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BACKGROUND: Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference—Individual Participant Data Collaboration. METHODS: One-stage multivariable Cox regression models, stratified by study, were used to examine associations of higher or lower reading arm BPs with cardiovascular mortality, all-cause mortality, and cardiovascular events, in individual participant data meta-analyses pooled from 23 cohorts. Cardiovascular events were modelled for Framingham and atherosclerotic cardiovascular disease risk scores. Model fit was compared throughout using Akaike information criteria. Proportions reclassified across guideline recommended intervention thresholds were also compared. RESULTS: We analyzed 53 172 participants: mean age 60 years; 48% female. Higher arm BP, compared with lower arm, reclassified 12% of participants at either 130 or 140 mm Hg systolic BP thresholds (both P< 0.001). Higher arm BP models fitted better for all-cause mortality, cardiovascular mortality, and cardiovascular events (all P P CONCLUSIONS: Using BP from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension. All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: CRD42015031227.

IntroductionPeripheral arterial disease (PAD) is a marker of cardiovascular morbidity, causing disability, loss of mobility and poor quality of life, manifesting clinically in the form of intermittent claudication (IC). Physical exercise increases the distance walked and improves quality of life. The aim of our study will be increased walking distance prolonging the time of onset of pain in patients with symptomatic PAD (IC).Methods and analysisThis study will be performed in Mataró Hospital’s vascular surgery service and School of Health Sciences, TecnoCampus. This population comes from 15 primary healthcare centres ofNorth Barcelona, Spain (450 000 inhabitants).This study will be a four-group parallel, longitudinal, randomised controlled trial, blind to analysis.The main primary outcome of this study will be the improvement in pain-free walking distance. Others primary objectives are and improvement in functional status, quality of life and Ankle-Brachial Index (ABI). Secondary outcomes will be the analysis of cardiorespiratory fitness, evaluation of muscle fitness, determine the maintenance of primary objectives at 6 and 12 months.We will be included 124 patients (31 per group). The changes of the outcome (Barthel, SF-12, VascQOL-6, ABI) of the three intervention groups vs the control group at 3, 6 and 12 months will be compared, both continuously (linear regression) and categorically (logistic regression). A person who has not performed at least 75% of the training will be considered to have not completed the intervention.Ethics and disseminationThe study will be conducted according to the Declaration of Helsinki . It was approved by the Ethics Committee of the Research Institute Primary Health IDIAP Jordi Gol (20/035 P),Barcelona 6 October 2020. Informed consent will be obtained from all patients before the start of the study. We will disseminate results through academic papers and conference presentations.Trial registration numberNCT04578990.

Background and aims Symptomatic intracranial atherosclerosis (ICAS) is associated with a high risk of stroke recurrence and occurrence of other vascular events. However, ICAS has been poorly studied from its asymptomatic stage. The objective of our study was to determine if subclinical intracranial atherosclerosis is associated with long-term incident vascular events in Caucasians. Methods The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) Study is a population-based study that enrolled 933 subjects with a moderate-high vascular risk and without history of stroke or coronary disease, and determined the prevalence of asymptomatic ICAS and associated risk factors. At baseline visit, carotid atherosclerosis and ICAS were screened by color-coded duplex ultrasound, and moderate-severe stenosis was confirmed by magnetic resonance angiography. At baseline, 8.9% of subjects had asymptomatic ICAS, of whom 3.3% were moderate-severe. In the longitudinal phase, subjects were prospectively followed-up to assess the incidence of a combined primary endpoint of vascular events (stroke, acute coronary syndrome and/or vascular death). Results After 7.17 years of follow-up, there were 51 incident cerebrovascular events (16 transient ischemic attacks, 27 ischemic, 8 hemorrhagic strokes), 63 incident coronary events and 23 vascular deaths. After multivariate Cox regression analyses adjusted by age, sex, vascular risk and presence of carotid plaques, ICAS was an independent predictor for overall vascular events (HR 1.83 [1.10–3.03], p = 0.020), and moderate-severe intracranial stenosis was also an independent predictor for cerebrovascular events (HR 2.66 [1.02–6.94], p = 0.046). Conclusions Asymptomatic ICAS is independently associated with the incidence of future vascular events in our population. These findings might have implications for the development of primary prevention strategies.

