A L Calle-Pascual

Hospital Carlos III - Madrid, Madrid, Madrid, Spain

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Publications (46)93.79 Total impact

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    ABSTRACT: Introducción y objetivos El objetivo de este estudio fue comparar la prevalencia de obesidad, diabetes mellitus y otros factores de riesgo cardiovascular en la región de Andalucía con las prevalencias en el resto de España. Métodos El estudio Di@bet.es es un estudio poblacional transversal de ámbito nacional sobre prevalencia de factores de riesgo cardiometabólicos y su asociación con el estilo de vida. Formaron la muestra 5.103 participantes de edad ≥ 18 años. Se realizó una encuesta clínica, demográfica y de estilo de vida, una exploración física y una prueba de sobrecarga oral de glucosa. La prevalencia de factores de riesgo cardiovascular en Andalucía (n = 1.517) se comparó con la del resto de España (n = 3.586). Resultados Según los datos ajustados para la población española, las prevalencias de diabetes mellitus (Organización Mundial de la Salud, 1999), hipertensión (presión arterial ≥ 140/90 mmHg), títulos elevados de PCR ultrasensible (≥ 3 mg/l) y obesidad (índice de masa corporal ≥ 30) fueron del 16,3, el 43,9, el 32,0 el 37,0% en Andalucía, en comparación con el 12,5, el 39,9, el 28,3 y el 26,6% en el resto de España (p < 0,001 para las diferencias excepto p = 0,01 para la diferencia en los títulos elevados de PCR ultrasensible). Las prevalencias en Andalucía ajustadas para la población andaluza fueron del 15,3, el 42,3, el 31,4 y el 34,0%, respectivamente. Las diferencias en la diabetes mellitus, la hipertensión y los títulos elevados de PCR ultrasensible no fueron significativas en los modelos con ajuste por edad, sexo y mediciones de la adiposidad. Las diferencias en la obesidad no fueron significativas en los modelos ajustados por edad, sexo, nivel de estudios, estado civil, situación laboral y actividad física (p = 0,086). Conclusiones Este estudio aporta información desde una perspectiva nacional y muestra una prevalencia de factores de riesgo cardiovascular superior en el sur de España, con estrecha correlación con la obesidad, el estilo de vida sedentario e indicadores de una situación socioeconómica desfavorecida.
    Revista Espa de Cardiologia 06/2014; · 3.20 Impact Factor
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    ABSTRACT: Dyslipidemia is a significant contributor to the elevated CVD risk observed in type 2 diabetes mellitus. We assessed the prevalence of dyslipidemia and its association with glucose metabolism status in a representative sample of the adult population in Spain and the percentage of subjects at guideline-recommended LDL-C goals. The di@bet.es study is a national, cross-sectional population-based survey of 5728 adults. A total of 4776 subjects were studied. Dyslipidemia was diagnosed in 56.8% of subjects; only 13.2% of subjects were treated with lipid lowering drugs. Lipid abnormalities were found in 56.8% of Spanish adults: 23.3% with high LDL-C, 21.5% high TG, 35.8% high non-HDL-C, and 17.2% low HDL-C. Most normal subjects showed an LDL-C≤3.36mmol/l. Pre-diabetics presented similar proportion when considering a goal of 3.36mmol/l, but only 35% of them reached an LDL-C goal≤2.6mmol/l. Finally, 45.3% of diabetics had an LDL-C≤2.6mmol/l, and only 11.3% achieved an LDL-C≤1.8mmol/l. Our study demonstrates a high prevalence of dyslipidemia in the adult Spanish population, and a low use of lipid-lowering drugs. Moreover, the number of subjects achieving their corresponding LDL-C goal is small, particularly in subjects at high cardiovascular risk, such as diabetics.
