Biomedical subjects

Joan Sala

Publications and source records attributed to Joan Sala.

17 recordsLinked to original sources

PubMed2007

Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA Study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Adult↗

PubMed2006

[Epidemiology of cardiovascular disease in women].

Both mortality due to cerebrovascular disease in individuals aged under 85 years and mortality due to acute myocardial infarction (AMI) are lower in women than men. In contrast, the age-adjusted 28-day case fatality rate after a first AMI is 20% higher in women, particularly in countries where the incidence of AMI is low. In Spain, the case fatality rate is elevated in women hospitalized for a first AMI, but not in those with other forms of coronary heart disease. The pattern of mortality observed after symptom onset, which shows that death is delayed in women, suggests that the mechanism of death is different in the two sexes. The substantial variation that exists in the way results are adjusted and presented make it very difficult to compare the findings of different studies. Relative to men, women with AMI are 10 years older, reach hospital one hour later on average, more frequently have a comorbid condition (mainly diabetes and hypertension), progress to a more serious clinical state, and have a higher adjusted 28-day mortality risk. Moreover, the treatment given to women during the acute phase is less aggressive. A change in healthcare workers' attitudes is needed so that women with acute coronary syndromes can be identified earlier, thereby increasing the use of diagnostic and therapeutic procedures to a level that corresponds to the greater severity of AMI observed in women at presentation.

Adult↗

PubMed2005

[Analysis with the propensity score of the association between likelihood of treatment and event of interest in observational studies. An example with myocardial reperfusion].

INTRODUCTION AND OBJECTIVES: Analysis of the effect of treatment in observational studies is complex due to differences between treated and nontreated patients. Calculating the probability of receiving treatment conditioned on relevant covariates (propensity score [PS]) has been proposed as a method to control for these differences. We report an application of PS to assess the association between reperfusion treatment and 28-day case fatality in patients with acute myocardial infarction (AMI). METHOD: We describe the procedure used to calculate PS for receiving reperfusion treatment, and different strategies to analyze the association between PS and case fatality with regression modeling and matching. Data were from a population-based registry of 6307 patients with AMI in Spain during 1997-98. RESULTS: The PS for reperfusion was calculated in 5622 patients. In the multivariate analysis, reperfusion was associated with lower case fatality (OR = 0.59; 95% confidence interval [95% CI]: 0.46-0.77). When PS was included as a covariate, this association became non- significant (OR = 0.76; 95% CI: 0.57-1.01). In the subgroup of matched patients with a similar PS (n = 3138), treatment was not associated with case fatality (OR = 0.95; 95% CI: 0.72-1.26). When the influence of cases with missing data on PS was controlled for, reperfusion treatment was associated with lower fatality (OR = 0.66; 95% CI: 0.55-0.80). CONCLUSIONS: Calculating propensity score is a method that controls for differences between treated and nontreated patients. This score has limitations when matching is incomplete and when data are missing. Results of the present example suggest that reperfusion treatment reduces AMI case fatality.

Adult↗

PubMed2005

[Effect of reactions to symptoms onset on early mortality from myocardial infarction].

INTRODUCTION AND OBJECTIVES: A patient's social circumstances at the time when acute myocardial infarction (AMI) symptoms first appear might influence survival. Our objectives were to study the living conditions, the location where symptoms started, the type of symptoms, and the delay before action was taken in patients with AMI who survived more than one hour, and to analyze the relationship between these variables and mortality in different time periods. PATIENTS AND METHOD: Population-based observational cohort study carried out in 1997-1998. Main data source: Registre Gironí del Cor (REGICOR). Death certificates provided information on patients who died before they could be included in the register. The patients' demographic characteristics, lifestyle, clinical history, electrocardiographic abnormalities, cardiac enzyme levels, treatment, and diagnosis were recorded. Mortality before and during hospitalization, and overall mortality at 28 days were studied. RESULTS: Of the 1,097 patients included, 274 (24.97%) died before reaching hospital, 171 (15.58%) died in hospital, and 652 (59.4%) were alive at 28 days. Mortality was lower in patients who went directly to hospital (OR = 0.32, 95% CI, 0.17-0.59). Mortality at 28 days was higher in those with atypical symptoms (OR = 5.52, 95% CI, 2.90-10.50), and in those who lived in an institution (OR = 9.47, 95% CI, 1.05-84.9). CONCLUSIONS: In the absence of specially equipped ambulances, AMI patients who went directly to the hospital or who had typical symptoms had a better chance of survival both before hospitalization and at 28 days. In contrast, 28-day mortality was higher in institutionalized patients.

