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Objetivo Analizar diferencias de presion arterial entre los ninos y adolescentes de Galicia y los de otras localizaciones en Espana. Diseno Estudio transversal realizado en el medio rural interior gallego. Participantes Participaron en el estudio 870 ninos y ninas con edades comprendidas entre 6 y 16 anos. Se comparan con el conjunto del estudio RICARDIN, que incluye 10.042 participantes seleccionados en nueve centros en Espana (uno de ellos el gallego). Todos los ninos fueron reclutados en los colegios. Mediciones Utilizacion de metodologia estandarizada y procedimientos de certificacion comunes para la determinacion de peso, talla, presion arterial sistolica y diastolica de quinta fase y estadificacion de Tanner de maduracion sexual. Se presentan los datos por grupo de edad (1 ano) y sexo en Galicia y Espana. Resultados A partir de los 11 anos en ninas y algo mas tarde en ninos, la presion arterial sistolica en Galicia es mayor que la del conjunto de los centros de Espana. En la presion arterial diastolica de quinta fase, se observan diferencias de gran magnitud entre Galicia y Espana en todos los grupos de edad en ambos sexos, siempre teniendo Galicia valores mas elevados. En cuanto a la obesidad, las diferencias en indice de masa corporal son pequenas, de nuevo Galicia con valores mas altos. Conclusiones Este es el primer estudio que demuestra que las diferencias observadas, y sugeridas con anterioridad, en la presion arterial no pueden atribuirse a diferencias metodologicas, al haberse realizado un proceso de entrenamiento comun y certificacion de todos los observadores participantes. Las diferencias en presion arterial e indices de obesidad entre Galicia y otras zonas del pais en adultos, sugeridas con anterioridad, pueden ser reflejo de diferencias presentes desde la ninez.

En este articulo se discuten los disenos experimentalesen investigacion clinica. Se utilizan comohilo conductor ejemplos del area de la cardiologia,en la medida de lo posible siempre el mismo. Se habuscado una optica diferente de la habitual en ladiscusion de las caracteristicas generales de los disenosexperimentales y mas especificamente de losensayos clinicos y se han abordado aspectos de losmismos que habitualmente escapan de la consideracionde los clinicos por su caracter marginal. Se inicia discutiendo que caracteristicas son diferencialesde los ensayos clinicos respecto a otrosdisenos y el tipo de pregunta a que respondenaquellos. A continuacion se discuten aspectos comoaleatorizacion y tipos (simple, por bloques, estratificada,prealeatorizacion), tipos de variables deevaluacion de la respuesta, enmascaramiento yproblemas para mantenerlo con determinados disenos,tamano muestral, etc. Se hace una breve mencion de dos casos particulares:el diseno factorial y el diseno cruzado y sediscuten sus puntos fuertes y debiles. Asimismo, sediscute otro diseno experimental como es el ensayocomunitario y se aportan ejemplos. El articulofinaliza con la discusion de aspectos de criteriocomo cuando parar un ensayo o a quien son aplicablessus resultados y se sugieren puntos a tener encuenta en esas tomas de decision.

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.

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.

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 law 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.

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.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.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).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.

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.

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.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.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.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.

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.

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).