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OBJECTIVE To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population. METHOD Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI)

To evaluate, with real world data (SIDIAP and CMBD), the evolution of the prevalence of peripheral arterial disease (PAD) in the Catalan population and the cardiovascular risk factors present in people with this pathology.Longitudinal descriptive population study. SITE: Primary health care.Patients listed in SIDIAP and CMBD with a diagnosis of peripheral artery disease between 2008 and 2018 ≥ 35 years, as well as those without a diagnosis, but with an ABI0.9 in SIDIAP.Main variable AP (ICD-9, ICD-10). Sociodemographic data, risk factors and cardiovascular disease, drug use and prevalent cardiovascular events at the time of diagnosis.141,520 patients were studied. 75% had hypertension, 58% were smokers or former smokers, and 23% had a myocardial infarction. The global prevalence increased from 1.15% in 2008 to 3.10% in 2018. The prevalence of PAD increased with age, with a moderate increase at younger ages, and more pronounced in55 years, exceeding 10% in85 years.This is a population study where it is observed that the evolution of the prevalence of peripheral artery disease has presented a constant increase during the years 2008-2018, being higher in men, especially from 55 years of age. Studies with large databases can facilitate the design and implementation of new policies in national health systems.

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.

To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population.Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI)0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI.The mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot.In our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk.

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.

Resumen Proposito Evaluar la utilidad de un sistema semiautomatico de medicion de relacion arteriovenosa (RAV) retiniana sobre imagenes retinograficas de pacientes hipertensos en la valoracion del riesgo cardiovascular y la deteccion de isquemia cerebral silente (ICS). Metodo Un total de 976 pacientes de la cohorte Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS) estudiados mediante resonancia magnetica craneal para valorar la presencia o no de ICS fueron invitados a realizar una retinografia para un examen convencional de fondo de ojo y una medicion semitautomatica del promedio de los calibres vasculares para el calculo de la relacion arteriovenosa (RAV). Resultados Se analizaron las retinografias de 768 pacientes. Entre las lesiones observadas, solamente se encontro una asociacion con la deteccion de ICS en aquellos pacientes con microaneurismas (OR: 2,50; IC 95%: 1,05–5,98) o una RAV alterada ( Conclusiones Los resultados muestran que el analisis semiautomatico de la vasculatura retiniana a partir de retinografias tiene el potencial de ser considerado como un factor de riesgo vascular importante en la poblacion hipertensa.

Objective To evaluate the usefulness of a semiautomatic measuring system of arteriovenous relation (RAV) from retinographic images of hypertensive patients in assessing their cardiovascular risk and silent brain ischemia (ICS) detection. Methods Semi-automatic measurement of arterial and venous width were performed with the aid of Imedos software and conventional fundus examination from the analysis of retinal images belonging to the 976 patients integrated in the cohort Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS), group of hypertensive patients. All patients have been subjected to a cranial magnetic resonance imaging (RMN) to assess the presence or absence of brain silent infarct. Results Retinal images of 768 patients were studied. Among the clinical findings observed, association with ICS was only detected in patients with microaneurysms (OR 2.50; 95% CI : 1.05–5.98) or altered RAV ( Conclusions The results show that the semiautomatic analysis of the retinal vasculature from retinal images has the potential to be considered as an important vascular risk factor in hypertensive population.

Resumen Objetivo La hipertensión arterial es una de las enfermedades más prevalentes en la población general adulta. Su importancia reside en las complicaciones que ocasiona en el lecho vascular de órganos diana como riñón, corazón, cerebro y ojo. El objetivo de este trabajo es evaluar la concordancia en la lectura e interpretación de retinografías de pacientes hipertensos realizads por médicos de familia y por oftalmólogos. Material y métodos Es un estudio transversal multicéntrico que contó con 976 pacientes hipertensos de 50 a 70 años, participantes del proyecto «Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study» (ISSYS) realizado en centros de Atención Primaria de Barcelona y que accedieron a realizarse una retinografía. Seis médicos de familia y 2 oftalmólogos valoraron la presencia de lesiones en la retina mediante los criterios de Keith-Wagener-Barker. Resultados Se analizó la concordancia Kappa inter- e intraobservador de las lecturas. La valoración de las retinografías en condiciones habituales de práctica clínica obtuvo un alto componente subjetivo, con valores de concordancia inter- e intraobservador pobres-bajos en los criterios de Keith-Wagener-Barker. Solo la valoración de los microaneurismas presentó una concordancia moderada; la ratio arteria/vena fue la menos concordante. Se recomienda la utilización de sistemas de lectura objetivos en la valoración de retinografías en pacientes hipertensos. Conclusiones La valoración de las retinografías en condiciones habituales de práctica clínica tiene un alto componente subjetivo que se refleja en unos valores de concordancia inter- e intraobservador pobres o bajos. Se recomienda la utilización de sistemas de lectura objetivos en la valoración de retinografías en pacientes hipertensos.