Adult↗

PubMed2004

Short-term (28 days) prognosis between genders according to the type of coronary event (Q-wave versus non-Q-wave acute myocardial infarction versus unstable angina pectoris).

The type of acute coronary syndrome may account for different prognoses between men and women after myocardial infarction. This study assessed gender differences in 28-day mortality rates for first or recurrent Q-wave and non-Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8% women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.

Adult↗

PubMed2004

Acute myocardial infarction population incidence and in-hospital management factors associated to 28-day case-fatality in the 65 year and older.

BACKGROUND AND OBJECTIVES: The myocardial infarction (MI) incidence rate, prognosis and hospitalisation rate in the population 65 and over are rarely studied. We sought to determine MI hospitalisation and incidence rates, and 28-day case-fatality, in the 65 year and older population, and to analyse whether their management and prognosis differed from that of younger patients. METHODS: All residents in Gerona (Spain) older than 24 years with suspected fatal or non-fatal MI were investigated and included in a population registry. RESULTS: MI mortality, incidence, and case-fatality dramatically increased with age after 64. Smoking, thrombolysis, antiplatelet and betablocker drug use, coronary angiograms, and coronary revascularisation decreased with age. The risk of death of patients between 75 and 84 years (OR: 4.15, 95% confidence interval, CI: 1.70-10.15) and between 85 and 94 years (OR: 4.68, 95% CI: 1.62-13.52) was higher than in the 34-64 years age group, independently of any patient characteristic. CONCLUSIONS: The magnitude of the impact of MI in the elderly at population and hospital levels is substantially higher than in those younger than 65 years of age. After this age patients receive less treatments and procedures than their younger counterparts.

Adult↗

PubMed2004

The role of age in cardiovascular risk factor clustering in non-diabetic population free of coronary heart disease.

UNLABELLED: The objectives were to analyse whether cardiovascular risk factors appear simultaneously in the population and to determine whether it depends on age. The participants belong to a random sample of individuals 25-74 years of age, representative of the non-diabetic population free of coronary heart disease of the province of Gerona, Spain, studied during 1994-1996. Exploratory factor analysis was used to assess clustering of cardiovascular risk factors and confirmatory factor analysis to compare clustering among age groups (25-54 and 55-74). RESULTS: In the 25-54 age group, we observed in both sexes the Central Metabolic Syndrome factor, which included glucose, lipids, and waist-to-hip ratio, and Metabolic Hypertension factor, which included systolic and diastolic blood pressures, waist-to-hip ratio, low-density lipoproteins, glycaemia, and triglycerides. In the 55-74 age group we observed in both sexes the Central Metabolic Syndrome factor, with the same composition as in younger subjects, and Isolated Hypertension factor, composed only of systolic and diastolic blood pressures. In both sexes, the chi2 value for the model of the combined age groups was higher than the sum of chi2 values of the best models for each age group separately (p < 0.01), which indicates that both sexes presented factor structures that differed by age group. CONCLUSIONS: The Central Metabolic Syndrome factor was common to all four sex and age groups studied. In younger subjects blood pressure was related to lipids, obesity, and glycaemia, suggesting the existence of a Metabolic Hypertension factor, while systolic and diastolic blood pressures were found to be the only significant variables in the hypertension factor after 54 years.

Adult↗

PubMed2004

Regional variability in population acute myocardial infarction cumulative incidence and mortality rates in Spain 1997 and 1998.

BACKGROUND: Myocardial infarction (MI) incidence and mortality display a high geographic variation. AIMS: The objective of the present study was to analyze MI mortality, cumulative incidence rate variability in seven regions of Spain from 1997 to 1998. METHODS AND RESULTS: Standardized methods were used to identify, find, register, and classify MI cases that were classified as definite, possible, insufficient-data MI, and non-MI. The total population of the seven monitored regions was 7,364,682 inhabitants. Of the 11,256 cases fulfilling eligibility criteria to investigate, 10,660 were selected to calculate MI rates: 6554 (61.5%) non-fatal definite MI, 1179 (11.1%) fatal definite MI, 1859 (17.4%) fatal possible MI, 1068 (10.0%) fatal cases with insufficient data. The IBERICA 25-74 years age-standardized cumulative incidence rates for men and women, were 207 (range: 175-252) and 45 (range: 36-65) per 100,000, respectively. The age-standardized mortality rates for men and women, were 73 (range: 62-94) and 20 (range: 13-29) per 100,000, respectively. Age-standardized case-fatality was 31.4 and 24.2% in men aged 25-74 and 35-64 years, respectively, and 32.7 and 27.0%, respectively, in women. CONCLUSIONS: MI cumulative incidence and mortality rates are low compared with other industrialized countries but, vary considerably among regions in a Mediterranean country like Spain.

Adult↗

PubMed2004

[Prevalence of diabetes mellitus in the province of Girona, Spain: the REGICOR study].

Our aim was to determine the prevalence of diabetes mellitus in the 25-to-74-year-old population in the province of Gerona, Spain. History of known diabetes mellitus was recorded, and fasting glycemia was measured in venous blood. The 1997 diagnostic criteria of the American Diabetes Association were used. Crude prevalence of known diabetes mellitus was 10.0%, and age-standardized prevalence was 7.7% (95% confidence interval [CI], 7.3%-8.1%). Crude prevalence of impaired fasting glucose was 8.6%, and age-standardized prevalence was 7.6% (95% CI, 7.25%-8.1%). Crude prevalence of known diabetes mellitus combined with diabetes mellitus according to glycemia value (total prevalence of diabetes mellitus) was 13.0%, and age-standardized prevalence was 10.0% (95% CI, 9.6%-10.5%). A higher prevalence in men and an increase in prevalence with age were observed. The figures are different from those of other studies in Spain.

Adult↗

PubMed2004

[Hospital resources and myocardial infarction case fatality. The IBERICA study].

INTRODUCTION AND OBJECTIVES: To determine the proportion of patients with myocardial infarction (MI) not admitted to a coronary care unit (CCU), the variables associated with admission into a CCU, and whether admission to a CCU, and the availability of coronary angiography in the same hospital, were associated with 28-day case fatality. PATIENTS AND METHOD: Population-based registry of MI in patients 25 to 74 years of age, admitted during 1996-1998. Demographic and clinical characteristics were recorded, as well as management, clinical course and survival after 28 days. Hospitals were classified according to the availability of a CCU and catheterization laboratory (advanced hospital), CCU only (intermediate hospital) or neither (basic hospital). Admission to the CCU was also recorded. RESULTS: In all, 9046 cases of MI were recorded; in 11.3% the patient was not admitted to a CCU. Age, smoking (OR=1.33; 95% CI, 1.08-1.64), non-Q MI (OR=0.62; 95% CI, 0.49-0.78) or undetermined location of MI (OR=0.34; 95% CI, 0.23-0.50), Killip 4 score on admission (OR=0.63; 95% CI, 0.40-1.00) and delay in arrival at the hospital >6 h were associated with CCU admission. Patients admitted to a CCU showed a lower case fatality in the first 24 h (4.2% vs 23.5%), which was independent of comorbidity, severity and treatment. The 24-hour survivors admitted to a basic hospital had higher case fatality (17.3% vs 7.8%) than other groups, which was related to differences in treatment. CONCLUSIONS: CCU admission is associated with a lower case fatality in the first 24 h. Admission to a basic hospital is associated with a higher 28-day case fatality even in patients who survive 24 h.

Adult↗

PubMed2003

[Myocardial infarction. Population case-fatality in seven Spanish autonomous communities: the IBERICA Study].

BACKGROUND AND OBJECTIVE: The magnitude of the problem of myocardial infarction (MI) is better understood by assessing the population case-fatality than by analyzing only the number of patients attending hospitals. PATIENTS AND METHOD: Our data come from the IBERICA Study (Investigation, Specific Search and Registry of Acute Myocardial Ischemic Syndrome). Twenty eight-day MI population case-fatality is described in the population aged 25 to 74 years during 1997 and 1998 in the following Spanish autonomous communities: Castilla-La Mancha (Toledo and Albacete), Catalonia (Girona), Valencia Community (Valencia), Balearic Islands (Majorca), Murcia, Navarra and Basque Country. The relationship between case-fatality and other variables such as sex, age and geographic area is also analyzed. RESULTS: A total of 10,660 MI cases were registered, 4,106 of whom died within the period of 28 days following the onset of symptoms (38.5%; CI 95%, 37.6-39.4%). The overall case-fatality was 37.0% (CI 95%, 35.9-38.0%) in men and 44.3% (CI 95%, 42.3-46.4%) in women. Death occurred out of hospitals in 2,869 (69.9%) cases. An increased case-fatality in women was associated with a higher in-hospital case-fatality (45% higher than men). The proportion of patients who died before reaching a hospital was similar in both genders. Classical symptoms of MI were more common among men than women (82.7% vs. 77.6%, p < 0,001). The interval between symptoms' onset and hospitalization was 30 minute longer among hospitalized women as compared with men (p < 0,001). CONCLUSIONS: Population MI case-fatality is high in the seven Spanish autonomous communities studied. Approximately 2 out of 3 deaths occur without patients being able to reach a hospital. These results emphasize the importance of primary and secondary prevention measures and the necessity to design ready-access systems to defibrillation and resuscitation manoeuvres for patients with cardiopulmonary arrest.

