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      Incidencia de cardiopatía isquémica y accidente cerebrovascular en trabajadores de una administración local del sur de España a lo largo de diez años de seguimiento Translated title: Incidence of ischemic heart disease and stroke in workers of a local administration in southern Spain over ten years of follow-up

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          RESUMEN

          Fundamentos:

          Las enfermedades cardiovasculares son la primera causa de muerte en España. Existen escasos estudios sobre incidencia de acontecimientos cardiovasculares en trabajadores. Los objetivos de este trabajo fueron conocer la incidencia de cardiopatía isquémica (CI) y enfermedad cerebrovascular (ECV) en trabajadores de una administración pública del sur de España, estimar la prevalencia de los factores de riesgo cardiovascular (FRCV) y su contribución a la misma, así como evaluar el comportamiento predictivo de la función REGICOR.

          Métodos:

          Se realizó un estudio longitudinal de cohortes históricas, no concurrentes, constituidas por 698 trabajadores, reclutados en los exámenes de salud laboral. Las variables dependientes fueron la aparición de CI o ECV, mientras que las principales independientes fueron glucosa, colesterol, triglicéridos, Índice de Masa Corporal (IMC), presión arterial, perímetro abdominal, actividad física, tabaquismo y puntuación REGICOR. Se llevó a cabo una regresión de Cox y se calculó el área ABC de la curva ROC para las variables explicativas.

          Resultados:

          Según la función REGICOR, se clasificó de alto riesgo al 0,6% de la población. La Densidad de Incidencia (DI) por cada 100.000 personas-año para cardiopatía isquémica en mujeres resultó ser de 53,9 por 357,4 en hombres, sin diferencias significativas respecto a las esperadas a partir de la función REGICOR. La DI combinada para cardiopatía isquémica y accidentes cerebrovasculares fue de 477,1 por cada 100.000 personas-año (en hombres).

          Conclusiones:

          La función REGICOR valora adecuadamente el riesgo cardiovascular de manera global, perdiendo capacidad predictiva según grupos de riesgo. El tabaquismo y la presión arterial se muestran como los factores de riesgo modificables con mayor asociación independiente en la aparición de una enfermedad cardiovascular.

          ABSTRACT

          Background:

          Cardiovascular disease is the first cause of death in Spain. There are a few studies about the incidence of ischemic heart disease and cerebrovascular disease in workers. The objectives of this study were to determine the incidence of coronary and cerebrovascular disease in a cohort of workers of a public administration in the south of Spain, to estimate the prevalence of CVRF and its contribution to it, as well as to evaluate the predictive behavior of the REGICOR function.

          Methods:

          Longitudinal historical cohort study, not concurrent, consisting of 698 workers, recruited from occupational health examinations. The dependent variables were the appearance of CI or CVD while leading independent were glucose, cholesterol, triglycerides, BMI, blood pressure, waist circumference, physical activity, smoking and REGICOR score and Score. Is performed Cox regression and its calculated area AUC of the ROC curve area for the explanatory variables.

          Results:

          According to the REGICOR function, 0.6% of the population was classified as high risk. The Incidence Density per 100,000 persons-year for ischemic heart disease in women was found to be 53.9 by 357.4 in men, without significant differences with respect to those expected from the REGICOR function. The combined DI for ischemic heart disease and stroke was 477.1 per 100,000 person-years (men).

          Conclusions:

          The REGICOR function adequately assesses cardiovascular risk globally, losing predictive capacity according to risk groups. Smoking and blood pressure are shown as modifiable risk factors with greater independent association in the onset of cardiovascular disease.

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          Most cited references62

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          Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.

          A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
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            Role of Insulin Resistance in Human Disease

            G M Reaven (1988)
            Resistance to insulin-stimulated glucose uptake is present in the majority of patients with impaired glucose tolerance (IGT) or non-insulin-dependent diabetes mellitus (NIDDM) and in approximately 25% of nonobese individuals with normal oral glucose tolerance. In these conditions, deterioration of glucose tolerance can only be prevented if the beta-cell is able to increase its insulin secretory response and maintain a state of chronic hyperinsulinemia. When this goal cannot be achieved, gross decompensation of glucose homeostasis occurs. The relationship between insulin resistance, plasma insulin level, and glucose intolerance is mediated to a significant degree by changes in ambient plasma free-fatty acid (FFA) concentration. Patients with NIDDM are also resistant to insulin suppression of plasma FFA concentration, but plasma FFA concentrations can be reduced by relatively small increments in insulin concentration. Consequently, elevations of circulating plasma FFA concentration can be prevented if large amounts of insulin can be secreted. If hyperinsulinemia cannot be maintained, plasma FFA concentration will not be suppressed normally, and the resulting increase in plasma FFA concentration will lead to increased hepatic glucose production. Because these events take place in individuals who are quite resistant to insulin-stimulated glucose uptake, it is apparent that even small increases in hepatic glucose production are likely to lead to significant fasting hyperglycemia under these conditions. Although hyperinsulinemia may prevent frank decompensation of glucose homeostasis in insulin-resistant individuals, this compensatory response of the endocrine pancreas is not without its price. Patients with hypertension, treated or untreated, are insulin resistant, hyperglycemic, and hyperinsulinemic. In addition, a direct relationship between plasma insulin concentration and blood pressure has been noted. Hypertension can also be produced in normal rats when they are fed a fructose-enriched diet, an intervention that also leads to the development of insulin resistance and hyperinsulinemia. The development of hypertension in normal rats by an experimental manipulation known to induce insulin resistance and hyperinsulinemia provides further support for the view that the relationship between the three variables may be a causal one.(ABSTRACT TRUNCATED AT 400 WORDS)
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              Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA Study.

              To assess the reliability and accuracy of the Framingham coronary heart disease (CHD) risk function adapted by the Registre Gironí del Cor (REGICOR) investigators in Spain. A 5-year follow-up study was completed in 5732 participants aged 35-74 years. The adaptation consisted of using in the function the average population risk factor prevalence and the cumulative incidence observed in Spain instead of those from Framingham in a Cox proportional hazards model. Reliability and accuracy in estimating the observed cumulative incidence were tested with the area under the curve comparison and goodness-of-fit test, respectively. The Kaplan-Meier CHD cumulative incidence during the follow-up was 4.0% in men and 1.7% in women. The original Framingham function and the REGICOR adapted estimates were 10.4% and 4.8%, and 3.6% and 2.0%, respectively. The REGICOR-adapted function's estimate did not differ from the observed cumulated incidence (goodness of fit in men, p = 0.078, in women, p = 0.256), whereas all the original Framingham function estimates differed significantly (p<0.001). Reliabilities of the original Framingham function and of the best Cox model fit with the study data were similar in men (area under the receiver operator characteristic curve 0.68 and 0.69, respectively, p = 0.273), whereas the best Cox model fitted better in women (0.73 and 0.81, respectively, p<0.001). The Framingham function adapted to local population characteristics accurately and reliably predicted the 5-year CHD risk for patients aged 35-74 years, in contrast with the original function, which consistently overestimated the actual risk.
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                Author and article information

                Journal
                Rev Esp Salud Publica
                Rev Esp Salud Publica
                resp
                Revista Española de Salud Pública
                Ministerio de Sanidad, Consumo y Bienestar social
                1135-5727
                2173-9110
                02 November 2020
                2020
                : 94
                : 202001001
                Affiliations
                [1 ] originalDepartamento de Seguridad y Salud Laboral. Ayuntamiento de Córdoba. Córdoba. España. orgnameAyuntamiento de Córdoba orgdiv1Departamento de Seguridad y Salud Laboral Córdoba, España
                [2 ] originalDistrito Sanitario Guadalquivir (Córdoba). Servicio Andaluz de Salud. Córdoba. España. orgnameServicio Andaluz de Salud orgdiv1Distrito Sanitario Guadalquivir Córdoba, España
                [3 ] originalDirección General de Prevención y Protección Ambiental. Universidad de Córdoba. Córdoba. España. orgnameUniversidad de Córdoba orgdiv1Dirección General de Prevención y Protección Ambiental Córdoba, España
                Author notes
                Correspondencia: Carlos Álvarez Fernández. C/ Palacio de la Galiana, 19, 14012 Córdoba, España. craf.19arauco@ 123456hotmail.com

                Los autores declaran que no existe conflicto de intereses.

                Article
                e202001001
                11567069
                806e9e42-e8a2-450c-aa5b-5e4763855ac2

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                : 04 May 2019
                : 27 November 2019
                : 07 January 2020
                Page count
                Figures: 0, Tables: 6, Equations: 0, References: 43
                Categories
                Originales

                enfermedad coronaria,accidente cerebrovascular,incidencia,trabajadores,factores de riesgo,funciones de riesgo,síndrome metabólico,coronary heart disease,cerebro-vascular diseases,incidence,workers,risk factor’s,risk functions,metabolic syndrome

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