Supplemental Digital Content is available in the text., Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02–1.08) and 1.06 (95% CI, 1.02–1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01–1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00–1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01–1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06–1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227

Apolipoprotein E (APOE) has an important role in the multiple trajectories of cognitive aging. However, environmental variables and other genes mediate the impact of APOE on cognition. Our main objective was to analyze the effect of APOE genotype on cognition and its interactions and relationships with sex, age, lipid profile, C-reactive protein, and Brain-derived neurotrophic factor (BDNF) genotype in a sample of 648 healthy participants over 50 years of age with a comprehensive neuropsychological assessment. Our results showed that APOE ε2 carriers performed better in the Verbal Memory (p = .002) and Fluency Domains (p = .001). When we studied the effect of sex, we observed that the beneficial effect of APOE ε2 on the normalized values of these cognitive domains occurred only in females (β = 0.735; 95% confidence interval, 0.396–1.074; p = 3.167·10−5 and β = 0.568; 95% confidence interval, 0.276–0.861; p = 1.853·10−4, respectively). Similarly, the sex-specific effects of APOE ε2 were further observed on lipidic and inflammation biomarkers. In the whole sample, APOE ε2 carriers showed significantly lower levels of total cholesterol, low-density lipoprotein cholesterol, and C-reactive protein. These differences were found only among females. Furthermore, total cholesterol and low-density lipoprotein cholesterol mediated the protective effect of APOE ε2 on cognition in the whole sample and total cholesterol in females, providing candidate physiological mechanisms for the observed genetic effects. Our results show that the neuroprotective role of APOE ε2 in cognition varies with sex and that the lipidic profile partially mediates this protection. Age-related cognitive and functional decline is a continuous biological process with different cognitive trajectories (1). Complex interactions between heritability, environmental influence, and cognitive functions in aging have been highlighted (2). In particular, genetic differences explain around 15%–25% of the variance in life expectancy (3). Therefore, the identification of susceptibility genes and their biological effects on cognitive aging is required to establish interindividual differences in this process and promote early personalized interventions to delay cognitive decline and minimize the financial burden of aging in the health care system., This work was supported by the grants 2009FI_B00285 to J.M. from the Generalitat of Catalonia, AP2006-00311 to J.J.S.-R. from the Ministerio de Ciencia y Educación, the Regional Government of Navarre to J.L.-O., FIS PI-070393 to J.F.A. from the Ministerio de Ciencia de Innovación, and from SEJ2006-15399/PSIC and the ICREA Academia program to M.M.

Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle&ndash, Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type, most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI &lt, 0.9 presented more recurrences than those with an ABI &ge, 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI &lt, 0.9 may be considered a predictor of recurrence risk.

Background and objective Although cardiovascular risk factors (CVRF) are well known, their degree of control is not optimal. The aim of this study is to assess the evolution and control of CVRFs after 5 years of monitoring a population-based cohort and their association with the incidence of peripheral arterial disease (PAD). Material and method Prospective cohort study recruited between 2006 and 2008. Second phase between 2011 and 2012. An ankle–brachial index was determined for all participants in both phases. Demographic variables, CVRF and previous cardiovascular events, blood pressure, total cholesterol and its fractions (HDL, LDL), triglycerides, glucose and glycosylated haemoglobin levels in diabetic patients and the cardiovascular risk score according to the REGICOR table were recorded. Results A total of 2125 individuals were analyzed. We observed an increase in the prevalence of hypertension (HT) (15.4%), diabetes (DM) (8.2%) and hypercholesterolemia (20.4%), with no changes in obesity and smoking. The cardiovascular risk determined on the basis of the REGICOR table remained at around 5.5%. We observed an increased control of CVRF throughout the follow-up period, except in the case of DM and obesity. In the multivariate analysis, uncontrolled HT 2-folded the risk of onset of PAD (odds ratio [OR] 2.3; 95% confidence interval [95% CI] 1.3–4.1), whereas smoking 5-folded this risk (OR 5.0; 95% CI 2.5–10.2). Conclusions Smoking and uncontrolled HT increase the risk of onset of PAD in this population. Despite the increase in drug treatments, the control of CVRFs continues to be suboptimal.