Background Guidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population. Aim The aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI 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 1.08 +/- 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events. Results 3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI. In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes. Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI. The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p

Resumen Fundamento y objetivo Niveles elevados de actividad fisica durante la vida diaria se asocian con un menor deterioro funcional en las personas con arteriopatia periferica (AP) y positivamente con el indice tobillo-brazo (ITB) en sujetos libres de esta enfermedad. El objetivo de este estudio es examinar la relacion entre la actividad fisica en el tiempo libre (AFTL) y el ITB en poblacion general. Material y metodo Se analizaron los datos basales de la cohorte ARTPER correspondientes a 2.840 sujetos mayores de 49 anos de Barcelona. La AFTL se obtuvo mediante la version reducida validada en espanol del Cuestionario de actividad fisica en el tiempo libre de Minnesota. Se considero AP un ITB Resultados Los sujetos que realizaban mas AFTL eran mas jovenes, mujeres, menos fumadores y tenian menos AP. La actividad total medida en metabolic energy turnover (MET) y el computo de horas totales de AFTL fue significativamente superior en sujetos sanos (p odds ratio 0,56, intervalo de confianza del 95% 0,38-0,81 para los que gastaban 2.700 o mas MET en 14 dias) ajustando por factores de confusion. Conclusiones La AFTL se relaciono positivamente con el ITB en nuestro estudio, siendo los sujetos con AP los que menos AFTL realizaban.

Background and objective 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. Material and method Baseline data from the ARTPER study cohort corresponding to 2840 subjects >49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI Results 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 Conclusions In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA.

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

Objective Ischemic stroke can lead to a continuum of cognitive sequelae, ranging from mild vascular cognitive impairment to vascular dementia. These cognitive deficits can be influenced by the disruption of cortico-subcortical circuits. We sought to explore remote thalamic microstructural abnormalities and their association with cognitive function after ischemic stroke. Method Seventeen patients with right hemispheric ischemic stroke and 17 controls matched for age, sex, and years of education were included. All participants underwent neurological, neuropsychological, and diffusion tensor image examination. Patients were assessed 3 months poststroke. Voxel-wise analysis was used to study thalamic diffusion differences between groups. Mean fractional anisotropy (FA) and mean diffusivity (MD) values in significant thalamic areas were calculated for each subject and correlated with cognitive performance. Results Stroke patients showed lower FA values and higher MD values in specific areas of both the left and right thalamus compared with controls. In patients, decreased FA values were associated with lower verbal fluency performance in the right thalamus (R(2) = 0.45, β = 0.74) and the left thalamus (R(2) = 0.57, β = 0.77) after adjusting for diabetes mellitus. Moreover, increased MD values were associated with lower verbal fluency performance in the right thalamus (R(2) = 0.27, β = -0.54) after adjusting for diabetes mellitus. In controls, thalamic FA and MD values were not related to any cognitive function. Conclusion Our findings support the hypothesis that ischemic stroke lesions are associated with remote thalamic diffusion abnormalities, and that these abnormalities can contribute to cognitive dysfunction 3 months after a cerebrovascular event.

Resting-state studies conducted with stroke patients are scarce. The study of brain activity and connectivity at rest provides a unique opportunity for the investigation of brain rewiring after stroke and plasticity changes. This study sought to identify dynamic changes in the functional organization of the default mode network (DMN) of stroke patients at three months after stroke. Eleven patients (eight male and three female; age range: 48–72) with right cortical and subcortical ischemic infarctions and 17 controls (eleven males and six females; age range: 57–69) were assessed by neurological and neuropsychological examinations and scanned with resting-state functional magnetic ressonance imaging. First, we explored group differences in functional activity within the DMN by means of probabilistic independent component analysis followed by a dual regression approach. Second, we estimated functional connectivity between 11 DMN nodes both locally by means of seed-based connectivity analysis, as well as globally by means of graph-computation analysis. We found that patients had greater DMN activity in the left precuneus and the left anterior cingulate gyrus when compared with healthy controls (P

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.