    Clinica e Investigacion en Arteriosclerosis 01/2014;
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    ABSTRACT: Introduction and objectives The aim of this study was to compare the prevalences of obesity, diabetes and other cardiovascular risk factors in the region of Andalusia with those in the rest of Spain. Methods The Di@bet.es study is a national, cross-sectional, population-based survey of cardiometabolic risk factors and their association with lifestyle. The sample consisted of 5103 participants ≥ 18 years. The variables analyzed were clinical, demographic and lifestyle survey, physical examination, and oral glucose tolerance test. The prevalence of cardiovascular risk factors in Andalusia (n = 1517) was compared with that for the rest of Spain (n = 3586). Results In data adjusted to the Spanish population, the prevalence of diabetes (World Health Organization, 1999), hypertension (blood pressure ≥ 140/90 mmHg), high-sensitivity C-reactive protein levels (≥ 3 mg/L) and obesity (body mass index ≥ 30 kg/m2) were 16.3%, 43.9%, 32.0%, and 37.0% in Andalusia compared with 12.5%, 39.9%, 28.3%, and 26.6% in the rest of Spain (P < .001 for differences except P = .01 for the difference in high-sensitivity C-reactive protein levels). The corresponding figures for the Andalusia data adjusted to the Andalusian population were 15.3%, 42.3%, 31.4%, and 34.0%, respectively. Differences in diabetes, hypertension and high-sensitivity C-reactive protein were not significant in models adjusted for age, sex, and adiposity measurements. Differences in obesity were not significant in models adjusted for age, sex, educational level, marital status, work status, and physical activity (P = .086) Conclusions This study contributes information from a national study perspective and shows a higher prevalence of cardiovascular risk factors in southern Spain, in close relation to obesity, a sedentary lifestyle, and markers of socioeconomic disadvantage. Full English text available from:www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2014;
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    ABSTRACT: Background Prevalence rates of “Metabolically healthy Obese” (MHO) subjects vary depending on the criteria used. This study examined the prevalence and characteristics of MHO subjects and metabolically abnormal normal-weight subjects and compared the findings with the NHANES 1999-2004 study. Methods Di@bet.es study is a national, cross-sectional population-based survey of 5728 adults conducted in 2009-2010. Clinical, metabolic, socio-demographic, anthropometric data and information about lifestyle habits as physical activity, smoking habit, alcohol intake and food consumption, were collected. Subjects were classified according to their body mass index (BMI) (normal-weight, <25kg/m2; overweight, 25-29.9 kg/m2; and obese, >30kg/m2). Cardiometabolic abnormalities (CA) included elevated blood pressure; elevated levels of triglycerides, fasting glucose, and high-sensitivity C-reactive protein (hs-CRP); elevated homeostasis model assessment of insulin resistance (HOMA-IR) value and low high-density lipoprotein cholesterol (HDL-c) level. Two phenotypes were defined: metabolically healthy phenotype (0-1 CA) and metabolically abnormal phenotype (≥2 CA). Results The prevalence of metabolically abnormal normal-weight phenotype was slightly lower in the Spanish population (6.5% vs. 8.1%). The prevalence of metabolically healthy overweight and MHO subjects was 20.9% and 7.0% respectively whilst in NHANES study was 17.9% and 9.7%. Cigarette smoking was associated with CA in each phenotype, while moderate physical activity and moderate alcohol intake were associated with being metabolically healthy. Olive oil intake was negatively associated with the prevalence of CA. Conclusions Smoking, physical activity level and alcohol intake contribute to the explanation of the prevalence of CA in the Spanish population, as in the US population. However in Spain, olive oil intake contributes significantly to the explanation of the variance in the prevalence of CA.
    Nutrition, Metabolism and Cardiovascular Diseases. 01/2014;
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    ABSTRACT: Background:Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population.Subjects and methods:A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged 18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g).Results:Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41-0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28-0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33-0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26-0.59, P=0.0001)).Conclusions:The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.European Journal of Clinical Nutrition advance online publication, 17 July 2013; doi:10.1038/ejcn.2013.130.
    European journal of clinical nutrition 07/2013; · 3.07 Impact Factor
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    ABSTRACT: Background and Aims: Mediterranean diet (MedDiet) is causally related to diabetes and is a dietary pattern recommended to individuals with diabetes. We investigated MedDiet adherence in individuals with prediabetes and unknown (PREDM/UKDM) or known diabetes (KDM) compared to those with normal glucose metabolism (NORMAL). Methods: This was a national, population-based, cross-sectional, cluster-sampling study. MedDiet adherence was scored (MedScore, mean ± SD 24 ± 5) using a qualitative food frequency questionnaire. Logistic regression was used to examine the association between MedScore and PREDM/UKDM or KDM versus control subjects. Results: We evaluated 5,076 individuals. Mean age was 50 years, 57% were female, 826 (582/244) were PREDM/UKDM, 478 were KDM and 3,772 were NORMAL. Mean age increased across MedScore tertiles (46, 51 and 56 years, p < 0.0001). Higher age-adjusted adherence to MedDiet (5-unit increment in the MedScore) was associated with lower and nondifferent odds (OR, 95% CI) of prevalent PREDM/UKDM (0.88, 0.81-0.96, p = 0.001) and KDM (0.97, 0.87-1.07, p = 0.279), respectively, compared to individuals in the NORMAL group. Conclusions: In a representative sample of the whole Spanish population, MedDiet adherence is independently associated with PREDM/UKDM. Therapeutic intervention may be, in part, responsible for the lack of differences in adherence observed between the KDM and NORMAL groups. However, reverse causation bias cannot be ruled out in cross-sectional studies.
    Annals of Nutrition and Metabolism 07/2013; 62(4):339-346. · 1.66 Impact Factor
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    ABSTRACT: BACKGROUND: Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients' baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT). METHODS: We performed a retrospective study from a cohort of 657 BS from a single center (2006-2011), of which 141 (57.4 % women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6 %, fasting glucose (FG) <100 mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment. RESULTS: Preoperative characteristic were (mean ± SD): age 53.9 ± 9.8 years, BMI 43.7 ± 5.6 kg/m(2), T2D duration 7.4 ± 7.6 years, FG 160.0 ± 54.6 mg/dL, HbA1c 7.6 ± 1.6 %. Fifty-six (39.7 %) individuals had IT. At 1-year follow-up, 74 patients (52.5 %) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5 ± 8.1 vs. 30.2 ± 9.5 %, p = 0.001; 73.6 ± 18.4 vs. 66.3 ± 22.8 %, p = 0.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3 ± 9.4 vs. 4.7 ± 3.8 years, p < 0.001; 55.1 ± 9.3 vs. 51.2 ± 9.9 years, p = 0.017; 58.9 vs. 33.3 %, p = 0.004, respectively. Prior treatment revealed differences in remission rates: 67.1 % in case of oral therapy (OT) vs. 30.4 % in IT, p < 0.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157-0.327 (p < 0.05), adjusting by different models. CONCLUSIONS: Consensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission.
    Obesity Surgery 05/2013; · 3.10 Impact Factor
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    ABSTRACT: The aim of the study is to assess the prevalence of metabolic syndrome (MetS) in Spain using specific cutoff points for waist circumference (WC) (>94.5 cm for men and >89.5 cm for women) and evaluating the influence of several socio-demographic and economic factors. Data on MetS were obtained from a national study of 4,727 subjects from 18 to 90 years of age, conducted in Spain between 2009 and 2010 (The di@bet.es study). MetS was defined applying the new Harmonized definition (evaluating the use of abdominal obesity (AO) as a obligatory criterion for MetS or not) as well as with other widely used criteria. Results were then compared with data from previous studies. Multiple logistic regression models were used to evaluate the influence of different social factors. The age-standardized MetS prevalence was 38.37 % (CI 35.74-40.99) in men and 29.62 % (CI 27.56-31.69) in women, when AO was required as a diagnostic criterion; 42.13 % (CI 39.37-44.89) and 32.31 % (CI 30.15-34.47) in men and women, respectively, if AO was not considered mandatory. Prevalence of MetS increased with age (p < 0.001 for trend). Women with a lower educational level were more likely to have MetS (OR 4.4; 95 % CI: 2.84-6.7) as compared with those with a higher educational level. Subjects with MetS had a worse physical quality of life. The combination of AO, hypertension and carbohydrate alterations was the most common MetS' pattern. A high prevalence of MetS was detected in the Spanish population especially in men, the elderly and women with a low educational level.
    Acta Diabetologica 03/2013; · 4.63 Impact Factor
  • Journal of Thrombosis and Thrombolysis 02/2013; · 1.99 Impact Factor
  • M del Carmen Montañez-Zorrilla, Alfonso Calle-Pascual
    Endocrinología y Nutrición 01/2013; 60 Suppl 1:15-8.
