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Resumen Introduccion y objetivos Estudiar la validez de la funcion SCORE original de bajo riesgo sin y con colesterol unido a lipoproteinas de alta densidad y SCORE calibrada en poblacion espanola. Metodos Analisis agrupado con datos individuales de 12 estudios de cohorte de base poblacional. Se incluyo a 30.919 participantes de 40-64 anos sin enfermedades cardiovasculares en el momento del reclutamiento, que se siguieron durante 10 anos para la mortalidad cardiovascular contemplada en el proyecto SCORE. La validez de las funciones se analizo mediante el area bajo la curva ROC (discriminacion) y el test de Hosmer-Lemeshow (calibracion), respectivamente. Resultados Se dispuso de 286.105 personas/ano. La mortalidad a 10 anos por causas cardiovasculares fue del 0,6%. La razon de casos esperados/observados fue de 9,1, 6,5 y 9,1 en varones y de 3,3, 1,3 y 1,9 en mujeres con las funciones SCORE original de bajo riesgo sin y con colesterol unido a lipoproteinas de alta densidad y SCORE calibrada, respectivamente; diferencias estadisticamente significativas con el test de calibracion de Hosmer-Lemeshow entre la mortalidad predicha con SCORE y la observada (p Conclusiones Todas las versiones de las funciones SCORE disponibles en Espana sobreestiman significativamente la mortalidad cardiovascular observada en la poblacion espanola. A pesar de la aceptable capacidad de discriminacion, la prediccion del numero de acontecimientos cardiovasculares mortales (calibracion) fue significativamente imprecisa.

The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity [Hazard Ratio=2.34 (95% confidence interval: 1.19-4.61) and 5.65 (1.54-20.73), respectively]. Overweight and obesity significantly increased the risk of cancer death in women [3.98 (1.53-10.37) and 11.61 (1.93-69.72)]. Finally, obese men had an increased risk of cancer death and overall mortality [1.62 (1.03-2.54) and 1.34 (1.01-1.76), respectively]. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations.

Objective To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. Method Pooled analysis of 11 population-based Spanish cohorts (1992–2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. Results The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. Conclusions The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.

Background and aims Transferring the results from clinical trials on type 2 diabetes prevention is the objective of the Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional intervention (DE-PLAN) project in Catalonia, whose cost-effectiveness analysis is now presented. Patients and methods A prospective cohort study was performed in primary care involving individuals without diagnosed diabetes aged 45–75 years (n = 2054) screened using the questionnaire Finnish Diabetes Risk Score (FINDRISC) and a subsequent oral glucose tolerance test. Where feasible, high-risk individuals who were identified (n = 552) were allocated sequentially to standard care (n = 219), a group-based (n = 230) or an individual-level (n = 103) intensive (structured programme of 6 h using specific teaching techniques) lifestyle intervention (n = 333). The primary outcome was the development of diabetes (WHO). We evaluated the cost of resources used with comparison of standard care and the intervention groups in terms of effectiveness and quality of life (15D questionnaire). Results After 4.2-year median follow-up, the cumulative incidences were 18.3% (14.3–22.9%) in the intensive intervention group and 28.8% (22.9–35.3%) in the standard care group (36.5% relative-risk-reduction). The corresponding 4-year HR was 0.64 (0.47–0.87; P

Background and aims: Knowledge of the effect of nut consumption on metabolic syndrome (MetS) components is limited. We assessed the effects of nut intake on adiposity, serum lipids, insulin resistance, and inflammatory biomarkers in patients with MetS. Methods and results: In a randomized, parallel-group, 12-week feeding trial, 50 patients with MetS were given recommendations for a healthy diet with or without supplementation with 30 g/day of raw nuts (15 g walnuts, 7.5 g almonds and 7.5 g hazelnuts) (Nut and Control diet groups, respectively). Adiposity measures, serum lipids, insulin, Homeostasis Model Assess- ment (HOMA), interleukin-6 (IL-6) and other inflammatory biomarkers, and 48-h fecal fat were determined basally and at study's completion. Moderate weight loss, decreased adiposity, and lower blood pressure occurred similarly after both diets. The Control, but not the Nut diet, was associated with significant (P