The objective of this study is to compare the clinical performance of different strategies, REASON, PREVALENT, Inter-Society Consensus (ISC), and the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines, in the selection of candidates for peripheral artery disease (PAD) screening using ankle-brachial index (ABI).Our work is a population-based cross-sectional study conducted in Extremadura (Spain) in 2007-2009. Participants were ≥50years old and free of cardiovascular disease. ABI and cardiovascular risk factors were measured.In total, 1288 individuals (53% women), with a mean age of 63years (standard deviation (SD) 9) were included. The prevalence of ABI0.9 was 4.9%. REASON risk score identified 53% of the sample to screen with sensitivity of 87.3%, quite similar to that identified in ISC and ACC/AHA strategies (both 90.5%), and specificity of 48.3%, higher than that of the ISC (30.9%) and ACC/AHA (31.1%) strategies. Although the Youden index was 0.4 for both REASON and PREVALENT risk scores, the latter's sensitivity was 60.3%, almost 30 points less than all other strategies.REASON risk score was the strategy with the highest clinical performance and efficiency, with sensitivity of 87.3% and specificity higher than that of the ISC and ACC/AHA strategies. Although very specific, the PREVALENT strategy had low sensitivity making it difficult to be implemented as a screening tool.

Background and purpose Carotid atherosclerosis has emerged as a relevant contributor to cognitive impairment and dementia whereas the role of intracranial stenosis and vascular resistance in cognition remains unknown. This study aims to assess the association of asymptomatic cervicocerebral atherosclerosis and intracranial vascular resistance with cognitive performance in a large dementia-free population. Methods The Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) Neuropsychology Study included 747 Caucasian subjects older than 50 with a moderate–high vascular risk (assessed by REGICOR score) and without history of neither symptomatic vascular disease nor dementia. Extracranial and transcranial color-coded duplex ultrasound examination was performed to assess carotid intima–media thickness (IMT), presence of carotid plaques (ECAD group), intracranial stenosis (ICAD group), and middle cerebral artery pulsatility index (MCA-PI) as a measure of intracranial vascular resistance. Neuropsychological assessment included tests in three cognitive domains: visuospatial skills and speed, verbal memory and verbal fluency. Results In univariate analyses, carotid IMT, ECAD and MCA-PI were associated with lower performance in almost all cognitive domains, and ICAD was associated with poor performance in some visuospatial and verbal cognitive tests. After adjustment for age, sex, vascular risk score, years of education and depressive symptoms, ECAD remained associated with poor performance in the three cognitive domains and elevated MCA-PI with worse performance in visuospatial skills and speed. Conclusions Carotid plaques and increased intracranial vascular resistance are independently associated with low cognitive functioning in Caucasian stroke and dementia-free subjects. We failed to find an independent association of intracranial large vessel stenosis with cognitive performance.

Resumen Fundamento y objetivo Conocer la prevalencia de indice dedo-brazo (IDB) patologico en un grupo de pacientes con diabetes mellitus tipo 2 (DM2). Conocer la correlacion entre el IDB y el indice tobillo-brazo (ITB) en estos pacientes y determinar a partir de que valor se debe considerar patologico el IDB. Pacientes y metodo Estudio descriptivo transversal realizado en atencion primaria. Se incluyeron pacientes mayores de 50 anos con DM2. Se determinaron las presiones arteriales sistolicas en el brazo, tobillo y dedo del pie para poder calcular el ITB y el IDB. Resultados Se estudiaron 175 pacientes (350 extremidades) de edad media (DE) 67 (9) anos. El 53,7% eran mujeres y un 72,3% hipertensos. El ITB fue patologico (≤ 0,90) en 8,3% de las extremidades y un 8,6% cumplia criterios de calcificacion (≥ 1,40). El IDB fue patologico (≤ 0,60) en el 18,6% de los casos. De las 291 extremidades con un ITB normal, 34 (11,7%) presentaban un valor patologico del IDB, y de las 30 extremidades con un ITB calcificado, 6 (20%) presentaban un valor patologico del IDB. Entre el ITB y el IDB se observo una correlacion lineal positiva (r = 0,395; p Conclusiones La determinacion del IDB aporta informacion adicional a la determinacion del ITB y puede ser una exploracion muy util en caso de calcificacion arterial. El valor inferior o igual a 0,60 es el mas adecuado para considerar un IDB patologico.