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    ABSTRACT: Aim: To examine the prevalence of urinary albumin-creatinine ratio (ACR)< 30 mg/g and the associated clinical and environmental factors in a representative sample of the population of Spain. Methods: Di@bet.es study is a national, cross-sectional population-based survey conducted in 2009-10. Clinical, metabolic, socio-demographic, anthropometric data and information about lifestyle habit were collected. Those subjects without known diabetes mellitus (KDM) were given an oral glucose tolerance test (OGTT). Albumin and creatinine were measured in an urinary sample and ACR was calculated. Results: The population prevalence of ACR < 30 mg/g was 7.65% (adjusted for sex and age). The prevalence of ACR<30 mg/g increased with age (p<0.001). Persons with carbohydrate metabolism disorders had a greater prevalence of ACR<30 mg/g but after adjusted for age, sex and hypertension, was significant only those subjects with unknown diabetes mellitus (UKDM) (OR=2.07, 95% CI 1.38-3.09) (p<0.001) and KDM (OR=3.55, 95%CI 2.63-4.80) (p<0.001). Prevalence of ACR<30 mg/g was associated with hypertension (OR=1.48, 95%CI 1.12-1.95) (p=0.001), HOMA-IR (OR=1.47, 95%CI 1.13-1.92) (p=<0.01), metabolic syndrome, (OR=2.17, 95%CI 1.72-2.72) (p<0.001), smoking (OR=1.40, 95%CI 1.06-1.83) (p=<0.05), physical activity (OR=0.68, 95%CI 0.54-0.88) (p=<0.01), and consumption of fish (OR=0.38, 95%CI 0.18-0.78) (p=<0.01). Conclusions: This is the first study that reports the prevalence of ACR < 30 mg/g in the Spanish population. The association between clinical variables and other potentially modifiable environmental variables contribute jointly, and sometimes interactively, to the explanation of prevalence of ACR < 30 mg/g. Many of these risk factors are susceptible to intervention.
    Clinical Science 09/2012; · 4.86 Impact Factor
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    ABSTRACT: Data about the immigrant population living in Spain, their lifestyle habits and risk factors for gestational diabetes (GDM) are very limited up to date. Objectives: To describe risk factors on the onset of GDM and the evolution of gestation, delivery and the newborn, in Hispanic women living in Spain as compared with Spanish women. Methods: 459 (115 Hispanic) pregnant women with a positive O'Sullivan test (24-28 week of gestation) between April 1, 2007 and March 31, 2008 were asked about their lifestyle habits using a semiquantitative questionnaire. Data on gestation, delivery and newborn were collected. Results: The prevalence of GDM was increased by mother age, pregestational overweight/obesity and multiparity. GDM was associated to lower pregestational fibre and low-glycaemic food intake in Hispanic women. The Odds Ratio for the total population for overweight was 2.53 (1.28-5.01, 95% CI), and for obesity 3.68 (1.72-7.90)], for T3 of age (≥35 years old) 3.83 (2.03-7.23), and for multiparity 1.64 (1.02-3.01). Newborns from Hispanic population had a significantly higher weight than the Spanish women and the rate of caesarean delivery was significantly higher in the Hispanic population with GDM compared with those without GDM. Conclusions: The immigrant Hispanic population living in Spain trends to acquire the same risk factors associated with lifestyle than the indigenous population. Preventive strategies must stress on the increase of physical activity and fibre intake, decrease of sweetened beverages and to achieve an effective reduction in body weight before pregnancy. The significant finding (s) of the study: This study identifies lifestyle risk-factors associated to GDM in immigrant Hispanic population living in Spain. This study adds to improve preconceptional counselling programs based on lifestyle modifications. These modifications must stress on the increase of the daily physical activity and of fibre intake and the decrease of sweetened beverages and juices consumption.
    Journal of Diabetes 06/2012; · 2.94 Impact Factor
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    ABSTRACT: Objective: To evaluate the association of maternal serum 25-hydroxyvitamin D (25[OH]D) status with glucose homeostasis and obstetric and newborn outcomes in women screened for gestational diabetes mellitus (GDM).Methods: Consecutive women were screened for GDM at 24 to 28 weeks' gestation during the months of maximal sunlight exposure in Spain (June through September). Serum 25(OH)D levels and parameters of glucose homeostasis were measured. Outcomes of the delivery and newborn were collected.Results: Two hundred sixty-six women were screened. Vitamin D deficiency (25[OH]D <20 ng/mL) was observed in 157 women (59%). We observed an inverse correlation between 25(OH)D levels and hemoglobin A1c, homeostasis model assessment of insulin resistance, serum insulin, and fasting and 1-hour oral glucose tolerance test glucose levels (P<.001). With a 25(OH)D concentration less than 20 ng/mL, the odds ratios were 3.31 for premature birth (95% confidence interval, 1.52-7.19; P<.002) and 3.93 for cesarean delivery (95% confidence interval, 2.00-7.73; P<.001). A 25(OH)D concentration of 20 ng/mL had 79% sensitivity and 51% specificity for cesarean delivery and 80% sensitivity and 45% specificity for premature birth. The cutoffs with the best combination of sensitivity and specificity were 16 ng/mL for cesarean delivery (62.9% sensitivity and 61.2% specificity) and 14 ng/mL for premature birth (66.7% sensitivity and 71.0% specificity).Conclusions: In the population we sampled, vitamin D deficiency is very common during pregnancy. Lower 25(OH)D levels are associated with disorders of glucose homeostasis and adverse obstetric and newborn outcomes.
