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Aim: To analyze differences in blood pressure levels in children and adolescents in Galicia with those of peers living in other parts of Spain., Design: Cross-sectional study done in a rural area in Galicia., Participants: 870 boys and girls 6 to 16 years old. They are compared with published data from the RICARDIN study, that includes 10,042 participants selected at the schools in nine centers of Spain (one was the center in Galicia)., Measurements: Standardized methodology and certification procedures were used in Galicia and Spain to measure weight, height, Quételet index, systolic (SBP) and fifth-phase diastolic blood pressure (DBP5) and sexual maturation. Data are presented by sex and age group (1 year) both in Galicia and Spain., Results: From 11 years and above, girls in Galicia present higher SBP than in Spain. In boys, the difference appears later. Galicia shows higher DBP5 levels than Spain in every age-sex group. In relation to obesity, the differences are of a small magnitude in the Quételet index, again, higher values in Galicia., Conclusions: This is the first population-based study available that rules out the possibility that the observed differences, previously already suggested, could be attributed to methodological problems. The differences in blood pressure and obesity between Galicia and other areas of Spain, already previously suggested in adults, can be the reflection of differences present from childhood.

Experimental designs in clinical investigation are discussed in this article. Guideline examples have been used in the area of Cardiology using always the same one only one whenever possible. We have looked for a different perspective from what is generally used in the discussion of the general characteristics of experimental designs, and more specifically of clinical trials and we deal with the aspects of clinical trials which are usually ignored due to their marginal character. We also discuss those characteristics which differentiate clinical trials in respect to other designs and types of questions which are answered by clinical trials. And we finally discuss various aspects such as randomization and its various types (simple, block, stratified, pre-randomized) and variable types of evaluating the answers, masking and the problems in its maintenance, with certain kinds of designs, sample size, etc. There is a brief mention of two particular cases: factorial and cross over designs are both discussed, mentioning their strong and weak points. Likewise, we discuss community trials as another experimental design and examples are provided. Finally, we discuss aspects of criteria: such as, When to stop the trials? or Who are the results applicable to?, and we suggest points to take into consideration when these decisions are made.

A cross-sectional study of the prevalence and distribution of diabetes among 40- to 69-year olds in Galicia (NW Spain) is presented. A (R)Reflotron system was used to measure the capillary fasting glucaemia in 1275 subjects randomly chosen from the electoral roll, who also answered a short questionnaire and were weighed and measured. The prevalence of diabetes was 7.5% regardless of sex or habitat (urban or rural), and increased significantly with age. These data are in keeping with the scant available information from other parts of Spain and the world in general. The lack of difference between urban and rural habitats was unexpected in view of previously reported dietary differences between both areas.

This paper is the written version of the conference that under the same title was presented in the XXX Congreso Nacional de la Sociedad Española de Cardiología. In the paper, the topic of arterial hypertension (AHT) in Spain is approached from different perspectives, as well as to what extend cardiologists influence or are influenced by it. First, there is a brief overview concerning the diagnostic and therapeutic status of AHT in the population, and its evolution in the last years. The paper continues analyzing the research on AHT sponsored by the Fondo de Investigación Sanitaria in recent years, and emphasizes the little participation of cardiologists as principal investigators in this area. Next, publications in Spanish and international scientific journals are assessed. To end the paper, a proposal of the possible role of the cardiologist on diagnosis, treatment, continued education and research on hypertension is presented.

Secondary prevention studies have shown that lipid-lowering therapy improve angiographic outcome and reduce mortality and incidence of ischemic clinical events in patients with coronary artery disease. The mechanism responsible for the improvement in prognosis seem to be subtle as this improvement cannot be explained by changes in the angiographic diameter of coronary arteries. Atherosclerotic plaque rupture and subsequent thrombosis are the central features in the pathogenesis of acute coronary events: unstable angina, myocardial infarction and sudden death. Cholesterol lowering might decrease the risk of plaque rupture and its thrombogenicity, as well as normalise the impaired endothelial function in hypercholesterolemic patients. In this report, the effects of lipid-lowering therapy on angiographic outcome and incidence of clinical events, in patients suffering from coronary artery disease, are reviewed, and the mechanisms that might explain these findings are discussed.

This paper is the written version of the conference that under the same title was presented in the XXX Congreso Nacional de la Sociedad Española de Cardiología. In the paper, the use of the most recent antihypertensive drugs is advocated as first line therapy. The defence is based in cardiac and non cardiac considerations. Among the former, there are certain advantages of the new drugs in areas as regression of left ventricular hypertrophy and improvement of coronary flow and coronary reserve. Among the non cardiac considerations there are some metabolic factors (non adverse effect on the lipid profile), as well as a positive effect on some endocrine-metabolic cascades like the insulin-resistance syndrome and a very important role in certain special situations as coexistence with other diseases and individual characteristics of the patient (pregnancy or elderly for example).

It has been suggested that a family history positive for coronary heart disease (CHD) increases the risk of CHD. We studied this association to determine the degree of risk, the independence of this association and the presence of interaction of a family history of CHD with the major known risk factors in a low incidence area. One hundred and six hospital cases (85 males and 21 females) of CHD and 106 hospital controls individually matched with each case for sex, age and place of residence (rural-urban) were studied. From every participant, information was collected on their personal and family history of cardiovascular disease and risk factors; height, weight, lipid profile and blood pressure were measured, and an electrocardiogram was recorded. Conditional logistic regression was used in the analysis. The observed odds ratio of patients suffering from CHD among those with, compared to those without, a positive family history of CHD was 4.95 (95% confidence interval = 1.27-19.28) after adjusting for the major known risk factors in each individual and their families (no interaction term remained in the model). The results support the hypothesis that a family history of CHD, acting through mechanisms other than known risk factors or their familial aggregation, is an independent risk factor for CHD even in a low incidence area. No interaction effect was observed between family history and the presence of the three major risk factors of CHD. This should help to identify individuals at greater risk of CHD.