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.

The recommendation of screening with ankle brachial index (ABI) in asymptomatic individuals is controversial. The aims of the present study were to develop and validate a pre-screening test to select candidates for ABI measurement in the Spanish population 50-79 years old, and to compare its predictive capacity to current Inter-Society Consensus (ISC) screening criteria.Two population-based cross-sectional studies were used to develop (n = 4046) and validate (n = 3285) a regression model to predict ABI0.9. The validation dataset was also used to compare the model's predictive capacity to that of ISC screening criteria. The best model to predict ABI0.9 included age, sex, smoking, pulse pressure and diabetes. Assessment of discrimination and calibration in the validation dataset demonstrated a good fit (AUC: 0.76 [95% CI 0.73-0.79] and Hosmer-Lemeshow test: χ(2): 10.73 (df = 6), p-value = 0.097). Predictions (probability cut-off value of 4.1) presented better specificity and positive likelihood ratio than the ABI screening criteria of the ISC guidelines, and similar sensitivity. This resulted in fewer patients screened per diagnosis of ABI0.9 (10.6 vs. 8.75) and a lower proportion of the population aged 50-79 years candidate to ABI screening (63.3% vs. 55.0%).This model provides accurate ABI0.9 risk estimates for ages 50-79, with a better predictive capacity than that of ISC criteria. Its use could reduce possible harms and unnecessary work-ups of ABI screening as a risk stratification strategy in primary prevention of peripheral vascular disease.

Background and objectives: Although peripheral arterial disease (PA) is an important clinical marker of cardiovascular morbimortality, the rate of under-diagnosis is unknown. Our aimed to know the proportion of patients underdiagnosed of PA and the associated factors. Patients and methods: 3786 patients 449 years old, randomly selected, were studied. PA was diagnosed by means of the ankle-brachial index (ABIo0, 9). Underdiagnosed was considered when ABIo0,9 and when they were not diagnosed of PA in the clinical record. We also determined the presence of intermittent claudication (IC) defined by Edinburgh’s questionnaire. Results: 7,6% had an ABI o0, 9 (IC95% 6,7–8, 4). Of these patients 80.7%, were underdiagnosed, although the 29,3% had IC. PA underdiagnosis was low in current smokers or former smokers (OR 0.20; IC95% 0,07–0,59), if IC (OR 0.40; IC95% 0,18–0,89), if ABI between o0.7 and 0.5 (OR 0.36; IC95% 0,16–0,81) or o0,5 (OR 0,04; IC95 % 0,01–0,20), being higher in 4 70 years (OR 3,12; IC95% 1,12–8,67). Conclusions: PA underdiagnosis is high, especially in old patients. It is necessary to reach consensus criteria for the practice of the ABI in the general population.

