title: Improving interMediAte risk management. MARK study.
abstract: BACKGROUND
  Cardiovascular risk functions fail to identify more than 50% of patients who develop cardiovascular disease. This is especially evident in the intermediate-risk patients in which clinical management becomes difficult. Our purpose is to analyze if ankle-brachial index (ABI), measures of arterial stiffness, postprandial glucose, glycosylated hemoglobin, self-measured blood pressure and presence of comorbidity are independently associated to incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate-risk population.
  
  
  METHODS
  This project involves 3 groups belonging to REDIAPP (RETICS RD06/0018) from 3 Spanish regions. We will recruit a multicenter cohort of 2688 patients at intermediate risk (coronary risk between 5 and 15% or vascular death risk between 3-5% over 10 years) and no history of atherosclerotic disease, selected at random. We will record socio-demographic data, information on diet, physical activity, comorbidity and intermittent claudication. We will measure ABI, pulse wave velocity and cardio ankle vascular index at rest and after a light intensity exercise. Blood pressure and anthropometric data will be also recorded. We will also quantify lipids, glucose and glycosylated hemoglobin in a fasting blood sample and postprandial capillary glucose. Eighteen months after the recruitment, patients will be followed up to determine the incidence of vascular events (later follow-ups are planned at 5 and 10 years). We will analyze whether the new proposed risk factors contribute to improve the risk functions based on classic risk factors.
  
  
  CONCLUSIONS
  Primary prevention of cardiovascular diseases is a priority in public health policy of developed and developing countries. The fundamental strategy consists in identifying people in a high risk situation in which preventive measures are effective and efficient. Improvement of these predictions in our country will have an immediate, clinical and welfare impact and a short term public health effect.
  
  
  BACKGROUND
  Clinical Trials.gov Identifier: NCT01428934.
authors: Unitat d'Investigació en Atenció Primària de Girona, IDIAP Jordi Gol, Institut Català de la Salut 11, Girona 17071, Espanya.
authors: Ruth
authors: R
authors: Martí
authors: Dídac
authors: D
authors: Parramon
authors: Luís
authors: L
authors: García-Ortiz
authors: Fernando
authors: F
authors: Rigo
authors: Manuel A
authors: MA
authors: Gómez-Marcos
authors: Irene
authors: I
authors: Sempere
authors: Natividad
authors: N
authors: García-Regalado
authors: Jose I
authors: JI
authors: Recio-Rodriguez
authors: Cristina
authors: C
authors: Agudo-Conde
authors: Natalia
authors: N
authors: Feuerbach
authors: Maria
authors: M
authors: Garcia-Gil
authors: Anna
authors: A
authors: Ponjoan
authors: Miquel
authors: M
authors: Quesada
authors: Rafel
authors: R
authors: Ramos
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001786:Blood Glucose; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020379:Risk Adjustment; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose