title: Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting.
abstract: BACKGROUND
  Ischaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors) using the information gathered by primary care practitioners on cardiovascular health of their population.
  
  
  METHODS
  A prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses.
  
  
  RESULTS
  Mean age at recruitment was 51.6 +/- 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate analyses. After multivariate adjustments, age, male gender, smoking, high total cholesterol, high HDL/LDL ratio, diabetes and overweight remained strongly associated with risk. Relative risks for hypertension in women and for diabetes in men did not reach statistical significance.
  
  
  CONCLUSIONS
  Despite high prevalence of vascular risk factors, incidence rates were lower than those reported for other countries and other periods, but similar to those reported in the few population-based studies in Spain. Effect measures of vascular risk factors were mainly as reported worldwide and support the hypothesis that protective factors not considered in this study must exist as to explain low rates. This study shows the feasibility of conducting epidemiological cohort studies in primary-care settings.
authors.affiliation: Department of General Medicine, San José Norte Health Centre, Zaragoza, Spain. amarini@semg.es
authors.forename: Alejandro
authors.initials: A
authors.lastname: Marín
authors.forename: María José
authors.initials: MJ
authors.lastname: Medrano
authors.forename: José
authors.initials: J
authors.lastname: González
authors.forename: Héctor
authors.initials: H
authors.lastname: Pintado
authors.forename: Vicente
authors.initials: V
authors.lastname: Compaired
authors.forename: Mario
authors.initials: M
authors.lastname: Bárcena
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Fustero
authors.forename: Javier
authors.initials: J
authors.lastname: Tisaire
authors.forename: José M
authors.initials: JM
authors.lastname: Cucalón
authors.forename: Aurelio
authors.initials: A
authors.lastname: Martín
authors.forename: Raquel
authors.initials: R
authors.lastname: Boix
authors.forename: Francisco
authors.initials: F
authors.lastname: Hernansanz
authors.forename: José
authors.initials: J
authors.lastname: Bueno
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D018572:Disease-Free Survival; D016021:Epidemiologic Studies; D017050:Episode of Care; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D002784:Cholesterol