    Endocrine Practice 05/2012; 18(5):676-84. · 2.49 Impact Factor
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    ABSTRACT: The Di@bet.es Study is the first national study in Spain to examine the prevalence of diabetes and impaired glucose regulation. A population-based, cross-sectional, cluster sampling study was carried out, with target population being the entire Spanish population. Five thousand and seventy-two participants in 100 clusters (health centres or the equivalent in each region) were randomly selected with a probability proportional to population size. Participation rate was 55.8%. Study variables were a clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, BMI, waist and hip circumference, blood pressure) and OGTT (75 g). Almost 30% of the study population had some carbohydrate disturbance. The overall prevalence of diabetes mellitus adjusted for age and sex was 13.8% (95% CI 12.8, 14.7%), of which about half had unknown diabetes: 6.0% (95% CI 5.4, 6.7%). The age- and sex-adjusted prevalence rates of isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined IFG-IGT were 3.4% (95% CI 2.9, 4.0%), 9.2% (95% CI 8.2, 10.2%) and 2.2% (95% CI 1.7, 2.7%), respectively. The prevalence of diabetes and impaired glucose regulation increased significantly with age (p < 0.0001), and was higher in men than in women (p < 0.001). The Di@bet.es Study shows, for the first time, the prevalence rates of diabetes and impaired glucose regulation in a representative sample of the Spanish population.
    Diabetologia 01/2012; 55(1):88-93. · 6.49 Impact Factor
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    ABSTRACT: Objective. To evaluate the association between diabetes mellitus and health-related quality of life (HRQOL) controlled for several sociodemographic and anthropometric variables, in a representative sample of the Spanish population. Methods. A population-based, cross-sectional, and cluster sampling study, with the entire Spanish population as the target population. Five thousand and forty-seven participants (2162/2885 men/women) answered the HRQOL short form 12-questionnaire (SF-12). The physical (PCS-12) and the mental component summary (MCS-12) scores were assessed. Subjects were divided into four groups according to carbohydrate metabolism status: normal, prediabetes, unknown diabetes (UNKDM), and known diabetes (KDM). Logistic regression analyses were conducted. Results. Mean PCS-12/MCS-12 values were 50.9 ± 8.5/ 47.6 ± 10.2, respectively. Men had higher scores than women in both PCS-12 (51.8 ± 7.2 versus 50.3 ± 9.2; P < 0.001) and MCS-12 (50.2 ± 8.5 versus 45.5 ± 10.8; P < 0.001). Increasing age and obesity were associated with a poorer PCS-12 score. In women lower PCS-12 and MCS-12 scores were associated with a higher level of glucose metabolism abnormality (prediabetes and diabetes), (P < 0.0001 for trend), but only the PCS-12 score was associated with altered glucose levels in men (P < 0.001 for trend). The Odds Ratio adjusted for age, body mass index (BMI) and educational level, for a PCS-12 score below the median was 1.62 (CI 95%: 1.2-2.19; P < 0.002) for men with KDM and 1.75 for women with KDM (CI 95%: 1.26-2.43; P < 0.001), respectively. Conclusion. Current study indicates that increasing levels of altered carbohydrate metabolism are accompanied by a trend towards decreasing quality of life, mainly in women, in a representative sample of Spanish population.
    International Journal of Endocrinology 01/2012; 2012:872305. · 2.52 Impact Factor
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    ABSTRACT: Hyperglycaemia has been associated with increased platelet reactivity and impaired prognosis in patients with acute coronary syndrome (ACS). Whether platelet reactivity can be reduced by lowering glucose in this setting is unknown. The aim of this study was to assess the functional impact of intensive glucose control with insulin on platelet reactivity in patients admitted with ACS and hyperglycaemia. This is a prospective, randomised trial evaluating the effects of either intensive glucose control (target glucose 80-120 mg/dl) or conventional control (target glucose 180 mg/dl or less) with insulin on platelet reactivity in patients with ACS and hyperglycaemia. The primary endpoint was platelet aggregation following stimuli with 20 μM ADP at 24 h and at hospital discharge. Aggregation following collagen, epinephrine and thrombin receptor-activated peptide, as well as P2Y₁₂ reactivity index and surface expression of glycoprotein IIb/IIIa and P-selectin were also measured. Of the 115 patients who underwent random assignment, 59 were assigned to intensive and 56 to conventional glucose control. Baseline platelet functions and inhospital management were similar in both groups. Maximal aggregation after ADP stimulation at hospital discharge was lower in the intensive group (47.9 ± 13.2% vs 59.1 ± 17.3%; p=0.002), whereas no differences were found at 24 h. Similarly all other parameters of platelet reactivity measured at hospital discharge were significantly reduced in the intensive glucose control group. In this randomised trial, early intensive glucose control with insulin in patients with ACS presenting with hyperglycaemia was found to decrease platelet reactivity. Clinical Trial Registration Number http://www.controlledtrials.com/ISRCTN35708451/ISRCTN35708451.
