RESUMEN
OBJECTIVES: To evaluate the external validity of the FINDRISC, DESIR and ADA risk scores for the prediction of diabetes in a Spanish population aged >45 years and to test the possible improvement of FINDRISC by adding a new variable of high risk of depression when Patient Health Questionnaire-9 (PHQ-9) questionnaire score ≥10 (FINDRISC-MOOD). DESIGN: Prospective population-based cohort study. SETTING: 10 primary healthcare centres in the north of the city of Madrid (Spain). PARTICIPANTS: A total of 1242 participants without a history of diabetes and with 2-hour oral glucose tolerance test (OGTT) plasma glucose <200 mg/dL (<11.1 mmol/L) were followed up for 7.3 years (median) using their electronic health records (EHRs) and telephone contact. PRIMARY AND SECONDARY OUTCOME MEASURES: Diabetes risk scores (FINDRISC, DESIR, ADA), PHQ-9 questionnaire and 2-hour-OGTT were measured at baseline. Incident diabetes was defined as treatment for diabetes, fasting plasma glucose ≥126 mg/dL (≥7.0 mmol/L), new EHR diagnosis or self-reported diagnosis. External validation was performed according to optimal cut-off, sensitivity, specificity and Youden Index. Comparison between diabetes risk scores, including FINDRISC-MOOD (original FINDRISC score plus five points if PHQ-9 ≥10), was measured by area under the receiver operating characteristic curve (AUROC). RESULTS: During follow-up, 104 (8.4%; 95% CI, 6.8 to 9.9) participants developed diabetes and 185 had a PHQ-9 score ≥10. The AUROC values were 0.70 (95% CI, 0.67 to 0.72) for FINDRISC-MOOD and 0.68 (95% CI, 0.65 to 0.71) for the original FINDRISC. The AUROCs for DESIR and ADA were 0.66 (95% CI, 0.63 to 0.68) and 0.66 (95% CI, 0.63 to 0.69), respectively. There were no significant differences in AUROC between FINDRISC-MOOD and the other scores. CONCLUSIONS: The results of FINDRISC-MOOD were like those of the other risk scores and do not allow it to be recommended for clinical use.
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Depresión , Prueba de Tolerancia a la Glucosa , Humanos , Femenino , España , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Depresión/diagnóstico , Depresión/epidemiología , Medición de Riesgo/métodos , Factores de Riesgo , Glucemia/análisis , Glucemia/metabolismo , Diabetes Mellitus/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Encuestas y Cuestionarios , Curva ROC , Cuestionario de Salud del PacienteRESUMEN
OBJECTIVES: To evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences. DESIGN AND SETTING: A cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin-angiotensin system blockers and statins had been prescribed for overt cardiovascular disease. RESULTS: The prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females. CONCLUSION: Our study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
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Enfermedades Cardiovasculares/etiología , Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 2/complicaciones , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Estudios Transversales , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/prevención & control , Femenino , Objetivos , Humanos , Masculino , Medición de Riesgo , Distribución por Sexo , Factores SexualesRESUMEN
La implicación de un mayor riesgo cardiovascular en algunas enfermedades dermatológicas ha sido evidenciada en las últimas décadas. Enfermedades como la psoriasis y el lupus eritematoso sistémico se encuentran actualmente incluidas en las guías de prevención de la enfermedad cardiovascular. Otras enfermedades como la alopecia androgénica, el síndrome del ovario poliquístico, la hidrosadenitis supurativa o el liquen plano disponen de numerosos estudios que apuntan a un mayor riesgo en estos pacientes, aunque todavía no han sido incluidas en estas guías. En el presente artículo se realiza una revisión de las evidencias que avalan esta asociación, con el objeto de advertir al clínico sobre la necesidad de un mayor control de los factores de riesgo cardiovascular en estos pacientes
The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients
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Humanos , Enfermedades Cardiovasculares/epidemiología , Enfermedades de la Piel/complicaciones , Factores de Riesgo , Síndrome Metabólico/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Alopecia/complicaciones , Hidradenitis/complicaciones , Síndrome Antifosfolípido/complicaciones , Lupus Eritematoso Cutáneo/complicaciones , Psoriasis/complicacionesRESUMEN
The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.