To assess the relevance of unrecognized hyperglycemia among high-risk subjects for developing diabetes a cross-sectional study was carried out. Subjects aged 40–75 years with (high-risk group) and without (control group) history of impaired glucose metabolism underwent a 2 h-oral glucose tolerance test (OGTT). All individuals with diabetes diagnostic criteria and all controls with glucose abnormalities at OGTT were excluded. An individualized 48-h continuous glucose monitoring (CGM) calibrated by fasting plasma glucose was performed. The microdialysis-based biosensor recordings were computerized in order to identify continuous glucose profiles. Of the 121 monitored subjects, 104 were finally analyzed (56.7% female, 57.8 years, BMI = 29.2, A1C = 4.9%, HOMA index = 2.5). Glucose profiles corresponded to 31 controls (29.8%), 32 high-risk individuals with normal OGTT (30.8%) and 41 (39.4%) with hyperglycemia at OGTT. The recordings defined as hyperglycemia (fasting ≥6.1 mmol/l, non-fasting ≥7.8 mmol/l) appeared during an average of 1.4 h, 4.9 h and 7.6 h (3.9%, 13.9% and 19% of the CGM time), respectively. The highest percentage of impaired CGM registers corresponded to the fasting period. Nevertheless, the longest duration corresponded to the non-fasting period. The CGM evidenced a relevant degree of casual undetected hyperglycaemia among high-risk individuals.

ObjetivoEstimar el riesgo de accidente cerebrovascular (ACV) de la diabetes, en el contexto del síndrome metabólico (SM) o fuera de él, según los criterios de la Organización Mundial de la Salud (OMS) y del National Cholesterol Education Program (NCEP).DiseñoEstudio multicéntrico y prospective de cohortes.EmplazamientoAtención primaria de salud.ParticipantesSujetos de 55-85 años libres de ACV incluidos desde 1998 en una muestra poblacional aleatoria y representativa para el seguimiento del SM en Reus (Tarragona).Mediciones principalesEl riesgo de ACV se estimó con la escala de Framingham aplicando un algoritmo informático de cálculo automático y un diseño factorial por diagnósticos (diabetes y/o SM). Se comparó el riesgo teórico con la incidencia real de acontecimientos cerebrovasculares (1998-2003).ResultadosEntre 728 sujetos (412 mujeres; edad media de 66 años; índice de masa corporal = 29), 457 (62,8%) no tenían diabetes ni SM, 93 (12,8%) con SM no tenían diabetes, 72 (9,9%) con diabetes no tenían SM y 106 (14,5%) presentaban ambas enfermedades (según criterios de la OMS). Según el NCEP, estas proporciones fueron del 60,7; el 14,8; el 7,8 y el 16,7%. El riesgo de ACV medio a 10 años para los 4 grupos (OMS/NCEP) fue: 8,4/9,1; 10,8/10,5; 18/17,3 y 18,8/19,1%, respectivamente. La incidencia acumulada de acontecimientos cerebrovasculares fue del 2,8; 1,4; 5,4 y 3,8% (OMS) y 2,5; 2,8; 3,5 y 5,8% (NCEP).ConclusionesEl riesgo de ACV calculado mediante la fórmula de Framingham es muy elevado en sujetos con diabetes, con independencia de su integración en el SM. Es muy probable que la escala también sobredimensione este riesgo en la población española.ObjectiveTo estimate stroke risk for diabetes, isolated or associated to metabolic syndrome (MS) according WHO and National Cholesterol Education Program (NCEP)criteria.DesignMulticentre and prospective cohort study.SettingPrimary health care.ParticipantsSubjects between 55-85 years-old without any evidence of stroke, included from 1998 in a random population sample for MS follow-up during routine practice in Reus (Tarragona, Spain).Main measurementsStroke risk was achieved using Framingham function by means of a computerized algorithm using a diagnostic factorial design (diabetes and/or MS). Theoretical stroke risk and cumulated incidence of stroke events (1998-2003) were compared.ResultsAmong 728 subjects (412 women, mean age =66 years old, body mass index =29 kg/m2), 457 (62.8%) did not have diabetes, nor MS, 93 (12.8%) had MS without diabetes, 72 (9.9%) diabetes without MS, and 106 (14.5%) presented both conditions (WHO rules). According NCEP criteria were 60.7%, 14.8%, 7.8%, and 16.7%, respectively. Ten-year estimated stroke risk accounted for (WHO/NCEP) 8.4/9.1%, 10.8/10.5%, 18/17.3%, and 18.8/19.1%. Cumulated incidence for stroke events were: 2.8%, 1.4%, 5.4%, and 3.8% (WHO), and 2.5%, 2.8%, 3.5%, and 5.8%, respectively (NCEP).ConclusionsStroke risk scores were extremely increased among diabetic subjects irrespective to MS diagnose. The Framingham function probably overestimates stroke risk among Spanish individuals.