Adult↗

PubMed2003

[Comparison of population coronary heart disease risk estimated by the Framingham original and REGICOR calibrated functions].

BACKGROUND AND OBJECTIVE: The therapeutic consequences of using the Framingham function calibrated by the REGICOR and Framingham investigators (Framingham-REGICOR) in the Spanish population are unknown. The objective of this study was to determine the differences in the classification of the population coronary risk when using the classical Framingham function (Framingham-Wilson) and that calibrated, and its consequences on the theoretical indication of lipid-lowering treatment. PATIENTS AND METHOD: The classification into the < 2%, 2-4,9%, 5-9,9%, 10-19,9%, 20-39,9%, and >= 40% risk categories observed by the two functions was compared in 3.270 individuals aged 35 to 74 years with no history of ischaemic heart disease or lipid-lowering drug treatment, recruited in two population samples representative of Girona between 1994 and 2001. The number of lipid-lowering treatment candidates was estimated applying the most recent guidelines for clinical practice, according to the risk level obtained with both functions. RESULTS: The proportion of patients excluded owing to the fact that they already were on lipid-lowering treatment was 6.2%. The Framingham-REGICOR assigned 54.2% of women and 67.9% of men to a lower level of risk as compared to the Framingham-Wilson function. In 0.2% of women and 21.2% of men the decrease was two categories of risk. The figures in diabetic participants were 75.7 and 18.5%, respectively. When the European recommendations published in 2003 were applied, lipid-lowering treatment would have been indicated in 14.5% and in 4.4% of non-diabetic participants by the Framingham-Wilson and the Framingham-REGICOR, respectively. CONCLUSIONS: The calibrated Framingham-REGICOR function assigns a lower coronary risk category in more than 50% of women and almost 90% of men than the uncalibrated Framingham function. The calibrated function is more suitable for risk estimation in primary prevention than the original function in Spain.

Adult↗

PubMed2003

[Coronary risk estimation in Spain using a calibrated Framingham function].

INTRODUCTION AND OBJECTIVES: The Framingham coronary heart disease (CHD) functions overestimate the risk of CHD in countries with a low incidence. Consequently, these functions should be calibrated for the purpose of primary prevention. Calibrated Framingham function charts of overall CHD risk for the Spanish population are presented. Patients and methods. The Framingham functions were calibrated by substituting the prevalence of CHD risk factors and incidence found in Framingham with the same values for Spain. The Framingham function that included high-density lipoprotein (HDL) cholesterol was used. The 10-year probability of developing a CHD event was estimated for several combinations of risk factors and HDL levels ranging from 35 to 59 mg/dl. Color-coded charts were prepared that show the exact probability of CHD corresponding to each combination of risk factors, shown in separate cells on the chart. RESULTS: The event rate and prevalence of CHD risk factors differed considerably between Girona and Framingham. HDL < 35 mg/dL increased risk by approximately 50% and HDL > 60 mg/dL reduced it by 50%. The proportion of cells in which the 10-year probability of developing a CHD event was > 9% was 2.3 times higher and that of cells with a probability > 19% was 13 times lower in the chart calibrated for Spain than in the original Framingham charts. CONCLUSIONS: The calibrated Framingham function may help to more accurately estimate the overall risk of CHD in the Spanish population for primary prevention purposes. The calibrated function should be validated, and the development of functions for the Spanish population should be promoted.

Algorithms↗

PubMed2003

Antioxidant paraoxonase 1 activity in the metabolic syndrome.