Resumen Fundamento y objetivo Los factores de riesgo cardiovascular (FRCV) son bien conocidos, pero su grado de control no es optimo. Este trabajo pretende valorar la evolucion y el control de los FRCV clasicos tras 5 anos de seguimiento de una cohorte poblacional y su relacion con la incidencia de arteriopatia periferica (AP). Material y metodo Estudio de cohortes prospectivo. Seleccion de pacientes 2006-2008; segunda visita entre 2011-2012. En ambas fases se realizo un indice tobillo-brazo en condiciones estandarizadas. Se registraron variables demograficas, antecedentes y FRCV, presion arterial, perfil lipidico, glucosa y hemoglobina glucosilada en pacientes diabeticos y calculo del riesgo cardiovascular mediante REGICOR. Resultados Fueron analizados 2.125 individuos. Se incremento la prevalencia de hipertension arterial (HTA) en un 15,4%, en un 8,2% la diabetes (DM) y en un 20,4% la hipercolesterolemia, manteniendose estables la obesidad y el tabaquismo. REGICOR se mantuvo alrededor de 5,5%. Se incremento el control de los FRCV durante el seguimiento, excepto para la DM y la obesidad. En el analisis multivariante la HTA no controlada presento un riesgo de mas del doble para AP incidente (odds ratio [OR] 2,3; intervalo de confianza al 95% [IC 95%] 1,3-4,1), y el tabaquismo, de 5 veces (OR 5,0; IC 95% 2,5-10,2). Conclusiones Tabaquismo y HTA mal controlados incrementan el riesgo para AP en esta poblacion. A pesar del aumento del tratamiento farmacologico persiste un control suboptimo de los FRCV.

Background The different cardiovascular risk prediction scales currently available are not sufficiently sensitive. Aim The aim of the present study was to analyze the contribution of the ankle-brachial index (ABI) added to the Framingham and REGICOR risk scales for the reclassification of cardiovascular risk after a 9-year follow up of a Mediterranean population with low cardiovascular risk. Design and setting A population-based prospective cohort study was performed in the province of Barcelona, Spain. Method A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was performed and cardiovascular risk was calculated with the Framingham and REGICOR scales. The participants were followed until November 2016 by telephone and review of the clinical history every 6 months to confirm the possible appearance of cardiovascular events. Results 2,716 individuals participated in the study. There were 126 incidental cases of first coronary events (5%) during follow up. The incidence of coronary events in patients with ABI

Resumen Fundamento y objetivos Determinar la concordancia del indice tobillo-brazo (ITB) determinado mediante esfigmografo automatico Omron y la medicion automatizada mediante triple toma respecto al metodo de referencia doppler, asi como su sensibilidad y especificidad. Pacientes y metodos Pacientes de la cohorte poblacional ARTPER, clasificados como arteriopatia periferica (AP) si ITB Resultados Se incluyeron 88 participantes, un 52% mujeres, con una edad comprendida entre 57 y 87 anos. Fue posible calcular el ITB en el 100% con doppler, en el 97% con Omron y en el 95% con triple toma. Las medias (desviacion estandar) de ITB con los 3 metodos fueron: doppler 1,089 (0,236), Omron 1,082 (0,110), triple toma 1,146 (0,134), con pobre concordancia (CCI doppler/Omron = 0,27, doppler/triple toma = 0,13 y triple toma/Omron = 0,39). Categorizando el ITB en AP-sano-calcificacion presentaron ITB Conclusiones Ni Omron ni triple toma tienen una buena concordancia con doppler, por lo que los primeros no parecen adecuados para el cribado de AP en las consultas de atencion primaria.

a b s t r a c t Background and purpose: The ongoing population-based Barcelona-Asymptomatic Intracranial Atherosclerosis (Barcelona-AsIA) study is a prospective study that plans to investigate the natural his- tory of asymptomatic intracranial atherosclerosis (AsIA) in a Caucasian-Mediterranean population, which remains unknown until now. The present study aims to determine the prevalence of AsIA and associated risk factors in the final study cohort. Methods: Crossover, population-based study of a representative sample (randomly selected from our ref- erence population) older than 50 with a moderate-high vascular risk assessed by the vascular equation REGICOR and prior history of neither stroke nor ischemic heart disease. Anthropometric, demographic, clinical data and blood samples were collected at baseline. All individuals underwent a complete extracra- nial and transcranial color-coded duplex (TCCD) examination. TCCD criteria were used to identify and classify the degree of intracranial stenoses. Results: A total of 933 subjects (64% men, mean age 66.3 years) were included in the study. One or more intracranial stenoses were detected at baseline in 80 subjects (8.6%) of whom 31 (3.3%) had moderate- severe lesions. The higher the REGICOR scores the greater the prevalence of AsIA (6.6%, 10.2% and 25% for REGICOR scores 5-9, 10-14 and ≥15, p < 0.001). Diabetes (OR 2.95; 95% CI (1.68-5.18); p < 0.001), age (OR 1.05; 95% CI (1.02-1.08); p = 0.001) and hypertension (OR 1.78; 95% CI (1.02-3.13); p = 0.04) were independently associated with any degree of AsIA, while diabetes (OR 2.85; 95% CI (1.16-6.96); p = 0.02) and age kept independently associated with moderate-severe AsIA. Conclusion: The prevalence of AsIA and moderate-severe AsIA in stroke-free Caucasians with a moderate- high vascular risk were 8.6% and 3.3% respectively. Diabetes and age were independently associated with moderate-severe AsIA.