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Enfermedades Cardiovasculares/etiología , Guías de Práctica Clínica como Asunto , Enfermedades de la Piel/complicaciones , Enfermedades Cardiovasculares/prevención & control , Humanos , Factores de Riesgo , Enfermedades de la Piel/fisiopatologíaRESUMEN
INTRODUCTION: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation of lifestyle changes and treatment options aimed at delaying the progression of the disease and to avoid cardiovascular complications. Different scores for identifying undiagnosed diabetes have been reported, however, their performance in populations of southern Europe has not been sufficiently evaluated. The main objectives of our study are: to evaluate the screening performance and cut-off points of the main scores that identify the risk of undiagnosed T2DM and prediabetes in a Spanish population, and to develop and validate our own predictive models of undiagnosed T2DM (screening model), and future T2DM (prediction risk model) after 5-year follow-up. As a secondary objective, we will evaluate the atherosclerotic burden of the population with undiagnosed T2DM. METHODS AND ANALYSIS: Population-based prospective cohort study with baseline screening, to evaluate the performance of the FINDRISC, DANISH, DESIR, ARIC and QDScore, against the gold standard tests: Fasting plasma glucose, oral glucose tolerance and/or HbA1c. The sample size will include 1352 participants between the ages of 45 and 74â years. ANALYSIS: sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative and receiver operating characteristic curves and area under curve. Binary logistic regression for the first 700 individuals (derivation) and last 652 (validation) will be performed. All analyses will be calculated with their 95% CI; statistical significance will be p<0.05. ETHICS AND DISSEMINATION: The study protocol has been approved by the Research Ethics Committee of the Carlos III Hospital (Madrid). The score performance and predictive model will be presented in medical conferences, workshops, seminars and round table discussions. Furthermore, the predictive model will be published in a peer-reviewed medical journal to further increase the exposure of the scores.
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Glucemia/análisis , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diagnóstico Precoz , Prueba de Tolerancia a la Glucosa/métodos , Estado Prediabético/diagnóstico , Anciano , Sesgo , Femenino , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Factores de Riesgo , España/epidemiologíaAsunto(s)
Humanos , Dislipidemias/diagnóstico , Dislipidemias/terapia , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo , LDL-Colesterol/análisis , HDL-Colesterol/análisis , Triglicéridos/análisis , Anticolesterolemiantes/farmacocinéticaRESUMEN
OBJECTIVE: To evaluate the understanding of patients receiving statins about the dietary and therapeutic measures taken to control their cholesterol and to relate this to the achievement of therapy objectives. DESIGN: Transversal, multi-centre study, conducted between March and November, 2004. SETTING: Three-hundred seventy six primary care and specialist doctors from all over the country. PARTICIPANTS: A total of 2347 patients, with an average age of 59 (12) and 48% women, being treated with statins. METHOD: Survey to evaluate understanding of lipid-lowering diet and pharmacological treatment. The percentage of patients achieving therapy objectives in line with ATP III guidelines was determined. RESULTS: Understanding of diet was adequate only for foods with negative effects on the concentration of cholesterol. Overall, understanding was better in the young, those with a higher level of education, those with hyperlipaemia originating in the family, those under treatment for longer, and in those attended in primary care or internal medicine clinics; it was worse in diabetic patients and in those with cardiovascular disease. Patients with more understanding of their treatment reached their therapy objectives to a greater extent. CONCLUSION: Patients receiving statins treatment have an adequate understanding of diet, but little information on pharmacological treatment. This understanding is associated with the achievement of therapy objectives.
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Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/dietoterapia , Hipercolesterolemia/tratamiento farmacológico , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Encuestas y CuestionariosRESUMEN
Objetivo. Evaluar el conocimiento de los sujetos que reciben tratamiento con estatinas sobre las medidas dietéticas y terapéuticas dirigidas a su control, relacionándolo con la consecución de objetivos terapéuticos. Diseño. Estudio transversal, multicéntrico, realizado entre marzo y noviembre de 2004. Emplazamiento. En total, 376 médicos de atención primaria y especializada distribuidos por toda la geografía nacional. Participantes. Se incluyó a 2.347 sujetos, con una edad media de 59 ± 12 años, el 48%, mujeres, y en tratamiento con estatinas. Método. Encuesta dirigida a evaluar el conocimiento sobre la dieta hipolipidemiante y el tratamiento farmacológico. Se determinó el porcentaje de sujetos que alcanzó los objetivos terapéuticos según el ATP III. Resultados. El conocimiento de la dieta era adecuado sólo para los alimentos con efectos negativos sobre la concentración de colesterol. Globalmente, el conocimiento fue mejor en los sujetos jóvenes, con un superior nivel de educación, con una hiperlipidemia de origen familiar, con más tiempo en tratamiento y que eran atendidos en consultas de atención primaria o medicina interna, y peor en los pacientes diabéticos y con enfermedad cardiovascular. Los sujetos con un mayor nivel de conocimientos sobre el tratamiento alcanzaron en mayor proporción los objetivos terapéuticos. Conclusión. Los pacientes que reciben tratamiento con estatinas tienen un adecuado conocimiento de la dieta y escasa información sobre el tratamiento farmacológico. Este conocimiento se asocia con la consecución de objetivos terapéuticos
Objective. To evaluate the understanding of patients receiving statins about the dietary and therapeutic measures taken to control their cholesterol and to relate this to the achievement of therapy objectives. Design. Transversal, multi-centre study, conducted between March and November, 2004. Setting. Three-hundred seventy six primary care and specialist doctors from all over the country. Participants. A total of 2347 patients, with an average age of 59 (12) and 48% women, being treated with statins. Method. Survey to evaluate understanding of lipid-lowering diet and pharmacological treatment. The percentage of patients achieving therapy objectives in line with ATP III guidelines was determined. Results. Understanding of diet was adequate only for foods with negative effects on the concentration of cholesterol. Overall, understanding was better in the young, those with a higher level of education, those with hyperlipaemia originating in the family, those under treatment for longer, and in those attended in primary care or internal medicine clinics; it was worse in diabetic patients and in those with cardiovascular disease. Patients with more understanding of their treatment reached their therapy objectives to a greater extent. Conclusion. Patients receiving statins treatment have an adequate understanding of diet, but little information on pharmacological treatment. This understanding is associated with the achievement of therapy objectives
Asunto(s)
Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Humanos , Hipercolesterolemia/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Educación del Paciente como Asunto/estadística & datos numéricos , Hipercolesterolemia/dietoterapia , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Conocimientos, Actitudes y Práctica en Salud , Estudios Transversales , España/epidemiología , Dieta con Restricción de Grasas , Educación en Salud , Atención Primaria de SaludRESUMEN
Fundamento y objetivo: Evaluar el grado general de consecución de objetivos de control de los factores de riesgo en prevención secundaria de los pacientes que han tenido un episodio coronario y son seguidos en atención primaria. Pacientes y método: Estudio descriptivo, transversal y multicéntrico con inclusión mediante muestreo consecutivo de los primeros 5 pacientes que acudieron a consulta y habían tenido un episodio coronario en un período previo de 6 meses a 10 años. Los objetivos de control fueron: presión arterial < 140/90 mmHg en población general y < 130/85 mmHg en diabéticos, colesterol de las lipoproteínas de baja densidad (cLDL) < 100 mg/dl y no ser fumador. Resultados: Se incluyó a 8.817 pacientes (varones el 73,7%) con una media (desviación estándar) de edad de 65,4 (10,3) años. El 76,6% eran hipertensos; el 73,4%, dislipémicos, y el 32,7%, diabéticos. El 60,2% alcanzó el objetivo de presión arterial, el 26,3% alcanzó el objetivo de cLDL < 100 mg/dl y el 11,4% siguió fumando. Cumplió la totalidad de las recomendaciones el 16,4%. Los factores relacionados de forma independiente con un buen control fueron la menor edad, el sexo masculino, el ingreso por síndrome coronario agudo sin elevación del ST (odds ratio [OR] = 1,39; intervalo de confianza [IC] del 95%, 1,01-1,93; p = 0,04) o para revascularización (OR = 1,37; IC del 95%, 1,12-1,67; p = 0,002), tener enfermedad arterial periférica (OR = 1,43; IC del 95%, 1,11-1,84; p = 0,005) y que los objetivos planteados por los médicos fueran adecuados (OR = 1,90; IC del 95%, 1,48-2,44; p < 0,0001). El control fue peor en los pacientes hipertensos o dislipémicos. Conclusiones: El control general de los factores de riesgo en prevención secundaria de la enfermedad coronaria se consigue en 1 de cada 6 pacientes atendidos en atención primaria