ObjetivoEvaluar si una nueva técnica, el registro continuo de la glucemia (RCG), es viable y útil para contrastar el diagnóstico y predecir la evolución durante la prediabetes tipo 2.DiseñoObservacional, multicéntrico, transversal (fase 1); posteriormente, longitudinal de seguimiento de cohortes (fase 2).EmplazamientoAtención primaria de salud (5 centros).ParticipantesSerá incluido un grupo de 84 sujetos de alto riesgo libres de diabetes si una prueba actual de tolerancia oral a la glucosa (PTOG) descarta la enfermedad. Se efectuará un primer RCG mediante un biosensor calibrado por la glucemia plasmática, obteniendo un perfil glucémico continuo. Se establecen 2 cohortes de seguimiento diferenciando los sujetos con PTOG normal (n=42) de aquellos con hiperglucemia prediabética (n=42). A los 12 y 24 meses, se reclasificará el diagnóstico mediante sobrecarga oral seguida de un nuevo registro.Mediciones principalesDatos demográficos, clínicos (incluidos componentes del síndrome metabólico), analíticos básicos y avanzados (marcadores de inflamación, insulinemia, péptido C). Análisis informático del RCG comparando sus períodos (basal, pre-posprandial, nocturno) y el área bajo la curva del perfil continuo con el diagnóstico convencional revisando su concordancia temporal. Estudio de su influencia sobre la incidencia de diabetes o la regresión a la normalidad glucémica. Evaluación de la satisfacción del usuario con el RCG mediante cuestionario estructurado tipo Likert.DiscusiónEl proyecto es un contrapunto diagnóstico evolutivo entre PTOG estándar y RCG, más fisiológico y basado en un criterio infrautilizado, la glucemia al azar. Una técnica aún no evaluada en atención primaria puede aportar datos de indudable interés científico para el estudio de la prediabetes tipo 2.ObjectiveTo evaluate the accuracy of continuous blood glucose monitoring (CBGM) in order to asses diagnostic procedures and predict glycaemic status in type 2 prediabetes.DesignObservational, multicenter, cross-sectional (phase 1) plus longitudinal, cohort follow-up study (phase 2).SettingFive primary health-care centers.InterventionsA total of 84 high-risk subjects will be included after a non-diabetic oral glucose tolerance test (OGTT). A first CBGM using a subcutaneous microdialysis glucose sensor technique in order to obtain a continuous profile will be carried out. Two different cohorts, subjects with normal OGTT (n=42) and individuals with prediabetic hyperglycemia (n=42) will be established. Diagnoses will be revised at 12 and 24 month follow-up by means of an OGTT together with a new monitoring.Main measurementDemographical, clinical (including metabolic syndrome items), basic, and advanced analyses (inflammation emergent markers, insulinemia, C-peptide). CBGM computerized analysis comparing fasting, preprandial, postprandial, nocturnal period, and area under the curve of continuous profile with regular diagnoses, taking into account temporary concordance. Relationship of CBGM parameters with normal glucose tolerance or diabetes incidence. Evaluation of day-to-day quality of life of CBGM users by means of an standardized Likert questionnaire.DiscussionThis study seeks to demonstrate the effectiveness and feasibility of CBGM, more physiological than OGTT and based on an underestimated random blood glucose diagnostic criterion. This innovative system may provide interesting scientific data in the field of type 2 prediabetes.