ResumenObjetivosEstudiar la prevalencia de calcificación arterial (índice tobillo-brazo ≥1,4) y de factores de riesgo cardiovascular asociados en población general >49 años de edad.MétodosEstudio transversal, 3786 sujetos seleccionados aleatoriamente en 28 centros. Para el cálculo de la prevalencia se usó toda la muestra, excluyendo los sujetos con arteriopatía periférica (índice tobillo-brazo 49 years.MethodsWe performed a cross-sectional study of 3,786 people randomly selected from 28 centers. To assess the factors associated with arterial calcification using a multivariate logistic model, the whole sample was used to compute prevalence, excluding persons with peripheral arterial disease (ankle-brachial index

Resumen Introduccion y objetivos Las funciones de riesgo cardiovascular tienen una baja sensibilidad, pues frecuentemente los eventos cardiovasculares se producen en personas en riesgo bajo o intermedio. El objetivo de este trabajo es estudiar como el indice tobillo-brazo (ITB) reclasifica a estos pacientes. Metodos Se realizo un estudio descriptivo transversal, multicentrico (28 centros), con 3.171 pacientes de edad > 49 anos seleccionados aleatoriamente. Se estudiaron variables demograficas, antecedentes y factores de riesgo cardiovasculares, ITB (patologico si era Resultados Los pacientes con ITB Conclusiones El ITB reclasifica a una importante proporcion de personas hacia la categoria de riesgo alto, sobre todo en mujeres y con la funcion REGICOR.

The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients.We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if0.9) and 10-year cardiovascular risk with the Framingham-Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham10%, REGICOR5% and SCORE2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high (≥20%, ≥10% and ≥5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI0.9.We compared patients with ABI0.9 and patients with ABI ≥0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE.The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores.

Introduction: Vascular risk factors (VRF) have been related to cognitive deficits and an increased risk of dementia. Cognitive impairment is considered to be one of the earliest manifestations of cerebrovascular disease. In Spain there is a high prevalence of VRF, but also one of the lowest incidences of cerebrovascular disease in Europe. This is the first study that investigates the relationship between VRF and cognition in a Spanish sample. Methods: A total of 90 people aged between 50–65 years with a low-to-moderate cardiovascular risk underwent a neuropsychological evaluation. None of them had a history of cardiovascular disease. The battery included tests assessing executive, attentional, mnesic, visuospatial and motor-speed/coordination functions. We used correlation and inter-groups comparison to relate VRF to multiple cognitive domains24. Results: Higher stroke risk was significantly related to a lowered profile in visuo-constructive functions and motor-speed/coordination. Moreover, the group with moderate cardiovascular risk showed a lower performance in visuoconstructive functions compared to the low-risk group. After statistical adjustment for age, sex and years of scholarship VRF were only related to motor-speed/coordination. Conclusions: In healthy, middle-aged adults, VRF are related with impairment in two cognitive domains. This effect is slight and tends to appear in people with moderate cardiovascular risk. Resumen: Introducción: Los factores de riesgo vascular (FRV) se han relacionado con déficit cognitivos e incremento del riesgo de demencia. De hecho, el deterioro cognitivo es considerado como una de las primeras manifestaciones de enfermedad cerebrovascular. En nuestro país se ha registrado una elevada prevalencia de FRV junto a una incidencia de ictus de las más bajas de Europa. Éste es el primer estudio con población española que investiga la relación entre los FRV y el rendimiento cognitivo en la edad adulta. Métodos: Se ha realizado evaluación neuropsicológica a 90 personas de 50–65 años de edad con riesgo cardiovascular bajo, leve y moderado, sin historia de enfermedad cardiovascular. Se les administró una batería de test sensible a funciones ejecutivas, atencionales, mnésicas, visuoconstructivas y de velocidad/coordinación visuomotriz. Se han hecho análisis de correlación y comparación entre grupos para estudiar la relación entre los FRV y las diferentes funciones cognitivas. Resultados: Se observó una relación estadísticamente significativa entre un mayor riesgo vascular y un peor rendimiento en funciones visuoconstructivas y en velocidad/coordinación visuomotriz. Además, el grupo de riesgo moderado presentó un rendimiento significativamente inferior respecto al de riesgo bajo en funciones visuoconstructivas. Tras covariar por edad, sexo y años de escolaridad los FRV únicamente se relacionaron con velocidad/coordinación visuomotriz. Conclusiones: Los FRV en personas de mediana edad están relacionados con disminución del rendimiento en dos funciones cognitivas. La afectación es leve y tiende a evidenciarse en personas con un riesgo moderado. Keywords: Cognition, Barcelona-ASIA Study, Risk factor, Stroke, Neuropsychology, Mediterranean paradox, Palabras clave: Cognición, Estudio Barcelona-ASIA, Factores de riesgo, Ictus, Neuropsicología, Paradoja mediterránea

