La Síndrome Plurimetabòlica (Síndrome X) com a factor de risc Cardiovascular a l'atencìò primària.
ABSTRACT OF DOCTORAL THESIS THE PLURIMETABOLIC SYNDROME (SYNDROME X) LIKE CARDIOVASCULAR RISK FACTOR IN PRIMARY HEALTH CARE Introduction: the metabolic syndrome (MS) constitutes an extremely prevalent pathology, that conditions a high cardiovascular risk and therefore, is a cause of potentially avoidable death. Hypothesis and objectives: probably the incidence of cardiovascular disease is superior in those subjects that fulfill MS criteria. Each component of the MS will have an impact determined on the probability of displaying active cardiovascular disease. The objectives were: to determine the prevalence of the MS and the agreement between the criteria diagnoses more accepted universally (the WHO and NCEP-ATP III); the cardiovascular risk of the individuals according to the MS diagnosis; the appearance of cardiovascular events according to the MS; the impact of the characteristics of the MS on the appearance of cardiovascular complications and the time in which these appear; and to compare diverse systems of calculation of the cardiovascular risk. Material and methods: a cross-sectional study were carried out in order to know the prevalence of MS; and a prospective study to analyze the cardiovascular events. Greater patients of 14 years of age were selected, pertaining to two basic areas of health, representative of the general population of Reus. The period of study includes from the 01/01/1998 to the 31/12/2002. The study had the ethical institutional approval and the consent informed from the subjects. Results: 1500 subjects are analyzed (871 women), between which 59 losses of pursuit took place during the 5 years of duration. The prevalence of arterial hypertension was of the 37,4%, the diabetes mellitus of the 15,7%, the intermediate alterations of the metabolism of the glucose of the 24%, obesity of the 32,4%, dyslipidaemias of the 22,9% and active smoking of the 18,7%. Considering the WHO criteria the prevalence of MS was of the 17,4%; and according to the NCEP-ATP III criteria of the 20,3%. The agreement between these two criteria diagnoses have been elevated, with an index kappa weighed of 0.693. The cardiovascular risk measured by the formula of Framingham has been superior in the patients with MS (19.6±11.4) that in the exempt of this condition (9.4±8.5) (p< 0.001). The differences also have been significant considering the tables of Girona (REGICOR) (12.5±15.4 versus 7.9±13.1, respectively) (p< 0.001). The cardiovascular complications also differ according to the considered group, thus, the population with MS had a prevalence of the 33,1% of complications during the 5 years, whereas the group without MS underwent only 7,8% of complications (p< 0.001). Analyzing the evolution of the groups by means of survival curves, it is observed that the group of high risk has a relative risk 16,6 times superior to the group of low risk of undergoing complications. As well as a relative risk 29,7 times superior to develope diabetes, in the 5 years of pursuit, of the group of high risk as opposed to the one of low risk. The multiple logistic regression of the components of the MS sample that the main factor is the arterial hypertension (OR= 8.9), followed of the obesity (OR= 7.3), dyslipidaemia (OR= 6.6) and finally the diabetes (OR= 1.5). Conclusions: these obtained prevalences are similar to those of the countries of our environment, but the incidence of cardiovascular disease in Catalonia is of the lowest of the world. Probably this difference comes given by dietary patterns, physical exercise or by genetic factors. The MS constitutes a problem of first order considering their high prevalence and its cardiovascular prognosis. NCEP-ATP III criterion seems more suitable for its application in primary health care given to its greater simplicity and use of more clinical parameters. The cardiovascular risk measured by the tables of the REGICOR is next to the true incidence of observed cardiovascular disease in this study. A point of great importance is the incorporation of the MS like a risk factor in the list of conditioners and problems of the clinical histories of primary attention.
Advisor:Bladé Creixenti, Jordi
School:Universitat Rovira i Virgili
Source Type:Master's Thesis
Keywords:departament de medicina i cirurgia
Date of Publication:04/23/2004