Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Cardiovascular risk estimated after 13 years of follow-up in a low-incidence Mediterranean region with high-prevalence of cardiovascular risk factors

Authors: José M Huerta, María-José Tormo, Diana Gavrila, Carmen Navarro

Published in: BMC Public Health | Issue 1/2010

Login to get access

Abstract

Background

Murcia (south-east Spain) shows increased cardiovascular (CV) morbimortality as compared to other Spanish regions. Our objective was to assess the CV risk associated with major risk factors (RF) among adult population of Murcia.

Methods

A cohort of 2314 subjects (18-70 years) with full biochemical and questionnaire data was followed-up for 13 years. Incident cases of ischemic heart disease and stroke were identified by record linkage, individual questionnaires and revision of medical records. Relative risks were obtained by multivariate Cox regression stratified by age and sex, and ischemic risk attributable to CVRF was calculated.

Results

After more than 26276 person-years of follow-up, 57 incident ischemic events (77% men) and 37 stroke cases (62% men) were identified. Independent risk factors of ischemic heart disease (IHD) and all CV events combined, with RR ranging from 1.6 to 2.6, were total serum cholesterol ≥ 240 mg/dl (HR = 2.6, 95%CI:1.3-5.1), blood pressure levels ≥ 140/90 mmHg (HR = 2.6, 95%CI:1.4-4.8), ever tobacco smoking (HR = 2.2; 95%CI:1.1-4.5), and diabetes (HR = 2.0; 95%CI: 1.0-3.8). No increased CV risk was detected for known participants under treatment who showed cholesterol and blood pressure values below the clinical risk threshold. Smoking was significantly associated with stroke. For all events combined, the major risk factors were hypercholesterolemia, hypertension and ever use of tobacco. Despite its high prevalence, obesity was not associated to CV risk. Most of the IHD cases were attributable to smoking (44%), hypertension (38%) and hypercholesterolemia (26%).