OBJECTIVE: To compare the prevalence of lower extremity peripheral artery disease (PAD) and to assess whether age-associated progression in ankle-brachial index (ABI) differs between individuals with chronic immune-mediated inflammatory diseases (CIID) and the general population. METHODS: Pooled analysis with data from individuals aged 50 years and older with ABI measurements, obtained from population-based cross-sectional studies conducted in Catalonia (Spain). Information on three CIID diagnoses (i.e., inflammatory bowel disease, systemic connective tissue disorders, and inflammatory polyarthropathies and spondylopathies, considered as one entity for purposes of analysis) was obtained from electronic medical records. To ascertain the statistical association between PAD and CIID, logistic regression models were fitted and adjusted for age, sex, and cardiovascular risk factors. We tested the interaction between age and CIID diagnosis for ABI values. RESULTS: We included 8799 individuals, 312 (3.6%) with CIID. The age-standardized prevalence of PAD was higher in the CIID group (12% vs. 6% in general population, p = 0.001), and the model adjusted for age, sex, and cardiovascular risk factors also showed higher risk in individuals with CIID [Odds Ratio (95% confidence interval) = 1.65 (1.15-2.38); p = 0.007]. The inflammatory polyarthropathies/spondylopathies diagnosis was significantly associated with PAD in the fully adjusted model [1.80 (1.18-2.75); p = 0.006]. The atherosclerotic process was accelerated in individuals with CIID, compared to the general population (p for interaction

High levels of daily physical activity have been shown to be linked to decreased functional impairment in peripheral artery disease (PAD) patients and positively related to the ankle brachial index (ABI) in subjects without PAD. The aim of this study was to examine the relationship between leisure time physical activity (LTPA) and the ABI in a general population.Baseline data from the ARTPER study cohort corresponding to 2,840 subjects49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI0.9 was taken to indicate PAD. Multivariate logistic regression analysis was performed to evaluate the independent association between LTPA and PAD.Subjects with more LTPA were younger, female, less smokers, and suffered fewer PAD. Total activity, measured in metabolic energy turnover (MET) and the LTPA hours, was significantly higher in subjects without PAD (P.001). There was an inverse relationship between LTPA and the risk of suffering PAD (odds ratio 0.56, 95% confidence interval 0.38-0.81 for those who expended 2,700 METs or more in 14 days) adjusting for confounding factors.In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA.

Objective To evaluate usefulness of ankle-brachial index (ABI) in the screening for asymptomatic cervico-cerebral atherosclerosis (CCA) against traditional vascular risk assessment. Methods This study included a random population sample of 933 Caucasians without prior cardiovascular disease but with a moderate and high vascular risk (REGICOR score 5–9% and ≥10%). Presence and degree of CCA was evaluated by color-coded duplex and significant stenosis >50% (SCCA) confirmed by MRA. Results Prevalence of significant carotid and/or intracranial stenosis was 6% in the whole population, but increased up to 25% among those subjects with ABI ≤0.9 regardless of REGICOR score. Using REGICOR ≥10%, the likelihood ratio (LR) for the detection of SCCA was 1.8, while using ABI ≤0.90 the LR was 6.0. After multivariate regression analysis, low ABI was independently associated with SCCA whereas REGICOR score was not. Less than 40% of subjects with SCCA were taking antiplatelet drugs or statins at the moment of diagnosis. Conclusion ABI emerged as a useful and simple tool in identifying asymptomatic SCCA in our population. This finding may be important for improving stroke primary prevention strategies.