Background: Stroke is the cardiovascular disease which causes the greatest number of deaths in Galicia, mortality, particularly in women, being higher than in the rest of Spain. The aim of this study was to investigate the risk factors of stroke and its importance in Galicia., Methods: A hospitalary study of cases and controls was performed including 76 patients with stroke and 76 controls individually paired for age, sex, population habitat and date of admission with anamnesis, weight, height and blood pressure, analysis and electrocardiogram being carried out in all., Results: An association was found between the disease and family history of stroke (odds ratio = 3.6, confidence interval 95% = 1.2-13.3), personal history of stroke (17.9; 4.0-79.1), personal history of atrial fibrillation (15.0; 3.3-68.3), high blood pressure (4.5; 1.9-11.6) and ingestion of alcohol greater than or equal to 80 g/day in comparison with abstemious patients adjusted for the effect of high blood pressure (2.5; 1.1-5.7). An association was also observed with serum cholesterol levels greater than or equal to 250 mg/dl (6.46 mmol/l) (3.3; 1.2-8.8, in comparison with cholesterol less than 200 mg/dl). No association was found with the cigarette smoking (1.2; 0.7-2.3)., Conclusions: The results observed for high blood pressure and the ingestion of alcohol regardless of the same are of importance in primary prevention due to being modifiable risk factors. The association with family history of stroke and auricular fibrillation reinforce the needs for primary prevention measures in these subpopulations while having had a stroke or a transitory ischemic attack is the characteristic with the most risk reinforcing the need for secondary prevention measures which have found to be effective. The controls presented abnormally low cholesterol levels that do not reflect those of the population from which they originate, thus existing the possibility that the association observed is spurious.

Background: The aim of this study was to determine the levels of certain factors of cardiovascular risk in children and adolescents in rural areas of Gallicia., Methods: One thousand eight children between the ages of 6 and 15 years selected from three primary schools were studied. Weight, height, blood pressure, serum levels of cholesterol and self admitted consumption of tobacco were determined in each participant., Results: The patterns of body mass, blood pressure and total cholesterol selected to age and sex are very similar to those observed in a great deal of the Spanish and foreign studies. However, the absolute values do not necessarily coincide. The children studied were more obese than those reported in other studies carried out in the rest of Spain with similar values of systolic blood pressure and lower cholesterol levels. The levels of cholesterol in this study were within the range observed in other Western countries, lower than those found in other parts of Spain but much higher than the ideal quantities recommended by the WHO. Blood pressure was similar to that of a recent meta-analysis of Spanish studies but much higher than that observed in the Second American Task Force Study. With regard to the use of tobacco, this population demonstrated lower prevalences to those of other Spanish populations. From the age of 14 the consumption of cigarettes greatly increases, especially in boys., Conclusions: Obesity and blood pressure appear to be a more important potential problem than cholesterol among the cardiovascular risk factors considered in the children studied in comparison with populations of a similar age. If prevention plans on the use of tobacco are foreseen in Spain, they should be made before the age of 14 when an important number of children already smoke or have tried cigarettes.

Aerolysin is one of the important virulence factors for Aeromonas hydrophila infection. To understand the characteristics of the aerolysin gene in clinical A. hydrophila, a genomic library was constructed by using pUC19 as cloning vector. The positive clone containing the aerolysin gene was selected by the colony hybridization method, using the aerolysin probe (an 48 mer oligonucleotide) of aquatic A. hydrophila. Four positive out of 1,200 transformants were obtained from the primarily screened genomic library, and were further identified for specific binding capability by the dot blot hybridization method. One of three positive clones, designated as pAH-1, was further analyzed by the restriction mapping technique. For further sequencing the aerolysin gene nucleotides, the 3.0 kb fragment of A. hydrophila isolated from pAH-1 was cloned into pBluescriptII, pKS+, resulting in plasmid pKAH-1. Subclones of pKAH-1 were constructed and determined for the presence of 48 mer aerolysin gene sequence by dot blot hybridization method. These (subclones pKS+SS and pSK+SS) were selected for nucleotide sequencing by single-stranded dideoxy sequencing method. The nucleotide sequence similarity coefficient between clinical and aquatic strains of A. hydrophila was 76%; whereas between clinical strains of A. hydrophila and A. sobria was 71%. Since the length of the A. hydrophila DNA fragment cloned into pAH-1 is 3.0 kb, a larger size than the aerolysin gene of aquatic A. hydrophila (1.45 kb) and, also, includes 3' region of aerolysin gene in aquatic A. hydrophila, the indication is that the clone, pKAH-1, contains an entire aerolysin gene of A. hydrophila. The similarity between a small region (containing 8 amino acids) of the aerolysin in the clinical A. hydrophila and the alpha toxin of Staphylococcus aureus suggests that there is functional significance in this region.

This paper briefly presents the situation of high blood pressure in Spain, both its prevalence in different parts of the country and its relevance as a cardiovascular risk factor and its relationship with demographic characteristics and other not removable risk factors. The association high blood pressure/hypercholesterolemia is discussed in greater detail, offering a multifactorial and quantitative approach of risk factors in the prevention of cardiovascular diseases.