Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

Introduction

The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking.

Materials and methods

A random group of 1,353 subjects aged between 40 and 70 years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV₁/FVC ratio was less than 0.70.

Results

The prevalence of COPD was 7.3% (95% CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P = .134). The incidence of smoking was 29.4% (95% CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P < .001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group i, 69.9% in group ii, 10.4% in group iii and 3.3% in group iv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated.

Conclusions

Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.     

Neumonía adquirida en la comunidad en fumadores

Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers.     

Cardiovascular risk factors. Insights from Framingham Heart Study

Epidemiology involves the study of disease frequency and its determinants within the population. Cardiovascular epidemiology began in the 1930s as a result of changes observed in the causes of death. In the 1950s, several epidemiological studies were set in motion with the aim of clarifying the cause of cardiovascular disease. Four years after the Framingham Heart Study started, researchers had identified high cholesterol and high blood pressure levels as important factors in the development of cardiovascular disease. In subsequent years, the Framingham study and other epidemiological studies have helped to identify other risk factors, which are now considered classical risk factors. By coining the expression "risk factor", the Framingham Heart Study helped to bring about a change in the way medicine is practiced. Today, a risk factor is defined as a measurable characteristic that is causally associated with increased disease frequency and that is a significant independent predictor of an increased risk of presenting with the disease. This wide-ranging overview describes some of the most important insights into the causes of cardiovascular disease to have come from the Framingham Heart Study. The emphasis is on the identification of risk factors, and the assessment of their predictive ability and their implications for disease prevention.     

Estrategias de reducción de riesgos en tabaquismo: ¿oportunidad o amenaza?

The smoking control policies recommended by the World Health Organisation have achieved a slight decrease in smoking prevalence in the developed countries, although associated mortality is still very high. The use of tobacco products other than cigarettes and even medicinal nicotine (known as nicotine replacement therapy (NRT)) has been proposed as a risk reduction strategy. Among the tobacco products with less individual risk than cigarettes would be any type of tobacco without smoke (smokeless) with a low content in nitrosamines and modified cigarettes; both forms included under the PREP (Potentially Reduced Exposure Products) concept. The idea would be to promote these products among those who cannot quit smoking or wish to reduce their risk without giving up nicotine intake. The possible effects of risk reduction strategies, including PREP, on the decreased prevalence and morbidity and mortality are reviewed, and the possible implications that this measure could have in our country are analysed. Tobacco control measures in Spain are recent and still insufficient. Therefore, the current priority in Spain is the development of policies of control that have shown to more than effective. The marketing and advertising of new tobacco products, even with reduced potential risk, seems more a serious threat than an opportunity for the development of smoking control policies.     

Validity for use in research on vascular diseases of the SIDIAP (Information System for the Development of Research in Primary Care): the EMMA study

Introduction and objectives

Information in primary care databases can be useful in research, but the validity of these data needs to be evaluated. We sought to analyze the validity of the data used in the EMMA study based on data from the Information System for the Development of Research in Primary Care.

Methods

We compared the prevalence of cardiovascular risk factors observed in EMMA–hypertension, diabetes, hypercholesterolemia (and its treatments), obesity, and smoking–with equivalent data from the Registre Gironí del Cor (REGICOR), a population-based study that uses standardized methodology, in 2000. We also compared the incidence rates of vascular diseases and its association with these risk factors in a 5-year follow-up.

Results

We analyzed data from 34 823 participants included in EMMA and 2540 REGICOR2000 study participants aged 35 to 74. The prevalence of risk factors did not differ significantly between the 2 studies, except for the prevalence of former smokers in men, which was higher in REGICOR2000 (24.7% [95% confidence interval, 23.9%-25.5%] vs 30.1% [95% confidence interval, 27.1%-33.1%]), and the proportion of patients with lipid-lowering and antihypertensive therapy, which was higher in EMMA (46.9% vs 32.7% and 8.7% vs 6.3%, respectively). There were no differences between the 2 studies when comparing the incidence of vascular diseases (2.1% in both studies in men and 1.18% [95% confidence interval, 0.7%-1.7%] in REGICOR2000 vs 0.75% [95% confidence interval, 0.64%-0.87%] in EMMA in women) and its association with risk factors.

