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      Riesgo de presentación de eventos cardiovasculares según la agrupación de los factores de riesgo modificables en la población mayor de 15 años de un centro de salud de Barcelona Translated title: Risk of Suffering from Cardiovascular Diseases because of the Clustering of the Modifiable Cardiovascular Risk Factors in the Population Older than 15 years of a Health Care Center in Barcelona

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          Abstract

          Fundamento: En la últimas décadas la mortalidad por enfermedades cardiovasculares ha mostrado una tendencia decreciente en los países desarrollados, confirmada asimismo en España. No obstante siguen siendo la principal causa de mortalidad El objetivo de este trabajo es estudiar la asociación entre las enfermedades cardiovasculares y diversos factores de riesgo cardiovascular modificables en relación a su agrupación (clustering). Métodos: Estudio descriptivo transversal realizado en un centro de salud urbano, que incluyó a 2.248 personas de 15 o más años, seleccionadas por muestreo aleatorio simple del archivo de historias clínicas. Se calculó en forma de odds ratio (OR) el riesgo de tener alguna enfermedad cardiovascular (cardiopatía isquémica, enfermedad cerebrovascular o arteriopatia periférica de extremidades inferiores) en relación al clustering de los factores de riesgo tabaquismo, hipertensión arterial, hipercolesterolemia, hipertrigliceridemia y diabetes mellitus, ajustado por edad, sexo y factores de riesgo. Resultados: Las personas estudiadas tenían 224 enfermedades cardiovasculares. En el tabaquismo la OR como factor de riesgo aislado fue de 1,5 (IC95%: 1,0-2,2) y de 1,6 (IC95%: 0,9-2,5) con el clustering con los otros 4 factores de riesgo; con la hipertensión arterial de 2,1 (IC95%: 1,5-2,9) y de 1,7 (IC95%: 1,1-2,6), respectivamente; con la hipercolesterolemia de 1,7 (IC95%: 1,2-2,4) y de 1,6 (IC95%: 1,1-2,4), respectivamente; con la diabetes de 2,5 (IC95%: 1,7-3,5) y 2,0 (IC95%: 1,3-3,0), respectivamente y con la hipertrigliceridemia de 1,8 (IC95%: 1,2-2,8) y 1,3 (IC95%: 0,8-2,1), respectivamente. Las OR se comportaron de manera similar al estratificar por cada enfermedad cardiovascular, aunque las OR más elevadas (entre 2,4 y 3,1) correspondieron al clustering de diabetes mellitus y tabaquismo. Conclusiones: El riesgo de tener enfermedades cardiovasculares sigue siendo elevado con el clustering de factores de riesgo cardiovascular, aunque se observan diferencias entre ellos.

          Translated abstract

          Background: Over recent decades, the death rate due to cardiovascular diseases has shown a downward trend in developed countries, as has also been the case in Spain. However, are still the leading cause of death. This study is aimed at studying the relationship between cardiovascular diseases and different modifiable cardiovascular risk factors related to their clustering. Methods: Descriptive cross-sectional study conducted at an urban healthcare center, which included 2248 individuals ages 15 and above selected by simple random sampling of the medical record files. The risk of having some cardiovascular disease (ischemic cardiopathy, cerebrovascular disease or peripheral arteriopathy of lower limbs) was calculated in the form of an odds ration (OR) in relation to the clustering of the risk factors of smoking, high blood pressure, hypercholesterolemia, hypertriglyceridemia and diabetes mellitus, adjusted by age, sex and risk factors. Results: The individuals studied had 224 cardiovascular diseases. For smoking, the OR as an isolated risk factor was 1.5 (95% CI: 1.0-2.2) and 1.6 (95% CI: 0.9-2.5) with the clustering with the other four risk factors; with high blood pressure, respectively of 2.1 (95% CI: 1.5-2.9) and 1.7 (95% CI: 1.1-2.6); with hypercholesterolemia, respectively of 1.7 (95% CI: 1.2-2.4) and 1.6 (95% CI: 1.1-2.4); and with hypertriglyceridemia, respectively of 1.8(95% CI: 1.2-2.8) and 1.3 (95% CI: 0.8-2.1). The OR's showed a similar behavior on layering by each cardiovascular disease, although the highest OR's (2.4 - 3.1 range) corresponded to the clustering of diabetes mellitus and smoking. Conclusions: The risk of having cardiovascular diseases remains high with the clustering of cardiovascular risk factors, although differences among them are found to exist.