Paraoxonase (PON1) is an antioxidant enzyme closely associated with high-density lipoproteins. Low PON1 has been shown in oxidative stress-associated processes such as dyslipidemia, diabetes mellitus, advancing age, and smoking. Indeed, oxidative stress is related to the degree of insulin resistance, a key component of the metabolic syndrome. Therefore, the possible relationship between PON1 activity and the metabolic syndrome was investigated. From 1364 randomly recruited subjects, 285 were found to have the metabolic syndrome, according to the guidelines published by the National Cholesterol Education Program, Adult Treatment Panel III. PON1 activity, lipid peroxides, and PON1 codon 192 genotypes, which strongly modulate PON1 activity, were determined. Serum PON1 activity levels were found to be significantly lower, and lipid peroxide concentrations significantly higher, in subjects with the metabolic syndrome compared with unaffected subjects (P = 0.033 and < 0.001, respectively). Study subjects showed a significant decreasing trend in PON1 activity levels and a significant increasing trend in lipid peroxide concentrations, with the increase in the number of metabolic disturbances. No differences in the prevalence of PON1 codon 192 genotypes were found among the categories of metabolic abnormalities. In conclusion, a greater degree of severity of the metabolic syndrome is associated with a progressively worse antioxidant/oxidant balance, which is consistent with increased oxidative stress and lower antioxidant PON1 enzymatic capacity.

Adult↗

PubMed2002

[Trends in the proportion of patients younger than 75 years with acute myocardial infarction and Killip class III and IV. variables associated with occurence and case-fatality: 1978-1997].

INTRODUCTION: Acute pulmonary edema (Killip III) or cardiogenic shock (Killip IV) is associated with a higher mortality in the acute phase of myocardial infarction (AMI). OBJECTIVES: To analyze trends in the proportion of patients who developed Killip III and IV in AMI over a 20-year period in order to identify the variables associated with occurrence and case-fatality. METHODS: Hospital registry of first AMI in patients under than 75 years, from 1978 to 1997. Sociodemographic variables, cardiovascular risk factors, clinical variables, treatments, procedures, and worst Killip class were recorded. RESULTS: The registry included 2,590 patients. Mean age was 60 years and 17% were women. Thirteen percent (13.5%) of the patients developed Killip III and IV, and no changes in this proportion were observed over the time period studied. Age, diabetes, previous angina, and anterior location of AMI were associated with a higher risk of Killip III and IV. Case-fatality at 28 days in this subgroup was 51.7%, with a decreasing linear trend over the years. Variables associated with a higher case-fatality were age and malignant ventricular arrhythmias, whereas the periods 1990-93 and 1994-97 were associated with a lower case-fatality. This protective effect disappeared after adjusting for treatment variables (antiplatelet agents and thrombolysis). CONCLUSIONS: The proportion of patients with AMI in which Killip class III and IV develops has remained stable in the last two decades. Although the 28-day case-fatality in these patients is high, a decrease has been observed in recent years in relation to the availability of new treatments (antiplatelet agents and thrombolysis).

Age Factors↗

PubMed2002

The paraoxonase-1 codon 192 polymorphism is associated with fasting total cholesterol and LDL-cholesterol concentrations only in postmenopausal women. The REGICOR study.

Paraoxonase-1 (PON1) is a high-density lipoprotein (HDL)-linked enzyme which appears to protect low-density lipoproteins (LDL) from oxidation. PON1 activity is associated with variation at the PON1 gene locus, specifically the common amino acid polymorphism at codon 192, for which the Q192 allele specifies low activity and the R192 allele specifies high activity. We investigated the association between the PON1 codon 192 polymorphism and fasting concentrations of glucose, lipids, lipoproteins and PON1 activity in 1380 subjects (724 men and 656 women). Several anthropometric and environmental factors were assessed in the present study. The PON1 Q192 allele frequency was 0.70 and 0.68 in men and women, respectively. In women, but not in men, significant associations were found between the PON1 codon 192 genotype and both total and LDL-cholesterol (p=0.004 and p=0.008, respectively), and subgroup analysis indicated that this relationship was predominant in postmenopausal women. Specifically, the Q192 allele was associated with increased total and LDL-cholesterol concentrations. Furthermore, these lipoprotein variables were higher among postmenopausal women with Q192/Q192 and Q192/R192 genotypes than in premenopausal women with the same genotypes (p<0.001). The findings suggest a gender-specific lipoprotein-genotype association with PON1 codon 192 genotypes in this study sample.

Adult↗

PubMedDate not supplied

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36).

OBJECTIVE: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). METHODS: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. RESULTS: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. CONCLUSIONS: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode.

Adult↗