faecalibacterium sp.UBA1819 and Phocea, are increased in EVA group. While Cedecea, Lactococcus, Pseudomonas, Succiniclasticum and Dielma exist in lower abundance. In logistic regression analysis, Bilophila (OR: 1.71, 95% CI: 1.12-2.6, p = .013) remained significant.

CONCLUSIONS

In the studied Spanish population, early vascular ageing is positively associated with gut microbiota abundance of the genus Bilophila. No relationship was found between phyla abundance and measures of diversity.

Relationship between addictions and obesity, physical activity and vascular aging in young adults (EVA-Adic study): a research protocol of a cross-sectional study

Background

Behavioral and substance addictions are prevalent health problems that, alongside obesity, are linked to reduced physical activity and increased sedentary time. Similarly, arterial stiffness and vascular aging are processes that begin gradually at an early age and are closely associated with morbidity and mortality from cardiovascular diseases. The main objective of this study is to analyze how addictions are related to obesity and body fat distribution, physical activity, sedentary time, arterial stiffness and vascular aging, as well as sleep quality, cognitive function and gender differences in young adults aged between 18 and 34 years.

Methods

This cross-sectional descriptive observational study will analyze data from 500 subjects (250 men and 250 women) aged 18-34 without cardiovascular disease, selected by simple random sampling with replacement from the urban population of the city center of Salamanca (34,044 people aged 18-34, with 18,450 women and 15,594 men). Behavioral and substance addictions, as well as sleep quality and cognitive impairment will be assessed using questionnaires. The Pittisburg Sleep Quality Index (PSQI) will be used to measure sleep quality and the Ford questionnaire will be used to measure insomnia in response to stress. For obesity, weight, height, waist and hip circumference, body composition will be measured with the Inbody 230® impedance meter. For physical activity and sedentary time, we will use the Actigraph® accelerometer alongside the international physical activity questionnaire (IPAQ) and the Marshall questionnaire. The Sphygmocor System® will be used for pulse wave analysis and carotid-femoral pulse wave velocity (cfPWV), while the Vasera VS-2000® will measure cardio ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Vascular aging will be calculated with the 10th and 90th percentiles of cfPWV or baPWV. Demographic, analytical variables will be collected, as will data to assess vascular, cardiac, renal, and brain injury.

Discussion

Addictions are on the rise in today's society, affecting the mental health and well-being of those who suffer from them, generating important social problems such as job loss, family dysfunction, debt and social isolation. Together with obesity, they are prevalent health problems in young adults and are associated with lower physical activity and higher sedentary time. Meanwhile, arterial stiffness and vascular aging are processes that begin gradually at an early age and determine morbidity and mortality caused by cardiovascular diseases. The results of this project will allow us to understand the situation regarding behavioral and substance addictions in young adults. Better understanding of these addictions will in turn facilitate the development of more effective prevention strategies and intervention programs, which can then reduce the negative impact at both the individual and societal levels.

Clinical trial registration

[ClinicalTrials.gov], identifier [NCT05819840].

Effect of a lifestyle-integrated functional exercise (LiFE) group intervention (sLiFE) to falls prevention in non-institutionalized older adults. Protocol of a randomised clinical trial

Introduction

Personalized programs of integrated strength and balance activities have been shown their effectiveness in falls reduction in the older adults.

Objective

To measure whether a group intervention with the strength and balance principles of the sLiFE program is more effective than standard health advice in reducing the incidence of falls.

Methods

The study will comprise 650 participants with more than 65 years who live at home, observing established inclusion and exclusion criteria. Participants will be randomly assigned in two groups: group intervention (n = 325) and standard health advice (n = 325). The intervention group will follow the balance and strength activities described in the LiFE program manual. The group intervention will be carried out in groups of 12-14 and will consist of seven one-hour sessions over 12 weeks in health centres. Incidence of falls and quality of life will be assessed as primary outcome variables. Fear of falling and exercise adherence will be analysed as secondary outcome variables.

Discussion

Physical activity has been put forward as an effective treatment technique for these patients; however, long-term adherence to these programs remains a challenge. Group interventions could reduce dropout rates.

Conclusion

Falls represent a major health problem globally due to the disability they cause in older people. Prevention would help reduce not only their incidence but also the health costs derived from their treatment. Group intervention helps clinicians to save resources and time, being able to attend more people with the same quality of care.

Clinical trial registration

https://clinicaltrials.gov/study/NCT05912088?distance=50&term=NCT05912088&rank=1, identifier NCT05912088.

Increase in Vascular Function Parameters According to Lifestyles in a Spanish Population without Previous Cardiovascular Disease-EVA Follow-Up Study

The aim of this longitudinal descriptive observational study was to analyze the influence of different lifestyles on arterial stiffness (AS) throughout five years of follow-up and to describe the differences by sex in a Spanish adult population without cardiovascular disease at the start of the study. A random stratified sampling by age and sex was used to obtain 501 subjects included in the initial assessment. No cardiovascular disease was allowed in the subjects. The average age was 55.9 years, and 50.3% were women. A total of 480 subjects were analyzed again five years later. Alcohol and tobacco consumption were collected with standardized questionnaires. Adherence to the Mediterranean diet was assessed with the Mediterranean diet adherence screener (MEDAS) questionnaire. Physical activity was assessed with the short version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and sedentary time was assessed with the Marshall Sitting Questionnaire (MSQ). AS was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central augmentation index (CAIx) with SphygmoCor System®, and ankle pulse wave velocity (baPWV) and cardio ankle vascular index (CAVI) with Vasera VS-1500®. Increases in vascular function measures per year of follow-up were: cfPWV = 0.228 ± 0.360 m/s, baPWV = 0.186 ± 0.308 m/s, CAVI = 0.041 ± 0.181 m/s, and CAIx = 0.387 ± 2.664 m/s. In multiple regression analysis, positive association was shown between an increase in baPWV and tobacco index (β = 0.007) and alcohol consumption (β = 0.005). Negative association was shown between CAVI and Mediterranean diet score (β = -0.051). In multinomial logistic regression analysis, the OR of tobacco index of subjects with a cfPWV increase >P75 was OR = 1.025 and of subjects classified between P25 and P75 was OR = 1.026 regarding subjects classified with an increase P75 was OR = 1.006 regarding subjects classified with an increase P75, and an OR = 0.841 was found of subjects classified between P25-75 regarding subjects classified with an increase Collapse

Key Words

• arterial stiffness
• lifestyle
• longitudinal study
• mediterranean diet

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MESH Headings

• Adult
• Female
• Humans
• Male
• Middle Aged
• Ankle Brachial Index
• Cardiovascular Diseases/epidemiology
• Follow-Up Studies
• Life Style
• Pulse Wave Analysis
• Longitudinal Studies

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Grants

• RD21/0016/0010 Instituto de Salud Carlos III
• GRS 1193/B/15; GRS2303/B/21 Gerencia Regional de Salud de la Junta de Castilla y León

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Relationship between the structure, function and endothelial damage, and vascular ageing and the biopsychological situation in adults diagnosed with persistent COVID (BioICOPER study). A research protocol of a cross-sectional study

Background: SARS-CoV-2 infection affects the vascular endothelium, which mediates the inflammatory and thrombotic cascade. Moreover, alterations in the endothelium are related to arterial stiffness, which has been established as a marker of cardiovascular disease. The objective of this study is to analyse how the structure, vascular function, vascular ageing and endothelial damage are related to the biopsychological situation in adults diagnosed with persistent COVID and the differences by gender. Methods: This cross-sectional, descriptive, observational study will be carried out in the Primary Care Research Unit of Salamanca (APISAL) and in the BioSepsis laboratory of the University of Salamanca. The sample will be selected from the persistent COVID monographic office at the Internal Medicine Service of the University Hospital of Salamanca, and from the population of subjects diagnosed with persistent COVID in the clinical history of Primary Care. Through consecutive sampling, the study will include 300 individuals diagnosed with persistent COVID who meet the diagnosis criteria established by the WHO, after they sign the informed consent. Endothelial damage biomarkers will be measured using ELLA-SimplePlexTM technology (Biotechne). Their vascular structure and function will be analysed by measuring the carotid intima-media thickness (Sonosite Micromax); the pulse wave and carotid-femoral pulse wave velocity (cfPWV) will be recorded with Sphygmocor System®. Cardio Ankle Vascular Index (CAVI), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index will be analysed with Vasera VS-2000®. The integral assessment of the subjects with persistent COVID will be conducted with different scales that evaluate fatigue, sleep, dyspnea, quality of life, attention, nutrition state, and fragility. We will also evaluate their lifestyles (diet, physical activity, smoking habits and alcohol consumption), psychological factors, and cognitive deterioration, which will be gathered through validated questionnaires; moreover, physical activity will be objectively measured using a pedometer for 7 days. Body composition will be measured through impedance using an Inbody 230. Vascular ageing will be calculated with 10 and 90 percentiles of cfPWV and baPWV. Furthermore, we will analyse the presence of vascular injury in the retina, heart, kidneys and brain, as well as cardiovascular risk. Demographic and analytical variables will also be gathered. Discussion: Arterial stiffness reflects the mechanic and functional properties of the arterial wall, showing the changes in arterial pressure, blood flow, and vascular diameter that occur with each heartbeat. SARS-CoV-2 affects the endothelial cells that are infected with this virus, increasing the production of pro-inflammatory cytokines and pro-thrombotic factors, which can cause early vascular ageing and an increase of arterial stiffness. Persistent COVID is a complex heterogeneous disorder that affects the lives of millions of people worldwide. The identifications of potential risk factors to better understand who is at risk of developing persistent COVID is important, since this would enable early and appropriate clinical support. It is unknown whether vascular alterations caused by COVID-19 resolve after acute infection or remain over time, favouring the increase of arterial stiffness and early vascular ageing. Therefore, it is necessary to propose studies that analyse the evolution of persistent COVID in this group of patients, as well as the possible variables that influence it. Clinical Trial registration: ClinicalTrials.gov, identifier NCT05819840.

Lifestyles, arterial aging, and its relationship with the intestinal and oral microbiota (MIVAS III study): a research protocol for a cross-sectional multicenter study

Background

The microbiota is increasingly recognized as a significant factor in the pathophysiology of many diseases, including cardiometabolic diseases, with lifestyles probably exerting the greatest influence on the composition of the human microbiome. The main objectives of the study are to analyze the association of lifestyles (diet, physical activity, tobacco, and alcohol) with the gut and oral microbiota, arterial aging, and cognitive function in subjects without cardiovascular disease in the Iberian Peninsula. In addition, the study will examine the mediating role of the microbiome in mediating the association between lifestyles and arterial aging as well as cognitive function.

Methods and analysis

MIVAS III is a multicenter cross-sectional study that will take place in the Iberian Peninsula. One thousand subjects aged between 45 and 74 years without cardiovascular disease will be selected. The main variables are demographic information, anthropometric measurements, and habits (tobacco and alcohol). Dietary patterns will be assessed using a frequency consumption questionnaire (FFQ) and the Mediterranean diet adherence questionnaire. Physical activity levels will be evaluated using the International Physical Activity Questionnaire (IPAQ), Marshall Questionnaire, and an Accelerometer (Actigraph). Body composition will be measured using the Inbody 230 impedance meter. Arterial aging will be assessed through various means, including measuring medium intimate carotid thickness using the Sonosite Micromax, conducting analysis with pulse wave velocity (PWA), and measuring pulse wave velocity (cf-PWV) using the Sphygmocor System. Additional cardiovascular indicators such as Cardio Ankle Vascular Index (CAVI), ba-PWV, and ankle-brachial index (Vasera VS-2000^®) will also be examined. The study will analyze the intestinal microbiota using the OMNIgene GUT kit (OMR-200) and profile the microbiome through massive sequencing of the 16S rRNA gene. Linear discriminant analysis (LDA), effect size (LEfSe), and compositional analysis, such as ANCOM-BC, will be used to identify differentially abundant taxa between groups. After rarefying the samples, further analyses will be conducted using MicrobiomeAnalyst and R v.4.2.1 software. These analyses will include various aspects, such as assessing α and β diversity, conducting abundance profiling, and performing clustering analysis.

Discussion

Lifestyle acts as a modifier of microbiota composition. However, there are no conclusive results demonstrating the mediating effect of the microbiota in the relationship between lifestyles and cardiovascular diseases. Understanding this relationship may facilitate the implementation of strategies for improving population health by modifying the gut and oral microbiota.

Trial registration

clinicaltrials.gov/ct2/show/NCT04924907, ClinicalTrials.gov, identifier: NCT04924907. Registered on 21 April 2021.

Promoting Physical Activity in a Primary Care Practice in People Living with Dementia and Their Family Caregivers

People living with dementia (PLWD) and their family caregivers report higher rates of having a sedentary lifestyle than their non-disabled peers do. This study analyzed the effectiveness of an intervention designed to increase physical activity among PLWD and their family caregivers in primary health care settings. A cluster-randomized multicenter clinical trial was conducted. Participants from four health centers were randomly assigned to the intervention group (IG) or the control group (CG) in a 1:1 ratio using Epidat software. After a seven-day period with a digital pedometer (Omron Hj-321 lay-UPS), participants were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ-SF). PLWD and caregivers allocated to the IG were given brief advice, educational materials and an additional 15 min appointment to prescribe an individualized physical activity plan. Seventy PLWD and 80 caregivers were assigned to the CG and 70 PLWD and 96 caregivers were assigned to the IG. Results of the pedometer assessment show that in PLWD, the IG's activity increased by 52.89 aerobic steps at 6 months and the CG's activity decreased by 615.93 aerobic steps, showing a net increase in the IG of 668.82 (95% CI: -444.27 to 1781.91; p = 0.227). For caregivers in the IG, activity increased by 356.91 aerobic steps and in the CG it decreased by 12.95 aerobic steps, showing a net increase in favor of the IG of 369.86 (95%CI: -659.33 to 1399.05; p = 0.476). The effectiveness of interventions to increase physical activity in this group of people with dementia and their caregivers did not achieved positive results overall but may have provided suggestions for family physicians and physical therapists to improve physical activity among people with dementia and their families.

Changes in lifestyles, cognitive impairment, quality of life and activity day living after combined use of smartphone and smartband technology: a randomized clinical trial (EVIDENT-Age study)

Background

The aim of this study was to assess the efficacy of the combined use of smartphone and smartband technology for 3-months alongside brief lifestyle counselling, versus counselling alone, in increasing physical activity. As secondary objectives, the effects of the intervention on dietary habits, body composition, quality of life, level of functionality and cognitive performance were assessed.

Methods

This study employed a randomized clinical trial of two-parallel groups design – control group (CG) and intervention group (IG). The study was conducted in 3 Spanish health-centres between October 2018-February 2020. Eligible participants were people of both sexes and aged between 65–80 years attending the health-centres with a score ≥ 24 points on the Mini-Mental State Examination. Key variables included physical activity, dietary pattern, body composition, cognitive performance, level of functionality and quality of life. All variables were measured at baseline and after 3-months. Both groups received a brief nutritional and physical activity advice. Intervention group participants were instructed to use a smartphone application for a period of 3-months. This application integrates information on physical activity received from a fitness bracelet and self-reported information on the patient’s daily nutritional composition.

Results

The study population comprised 160 participants (IG = 81, CG = 79), with a mean age of 70.8 ± 4.0 years (61.3% women). No difference was found in the primary and secondary outcomes analyzed (physical activity (steps/min -0.4 (-1.0 to 0.2) p = 0.174), and dietary habits (Mediterranean diet score 0.0 (-0.6 to 0.6) p = 0.956) that could be attributed to either group after an ANCOVA test. A difference attributable to the intervention was observed in the total Clock test score (0.7 (0.1 to 1.2) p = 0.018.

Conclusions

In a sample of people over 65 years of age, the combined use of the EVIDENT 3 smartphone app and an activity tracking bracelet for 3-months did not result in lifestyles changes related to the amount and level of physical activity or the eating habits, compared to brief lifestyle advice. Other clinical parameters were not changed either, although at the cognitive level, a slight improvement was observed in the score on the Clock test assessing a variety of cognitive functions such as memory.

Trial registration

The study was registered in ClinicalTrials.gov Identifier: NCT03574480. Date of trial Registration 02/07/2018.

Association of physical activity with vascular aging in a population with intermediate cardiovascular risk, analysis by sex: MARK study

Background

The aim of this study was to analyze the association of physical activity and its intensity with arterial stiffness and vascular aging and differences by sex in a Spanish population with intermediate cardiovascular risk.

Methods

Cross-sectional study. A total of 2475 individuals aged 35–75 years participated in the study. Brachial–ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500^® device. Based on the age and sex percentile presented by the participants, the latter were classified as follows: those with a percentile above 90 and presenting established cardiovascular disease were classified as early vascular aging (EVA); those with a percentile between 10 and 90 were classified as normal vascular aging (NVA) and those with a percentile below 10 were classified as healthy vascular aging (HVA). Physical activity was analyzed through the short version of the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ).

Results

The mean age of the participants was 61.34 ± 7.70 years, with 61.60% men. Of the total sample, 86% were sedentary (83% men vs 90% women). The total physical activity showed a negative association with baPWV (β = − 0.045; 95% CI − 0.080 to − 0.009). Intense physical activity showed a negative relationship with baPWV (β = − 0.084; 95% CI − 0.136 to − 0.032). The OR of the total physical activity and the intense physical activity carried out by the subjects classified as NVA with respect to those classified as HVA was OR = 0.946; (95% CI 0.898 to 0.997) and OR = 0.903; (95% CI 0.840 to 0.971), and of those classified as EVA it was OR = 0.916; (95% CI 0.852 to 0.986) and OR = 0.905; (95% CI 0.818 to 1.000). No association was found with moderate- or low-intensity physical activity.

Conclusions

The results of this study suggest that, when intense physical activity is performed, the probability of presenting vascular aging is lower. In the analysis by sex, this association is only observed in men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13293-022-00456-w.

This study is the first to find a negative association between total physical activity and arterial stiffness and vascular aging in adults with intermediate cardiovascular risk.

This study also shows that the association of physical activity with arterial stiffness and vascular aging in adults with intermediate cardiovascular risk varies depending on its intensity, with a negative association being found only with intense physical activity.

In the analysis by sex, the results found suggest that the association is greater in men.

Relationship of Different Anthropometric Indices with Vascular Ageing in an Adult Population without Cardiovascular Disease-EVA Study

The objectives of this study were to analyse the capacity of different anthropometric indices to predict vascular ageing and this association in Spanish adult population without cardiovascular disease. A total of 501 individuals without cardiovascular disease residing in the capital of Salamanca (Spain) were selected (mean age: 55.9 years, 50.3% women), through stratified random sampling by age and sex. Starting from anthropometric measurements such as weight, height, and waist circumference, hip circumference, or biochemical parameters, we could estimate different indices that reflected general obesity, abdominal obesity, and body fat distribution. Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (cf-PWV) using a SphygmoCor^® device. Vascular ageing was defined in three steps: Step 1: the participants with vascular injury were classified as early vascular ageing (EVA); Step 2: classification of the participants using the 10 and 90 percentiles of cf-PWV in the study population by age and sex in EVA, healthy vascular ageing (HVA) and normal vascular ageing (NVA); Step 3: re-classification of participants with arterial hypertension or type 2 diabetes mellitus included in HVA as NVA. The total prevalence of HVA and EVA was 8.4% and 21.4%, respectively. All the analysed anthropometric indices, except waist/hip ratio (WHpR), were associated with vascular ageing. Thus, as the values of the different anthropometric indices increase, the probability of being classified with NVA and as EVA increases. The capacity of the anthropometric indices to identify people with HVA showed values of area under the curve (AUC) ≥ 0.60. The capacity to identify people with EVA, in total, showed values of AUC between 0.55 and 0.60. In conclusion, as the values of the anthropometric indices increased, the probability that the subjects presented EVA increased. However, the relationship of the new anthropometric indices with vascular ageing was not stronger than that of traditional parameters. Therefore, BMI and WC can be considered to be the most useful indices in clinical practice to identify people with vascular ageing in the general population.

Sedentary Behaviour and Its Relationship with Early Vascular Ageing in the General Spanish Population: A Cross-Sectional Study

Sedentary behaviour is associated with a greater predisposition to developing cardiovascular diseases. The aim of the study was to analyse the relationship between sedentary time and early vascular ageing. A total of 501 participants (49.70% men) were recruited through random sampling stratified by age group and sex. Vascular ageing was evaluated considering three criteria: (1) the vascular ageing index (VAI); (2) the carotid−femoral pulse wave velocity (cfPWV) 10th and 90th percentiles of the reference values in the European population by age; and (3) the Framingham’s heart age. The carotid intima−media thickness was measured using a Sonosite Micromaxx ultrasound, the presence of peripheral artery disease was assessed by calculating the ankle−brachial index using a VaSera VS-1500, and the cfPWV was measured with a SphygmoCor® device. Weekly sedentary hours were evaluated through a sitting time questionnaire. The average age of the population was 55.90 ± 14.24 years. The men spent more hours sitting per week (47.6 ± 16.6 vs. 36.8 ± 17.3 h/W), at work (16.7 ± 16.2 vs. 9.73 ± 14.9 h/W), and watching TV (21.6 ± 12.5 vs. 18.7 ± 11.9 h/W). In the logistic regression analysis, the individuals with early vascular aging (EVA), with respect to those with healthy vascular aging (HVA), spent more hours sitting per week (OR = 1.03 vs. OR = 1.02; p < 0.05) and watching TV (OR = 1.03 vs. OR = 1.03; p < 0.05), using the criteria of the European guideline and VAI, and more hours sitting when commuting (OR = 1.04; p < 0.05), using Framingham’s heart age to define EVA. The results of this study indicate that sedentary time is associated with early vascular ageing. Therefore, reducing sedentary time would improve vascular health.

Retinal blood vessel calibre and vascular ageing in a general Spanish population: A EVA study

INTRODUCTION

The aim of this work was to analyse the association of the retinal arteriolar calibre and the arteriole/venule index (AV index) with vascular ageing in a general population without previous cardiovascular disease.

MATERIALS AND METHODS

Descriptive cross-sectional study. A total of 482 individuals without cardiovascular disease (mean age: 55.6 ± 14.2 years) were selected by random sampling, stratified by age and sex. The retinal arteriolar calibre was measured using digital fundus images of the back of the eye captured with a validated, semiautomatized and computer-assisted software (Index calculator). Vascular ageing was defined using three criteria based on the values of: (1) Carotid-femoral Pulse Wave Velocity (cfPWV), (2) Brachial-ankle Pulse Wave Velocity (baPWV) and (3) Carotid Intima-Media Thickness.

RESULTS

The AV index and arteriolar calibre show a negative correlation with age, arterial pressure, cardiovascular risk and parameters of vascular structure and function (p < 0.001 in all cases). We found lower mean values of the AV index and arteriolar calibre in the individuals with early vascular ageing compared to those with healthy vascular ageing. AV index was negatively correlated with cfPWV ((β=-2.9; 95% CI (-4.7; -1.1)), baPWV ((β=-3.2; 95% CI (-5.4; -0.9)) and vascular ageing index ((β=-1.7; 95% CI (-2.7; -0.7)). Arteriolar calibre showed a negative correlation with baPWV (β=-0.1; 95% CI (-0.2; -0.1)). In the logistic regression analysis, lower values of AV index ((OR=0.01; 95% CI (0.01-0.10), OR=0.03; 95% CI (0.01-0.11) and OR=0.09; 95% CI (0.01-0.67)) were associated with EVA defined with cfPWV, baPWV and vascular ageing index respectively, and lower values of arteriolar calibre ((OR=0.71; 95% CI (0.55-0.91)) were associated with EVA defined with vascular ageing index.

CONCLUSIONS

Lower values of AV index and retinal arteriolar calibre were associated with vascular ageing in a general Spanish population without previous cardiovascular disease.

Association of Insulin Resistance with Vascular Ageing in a General Caucasian Population: An EVA Study

The data on the relationship between insulin resistance and vascular ageing are limited. The aim of this study was to explore the association of different indices of insulin resistance with vascular ageing in an adult Caucasian population without cardiovascular disease. We selected 501 individuals without cardiovascular disease (mean age: 55.9 years, 50.3% women) through random sampling stratified by sex and age. Arterial stiffness was evaluated by measuring the carotid-to-femoral pulse wave velocity (cfPWV) and brachial-to-ankle pulse wave velocity (baPWV). The participants were classified into three groups according to the degree of vascular ageing: early vascular ageing (EVA), normal vascular ageing (NVA) and healthy vascular ageing (HVA). Insulin resistance was evaluated with the homeostatic model assessment of insulin resistance (HOMA-IR) and another five indices. The prevalence of HVA and EVA was 8.4% and 21.4%, respectively, when using cfPWV, and 7.4% and 19.2%, respectively, when using baPWV. The deterioration of vascular ageing, with both measurements, presented as an increase in all the analysed indices of insulin resistance. In the multiple regression analysis and logistic regression analysis, the indices of insulin resistance showed a positive association with cfPWV and baPWV and with EVA.

Association between measurements of arterial stiffness and target organ damage in a general Spanish population

INTRODUCTION

Little is known about the relationship between arterial stiffness and cardiovascular target organ damage (TOD) in the general population. The aim was to analyse the relationship between different measurements of arterial stiffness and TOD, in a general Spanish population without a history of cardiovascular event.

MATERIALS AND METHODS

Transversal descriptive study. Through stratified random sampling, a total of 501 individuals were included. Carotid-femoral pulse wave velocity (cf-PWV) was measured using a SphygmoCor System®, the cardio-ankle vascular index (CAVI) was determined with aVasera VS-1500® and brachial-ankle pulse wave velocity (ba-PWV)was calculated through a validated equation.

RESULTS

The average age was 55.84 ± 14.26.The percentage of vascular TOD, left ventricular hypertrophy (LVH) and renal TOD was higher in men (p < .001). A positive correlation was obtained between carotid intima-media thickness (c-IMT) and the measurements of vascular function. In the model 1 of the logistic regression analysis, cf-PWV was associated with vascular TOD (OR = 1.15, p = .040), ba-PWV was associated with vascular TOD (OR = 1.20, p = .010) and LVH (OR = 1.12, p = .047).

CONCLUSIONS

The different measurements of arterial stiffness are highly associated with each other. Moreover, cf-PWV and ba-PWV were associated with vascular TOD, and ba-PWV with LVH, although they disappear when adjusting for cardiovascular risk factors. Key Messages There is a strong correlation between the different measurements of vascular structure and function. Carotid-femoral and brachial-ankle pulse wave velocity were positively associated with vascular target organ damage, the latter was also positively associated with left ventricular hypertrophy. This associations disappear when adjusting for cardiovascular risk factors.

Relationship of healthy vascular aging with lifestyle and metabolic syndrome in the general Spanish population. The EVA study

INTRODUCTION AND OBJECTIVES

Our objective was to study the relationship of healthy vascular aging (HVA) with lifestyle and the components of metabolic syndrome. We also analyzed the differences between chronological age and heart age (HA) and vascular age (VA) in the Spanish adult population without cardiovascular disease.

METHODS

This descriptive cross-sectional study selected 501 individuals without cardiovascular disease (mean age, 55.9 years; 50.3% women) via random sampling stratified by age and sex. HA was estimated with the Framingham equation, whereas VA was estimated with the VaSera VS-1500 device. HVA was defined as a <5-year difference between the chronological age and the HA or VA and the absence of a vascular lesion, hypertension, and diabetes mellitus.

RESULTS

Compared with the chronological age, the mean HA and VA were 2.98±10.13 and 3.08±10.15 years lower, respectively. Smoking (OR, 0.23), blood pressure ≥ 130/85mmHg (OR, 0.11), altered baseline blood glucose (OR, 0.45), abdominal obesity (OR, 0.58), triglycerides ≥ 150mg/dL (OR, 0.17), and metabolic syndrome (OR, 0.13) decreased the probability of HVA estimated by HA; an active lifestyle (OR, 1.84) and elevated high-density lipoprotein-cholesterol (OR, 3.26) increased the probability of HVA estimated by HA. Smoking (OR, 0.45), blood pressure ≥ 130/85mmHg (OR, 0.26), altered baseline blood glucose (OR, 0.42), and metabolic syndrome (OR, 0.40) decreased the probability of HVA estimated by VA; abdominal obesity (OR, 1.81) had the opposite effect.

CONCLUSIONS

HA and VA were 3 years lower than the chronological age. HA was associated with tobacco consumption, physical activity, and the components of metabolic syndrome. Meanwhile, VA was associated with tobacco consumption, blood pressure, waist circumference, and altered baseline glycemia.

CLINICAL TRIAL REGISTRATION

http://www.clinicaltrials.gov. Identifier: NCT02623894.

Vascular target organ damage in patients with Philadelphia negative myeloproliferative syndrome: A propensity score analysis

PURPOSE

To assess whether subjects with Philadelphia negative myeloproliferative neoplasms (Ph-MPNs) show differences in the presence of vascular, cardiac or renal target organ damage (TOD) and other vascular function parameters as compared to individuals without this condition.

METHODS

An observational study was conducted. Fifty-seven subjects diagnosed with Ph-MPNs used as cases and 114 subjects without Ph-MPNs as controls. We matched the subjects with and without Ph-MPNs using the propensity scores in a 1:2 ratio using the variables gender, type 2 diabetes mellitus, high blood pressure, hyperlipidaemia and smoking. Vascular, cardiac and renal TOD were established according to the criteria of the European Society of Hypertension and Cardiology guidelines. Arterial stiffness was also assessed using the cardio-ankle vascular index (CAVI).

RESULTS

Mean age was 63.50±11.70 and 62.90±8.32 years in subjects with and without Ph-MPNs, 32 females (56%) in the first group and 62 (54%) in the second. Subjects with Ph-MPNs have a higher percentage of carotid injury than subjects without Ph-MPNs (35.1% vs. 21.1%) and higher albumin/creatinine ratio. In the logistic regression analysis, subjects with Ph-MPNs had an OR=2.382 (IC95% 1.066-5.323) for carotid injury versus those without haematological disease.

CONCLUSIONS

Subjects with Ph-MPNs have twice the risk of by carotid injury than those without haematological disease.

Effect of an intensive intervention on the increase of physical activity and the decrease of sedentary lifestyle in inactive postmenopausal

BACKGROUND

During the transition to menopause, women experience different psychological, hormonal, and physical alterations that can affect their health. Physical activity is considered an important strategy in the prevention and control of such changes.

AIM

To evaluate the short-term effect of an intensive intervention, based on a combined exercise programme using a Smartband, on the increase of physical activity and the decrease of sedentary lifestyle in postmenopausal and inactive women.

DESIGN

Randomized clinical trial with two parallel groups.

METHODS

In total, 100 postmenopausal and inactive women aged 45-70 years will be randomized to a control group or an intervention group. Both groups will be given a standardized advice about physical activity. The intervention group will carry out a supervised 12-week programme of aerobic and muscle strengthening exercise; moreover, the women in this group will receive a Smartband to assist them in the intervention. The main result will be the increase of physical activity and the decrease of sedentary lifestyle, measured with an accelerometer for 1 week. This programme will be conducted by a nurse and a physiotherapist of the health centre. The study was approved by the Drug Research Ethics Committee of the Salamanca Health Service on 15 February 2019. The project was funded by the Autonomous Government of Castile and Leon and by the Carlos III Health Institute.

DISCUSSION

Physical activity is an important strategy to consider when addressing the changes caused by menopause, although the current evidence shows that further studies should be carried out with longer intervention periods and new technologies.

IMPACT

This study will allow determining the effectiveness of the intensive intervention based on a combined programme of physical activity using a Smartband in postmenopausal and inactive women.

TRIALS REGISTRATION

ClinicalTrials.gov with identifying code NCT03872258.

Behavioural intervention to reduce disruptive behaviours in adult day care centres users: A randomizsed clinical trial (PROCENDIAS study)

AIM

This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers.

DESIGN

Randomized controlled clinical trial.

METHODS

The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8-10 people where caregivers were trained in the Antecedent-Behavior-Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC).

RESULTS

An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann-Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES-D) (U = -2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = -4.10; p < 0.01; Cohen d = 0.98).

CONCLUSION

The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver.

IMPACT

To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.

Prevalence of coronary atherosclerosis and reclassification of cardiovascular risk in Spanish population by coronary computed tomography angiography: EVA study

BACKGROUND

A more complete assessment of coronary artery disease (CAD) can be performed by coronary computed tomography angiography (CCTA). The aim was to assess the prevalence, distribution and characteristics of coronary artery disease (CAD) and the reclassification of cardiovascular risk by CCTA in an asymptomatic Spanish population.

DESIGN

We included, in a cross-sectional study, 501 random subjects from asymptomatic population, aged 35 and 75. Risk factors, target organ damage and cardiovascular risk were assessed. CCTA was offered to measure the coronary artery calcium score(CACS), segment involvement score(SIS) and segment stenosis score(SSS). The offer was accepted by 220 subjects (44%), with a mean age of 58 ± 14 years, 56% of them male.

RESULTS

The mean CACS was 119.6 ± 381.7 (median (IQR) (0 (0-61.55))), with higher scores in males (191.9 ± 493.1) than females (26.1 ± 73.3; P < .01). CCTA revealed coronary atherosclerosis in 89 cases, 40% (CI95%:34%-46%) in global, 51% in male and 25% in female, of which 13 had obstructive lesions (5.9%). Mean SIS was 1.5 ± 2.5 and SSS 1.2 ± 3.1. When the CACS was included in the CAD risk scale, there was a reclassification of 24%, and when using the SIS percentile, it was 38%, with a 9% increase in risk in both cases.

CONCLUSIONS

The prevalence of CAD in asymptomatic Spanish population was 40%, with greater proportion among males. The incorporation of CACS and SIS in the assessment of cardiovascular risk allows reclassifying subjects who are at low or moderate risk and thus identify those with high cardiovascular risk and also the other way.

Adherence to the Mediterranean Diet in Spanish Population and Its Relationship with Early Vascular Aging according to Sex and Age: EVA Study

The objective of this study is to analyze the influence of adherence to the Mediterranean diet (MDA) and its components on early vascular aging (EVA) in a Spanish population sample free of cardiovascular disease and to analyze the differences by sex.

METHODS

We recruited 501 individuals aged 35-75 without cardiovascular disease by random sampling (55.90 ± 14.24 years, 49.70% men). EVA was defined in two steps: Step 1: subjects with vascular damage in carotid arteries or peripheral artery disease were classified as EVA. Step 2: subjects at the percentile of the combined Vascular Aging Index (VAI) were classified; ≥ p90 was considered EVA and < p90 was considered normal vascular aging (NVA), estimated using the following formula (VAI = (log (1.09) × 10 cIMT + log (1.14) cfPWV) × 39.1 + 4.76 by age and sex. Carotid-femoral pulse wave velocity (cfPWV) was measured by SphigmoCor System® and carotid intima-media thickness by Sonosite Micromax® ultrasound and classified thus: values ≥ Percentile 90 were considered EVA and those < Percentile 90 as NVA, with population percentiles analyzed. The principal result variable was assessed using the 14-item MEDAS questionnaire, developed and validated by the PREDIMED group, comprising 12 questions about the frequency of food consumption and two questions regarding the Spanish population's typical eating habits.

RESULTS

MDA was observed by 25% (17% men and 34% women). EVA was present in 17% (29% men and 4% women). The adjusted logistic regression models showed that an increase in MDA decreases the probability of EVA in the global analysis (OR = 0.36; 95% CI: 0.16-0.82). In the analysis by sex, this association was only seen in men (OR = 0.33; 95% CI: 0.12-0.86), but not in women (OR = 0.31; 95% CI: 0.04-2.50).

CONCLUSION

The results of this study suggest that a greater adherence to the Mediterranean diet decreases the probability of presenting EVA. In the analysis by sex, this association applies only to men.

Automatic image analyser to assess retinal vessel calibre (ALTAIR). A new tool to evaluate the thickness, area and length of the vessels of the retina

BACKGROUND AND OBJECTIVES

The examination of the fundus allows to evaluate retinal the microcirculation in vivo. We assess the reliability and validity of ALTAIR software, and to evaluate its clinical relevance by the association of thickness, area and length of the retinal vessels with other measures of vascular structure and function, target organ damage and cardiovascular risk.

METHODS

Cross-sectional study involving a total of 250 subjects aged 62 ± 9 years, 51 % males. In a random subsample of 60 subjects (118 retinographies), we estimated the intraobserver, interobserver and interdevice intraclass correlation coefficients (ICC) of the measurements of retinal vascular thickness, area and length in 3 concentric circles. Concurrent validity was assessed with all 250 subjects (495 retinographies), analysing the relationship to age, blood pressure, target organ damage, vascular structure and function, and cardiovascular risk.

RESULTS

Of the sample, 69 % were diagnosed with hypertension and 17 % with diabetes. Intraobserver ICC ranged from 0.640 for venous length to 0.906 for arterial area. Interobserver ICC ranged from 0.809 for arterial length to 0.916 for venous area, and interdevice ICC for arteriovenous ratio (AVR) was 0.887, thickness of arteries 0.590 and vein thickness 0.677. We found a moderate correlation between retinal vascular parameters and vascular structure and function, and target organ damage. In multiple linear regression analysis, the association with blood pressure, albumin/creatinine ratio, carotid intima-media thickness and cardiovascular risk is maintained.

CONCLUSION

The ALTAIR tool has been useful for analysing the thickness, area and length of retinal vessels, with adequate reliability and a concomitant association of retinal vessel measurements with other cardiovascular parameters and cardiovascular risk. Therefore, in addition to thickness, the area and length of retinal vessels could also play a role in the prediction of cardiovascular risk.

Reference values of arterial stiffness parameters and their association with cardiovascular risk factors in the Spanish population. The EVA Study

INTRODUCTION AND OBJECTIVES

To describe, for the first time, reference values for the cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (BA-PWV), carotid-femoral pulse wave velocity (CF-PWV), and the central augmentation index and to establish their association with cardiovascular risk factors in the Spanish adult population aged 35 to 75 years without cardiovascular disease.

METHODS

We conducted a cross-sectional study. Through random sampling stratified by age and sex, we included 501 participants without cardiovascular disease. The mean age was 55.9 years and 50.3% were women. The measurements were taken using the SphigmoCor and Vasera VS-1500 devices.

RESULTS

Values for all measures, except those for the central augmentation index, were higher in men and increased with age and blood pressure. The mean values were as follows: CAVI, 8.01±1.44; BA-PWV, 12.93±2.68m/s; CF-PWV, 6.53±2.03 m/s, and central augmentation index, 26.84±12.79. On multiple regression analysis, mean blood pressure was associated with the 4 measures, glycated hemoglobin was associated with all measures except the central augmentation index, and body mass index showed an inverse association with CAVI. The explanatory capacity of age, sex, and mean blood pressure was 62% for BA-PWV, 49% for CF-PWV 49%, 54% for the CAVI, and 38% for the central augmentation index. On logistic regression, hypertension was associated with the CAVI (OR=3.45), VOP-BT (OR=3.44), VOP-CF (OR=3.38) and with the central augmentation index (OR=3.73).

CONCLUSIONS

All arterial stiffness measures increased with age. The CAVI and CF-PWV were higher in men and the central augmentation index was higher in women, with no differences in BA-PWV. This study is registered at ClinicalTrials.gov. Identifier NCT02623894.

Comparative effect of statins and types of physical exercise on arterial stiffness: Protocol for network meta-analysis

INTRODUCTION

The purpose of this study protocol is to provide the methodology for a review to compare the effect of statins vs physical exercise interventions and the effect of different types of physical exercise, on reducing arterial stiffness associated with cardiovascular diseases and mortality.

METHODS AND ANALYSIS

The literature search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception until July 31, 2019. We will include randomized controlled trials, nonrandomized experimental studies, and controlled pre-post studies assessing the effect in the general population of statins and physical exercise interventions on arterial stiffness measured by pulse wave velocity. The Cochrane Collaboration's tool and the Quality Assessment Tool for Quantitative Studies will be used to assess the risk of bias for studies included in the systematic review. A Bayesian network meta-analysis will be carried out to determine the comparative effect of the different physical exercise interventions and/or statin intervention.

ETHICS AND DISSEMINATION

This study will generate evidence about the effectiveness of both statins and exercise on reducing arterial stiffness that potentially can be transferred to patients and practitioners. Moreover, in light of the importance of reducing arterial stiffness for preventing cardiovascular disease, the evidence provided by this study will be potentially suitable to be included in cardiovascular clinical practice guidelines.

STRENGTHS AND LIMITATIONS

This protocol describes the methods of a study examining, using network meta-analysis strategies, the efficacy of statins and different types of exercise on improving arterial stiffness, which is an early marker of atherosclerosis. The results of this study could immediately help clinicians to recommend the best evidence-based intervention to their patients to reduce arterial stiffness and, as a consequence, prevent major complications, such as heart failure, stroke, or myocardial infarction.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019123120.

The Relationship of the Atlantic Diet with Cardiovascular Risk Factors and Markers of Arterial Stiffness in Adults without Cardiovascular Disease

Background: Studying the adherence of the population to the Atlantic Diet (AD) could be simplified by an easy and quickly applied dietary index. The aim of this study is to analyse the relationship of an index measuring compliance with recommendations regarding the Atlantic diet and physical activity with cardiovascular disease risk factors, cardiovascular risk factors, obesity indexes and arterial stiffness markers.

METHODS

We included 791 individuals from the EVIDENT study (lifestyles and arterial ageing), (52.3 ± 12 years, 61.7% women) without cardiovascular disease. Compliance with recommendations on AD was collected through the responses to a food frequency questionnaire, while physical activity was measured by accelerometer. The number of recommendations being met was estimated using a global scale between 0 and 14 points (a higher score representing greater adherence). Blood pressure, plasma lipid and glucose values and obesity rates were measured. Cardiovascular risk was estimated with the Framingham equation.

RESULTS

In the overall sample, 184 individuals (23.3%) scored between 0⁻3 on the 14-point index we created, 308 (38.9%) between 4 and 5 points, and 299 (37.8%) 6 or more points. The results of multivariate analysis yield a common tendency in which the group with an adherence score of at least 6 points shows lower figures for total cholesterol (p = 0.007) and triglycerides (p = 0.002). Similarly, overall cardiovascular risk in this group is the lowest (p < 0.001), as is pulse wave velocity (p = 0.050) and the mean values of the obesity indexes studied (p < 0.05 in all cases).

CONCLUSION

The rate of compliance with the Atlantic diet and physical activity shows that greater adherence to these recommendations is linked to lower cardiovascular risk, lower total cholesterol and triglycerides, lower rates of obesity and lower pulse wave velocity values.

Acute effect of healthy walking on arterial stiffness in patients with type 2 diabetes and differences by age and sex: a pre-post intervention study

BACKGROUND

Daily aerobic exercise such as healthy walking could have an immediate effect on parameters of arterial stiffness; however, there is little evidence in the diabetic population. Our aim, therefore, is to evaluate the association between healthy walking and acute effects on the parameters of arterial stiffness in subjects with type 2 diabetes.

METHODS

The Effectiveness of a multifactorial intervention in diabetics study (EMID), is a study based on an application for smartphones, healthy walking and a nutritional workshop in patients with type 2 diabetes in primary care, is a randomized controlled trial of two parallel groups. This is a subanalysis of the intervention group to evaluate the response to the healthy walking according to age and sex, in 89 subjects with type 2 diabetes, aged between 40 and 70 years. The intervention was a 4 km of a healthy walking at low-moderate intensity. To value our aim, the main study variables were measured before and after it.

RESULTS

The study population had an average age of 65.0 years (61.2-68.1). After the healthy walking, there was a decrease in the parameters of arterial stiffness: Cardio ankle vascular index (CAVI) of - 0.2 (95%CI:-0.4 to - 0.1) and pulse pressure (PP) of the lower extremities of - 3.9 mmHg (95%CI: -5.9 to - 2.0). Furthermore, in the lower extremities there was a decrease in systolic blood pressure of - 5.3 mmHg (95% CI: -7.3 mmHg to - 3.3 mmHg), in diastolic blood pressure of - 1.5 mmHg (95% CI: -2.6 mmHg to - 0.4 mmHg) (p < 0.05 for all). It is observed that males have an OR of 2.981 (IC = 95% 1.095 to 8.119) to achieve a reduction in the CAVI (p < 0.05) and an OR of 2.433 (95%CI: 0.871 to 6.794) in the ankle PP (p > 0.05), compared with females.

CONCLUSIONS

The findings of this study suggest that daily aerobic exercise at a low to moderate intensity, such as healthy walking, has an immediate beneficial effect on the cardio-ankle vascular index, especially in males.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02991079 .

Effect of a multifactorial intervention on the increase in physical activity in subjects with type 2 diabetes mellitus: a randomized clinical trial (EMID Study)

Background:

Regular physical activity is essential for metabolic control in type 2 diabetes mellitus.

Aims:

The aim of this study was to assess the short and long-term impact of a multifactorial intervention on physical activity and clinically relevant biochemical parameters in patients with type 2 diabetes mellitus.

Methods:

This randomised, controlled clinical trial (NCT02991079) included two parallel groups aged 25–70 years from a primary care health centre in Salamanca, Spain. The subjects were assigned randomly (1:1) to control and intervention groups, using Epidat 4.0 software. Both were counselled on the importance of physical activity and maintaining a healthy diet. The intervention group also took five low–moderate intensity 4 km nurse-guided walks, received a smartphone application to promote healthy habits and attended a diet workshop. Physical activity was measured objectively using a pedometer and subjectively using a shortened international physical activity questionnaire (at baseline, 3 and 12 months).

Results:

In total, 204 subjects were included (mean age 60.6 years, 45.6% were women). After 3 months, relative to the control group, the intervention group increased their daily number of steps by 1852, aerobic steps by 1623, distance walked by 994 m, and total metabolic equivalent minutes per week by 1297 and decreased sedentary time by 34.3 minutes per day. Differences from baseline persisted at 12 months, including mean increases of 1141 daily steps, 917 aerobic steps, and 1065 total metabolic equivalent minutes per week in the intervention group relative to the control group ( P<0.05 for all).

Conclusions:

The success of this multifactorial intervention should help inform future clinical approaches and application designs towards managing type 2 diabetes mellitus and improving patient outcomes.

Combined use of smartphone and smartband technology in the improvement of lifestyles in the adult population over 65 years: study protocol for a randomized clinical trial (EVIDENT-Age study)

BACKGROUND

The increasing use of smartphones by older adults also increases their potential for improving different aspects of health in this population. Some studies have shown promising results in the improvement of cognitive performance through lifestyle modification. All this may have a broad impact on the quality of life and carrying out daily living activities. The objective of this study is to evaluate the effectiveness of combining the use of smartphone and smartband technology for 3 months with brief counseling on life habits, as opposed to providing counseling only, in increasing physical activity and improving adherence to the Mediterranean diet. Secondary objectives are to assess the effect of the intervention on body composition, quality of life, independence in daily living activities and cognitive performance.

METHODS

This study is a two-arm cluster-randomized trial that will be carried out in urban health centers in Spain. We will recruit 160 people aged between 65 and 80 without cardiovascular disease or cognitive impairment (score in the Mini-mental State Examination ≥24). On a visit to their center, intervention group participants will be instructed to use a smartphone application for a period of 3 months. This application integrates information on physical activity received from a fitness bracelet and self-reported information on the patient's daily nutritional composition. The primary outcome will be the change in the number of steps measured by accelerometer. Secondary variables will be adherence to the Mediterranean diet, sitting time, body composition, quality of life, independence in daily living activities and cognitive performance. All variables will be measured at baseline and on the assessment visit after 3 months. A telephone follow-up will be carried out at 6 months to collect self-reported data regarding physical activity and adherence to the Mediterranean diet.

DISCUSSION

Preventive healthy aging programs should include health education with training in nutrition and lifestyles, while stressing the importance of and enhancing physical activity; the inclusion of new technologies can facilitate these goals. The EVIDENT-AGE study will incorporate a simple, accessible intervention with potential implementation in the care of older adults.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03574480 . Date of trial Registration July 2, 2018.

Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study)

The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns and has benefits such as improving glycaemic control among patients with type 2 diabetes (T2DM). Our aim is to assess the effectiveness of a multifactorial intervention to improve adherence to the MD, diet quality and biomedical parameters. The EMID study is a randomized and controlled clinical trial with two parallel groups and a 12-month follow-up period. The study included 204 subjects between 25–70 years with T2DM. The participants were randomized into intervention group (IG) and control group (CG). Both groups received brief advice about healthy eating and physical activity. The IG participants additionally took part in a food workshop, five walks and received a smartphone application for three months. The population studied had a mean age of 60.6 years. At the 3-month follow-up visit, there were improvements in adherence to the MD and diet quality of 2.2 and 2.5 points, compared to the baseline visit, respectively, in favour of the IG. This tendency of the improvement was maintained, in favour of the IG, at the 12-month follow-up visit. In conclusion, the multifactorial intervention performed could improve adherence to the MD and diet quality among patients with T2DM.

Vascular and cognitive effects of cocoa-rich chocolate in postmenopausal women: a study protocol for a randomised clinical trial

INTRODUCTION

The intake of polyphenols has certain health benefits. This study will aim to assess the effect of adding a daily amount of chocolate high in cocoa content and polyphenols to the normal diet on blood pressure, vascular function, cognitive performance, quality of life and body composition in postmenopausal women.

METHODS AND ANALYSIS

Here we plan a randomised clinical trial with two parallel groups involving a total of 140 women between 50 and 64 years in the postmenopausal period, defined by amenorrhoea of ​​at least 12 consecutive months. The main variable will be the change in blood pressure. Secondary variables will be changes in vascular function, quality of life, cognitive performance and body composition. The intervention group will be given chocolate containing 99% cocoa, with instructions to add 10 g daily to their normal diet for 6 months. The daily nutritional contribution of this amount of chocolate is 59 kcal and 65.4 mg of polyphenols. There will be no intervention in the control group. All variables will be measured at the baseline visit and 3 and 6 months after randomisation, except cognitive performance and quality of life, which will only be assessed at baseline and at 6 months. Recruitment is scheduled to begin on 1 June 2018, and the study will continue until 31 May 2019.

ETHICS AND DISSEMINATION

This study was approved by the Clinical Research Ethics Committee of the Health Area of Salamanca, Spain ('CREC of Health Area of Salamanca'), in February 2018. A SPIRIT checklist is available for this protocol. The clinical trial has been registered at ClinicalTrials.gov provided by the US National Library of Medicine, number NCT03492983. The results will be disseminated through open access peer-reviewed journals, conference presentations, broadcast media and a presentation to stakeholders.

EVIDENT 3 Study: A randomized, controlled clinical trial to reduce inactivity and caloric intake in sedentary and overweight or obese people using a smartphone application: Study protocol

INTRODUCTION

Mobile technology, when included within multicomponent interventions, could contribute to more effective weight loss. The objective of this project is to assess the impact of adding the use of the EVIDENT 3 application, designed to promote healthy living habits, to traditional modification strategies employed for weight loss. Other targeted behaviors (walking, caloric-intake, sitting time) and outcomes (quality of life, inflammatory markers, measurements of arterial aging) will also be evaluated.

METHODS

Randomized, multicentre clinical trial with 2 parallel groups. The study will be conducted in the primary care setting and will include 700 subjects 20 to 65 years, with a body mass index (27.5-40 kg/m), who are clinically classified as sedentary. The primary outcome will be weight loss. Secondary outcomes will include change in walking (steps/d), sitting time (min/wk), caloric intake (kcal/d), quality of life, arterial aging (augmentation index), and pro-inflammatory marker levels. Outcomes will be measured at baseline, after 3 months, and after 1 year. Participants will be randomly assigned to either the intervention group (IG) or the control group (CG). Both groups will receive the traditional primary care lifestyle counseling prior to randomization. The subjects in the IG will be lent a smartphone and a smartband for a 3-month period, corresponding to the length of the intervention. The EVIDENT 3 application integrates the information collected by the smartband on physical activity and the self-reported information by participants on daily food intake. Using this information, the application generates recommendations and personalized goals for weight loss.

DISCUSSION

There is a great diversity in the applications used obtaining different results on lifestyle improvement and weight loss. The populations studied are not homogeneous and generate different results. The results of this study will help our understanding of the efficacy of new technologies, combined with traditional counseling, towards reducing obesity and enabling healthier lifestyles.

ETHICS AND DISSEMINATION

The study was approved by the Clinical Research Ethics Committee of the Health Area of Salamanca ("CREC of Health Area of Salamanca") on April 2016. A SPIRIT checklist is available for this protocol. The trial was registered in ClinicalTrials.gov provided by the US National Library of Medicine-number NCT03175614.

Effectiveness of a multifactorial intervention based on an application for smartphones, heart-healthy walks and a nutritional workshop in patients with type 2 diabetes mellitus in primary care (EMID): study protocol for a randomised controlled trial

INTRODUCTION

New information and communication technologies (ICTs) may promote lifestyle changes, but no adequate evidence is available on their combined effect of ICTs with multifactorial interventions aimed at improving diet and increasing physical activity in patients with type 2 diabetes mellitus (DM2). The primary objective of this study is to assess the effect of a multifactorial intervention to increase physical activity and adherence to Mediterranean diet in DM2. METHODS AND ANALYSIS: Study scope and population: The study will be conducted at 'La Alamedilla' primary care research unit in Salamanca (Spain). 200 patients with DM2 of both sexes, aged 25-70 years and who meet the inclusion criteria and sign the informed consent will be recruited. Each participant will attend the clinic at baseline and 3 and 12 months after intervention.

INTERVENTION

Both groups will be given short advice on diet and physical activity. The intervention group will also take five heart-healthy walks and attend a group session on diet education and will be trained on use of an application for smartphone (EVIDENT II) for 3 months.

VARIABLES AND MEASUREMENT INSTRUMENTS

The main study endpoints will be changes in physical activity, as assessed by a pedometer and the International Physical Activity Questionnaire, and adherence to the Mediterranean diet, as evaluated by an adherence questionnaire and the Diet Quality Index. Anthropometric parameters and laboratory values, lifestyles and quality of life will also be assessed.

ETHICS AND DISSEMINATION

It was approved by the Clinical Research Ethics Committee of Salamanca on 28/11/2016.

TRIAL REGISTRATION

NCT02991079; Pre-results.

The EVIDENT diet quality index is associated with cardiovascular risk and arterial stiffness in adults

Background

We aimed to simplify information from food frequency questionnaires (FFQs) in a single parameter that allows for rapid identification of quality of patient diet and its relationship to cardiovascular risk and pulse wave velocity (PWV).

Methods

The sample from the EVIDENT study, consisting of 1553 subjects (aged 20–80 years) with no cardiovascular disease selected by random sampling among those attending primary care clinics, was used. The EVIDENT diet index (range 0–100) was calculated based on the results of a FFQ. Evaluation of dietary habits also included adherence to the Mediterranean diet (MD). Cardiovascular risk was estimated, and carotid-femoral pulse wave velocity was measured.

Results

Mean subject age was 54.9 ± 13.8 years, and 60.3% of subjects were female. The mean value of the EVIDENT diet index was 52.1 ± 3.2 points. Subjects in the third tertile (the highest score) had the greatest adherence to MD and the highest energy intake, with greater amounts of carbohydrates, protein, and fiber. The best cut-off point of the EVIDENT diet index for predicting good adherence to the MD is 52.3 (0.71 sensitivity, 0.61 specificity). In a multiple regression analysis, after a complete adjustment, it was estimated that for each one-point increase in the EVIDENT diet index, cardiovascular risk (CVR), blood-pressure, waist circumference, and PWV decreased by 0.14, 0.43, 0.24, and 0.09 respectively (p < 0.05, all).

Conclusions

The diet quality index developed is associated to CVR and its components, and also with arterial stiffness, as measured with PWV. This index is also a good predictor of adherence to MD.

Vascular structure and function and their relationship with health-related quality of life in the MARK study

Background

There is limited evidence concerning the relationship between vascular disease and health-related quality of life (HRQL). We investigated the relationship between vascular structure and function with health-related quality of life in a population with intermediate cardiovascular risk.

Methods

This study analyzed 303 subjects with ankle-brachial index (ABI) values ranging from 0.9 to 1.4 who were included in the MARK study (age 35 to 74 years; mean:60.5 ± 8.5), of which 50.2 % were women. Measurements included: ABI, brachial-ankle pulse wave velocity (ba-PWV), and cardio-ankle vascular index (CAVI), all measured using the VaSera device. The central augmentation index was adjusted to 75 lpm (AIx_75) using the Mobil-O-Graph device. HRQL was assessed by the Spanish version of the SF-12, version2. The highest obtained CAVI and ba-PWV values and the lowest ABI values were considered for the study.

Results

The cohort was composed of21 % smokers, 76 % hypertensive patients, and 24 % diabetic patients. The ABI mean was 1.09 ± 0.07,the ba-PWV mean was 14.64 ± 2.55 m/s with a 12.9 % of subjects higher than 17.5 m/s, AIx_75 26.46 ± 14.05, and CAVI 8.61 ± 1.08 with a 36.6 % of subjects higher than 9. Men scored higher than women in the HRQL measurements for physical (PSC-12; 49.9 vs. 46.9, p = 0.004) and mental (MSC-12) domains (51.2 vs. 47.7, p = 0.003). Age was positively correlated with CAVI (r = 0.547), ba-PWV (r = 0.469), AIx_75 (r = 0.255, p < 0.01), and the MSC-12 (r = 0.147, p < 0.05), but not the PSC-12. In the adjusted multiple linear regression analysis, the positive association of ABI and CAVI with the PSC-12 was maintained.

Conclusions

The ABI in the normal range has a positive association with the PSC-12 of HRQL evaluated with the SF-12. The CAVI also showed a positive association with the PSC-12 of HRQL.

Trial Registration

ClinicalTrials.gov Identifier: NCT01428934.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-016-0272-9) contains supplementary material, which is available to authorized users.

Características basales y cambios en el tratamiento tras el periodo de optimización de los pacientes incluidos en el estudio EFICAR

Objetivo

Se describen los datos basales de clase y capacidad funcional, comorbilidades, calidad de vida y cambios en la medicación durante la optimización del tratamiento, en pacientes con insuficiencia cardiaca y función sistólica deprimida (ICFSD) incluidos en el estudio EFICAR.

Diseño

Ensayo clínico aleatorizado multicéntrico.

Emplazamiento

Siete Centros de Salud.

Participantes

Ciento cincuenta pacientes con ICFSD; edad 68 ± 10 años, 77% varones

Mediciones

Variables sociodemográficas e índice de Charlson. Se evaluó la calidad de vida y la capacidad funcional Se realizó optimización del tratamiento.

Resultados

La etiología principal fue la cardiopatía isquémica (45%). Índice de Charlson global: 2,03 ± 1,05. El 31% ingresaron durante el último año por insuficiencia cardiaca. Fracción de eyección media: 37% ± 8. Clase funcional ii: 89%. Capacidad funcional con prueba de esfuerzo: 6,3 ± 1,6. Test 6 min: 446 ± 78 m. Test de la silla: 13,7 ± 4,4 s. Dinamómetro: 34,53 ± 10,12 kgf y 0,58 ± 0,16 bar. Short Form-36 Health Survey: salud física: 43,3 ± 8,4; salud mental: 50,1 ± 10,6. Minnesota Living with Heart Failure Questionnaire global: 22,8 ± 18,7. Tras optimizar el tratamiento no varió el porcentaje de pacientes ni la dosis media de fármacos analizados.

Conclusiones

La mayoría de los sujetos están en clase funcional ii, con capacidad funcional y calidad de vida disminuida e índice de comorbilidad elevado. Un ajuste protocolizado del tratamiento no consigue aumentar la dosis ni el número de pacientes con fármacos eficaces para la insuficiencia cardiaca con función cardiaca deprimida.

Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study)

BACKGROUND

We analyzed the associations between diabetes and cognitive impairment (CI) and dependence in a population of patients 65 years or older.

METHODS

Cross-sectional study. We randomly selected 311 participants over the age of 65 living in an urban area of Spain. The mean age of the cohort was 75.89 ± 7.12 years, and 69 of the individuals (22.2%) had diabetes. Two questionnaires were used to assess cognitive performance (MMSE and Seven Minute Screen Test), and two assessments were used to evaluate patient dependence (Barthel Index and Lawton-Brody Index). Clinical information and sociodemographic data were also gathered.

RESULTS

Nearly one quarter of patients with diabetes (21.7%) lived alone. Diabetic patients were more sedentary (p = .033) than non-diabetic patients. Roughly one sixth (15.3%) of the diabetics and 10.1% of the non-diabetics were depressed (p = .332). CI was present in 26.1% of the diabetics and 14.5% of non-diabetics (p = .029). Diabetic patients had a MMSE score that was significantly worse than non-diabetics (24.88 ± 4.74 vs 26.05 ± 4.03; p <.05), but no differences were found in the Seven Minute Screen Test. Logistic regressions revealed that the presence of diabetes was independently associated with CI (adjusted for age, gender, years of education, sedentary lifestyle, body mass index, diastolic blood pressure, cholesterol, and depression (OR = 2.940, p = .013). Patients with diabetes showed greater dependence, as measured by the Barthel Index (p = .03) and Lawton-Brody Index (p <.01). Nevertheless, when dependence (dependence or not dependence for each questionnaire) used as a dependent variable in the logistic regression analyses, no significant association with diabetes was found, after adjusting for confounding variables.

CONCLUSIONS

Diabetic patients over the age of 65 are more likely to present CI but not dependence. These findings support the need to include both a functional and cognitive assessment as necessary components in a standard evaluation in both clinical guides and randomized trials of therapeutic interventions in patients with diabetes.

Abdominal obesity as a mediator of the influence of physical activity on insulin resistance in Spanish adults

OBJECTIVE

The aim of the study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and insulin resistance (IR) in Spanish adults and to examine whether this relationship is mediated by abdominal obesity (waist circumference - WC).

METHODS

The cross-sectional study included 1162 healthy subjects belonging to the EVIDENT study (mean age 55.0±13.3years; 61.8% women) from six different Spanish provinces. Moderate-to-vigorous physical activity (MVPA) was measured objectively over 7days using Actigraph accelerometers, collecting data in 60-second epochs, and retaining respondents with ≥4 valid days for the analysis. The homeostasis model of assessment (HOMA-IR) was used to determine IR, and its individual components - fasting glucose and insulin - were determined using standard protocols. Linear regression models were fitted according to Baron and Kenny's procedures for mediation analysis.

RESULTS

Fasting insulin and HOMA-IR levels were significantly worse in adults who spent fewer minutes in MVPA (first quartile≤30.1 and 22.7min/day in men and women, respectively) after adjusting for age, sex, smoking habits, drinking habits, accelerometer wear time, sedentary time, and Mediterranean diet adherence. However, when WC was added to the ANCOVA models as a covariate, the effects disappeared. Mediation analysis reported that WC acts as a full mediator in the relationship between MVPA and IR (HOMA-IR and fasting insulin).

CONCLUSION

These findings show that WC plays a pivotal role in the relationship between MVPA and IR, and therefore highlights that decreasing abdominal obesity might be considered as an intermediate outcome for evaluating interventions aimed at preventing diabetes mellitus.

Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk

The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker.This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity-PWV, carotid intima-media thickness-C-IMT, and ankle-brachial index-ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate).Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product.Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage.

[Relationship between physical activity and hemodynamic parameters in adults]

OBJECTIVES

To analyze the relationship between physical activity, as assessed by accelerometer, with central and peripheral augmentation index and carotid intima media thickness (IMT) in adults.

METHODS

This study analyzed 263 subjects who were included in the EVIDENT study. Physical activity was assessed during 7 days using the ActigraphGT3X accelerometer (counts/min). Carotid ultrasound was used to measure carotid IMT. The Sphygmo Cor System was used to measure central and peripheral augmentation index (CAIx and PAIx).

RESULTS

Mean age 55.85±12 years; 59.30% female; 26.7 body mass index and blood pressure 120/77mmHg. Mean physician activity counts/min was 244.37 and 2.63±10.26min/day of vigorous or very vigorous activity. Physical activity showed an inverse correlation with PAIx (r=-0.179; P<.01) and vigorous activity day time with IMT(r=-0.174; P<.01), CAIx (r=-0.217; P<.01) and PAIx (r=-0.324; P<.01). After adjusting for confounding factors in the multiple regression analysis, the inverse association of CAIx with counts/min and the time spent in vigorous/very vigorous activity was maintained.

CONCLUSION

The results suggest that both physical activity and time spent in vigorous or vigorous activity are associated with the central augmentation index in adults.

Modification over time of pulse wave velocity parallel to changes in aortic BP, as well as in 24-h ambulatory brachial BP

Arterial stiffness as assessed by carotid-femoral pulse wave velocity (cfPWV) is a marker of preclinical organ damage and a predictor of cardiovascular outcomes, independently of blood pressure (BP). However, limited evidence exists on the association between long-term variation (Δ) on aortic BP (aoBP) and ΔcfPWV. We aimed to evaluate the relationship of ΔBP with ΔcfPWV over time, as assessed by office and 24-h ambulatory peripheral BP, and aoBP. AoBP and cfPWV were evaluated in 209 hypertensive patients with either diabetes or metabolic syndrome by applanation tonometry (Sphygmocor) at baseline(b) and at 12 months of follow-up(fu). Peripheral BP was also determined by using validated oscillometric devices (office(o)-BP) and on an outpatient basis by using a validated (Spacelabs-90207) device (24-h ambulatory BP). ΔcfPWV over time was calculated as follows: ΔcfPWV=[(cfPWVfu-cfPWVb)/cfPWVb] × 100. ΔBP over time resulted from the same formula applied to BP values obtained with the three different measurement techniques. Correlations (Spearman 'Rho') between ΔBP and ΔcfPWV were calculated. Mean age was 62 years, 39% were female and 80% had type 2 diabetes. Baseline office brachial BP (mm Hg) was 143±20/82±12. Follow-up (12 months later) office brachial BP (mm Hg) was 136±20/79±12. ΔcfPWV correlated with ΔoSBP (Rho=0.212; P=0.002), Δ24-h SBP (Rho=0.254; P<0.001), Δdaytime SBP (Rho=0.232; P=0.001), Δnighttime SBP (Rho=0.320; P<0.001) and ΔaoSBP (Rho=0.320; P<0.001). A multiple linear regression analysis included the following independent variables: ΔoSBP, Δ24-h SBP, Δdaytime SBP, Δnighttime SBP and ΔaoSBP. ΔcfPWV was independently associated with Δ24-h SBP (β-coefficient=0.195; P=0.012) and ΔaoSBP (β-coefficient= 0.185; P=0.018). We conclude that changes in both 24-h SBP and aoSBP more accurately reflect changes in arterial stiffness than do office BP measurements.