Background: To estimate the prevalence of overweight and obesity in the Spanish population as measured with body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) and to determine the associated cardiovascular risk factors. Methods: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. Participants aged 35-74 years were asked about the history of cardiovascular diseases, hypertension, diabetes and hypercholesterolemia. Height, weight, WC, blood pressure, glycaemia, total cholesterol, low-density and high-density lipoprotein cholesterol and coronary risk were measured. The prevalence of overweight (BMI 25-29.9 kg/m(2)), general obesity (BMI >= 30 kg/m2), suboptimal WC (>= 80 cm and < 88 in women, >= 94 and < 102 in men), abdominal obesity (WC >= 88 cm >= 102 cm in women and men, respectively) and WHtR >= 0.5 was estimated, standardized for the European population. Results: We included 28,743 individuals. The prevalence of overweight and suboptimal WC was 51% and 30% in men and 36% and 22% in women, respectively; general obesity was 28% in both sexes and abdominal obesity 36% in men and 55% in women. The prevalence of WHtR >= 0.5 was 89% and 77% in men and women, respectively. All cardiovascular risk factors were significantly associated with abnormal increased values of BMI, WC and WHtR. Hypertension showed the strongest association with overweight [OR = 1.99 (95% confidence interval 1.81-2.21) and OR = 2.10 (1.91-2.31)]; suboptimal WC [OR = 1.78 (1.60-1.97) and OR = 1.45 (1.26-1.66)], with general obesity [OR = 4.50 (4.02-5.04), and OR = 5.20 (4.70-5.75)] and with WHtR = 0.5 [OR = 2.94 (2.52-3.43), and OR = 3.02 (2.66-3.42)] in men and women respectively, besides abdominal obesity in men only [OR = 3.51 (3.18-3.88)]. Diabetes showed the strongest association with abdominal obesity in women [OR = 3,86 (3,09-4,89). Conclusions: The prevalence of obesity in Spain was high. Overweight, suboptimal WC, general, abdominal obesity and WHtR = 0.5 was significantly associated with diabetes, hypertension, hypercholesterolemia and coronary risk. The use of lower cut-off points for both BMI and particularly WC and could help to better identify the population at risk and therefore achieve more effective preventive measures., This study was financed in its entirety with unconditional support from AstraZeneca. Data from the original component studies was obtained with financial support from: FEDER, Ministerio de Ciencia e Innovacion, Instituto de Salud Carlos III (Programa HERACLES RD12/0042; Fondos para investigacion. Acuerdo del Consejo Interterritorial de 8 de abril de 2003; EMER07/046 RCESP C3/09); Fondo de Investigacion Sanitaria (FIS-FEDER) (PI01/0711, PI02/1158, PI02/1179, PI02/1717, PI03/20471, PI05/2364, PI05/2751, PI07/040, PI07/0934, PI07/1213, G03-045, FIS ETES 2007, CP06/00100, CM12/03287); Ministerio de Sanidad y Consumo, Plan Nacional I + D + i 2004-7 (IP071218); Agencia de Avaluacio de Tecnologia i Recerca Medica (034/33/02); Agencia de Gestio d'Ajuts Universitaris i de Recerca (2005SGR00577); Departament de Salut de la Generalitat de Catalunya; Fundacion Canaria de Investigacion y Salud (45/98); Departamento de Salud del Gobierno de Navarra; Junta de Castilla y Leon; Beca Intensificacion de la investigacion (INT 07/289); Subdireccion General de Promocion de la salud y Prevencion. Consejeria de Sanidad de la Comunidad de Madrid; Govern Balear; Servicio Andaluz de Salud; Programa de Iniciativa Comunitaria INTERREG IIIA (SP5.E51); Consejeria de Salud de la Junta de Andalucia, Ayuda a Proyectos de Investigacion (290/04 y 036/06); Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFYC 2008); Sociedad Espanola de Medicina de Familia y Comunitaria (semFYC 2009); Consejeria de Sanidad y Consumo de la Region de Murcia; Consejeria de Salud y Bienestar Social, Junta de Comunidades de Castilla-La Mancha.

To determine the concordance of the ankle-brachial index (ABI) determined by automatic measurements (sphygmomanometer Omron and the triple cuff device) using doppler as the gold-standard, computing as well as sensitivity and specificity.ARTPER population cohort subjects, classified as peripheral arterial disease (PAD) if ABI0.9, calcified if ABI≥1.4 and healthy otherwise. To asses concordance we used kappa index using the 3 categories and the intraclass correlation coefficient (ICC) for ABI continuous values.Eighty-eight participants, 52% women, 57-87 years. It was possible to calculate the ABI using doppler for 100%, 97% using Omron and 95% using triple. ABI means (standard deviation) were: doppler 1.089 (0.236), Omron 1.082 (0.110), triple 1.146 (0.134), with poor agreement (ICC doppler/Omron=0.27, doppler/triple=0.13, and triple/Omron=0.39). Categorizing ABI as PAD-healthy-calcified 13.6% (doppler), 6.8% (Omron) and 3.4% (triple) were PAD and 9.1% (doppler), 1.1% (Omron) and 9.1% (triple) were calcified. Kappa indexes were weak (doppler/Omron=0.22, doppler/triple=0.01, triple/Omron=0.17). Both triple and Omron were highly specific (97%) but had very low sensitivity (8 and 33%, respectively) compared to doppler.Concordance of ABI automatic measurements as Omron and triple with doppler was poor, and they do not seem suitable for screening for PAD in primary care consultations.