Conclusions

The prevalence of cardiovascular risk factors and their association with the incidence of vascular disease observed in the EMMA study are consistent with those observed in an epidemiological population-based study with a standardized methodology.Full English text available from:www.revespcardiol.org     

Preoperative risk evaluation in beating-heart coronary artery bypass surgery

INTRODUCTION AND OBJECTIVES: Operative risk stratification scales for use in cardiac surgery have been developed for patients who undergo procedures using extracorporeal circulation. The aims of the present study were to investigate the use of six preoperative risk stratification scales in patients undergoing beating-heart surgery and to identify risk factors for major complications and mortality in our group of patients who underwent revascularization using this approach. PATIENTS AND METHOD: Between January 1997 and December 2002, we performed 762 coronary artery bypass operations on the beating heart; 61 patients suffered major complications (8%) and 25 died (3.3%). Risk factors for major complications and death were identified using logistic regression analysis of prospectively collected data. The following risk scores were calculated for each patient: Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario, and French. Receiver operating characteristic curves were used to compare the ability of each scale to predict mortality and major complications. RESULTS: In our patient group, the preoperative variables associated with increased risk were: need for cardiopulmonary resuscitation, renal dysfunction, peripheral vasculopathy, and the presence of severe left main coronary artery disease, three-vessel disease, or an impaired ejection fraction. CONCLUSIONS: Mortality and major complications were best predicted by the Parsonnet 95 and Euroscore scales.     

Preventing lung cancer by treating tobacco dependence

Tobacco use is a chronic medical disorder. Providing evidence-based treatment of tobacco-dependent patients is a challenge, and a team approach provides an efficient treatment model. Tobacco treatment specialists could expand the collective tobacco treatment expertise in the medical setting. Effective tobacco dependence treatment frequently requires tailoring and intensifying of interventions to meet the needs of the individual patient. Stopping smoking reduces the risk of lung cancer and many other cancers, cardiovascular disease, stroke, peripheral vascular disease. Treating tobacco dependence is one of the most cost-effective therapies in medicine and it deserves adequate reimbursement for it to be more widely available.     

The case for treating tobacco dependence as a chronic disease

Smoking remains the leading cause of preventable death in the United States, yet it is still regarded by many as merely a bad habit. Most smokers want to quit but find it difficult. Behavioral counseling and pharmacotherapies are available, safe, and effective in the treatment of tobacco dependence. Nicotine replacement therapy effectively delivers nicotine in safer doses without exposure to the toxins and chemicals in cigarette smoke. The optimal duration of tobacco dependence treatment is unknown, and some smokers may require extended courses. For smokers using long-term cessation medications, health care providers should encourage treatment and insurance carriers should cover it. Both tobacco dependence and such conditions as diabetes are similar in their potential to exacerbate other diseases, their behavioral components of treatment, and their effectiveness of medications. Despite these similarities, treatments for diabetes are well covered by insurance, whereas tobacco dependence treatments are often limited. Tobacco dependence should share the status of other chronic illnesses, with effective treatments given as long as is necessary to achieve successful clinical outcomes.     

Risk functions and the primary prevention of cardiovascular disease

Cardiovascular risk functions are regarded as the best tools for establishing priorities in primary prevention. Since the original Framingham risk chart fell into disuse because it greatly overestimated the real risk, the adjusted REGICOR and SCORE functions have become widely available in Spain, although the REGICOR function is the only one that has been validated for use in the Spanish population. Risk estimates have been shown to be useful for decision-making, particularly on the treatment of hypercholesterolemia. However, the fact that the majority of cardiovascular events occurs in individuals classified as being at a medium risk is evidence for the poor discriminative ability of classical risk factors. Despite the use of new parameters proposed for estimating cardiovascular risk, such as the C-reactive protein level, the detection of coronary calcification, the carotid intima-media thickness and the ankle-brachial index, there has been no improvement in the predictive capacity of classical risk factors. The most promising alternative seems to be the identification of "vulnerable patients" using markers of vulnerable plaque (ie, unstable or high-risk plaque), vulnerable blood (ie, with a tendency for thrombosis), and vulnerable myocardium (ie, electrically unstable or with a tendency for arrhythmia). In this article, we discuss whether the combined use of cardiovascular risk functions, novel risk markers and noninvasive tests can be effective in increasing the accuracy of patient selection for the primary prevention of cardiovascular disease.     

The importance of investigating the internal thoracic artery before coronary artery surgery in Leriche's syndrome

Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery.     

Atherosclerosis as a systemic disease

Atherosclerosis is a widespread, chronic progressive disease that mainly involves medium-sized arteries. Clinically, it can become apparent as ischemic heart disease, cerebrovascular disease, or peripheral arterial disease. In Spain, atherosclerosis is responsible for 124,000 deaths each year. Despite the trend towards a reduction in the aged-adjusted mortality rate for cardiovascular disease, the public health burden is expected to increase. The risk factors are the same for all affected vascular beds, regardless of location, and can be classified as either causal, conditional or predisposing. The presence of atherosclerosis in a particular vascular bed is frequently associated with disease in other vascular territories. Risk assessment tables, inflammatory markers, imaging, and the ankle-brachial index can help in identifying subclinical atherosclerosis. Given the systemic nature of the disease, treatment with statins, antiplatelet agents and angiotensin-converting enzyme inhibitors have consistently proven beneficial, irrespective of the vascular bed affected.