Moderate-to-vigorous physical activity as a mediator between sedentary behavior and cardiometabolic risk in Spanish healthy adults: a mediation analysis

BACKGROUND

Public health strategies for cardiovascular prevention highlight the importance of physical activity, but do not consider the additional potentially harmful effects of sedentary behavior. This study was conducted between 2010 and 2012 and analyzed between 2013 and 2014. The aim of the study was to analyze the relationship between sedentary behavior and cardiometabolic risk factors in the Spanish adult population and to examine whether this relationship is mediated by moderate-to-vigorous physical activity (MVPA).

METHODS

The cross-sectional study included 1122 healthy subjects belonging to the EVIDENT study. Sedentary behavior was objectively measured over 7 days using Actigraph accelerometers. We assessed waist circumference (WC), triglycerides-to-HDL-C ratio (TG/HDL-C), and mean arterial pressure (MAP), and undertook homeostasis model assessment (HOMA-IR). Linear regression models were fitted according to Baron and Kenny procedures for mediation analysis.

RESULTS

TG/HDL-C and HOMA-IR were significantly higher in adults who spent more minutes in sedentary activities after adjusting for potential covariates. However when MVPA was added to the ANCOVA models as covariate the effect of sedentary time on HOMA-IR disappeared. In addition, MVPA acted as a full mediator of the relationship between sedentary time and HOMA-IR. In contrast, subjects with lower levels of MVPA presented worse cardiometabolic profiles than those from higher MVPA categories, even after controlling for sedentary time and other potential confounders.

CONCLUSIONS

These results suggest that both MVPA and sedentary time should be considered when developing cardiometabolic risk guidelines.

TRIAL REGISTRATION

NCT01083082 .

Validation of the automatic image analyser to assess retinal vessel calibre (ALTAIR): a prospective study protocol

INTRODUCTION

The fundus examination is a non-invasive evaluation of the microcirculation of the retina. The aim of the present study is to develop and validate (reliability and validity) the ALTAIR software platform (Automatic image analyser to assess retinal vessel calibre) in order to analyse its utility in different clinical environments.

METHODS AND ANALYSIS

A cross-sectional study in the first phase and a prospective observational study in the second with 4 years of follow-up. The study will be performed in a primary care centre and will include 386 participants. The main measurements will include carotid intima-media thickness, pulse wave velocity by Sphygmocor, cardio-ankle vascular index through the VASERA VS-1500, cardiac evaluation by a digital ECG and renal injury by microalbuminuria and glomerular filtration. The retinal vascular evaluation will be performed using a TOPCON TRCNW200 non-mydriatic retinal camera to obtain digital images of the retina, and the developed software (ALTAIR) will be used to automatically calculate the calibre of the retinal vessels, the vascularised area and the branching pattern. For software validation, the intraobserver and interobserver reliability, the concurrent validity of the vascular structure and function, as well as the association between the estimated retinal parameters and the evolution or onset of new lesions in the target organs or cardiovascular diseases will be examined.

ETHICS AND DISSEMINATION

The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent to agree to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. Validation of this tool will provide greater reliability to the analysis of retinal vessels by decreasing the intervention of the observer and will result in increased validity through the use of additional information, especially in the areas of vascularisation and vessel branching patterns.

TRIAL REGISTRATION NUMBER

Clinical Trials.gov Identifier: NCT02087605.

Physical activity program for patients with dementia and their relative caregivers: randomized clinical trial in Primary Health Care (AFISDEMyF study)

BACKGROUND

The aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving.The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed.

METHODS/DESIGN

DESIGN

Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1).

VARIABLES

The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life.

INTERVENTION

For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care.

ANALYSIS

An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result.

DISCUSSION

If the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT02044887.

Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol

BACKGROUND

New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging.

METHODS/DESIGN

A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness.

DISCUSSION

Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT02016014.

Electrocardiographic left ventricular hypertrophy criteria and ambulatory blood pressure monitoring parameters in adults

BACKGROUND

To examine the relationship between ambulatory blood pressure monitoring parameters (ABPM) and electrocardiographic criteria for left-ventricular hypertrophy (LVH) in adults.

METHODS

This study analyzed 1,544 subjects from the EVIDENT study (mean age = 55 ± 14 years; 61% women). A standard electrocardiograph (ECG) and 10 criteria were used to detect LVH. Office and ABPM were performed, and we analyzed 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP), percentage of time awake with SBP ≥135 mm Hg, percentage of time asleep with SBP ≥120 mm Hg, and central aortic blood pressure.

RESULTS

LVH according to some electrocardiographic criteria was found in 11.30% of the patients (16.60% of men and 7.70% of women). The patients with LVH were older; had higher values for office, 24-hour and, central aortic blood pressure; were more likely to be men; and had a higher prevalence of obesity, diabetes, and antihypertensive or lipid-lowering drug use. In the logistic regression analysis, the association between the parameters of ABPM and LVH, after adjusting for age, sex, body mass index, and heart rate, remained statistically significant.

CONCLUSIONS

Twenty-four hour blood pressure, the percentage of time with elevated awake and asleep SBPs, and the central systolic blood pressure are related to the presence of LVH as determined by ECG in adults. These results indicate the potential importance of the monitoring and control of different 24-hour parameters of blood pressure in addition to the standard clinic blood pressure with respect to the development of LVH.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT01325064.

Relationship between objectively measured physical activity and cardiovascular aging in the general population--the EVIDENT trial

BACKGROUND

Aging has been associated with an increase in arterial stiffness. We analyzed the relationship between regular physical activity and cardiovascular aging evaluated by the radial augmentation index (rAIx), ambulatory arterial stiffness index (AASI), pulse pressure (PP) and heart age in subjects without atherosclerotic disease.

METHODS

A cross-sectional study was performed including 1365 subjects from the EVIDENT trial (mean age 54.9±13.7 years; 60.3% women). As a measure of total volume of physical activity we used counts/minute recorded in an accelerometer (Actigraph GT3X) that participants wore for seven days, collecting data in 60-sec epochs, and respondents with ≥4 valid days were retained for the analysis. Arterial stiffness was evaluated using measures of rAIx, AASI, and central and peripheral PP on the B-pro device. rAIx was adjusted to 75 heart rate(rAIx75). Cardiovascular risk and heart age was estimated by the Framingham Risk Score.

RESULTS

The median (IQR) of counts/min was 236.9 (176.3-307.8), rAIx75 90 (77-100), sleep PP 40 mmHg (33-47), central PP 39 mmHg (32-47) and heart age 57 years (45-73) and the mean±SD of the ASSI was 0.44±0.07. We found an inverse correlation between counts/minute and rAIx75 (r=-0.086; p<0.01), AASI (r=-0.146; p<0.001), heart age (r=-0.163; p<0.001) and peripherals PP. These associations were remained after controlling for potential confounders, except for rAIx75. In the multiple regression analysis, after adjustment, an inverse association persisted between counts/minute and AASI, sleep PP and heart age, but not with rAIx75. Accordingly, for every 100 higher counts/minute of accelerometer measures, both AASI and sleep PP would be lower by one measurement unit (beta=-0.979 and -1.031 respectively, p<0.001) and the estimated heart age by half year (beta=-0.525, p=0.023).

CONCLUSIONS

Regular physical activity was inversely associated with parameters related to advanced cardiovascular aging after adjustment for potentially influencing variables.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT01083082.

[Prevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study]

OBJECTIVE

To estimate the prevalence of cardiovascular diseases, cardiovascular risk factors, and the psychosocial characteristics associated with them in an urban population aged 65 years and older.

DESIGN

Descriptive cross-sectional study of the population.

SETTING

City of Salamanca (Spain).

PARTICIPANTS

A total of 480 participants aged 65 and older were selected using a stratified randomized sampling method. A health questionnaire was completed in the participants' homes.

MAIN MEASUREMENTS

Weight, height, waist circumference, arterial pressure, blood glucose and cholesterol, were measured, and the standardized prevalence for a European population was estimated.

RESULTS

A total of 327 participants were interviewed (68.10% of those selected), mean age of participants was 76 (SD: 7.33). Of the total, 64.5% were women and 20.2% (15.8-24.5) had some cardiovascular disease. In males, the most prevalent cardiovascular disease was ischemic heart disease (12.1% [6.1-18]), while in females it was heart failure (10.4% [6.3-14.6]). Hypertension was the most frequent cardiovascular risk factor for males (63.8% [53.2-70.9]) and females (69.7%.[63.5-75.9]), followed by diabetes in males (36.2% [27.5-45]), and sedentary lifestyle in females (36.0% [29.5-42.5]). Those with cardiovascular diseases were more dependent and had a worse prognosis (Charlson's Comorbility Index).

CONCLUSIONS

Ischemic heart disease is the most prevalent heart disease in males, while heart failure is the most prevalent disease for females. Almost 80% of the population aged 65 and older did not suffer any of the three cardiovascular diseases that are the main causes of mortality in this group of age. Participants who had a CVD were more dependent for activities of daily living.