Background and Purpose— Intracranial atherosclerotic disease (ICAD) remains a challenge for stroke primary and secondary prevention. Molecular pathways involved in the development of ICAD from its asymptomatic stages are largely unknown. In our population-based study, we aimed to compare the risk factor and biomarker profiles associated with intracranial and extracranial asymptomatic cerebral atherosclerosis. Methods— The Asymptomatic Intracranial Atherosclerosis (AsIA) study cohort includes a random sample population of 933 white subjects >50 years with a moderate to high vascular risk (based on REGICOR score) and without a history of stroke (64% males; mean age, 66 years). Carotid and intracranial atherosclerosis were screened by cervical and transcranial color-coded Duplex ultrasound, being moderate to severe stenoses confirmed by MR angiography. We registered clinical and anthropometric data and created a biobank with blood samples at baseline. A panel of biomarkers involved in atherothrombogenesis was determined: C-reactive protein, asymmetric-dimethylarginine, resistin, and plasminogen activator inhibitor-1. Insulin resistance was quantified by Homeostasis Model Assessment index. Results— After multinomial regression analyses, male sex, hypertension, smoking, and alcoholic habits were independent risk factors of isolated extracranial atherosclerotic disease. Diabetes and metabolic syndrome conferred a higher risk for ICAD than for extracranial atherosclerotic disease. Moreover, metabolic syndrome and insulin resistance were independent risk factors of moderate to severe ICAD but were not risk factors of moderate to severe extracranial atherosclerotic disease. Regarding biomarkers, asymmetric-dimethylarginine was independently associated with isolated ICAD and resistin with combined ICAD–extracranial atherosclerotic disease. Conclusions— Our findings show distinct clinical and biological profiles in subclinical ICAD and extracranial atherosclerotic disease. Insulin resistance emerged as an important molecular pathway involved in the development of ICAD from its asymptomatic stage.

To determine the prevalence of arterial calcification (ankle-brachial index ≥1.4) and its related factors among the general population aged49 years.We performed a cross-sectional study of 3,786 people randomly selected from 28 centers. To assess the factors associated with arterial calcification using a multivariate logistic model, the whole sample was used to compute prevalence, excluding persons with peripheral arterial disease (ankle-brachial index0.9).Arterial calcification was found in 235 persons (prevalence: 6.2%; 95% CI: 5.6-7.0), and was twice as frequent in men as in women. Patients with arterial calcification were older, had more previous cardiovascular events, diabetes and obesity, and were less able to perform physical activity than persons with a healthy ankle-brachial index.We recommend measurement of the ankle-brachial index in primary care centers to detect arterial calcification among men, persons with diabetes, overweight, obesity or difficulty in performing physical activity, and in those with left ventricular hypertrophy.

Background In Spain, stroke is one of the major causes of death and the main cause of severe disability in people over 65 years. We analyzed the incidence of ischemic stroke, stroke subtypes, case fatality and disability at 90 days after the event in a Spanish population. Methods A prospective community-based register of ischemic strokes was established in Santa Coloma de Gramenet (Barcelona) [116,220 inhabitants of all ages, according to the municipal census of December 31,2001], from January 1 to December 31, 2003. Standard definitions and case finding methods were used to identify all cases in all age groups. Every patient underwent a complete clinical evaluation and systematic tests including neuroimaging (CT/MRI) and vascular studies (carotid duplex ultrasound intra and extracranial and MR angiography). Results Over a one year period, 196 ischemic strokes were registered [107 men; median age = 76 years (range 39–98)], being the first event in 159 patients (81.1%) and a recurrent stroke in 37 (18.9%). After age-adjustment to the European population, the incidence of ischemic stroke per 100,000 inhabitants was 172 (95% CI, 148–196); 219 (176–261) in men and 133 (105–160) in women, with an annual incidence for first ischemic stroke of 139 (118–161); 165 (128–201) in men and 115 (89–140) in women. The incidence of stroke increased with age. Stroke subtypes (TOAST classification criteria) were lacunar in 28.8%, atherothrombotic in 18.6%, cardioembolic in 26.6% and undetermined in 26.0% of patients. At 90 days, the case-fatality was 12%, and among survivors, moderate-to-severe disability was present in 45 % at 3 months. Conclusion This prospective community-based study shows one of the lowest incidences of stroke in Europe, as well as one of the lowest case fatality and disability rates at 90 days after stroke.