ObjetivoValorar los conocimientos de la población sobre el cribado del cancer de próstata.DiseñoEstudio descriptivo.EmplazamientoEquipos de atención primaria (EAP) de la provincia de Barcelona, durante el período comprendido entre abril y septiembre de 2005.Participantes y contextoParticiparon varones de 50-70 años de edad atendidos en las Consultas de 12 EAP, sin sintomatología prostática.MétodoSe realizó una muestra sistemática. Las variables analizadas fueron: edad, estadocivil, nivel de estudios y estado de salud autopercibido. Se llevó a cabo una valoración de los conocimientos mediante un cuestionario de 14 preguntas referidas a las ideas clave (previamente definidas por un grupo de expertos) que son necesarias para poder decidir sobre el cribado del cancer de próstata.ResultadosSe incluyó a 221 varones. Su edad media era de 59,9 años (desviación estándar [DE] = 5,9); el 63,4% tenía un nivel de estudios primario o inferior. El 89,1% (intervalo de confianza del 95%, 84,4-92,6) no tienen conocimientos suficientes sobre el cribado del cáncer de próstata. En las preguntas referentes a qué es y para qué sirve el antígeno prostático específico, más del 50% responde que no lo saben. El 63,3% reconoce que el cancer de próstata es una enfermedad con una alta prevalencia. El 84,6% responde que la detección precoz del cáncer de próstata evita muertes. El 49,8% no sabe si el médico tiene dudas sobre este tema y el 38,9% cree que no las tiene. No existen diferencias en los conocimientos para ninguna de las variables estudiadas.ConclusionesA pesar de la amplia extension del cribado del cáncer de próstata, la información que tiene la población es muy escasa y a menudo errónea. La incertidumbre científica existente sobre la utilidad del cribado es el aspecto más desconocido por los usuarios.ObjectiveTo evaluate the understanding of the population on prostate cancer screening.DesignDescriptive study.SettingPrimary care teams in the province of Barcelona, Spain, from april to september 2005.Participants and contextMen between 50 and 70 years old without prostate symptoms and seen in the clinics of 12 primary care teams.MethodSystematic sample. Variables: age, marital status, educational level, and self-perceived health status. Appraisal of knowledge through a 14-question questionnaire referring to the key ideas, previously defined by a group of experts, requisite before deciding on prostate cancer screening.ResultsN=221. Mean age, 59.9 (SD, 5.9); educational level, primary or lower: 63.4%; 89.1% (95% CI, 84.4-92.6) did not have sufficient knowledge about prostate cancer screening. In the questions on what PSA is and what it is for, over 50% said they did not know; 63.3% recognised that prostate cancer was a highly prevalent illness; 84.6% replied that early detection of prostate cancer avoids deaths; 49.8% did not know whether the doctor had doubts on this question; and 38.9% thought he didn’t. There were no differences in knowledge for any of the variables studied.ConclusionsAlthough prostate cancer screening is widely known about, the information of the population is scant and often wrong. Existing scientific uncertainty on the use of screening is the aspect that is least known by users.

Background To know the epidemiology (prevalence, incidence, progression and morbidity and mortality associated) of peripheral artery disease in general population and the factors associated with this progression is essential to know the evolution of atherosclerosis and develop preventive strategies. The aim of the study was to determine the incidence of PAD after 5 years of follow-up population-based cohort ARTPER, and the evolution of Ankle brachial Index (ABI) in this period. Methods Peripheral artery disease incidence analysis after 5 years of follow-up of 3786 subjects > 50 years old. Peripheral artery disease incident when the second cross section Ankle brachial Index was

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.

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.

The aim of this study is to develop and validate a shorter version (VREM) of the Spanish version of the Minnesota leisure time Physical Activity Questionnaire (CAFM), in order to have a shorter physical activity questionnaire to be used in Primary Care.Descriptive study of validation of a new physical activity measurement questionnaire. 200 patients older than 50, who visited one of 5 primary care centers in Barcelona for any reason were selected, with age-sex Catalonia's distribution. Two phases: first, VREM construction through items reduction. Second, validity of VREM against CAFM (gold standard) and test-retest reliability of VREM were analyzed, using kappa index and the intraclass correlation coefficient (ICC).6 items were included in the VREM: Walking, Gardening, Sport/dancing, Climbing stairs, Shopping walking and Cleaning house. The interview using VREM lasted 5 minutes (standard deviation 2). Agreement between both questionnaires, using 4 levels of physical activity, was 95.5% (kappa=0.93). Test-retest reliability of the questionnaire was 92.5% (kappa=0.88). Using a continuous outcome in metabolic energy turnover (MET), VREM also proved to be valid and reliable (ICC=0.95 and ICC=0.96 respectively).This short version of CAFM has shown good validity and reliability in people ≥50 years.

We aimed to know the prevalence of abnormal toe-brachial index (TBI) in a group of patients with type 2 diabetes mellitus (DM2). We also aimed to know the correlation between TBI and the ankle-brachial index (ABI) in these patients and determine the abnormal value of TBI.Descriptive cross-sectional study conducted in primary care. DM2 patients over 50 years were included. Systolic blood pressure at the arm, ankle and toe were determined to calculate the ABI and the TBI.We studied 175 patients (350 limbs) of a mean age of 67 years (SD=9), 53.7% were women and 72.3% had hypertension. The ABI was abnormal (≤ 0.90) in 8.3% of the limbs and 8.6% met criteria of calcification (≥ 1.40). The TBI was abnormal (≤ 0.60) in 18.6% of cases. Of the 291 limbs with a normal ABI, 34 (11.7%) had an abnormal value of TBI and the 30 limbs with a calcified ABI, 6 (20%) had an abnormal value of TBI. There was a positive linear correlation between ABI and TBI (r = 0.395, P.001).Determination of TBI provides additional information to ABI determination and exploration can be very useful in cases of arterial calcification. The value ≤ 0.60 is the best one to consider an abnormal TBI.

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.

Although peripheral arterial disease (PA) is an important clinical marker of cardiovascular morbimortality, the rate of under-diagnosis is unknown. Our aimed to know the proportion of patients underdiagnosed of PA and the associated factors.3786 patients49 years old, randomly selected, were studied. PA was diagnosed by means of the ankle-brachial index (ABI0, 9). Underdiagnosed was considered when ABI0, 9 and when they were not diagnosed of PA in the clinical record. We also determined the presence of intermittent claudication (IC) defined by Edinburgh's questionnaire.7,6% had an ABI0, 9 (IC95% 6.7-8.4). Of these patients 80.7%, were underdiagnosed, although the 29.3% had IC. PA underdiagnosis was low in current smokers or former smokers (OR 0.20; IC95% 0.07-0.59), if IC (OR 0.40; IC95% 0.18-0.89), if ABI between0.7 and 0.5 (OR 0.36; IC95% 0.16-0.81) or0,5 (OR 0.04; IC95 % 0.01-0.20), being higher in70 years (OR 3.12; IC95% 1.12-8.67).PA underdiagnosis is high, especially in old patients. It is necessary to reach consensus criteria for the practice of the ABI in the general population.

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.

e122 Volume 37 Number 8S CiloSTazol iN peripheral arTery diSeaSe: CardioVaSCular aNd bleediNg eVeNTS iN real-uSe CoNdiTioNS J. Real; M. Giner-Soriano; R. Morros; G. Pera; and R. Fores IDIAP Jordi Gol, USR Lleida, Spain; IDIAP Jordi Gol, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; IDIAP Jordi Gol, USR Metropolitana Nord, Spain; and Institut Catala de la Salut, Catalunya, Spain Background: On 2013, the European Medicines Agency’s Committee on Medicinal Products for Human Use (CHMP) recommended that the use of cilostazol should be restricted. The Spanish Agency for Medicines and Health Products (AEMPS) asked the CHMP to carry out a review following reports of serious suspected side effects such as coronary heart disease (CHD), arrhythmias and haemorrhages. Objectives: To estimate the risk for ischemic events, arrhythmias and haemorrhages in patients with peripheral artery disease treated with cilostazol vs pentoxifylline. Material and Methods: Design: retrospective observational cohort study. Population: ≥ 40 years-old individuals initiating cilostazol or pentoxifylline for peripheral artery disease between 01/04/2009-30/09/2011, not previously treated. End of follow-up: 31/12/2013. Data Sources: SIDIAP database; contains anonymized clinical information from electronic clinical records in Primary Care of 5.8 million people from Catalonia on sociodemographic data, comorbidities, medical procedures, clinical parameters, laboratory data and pharmacy invoicing data. Diagnoses of CHD events, arrhythmias and haemorrhages were linked from hospital discharge database. Statistical Analysis: Two cohorts (cilostazol and pentoxifylline) were matched 1:1 using propensity-score methods to ensure comparability among groups and then followed-up from treatment initiation until event, end of follow-up or death. Survival analysis was performed and cumulative incidence rates of events were obtained for each cohort. Cox proportional-hazards regression models were performed to estimate hazard ratios and 95% confidence intervals (HR; 95% CI). Results: We included 2,953 patients per cohort. They were 68.9 years-old, 76.1% were men. Median follow-up were 1217 days. Preliminary analysis showed no statistically significant differences in the cumulative incidence rates between cohorts: 10.5% vs 11.0% CHD events with cilostazol and pentoxifylline respectively (HR= 0.97; 95% CI: 0.83–1.13), 7.1% vs 8.1% arrhythmias (HR= 0.88; 95% CI: 0.73–1.06), 0.7% cerebral haemorrhages in both cohorts (HR= 1.1; 95% CI: 0.63–2.15) and 3.6% vs 3.4% digestive haemorrhages (HR= 1.07; 95% CI: 0.81–1.40). Conclusions: We found no differences between our cilostazol and pentoxifylline patients in CHD, arrhythmias and bleeding events.