Conclusions

In the Region of Murcia, smoking accounted for the largest proportion of cardiovascular risk, whereas hypertension displaced hypercholesterolemia as the second leading cause of CV disease. Our study deepens in our understanding of the cardiovascular epidemiology in Spanish areas of Mediterranean Europe with relatively high cardiovascular morbimortality, that are poorly represented by the available risk equations.
Appendix
Available only for authorised users
Literature
1.
Sans S, Kesteloot H, Kromhout D: The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J. 1997, 18: 1231-1248.CrossRef
2.
Marrugat J, Elosúa R, Aldasoro E, Tormo MJ, Vanaclocha H, Segura A, Fiol M, Moreno-Iribas C, Pérez G, Arteagoitia JM, et al: Regional variability in population acute myocardial infarction cumulative incidence and mortality rates in Spain 1997 and 1998. Eur J Epidemiol. 2004, 19: 831-839. 10.1023/B:EJEP.0000040531.77638.17.CrossRefPubMed
3.
Gabriel R, Alonso M, Segura A, Tormo MJ, Artigao LM, Banegas JR, Brotons C, Elosúa R, Fernández-Cruz A, Muñiz J, et al: Prevalence, geographic distribution and geographic variability of major cardiovascular risk factors in Spain. Pooled analysis of data from population-based epidemiological studies: the ERICE Study. Rev Esp Cardiol. 2008, 61: 1030-1040. 10.1157/13126043.CrossRefPubMed
4.
Masiá R, Pena A, Marrugat J, Sala J, Vila J, Pavesi M, Covas M, Aubo C, Elosua R: High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGICOR Investigators. J Epidemiol Community Health. 1998, 52: 707-715. 10.1136/jech.52.11.707.CrossRefPubMedPubMedCentral
5.
Valverde JC, Tormo MJ, Navarro C, Rodríguez-Barranco M, Marco R, Egea JM, Pérez-Flores D, Ortolá JB, González-Sicilia L, Tebar J, et al: Prevalence of diabetes in Murcia (Spain): a Mediterranean area characterised by obesity. Diabetes Res Clin Pract. 2006, 71: 202-209. 10.1016/j.diabres.2005.06.009.CrossRefPubMed
6.
Buckland G, González CA, Agudo A, Vilardell M, Berenguer A, Amiano P, Ardanaz E, Arriola L, Barricarte A, Basterretxea M, et al: Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol. 2009, 170: 1518-1529. 10.1093/aje/kwp282.CrossRefPubMed
7.
Medrano MJ, Pastor-Barriuso R, Boix R, del Barrio JL, Damián J, Álvarez R, Marín A: Coronary disease risk attributable to cardiovascular risk factors in the Spanish population. Rev Esp Cardiol. 2007, 60: 1250-1256. 10.1157/13113930.CrossRefPubMed
8.
Marrugat J, Solanas P, D'Agostino R, Sullivan L, Ordovás J, Cordón F, Ramos R, Sala J, Masiá R, Rohlfs I, et al: Coronary risk estimation in Spain using a calibrated Framingham function. Rev Esp Cardiol. 2003, 56: 253-261. 10.1157/13043951.CrossRefPubMed
9.
Sans S, Fitzgerald AP, Royo D, Conroy R, Graham I: Calibrating the SCORE cardiovascular risk chart for use in Spain. Rev Esp Cardiol. 2007, 60: 476-485.CrossRefPubMed
10.
Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation. 1998, 97: 1837-1847.CrossRefPubMed
11.
Marrugat J, Subirana I, Comín E, Cabezas C, Vila J, Elosúa R, Nam BH, Ramos R, Sala J, Solanas P, et al: Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA Study. J Epidemiol Community Health. 2007, 61: 40-47. 10.1136/jech.2005.038505.CrossRefPubMedPubMedCentral
12.
Marrugat J, D'Agostino R, Sullivan L, Elosúa R, Wilson P, Ordovás J, Solanas P, Cordón F, Ramos R, Sala J, et al: An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003, 57: 634-638. 10.1136/jech.57.8.634.CrossRefPubMedPubMedCentral
13.
Marín A, Medrano MJ, González J, Pintado H, Compaired V, Bárcena M, Fustero MV, Tisaire J, Cucalon JM, Martin A, et al: Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting. BMC Public Health. 2006, 6: 38-10.1186/1471-2458-6-38.CrossRefPubMedPubMedCentral
14.
Tomàs i Abadal Ll, Varas LC, Pérez I, Puig T, Balaguer I: Factores de riesgo y morbimortalidad coronaria en una cohorte laboral mediterránea seguida durante 28 años [Risk factors and coronary morbimortality in a Mediterranean industrial cohort over 28 years of follow-up. The Manresa Study]. Rev Esp Cardiol. 2001, 54: 1146-1154.CrossRef
15.
Tormo MJ, Navarro SC, Chirlaque L, Pérez FD: Factores de riesgo cardiovascular en la Región de Murcia, España [Cardiovascular risk factors in the Region of Murcia, Spain]. Rev Esp Salud Publica. 1997, 71: 515-529.
16.
WHO MONICA Project: MONICA Manual Part III: Population Survey. Section 1: Population survey data component. 1990, Geneva
17.
Tormo MJ, Moreno-Sueskun I, Chirlaque L, Navarro SC: Validez de un cuestionario de actividad física reciente [Validity of a questionnaire on recent physical activity]. Gac Sanit. 1995, 9: 174-182.CrossRef
18.
19.
Benichou J, Palta M: Rates, Risks, Measures of Association and Impact. Handbook of Epidemiology. Edited by: Ahrens W, Pigeot I. 2005, Berlin: Springer, 89-156. full_text.CrossRef
20.
21.
Boix MR, Aragones SN, Medrano Albero MJ: Trends in mortality from ischemic heart disease in 50 Spanish provinces. Rev Esp Cardiol. 2003, 56: 850-856. 10.1157/13051611.CrossRef
22.
Larrañaga N, Moreno C, Basterretxea M, Marín P, Chirlaque MD, Amiano P, Castilla J, Dorronsoro M, Quirós JR, Sánchez MJ, et al: Incidence of acute myocardial infarction in the Spanish EPIC cohort. An Sist Sanit Navar. 2009, 32: 51-59.CrossRefPubMed
23.
Heras M, Marrugat J, Aros F, Bosch X, Enero J, Suárez MA, Pabón P, Ancillo P, Loma-Osorio A, Rodríguez JJ, et al: Reduction in acute myocardial infarction mortality over a five-year period. Rev Esp Cardiol. 2006, 59: 200-208. 10.1157/13086076.CrossRefPubMed
24.
Medrano MJ, Cerrato E, Boix R, Delgado-Rodríguez M: Factores de riesgo cardiovascular en la población española: metaanálisis de estudios transversales [Cardiovascular risk factors in Spanish population: metaanalysis of cross-sectional studies]. Med Clin (Barc). 2005, 124: 606-612. 10.1157/13074389.CrossRef
25.
26.
Gutiérrez Fuentes JA, Gómez-Jerique J, Gómez de la Cámara, Rubio MA, García HA, Arístegui I: Descripción de la evolución del perfil cardiovascular [Diet and cardiovascular risk in Spain. Description of the evolution of cardiovascular profile]. Med Clin (Barc). 2000, 115: 726-729.CrossRef
27.
Huerta JM, Tormo MJ, Egea-Caparrós JM, Ortolá-Devesa JB, Navarro C: Accuracy of self-reported diabetes, hypertension and hyperlipidemia in the adult Spanish population. DINO study findings. Rev Esp Cardiol. 2009, 62: 143-152.CrossRefPubMed
28.
29.
Martínez-Ros MT, Tormo MJ, Navarro C, Chirlaque MD, Pérez-Flores D: Extremely high prevalence of overweight and obesity in Murcia, a Mediterranean region in south-east Spain. Int J Obes Relat Metab Disord. 2001, 25: 1372-1380. 10.1038/sj.ijo.0801684.CrossRefPubMed
30.
Arriola L, Martínez-Camblor P, Larrañaga N, Basterretxea M, Amiano P, Moreno-Iribas C, Carracedo R, Agudo A, Ardanaz E, Barricarte A, et al: Alcohol intake and the risk of coronary heart disease in the Spanish EPIC cohort study. Heart. 2010, 96: 124-130. 10.1136/hrt.2009.173419.CrossRefPubMed
31.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, de BG, Ebrahim S, Gjelsvik B, et al: European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J. 2007, 28: 2375-2414. 10.1093/eurheartj/ehm316.CrossRefPubMed
Metadata
Title
Cardiovascular risk estimated after 13 years of follow-up in a low-incidence Mediterranean region with high-prevalence of cardiovascular risk factors
Authors
José M Huerta
María-José Tormo
Diana Gavrila
Carmen Navarro
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-640

Other articles of this Issue 1/2010

BMC Public Health 1/2010 Go to the issue

Research article

Effects of worksite health promotion interventions on employee diets: a systematic review

Research article

Increasing uptake of colorectal cancer screening in Korea: a population-based study

Research article

My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda

Research article

Consumer perceptions of beef healthiness: results from a qualitative study in four European countries

Research article

The association between problematic cellular phone use and risky behaviors and low self-esteem among Taiwanese adolescents

Study protocol

Primary care Identification and Referral to Improve Safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial