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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.

To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment.Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure150mmHg, diastolic blood pressure90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications.The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication.The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription.

Resumen Fundamento y objetivo Estudiar la proporcion de pacientes mayores de 80 anos con hipertension arterial y sobretratamiento farmacologico. Pacientes y metodos Estudio de simulacion, descriptivo transversal, incluyendo 281 pacientes mayores de 80 anos de prevencion primaria, seleccionados aleatoriamente, con buen control (presion arterial sistolica Resultados La edad media fue de 85,3 anos (64,8% mujeres). Tomaban un principio activo el 33,6%, 2 el 46,3% y 3 el 22,1%, siendo los mas prescritos tiazidas (69,4%), IECA (51,3%), ARA- II (23,4%), antagonistas del calcio (21%) y betabloqueantes (19,6%). El sobretratamiento fue del 90,7%, pudiendose retirar 2 principios activos en un 63,1% y 3 en el 43,1%. La polifarmacia (OR 2,47; IC 95% 1,07-5,69; p = 0,033) se asocio a una probable retirada de al menos un principio activo. Conclusiones La proporcion de pacientes con sobretratamiento es elevada. El cambio de criterios de control puede contribuir a una deprescripcion razonada.

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.

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis, patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Introduction and objectives To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. Methods Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. Results Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. Conclusions All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate.

Fundamento y objetivo Analizar el papel de la presion de pulso (PP), la presion arterial sistolica (PAS) y la diastolica (PAD) en la prediccion del riesgo cardiovascular. Pacientes y metodo Se realizo un estudio de cohortes, prospectivo, en 2 centros de salud, que incluyo a 932 personas de 35-84 anos sin episodios cardiovasculares, seleccionadas por muestreo aleatorio simple y seguidas durante 8 anos. La PP, PAS y PAD se categorizaron en terciles y el superior se comparo con los 2 inferiores. Se registro como variable combinada el primer episodio cardiovascular, mortal o no, en forma de cardiopatia isquemica, enfermedad cerebrovascular y arteriopatia periferica. Los resultados se analizaron mediante modelos de Cox ajustando por edad, sexo, tabaquismo, colesterol total, colesterol unido a lipoproteinas de alta densidad y diabetes mellitus. Se estudio la correlacion entre PP y PAS, PAD y factores de riesgo cardiovascular. Resultados Se registraron 85 episodios cardiovasculares: 43 casos de cardiopatia isquemica, 27 de enfermedad cerebrovascular y 17 de arteriopatia periferica. Los cocientes de riesgo ajustados para la variable combinada fueron: tercil superior (≥ 59 mmHg) de la PP = 1,3 (intervalo de confianza [IC] del 95%, 0,8-2,1); tercil superior (≥ 140 mmHg) de la PAS = 1,5 (IC del 95%, 1,0-2,5); tercil superior (≥ 84 mmHg) de la PAD = 1,1 (IC del 95%, 0,7-1,8). Los resultados fueron similares para los episodios cardiovasculares especificos. La PP se correlaciono con la PAS (r = 0,825; p Conclusiones La PP es un componente de la presion arterial muy relacionado con la PAS y otros factores de riesgo, pero no es mejor predictor del riesgo cardiovascular que la PAS.

Fundamento y objetivo Se considera que el riesgo coronario (RC) es una buena aproximacion al riesgo cardiovascular global (RCG). Si se multiplica el RC por 1,3, se obtendria el RCG, pero desconocemos si esto es cierto en Espana. Pacientes y metodo Estudio de cohorte prospectiva, con 851 pacientes de 35-74 anos sin enfermedades cardiovasculares, seguidos durante 5 anos. El RC incluyo la cardiopatia isquemica (angina o infarto agudo de miocardio) y el RCG, el RC mas la enfermedad cerebrovascular y la arteriopatia periferica de extremidades inferiores. Resultados Se registro 21 casos de cardiopatia isquemica, 15 de enfermedad cerebrovascular y 8 de arteriopatia periferica. La incidencia acumulada fue del 2,5% para el RC y el 5,2% para el RCG (diferencia del 2,7%; intervalo de confianza del 95% de la diferencia, 0,9-4,6%; p Conclusiones El RC no es una buena aproximacion al RCG. Es preciso desarrollar ecuaciones que incluyan el RCG y no solo el RC.

To analize the role of pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk.A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models, adjusting for age, sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors.We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (/= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1); upper SBP tertile (/= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (/= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p0.001), age (r = 0.422; p0.001), diabetes mellitus (r = 0.242; p0.001), and smoking (r = -0.158; p = 0.01), with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9).PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.

The coronary risk (CR) is a good approximation of the global cardiovascular risk (GCR). Multiplying the CR per 1.3 we obtain the GCR, but we don't know if it is certain in our country.Prospective cohort study with 851 patients of ages between 35-74 years old, without cardiovascular disease and followed during 5 years. CR include myocardial ischemia (angor pectoris or myocardial infarction). GCR include CR, cerebrovascular disease, and peripheral vascular disease.We registered 21 myocardial ischemia cases, 15 cerebrovascular disease cases and 8 peripheral vascular disease cases. The accumulated incidence was: 2.5% for CR and 5.2% for GCR (difference 2.7%; 95% confidence interval for the difference 0.9-4.6%; p0.05). To estimated GCR we should multiple CR per 2.1.CR is not a good approximation of GCR. We need to developed equation that include not only CR but also GCR.