Background and objective: Evaluate the overall achievement of goals in the control of risk factors in secondary prevention in patients who have suffered a coronary event and are followed up in primary care centers. Patients and method: Descriptive, transversal, multicenter study with sampling by consecutive inclusion of the first 5 patients attending the doctor's office who had suffered a coronary event 6 months to 10 years previously. The targets for control were: blood pressure < 140/90 mmHg in the general population and < 130/85 mmHg in diabetics; LDL-cholesterol < 100 mg/dl and no smoking habit. Results: 8,817 patients (73.7% males) were included, with a mean (SD) age of 65.4 (10.3) years; 76.6% were hypertensive, 73.4% dyslipidemic and 32.7% diabetics; 60.2% achieved target blood pressure; 26.3% achieved LDL-cholesterol <100 mg/dl and 11.4% continued smoking; 16.4% fulfilled all recommendations. Factors independently related with good control were a lower age, male sex, patients who had been admitted with acute coronary syndrome without ST elevation (OR = 1.39; CI 95%, 1.01-1.93; p = 0.04) or for revascularization (OR = 1.37; CI 95%; 1.12-1.67; p = 0.002), patients with peripheral arterial disease (OR = 1.43; CI 95%, 1.11-1.84; p = 0.005) and when the physicians proposed suitable objectives (OR = 1.90; CI 95%, 1.48-2.44; p < 0.0001). Control was poorer in hypertensive or dyslipidemic patients. Conclusions: Overall control of risk factors in secondary prevention of coronary disease is achieved in one in six patients attending primary care
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Masculino , Femenino , Persona de Mediana Edad , Anciano , Humanos , Ajuste de Riesgo/métodos , Enfermedad Coronaria/prevención & control , Factores de Riesgo , Atención Primaria de Salud/métodos , Epidemiología Descriptiva , Comorbilidad , Hipertensión/epidemiología , Hiperlipidemias/epidemiologíaRESUMEN
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Humanos , Hipertensión/diagnóstico , Determinación de la Presión Sanguínea/métodos , Ajuste de Riesgo/métodos , Enfermedades Cardiovasculares/epidemiología , Tobillo , BrazoRESUMEN
BACKGROUND AND OBJECTIVE: Evaluate the overall achievement of goals in the control of risk factors in secondary prevention in patients who have suffered a coronary event and are followed up in primary care centers. PATIENTS AND METHOD: Descriptive, transversal, multicenter study with sampling by consecutive inclusion of the first 5 patients attending the doctor's office who had suffered a coronary event 6 months to 10 years previously. The targets for control were: blood pressure < 140/90 mmHg in the general population and < 130/85 mmHg in diabetics; LDL-cholesterol < 100 mg/dl and no smoking habit. RESULTS: 8,817 patients (73.7% males) were included, with a mean (SD) age of 65.4 (10.3) years; 76.6% were hypertensive, 73.4% dyslipidemic and 32.7% diabetics; 60.2% achieved target blood pressure; 26.3% achieved LDL-cholesterol <100 mg/dl and 11.4% continued smoking; 16.4% fulfilled all recommendations. Factors independently related with good control were a lower age, male sex, patients who had been admitted with acute coronary syndrome without ST elevation (OR = 1.39; CI 95%, 1.01-1.93; p = 0.04) or for revascularization (OR = 1.37; CI 95%; 1.12-1.67; p = 0.002), patients with peripheral arterial disease (OR = 1.43; CI 95%, 1.11-1.84; p = 0.005) and when the physicians proposed suitable objectives (OR = 1.90; CI 95%, 1.48-2.44; p < 0.0001). Control was poorer in hypertensive or dyslipidemic patients. CONCLUSIONS: Overall control of risk factors in secondary prevention of coronary disease is achieved in one in six patients attending primary care.
Asunto(s)
Enfermedad Coronaria/prevención & control , Factores de Edad , Anciano , Presión Sanguínea , Distribución de Chi-Cuadrado , Estudios Cruzados , Interpretación Estadística de Datos , Complicaciones de la Diabetes/terapia , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Dislipidemias/complicaciones , Dislipidemias/epidemiología , Dislipidemias/terapia , Electrocardiografía , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Prevención del Hábito de Fumar , España/epidemiologíaRESUMEN
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