Background The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study). Methods/Design This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality. From September 2006 to June 2007, a total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain). The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.90, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluted every 6 months by telephone interview and the clnical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infartction, symptomatic abdominal aneurysm and vascular mortality. Discussion In this study we hope to determine the prevalence of peripheral arterial disease, especially the silent forms, in the general population and establish its relationship with cardiovascular morbimortality. A low AAI may be a better marker of arterial disease than the classical cardiovascular risk factors and may, therefore, contribute to improving the predictive value of the equations of cardiovascular risk and thereby allowing optimisation of multifactorial treatment of atherosclerotic disease.

The aim was to investigate the relationship between blood markers of vascular dysfunction with brain microstructural changes and cognition. Eighty-six participants from the Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) neuropsychology study were included. Subjects were 50–65 years old, free from dementia and without history of vascular disease. We assessed correlations of blood levels of inflammatory biomarkers (C-reactive protein [CRP] and resistin) and fibrinolysis inhibitors (plasminogen activator inhibitor-1 [PAI-1] and A-lipoprotein (Lp (a)) with fractional anisotropy (FA) measurements of diffusion tensor images (DTI), regional gray matter (GM) volumes and performance in several cognitive domains. Increasing levels of C-reactive protein and PAI-1 levels were associated with white matter (WM) integrity loss in corticosubcortical pathways and association fibers of frontal and temporal lobes, independently of age, sex and vascular risk factors. PAI-1 was also related to lower speed and visuomotor/coordination. None of the biomarkers were related to gray matter volume changes. Our findings suggest that inflammation and dysregulation of the fibrynolitic system may be involved in the pathological mechanisms underlying the WM damage seen in cerebrovascular disease and subsequent cognitive impairment.

Background The removal of mercury sphygmomanometers from health centers requires the validation of other instruments to measure blood pressure in the limbs to calculate the ankle-brachial index (ABI). Methods Descriptive cross-sectional study of agreement between two measurement methods in type 2 diabetes patients from three urban primary healthcare centres in the Barcelonès Nord i Maresme area (Catalonia, Spain). ABI was determined with Doppler and mercury sphygmomanometer and Doppler and the “hybrid” sphygmomanometer OMRON HEM-907 model. Agreement was evaluated using the weighted kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using the mercury sphygmomanometer as the gold standard. Results 211 patients were included, from these, 421 limbs were available for study. The mean age of the participants was 67 years (SD = 10), 51.7% were women. The index of agreement between ABI measured with a mercury sphygmomanometer and with the OMRON HEM-907 blood pressure monitor was good (weighted kappa index = 0.68; CI 95%: [0.55–0.79]) and improved when the ABI cut-off value was set at ≤0.70 (weighted kappa index = 0.92; CI 95%: [0.81–1.00]). Sensitivity and specificity were 77.5% and 98.2%, respectively. PPV was 83.8% and NPV was 97.3%. With the ABI cut-off value ≤0.70, sensitivity and specificity increased to 85.7% and 100%, respectively, PPV to 100% and NPV to 99.4%. Conclusion The combination of a Doppler device with the hybrid sphygmomanometer is a simple and reliable method to measure ABI showing that hybrid sphygmomanometer is a good alternative to the use of mercury sphygmomanometers.

Background Peripheral arterial disease (PAD) of the lower limbs is a cardiovascular disease highly prevalent particularly in the asymptomatic form. Its prevalence starts to be a concern in low coronary risk countries like Spain. Few studies have analyzed the relationship between ankle-brachial index (ABI) and cardiovascular morbi-mortality in low cardiovascular risk countries like Spain where we observe significant low incidence of ischemic heart diseases together with high prevalence of cardiovascular risk factors. The objective of this study is to determine the relationship between pathological ABI and incidence of cardiovascular events (coronary disease, cerebrovascular disease, symptomatic aneurism of abdominal aorta, vascular surgery) and death in the >49 year population-based cohort in Spain (ARTPER). Methods Baseline ABI was measured in 3,786 randomly selected patients from 28 Primary Health Centers in Barcelona, distributed as: ABI