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          Physical activity and risk of stroke in women.

          Persuasive evidence has demonstrated that increased physical activity is associated with substantial reduction in risk of coronary heart disease. However, the role of physical activity in the prevention of stroke is less well established. To examine the association between physical activity and risk of total stroke and stroke subtypes in women. The Nurses' Health Study, a prospective cohort study of subjects residing in 11 US states. A total of 72,488 female nurses aged 40 to 65 years who did not have diagnosed cardiovascular disease or cancer at baseline in 1986 and who completed detailed physical activity questionnaires in 1986, 1988, and 1992. Incident stroke occurring between baseline and June 1, 1994, compared among quintiles of physical activity level as measured by metabolic equivalent tasks (METs) in hours per week. During 8 years (560,087 person-years) of follow-up, we documented 407 incident cases of stroke (258 ischemic strokes, 67 subarachnoid hemorrhages, 42 intracerebral hemorrhages, and 40 strokes of unknown type). In multivariate analyses controlling for age, body mass index, history of hypertension, and other covariates, increasing physical activity was strongly inversely associated with risk of total stroke. Relative risks (RRs) in the lowest to highest MET quintiles were 1. 00, 0.98, 0.82, 0.74, and 0.66 (P for trend=.005). The inverse gradient was seen primarily for ischemic stroke (RRs across increasing MET quintiles, 1.00, 0.87, 0.83, 0.76, and 0.52; P for trend=.003). Physical activity was not significantly associated with subarachnoid hemorrhage or intracerebral hemorrhage. After multivariate adjustment, walking was associated with reduced risk of total stroke (RRs across increasing walking MET quintiles, 1.00, 0. 76, 0.78, 0.70, and 0.66; P for trend=.01) and ischemic stroke (RRs across increasing walking MET quintiles, 1.00, 0.77, 0.75, 0.69, and 0.60; P for trend=.02). Brisk or striding walking pace was associated with lower risk of total and ischemic stroke compared with average or casual pace. These data indicate that physical activity, including moderate-intensity exercise such as walking, is associated with substantial reduction in risk of total and ischemic stroke in a dose-response manner. JAMA. 2000.
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            Contribution of trends in survival and coronar y-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations

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              Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study.

              The role of triglycerides as a risk factor of ischemic heart disease (IHD) remains controversial. For the present study, we examined the relation between fasting triglycerides and risk of IHD in the Copenhagen Male Study. Baseline measurements of fasting lipids and other IHD risk factors were obtained for 2906 white men (age range, 53 to 74 years) who were initially free of overt cardiovascular disease. During an 8-year follow-up period, 229 men had a first IHD event. Crude cumulative incidence rates of IHD were 4.6% for the lowest, 7.7% for the middle, and 11.5% for the highest third of triglyceride levels (P for trend <.001). Compared with the lowest third level and adjusted for age, body mass index, alcohol, smoking, physical activity, hypertension, non-insulin-dependent diabetes mellitus, social class, and LDL and HDL cholesterol, relative risks of IHD (95% confidence interval) were 1.5 (1.0 to 2.3; P=.05) and 2.2 (1.4 to 3.4; P<.001) for the middle and highest third of triglyceride levels, respectively. When triglyceride levels were stratified by HDL cholesterol levels (triglyceride third multiplied by HDL cholesterol third), a clear gradient of risk of IHD was found with increasing triglyceride levels within each level of HDL cholesterol, including high HDL cholesterol level, which are thought to provide protection against IHD. In middle-aged and elderly white men, a high level of fasting triglycerides is a strong risk factor of IHD independent of other major risk factors, including HDL cholesterol.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                June 2005
                : 79
                : 3
                : 365-378
                Affiliations
                [01] Barcelona orgnameÁrea Básica de Salud Dr. Carles Ribas
                Article
                S1135-57272005000300005 S1135-5727(05)07900300005
                10.1590/s1135-57272005000300005
                e752219b-ffe5-44cb-a2cf-2a6c695b92c7

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Coronary heart disease,Enfermedades vasculares periféricas,Accidente cerebrovascular,Risk factors,Cardiovascular diseases,Cardiopatía isquémica,Peripheral angiopathies,Factores de riesgo,Análisis por conglomerados,Enfermedades cardiovasculares,Clustering,Agrupamientos,Cerebrovascular accident

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