Introduccion Estimar la prevalencia del sindrome metabolico (SM) y de enfermedad cardiovascular asociada en poblacion diabetica asistida en Atencion Primaria en comparacion con la poblacion libre de diabetes. Diseno y ambito Diseno y ambito: estudio observacional, transversal y multicentrico (10 centros) en Atencion Primaria. Mediciones e intervenciones: muestreo sistematico entre los sujetos de 15 a 74 anos atendidos durante el ano 2001 (error ?: 0,05; precision: 1%; prevalencia de diabetes: 6%-7%). Se registraron datos demograficos y antropometricos (edad, sexo e indice de masa corporal), factores de riesgo y episodios confirmados de enfermedad cardiovascular en cualquiera de sus formas. Se determino presion arterial, glucemia basal, glucohemoglobina A1c, perfil lipidico (colesterol total, c-HDL, c-LDL y trigliceridos) y microalbuminuria, calculando el riesgo cardiovascular teorico mediante la ecuacion de Framingham. Resultados Se revisaron datos de 2.222 sujetos (1.181 mujeres; 53,2 %) con 49,8±18,4 anos de edad media, 702 (31,6%) con hipertension, 499 (22,4 %) con dislipidemia, 453 (20,4%) fumadores activos y 235 (10,6 %) con diabetes mellitus. Entre estos ultimos, 154 (65,5 %) presentaron criterios de SM (criterios OMS), con un riesgo cardiovascular promedio de 20,2± 7,8 frente a 7,0 ± 7,0 de la poblacion sin diabetes ni SM (p Discusion En poblacion asistida en Atencion Primaria la prevalencia del SM asociado a la diabetes es muy elevada, comportando un incremento significativo tanto del riesgo como de la enfermedad cardiovascular.

Fundamento y objetivo: Evidenciar la hiperglucemia inadvertida en sujetos con alto riesgo de diabetes tipo 2. Sujetos y metodo: Estudio transversal multicentrico en atencion primaria. Se selecciono a sujetos de 40-75 anos con antecedentes de hiperglucemia no diabetica a los que se cribo mediante una prueba de tolerancia oral a la glucosa (PTOG), excluyendo a aquellos con criterios de diabetes segun la Organizacion Mundial de la Salud. Se desarrollo un registro continuo de la glucosa (RGC) individualizado y ambulatorio de 48 h mediante un biosensor subcutaneo (GlucoDay®) calibrado por la glucemia plasmatica. Se informatizo la actividad del biosensor para evidenciar posibles registros de hiperglucemia. Resultados: Se efectuo el RCG a 50 de 64 sujetos seleccionados, de los que 30 eran mujeres. El indice de masa corporal medio fue de 30,9 kg/m2; la hemoglobina glucosilada del 5,3%, y el indice HOMA de 2,8, descartando 9 perfiles completos (18%) por problemas tecnicos. Se evaluaron 41 RCG (82%) pertenecientes a 17 sujetos con PTOG normal (41,5%) y a 24 (58,5%) con PTOG alterada. Por termino medio, se obtuvieron registros de hiperglucemia (basal e 6,1 mmol/l o no basal e 7,8 mmol/l) durante 5,8 h, un 17,2% del tiempo total de registro efectivo (33,8 h). La hiperglucemia en el intervalo de diabetes (basal e 7 mmol/l o no basal e 11,1 mmol/l) concurrio durante el 3,6% del tiempo (1,2 h) y el 3,3% (1,1 h), respectivamente. Conclusiones: El RCG evidencio indices altos de hiperglucemia no reconocida en sujetos de riesgo. Este hallazgo indica que medir la glucemia en cualquier momento del dia incrementaria la deteccion de anomalias glucidicas.