    Heart (British Cardiac Society) 03/2011; 97(10):803-9. · 5.01 Impact Factor
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    ABSTRACT: To assess whether patients with Type 2 diabetes mellitus and unrecognized peripheral arterial disease (PAD), detected by the ankle-brachial index (ABI), have poorer cardiovascular risk factor management (CVRFs) and receive fewer medications than patients previously diagnosed with coronary heart disease (CHD) or cerebrovascular disease (CVD). In 31 diabetes centres throughout Spain, 1303 patients with Type 2 diabetes mellitus were screened for PAD using the ABI. Patient history of CHD and CVD and treatment and control of CVRFs were recorded. Forty-one patients had an ABI > 1.30 and were excluded, leaving 1262 patients (age 65.3 +/- 7.7 years) for the study. Of those screened, 790 patients had a normal ABI (ABI > 0.9) and no known history of CHD or CVD (no CHD/CVD/PAD group), 194 had unrecognized PAD (ABI < or = 0.9) with no known history of CHD or CVD (undiagnosed PAD group) and 278 had a known history of CHD and/or CVD (CHD/CVD group). The undiagnosed PAD group had higher low-density lipoprotein (LDL) cholesterol (2.9 +/- 0.83 vs. 2.4 +/- 0.84 mmol/l; P < 0.001) and systolic blood pressure (150 +/- 20 vs. 145 +/- 21 mmHg; P < 0.001) compared with the CHD/CVD group. They were less likely to take statins (56.9 vs. 71.6%; P < 0.001), anti-hypertensive agents (75.9 vs. 90.1%, P = 0.001), and anti-platelet agents (aspirin, 28.7 vs. 57.2%; P < 0.001; clopidogrel, 5.6 vs. 20.9%; P < 0.001) and more likely to smoke (21.0 vs. 9.2%; P < 0.001). Higher LDL in the undiagnosed PAD group was associated with the underutilization of statins. Measurement of ABI detected a significant number of patients with PAD, who did not have CHD or CVD, but whose CVRFs were under treated and poorly controlled compared with subjects with CHD and/or CVD.
    Diabetic Medicine 04/2008; 25(4):427-34. · 3.24 Impact Factor
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    ABSTRACT: Existe suficiente evidencia sobre la asociación de alteraciones en el metabolismo de la glucosa, las lipoproteínas, la acción de la insulina, la hipertensión y la obesidad de distribución central. Esta asociación se denomina Síndrome Metabólico. A pesar de que ha sido cuestionada su existencia por la ADA y la EASD, es una herramienta útil que permite identificar a las personas que tienen un alto riesgo de desarrollar enfermedad cardiovascular. El síndrome metabólico y sus componentes individuales se asocian a una elevada incidencia de enfermedad cardiovascular. La obesidad y el sedentarismo son factores de riesgo subyacentes en la ruta patogénica de este síndrome, por tanto la modificación de los hábitos de vida es una intervención de primera línea en la prevención y tratamiento de la resistencia insulínica, la hiperglucemia, la dislipemia aterogénica y la hipertensión arterial. La reducción ponderal y el ejercicio son las claves del plan global, pero entre los tratamientos no farmacológicos la dieta permanece como una de las estrategias de reducción del riesgo cardiovascular más importantes. Estudios epidemiológicos han observado que una ingesta elevada de azúcares simples, de alimentos con alto índice glucémico y de dietas con alta carga glucémica se asocian a resistencia insulínica, diabetes mellitus tipo 2, hipertrigliceridemia y cifras bajas de colesterol- HDL. Un bajo consumo de grasa saturada a favor de ácidos grasos poliinsaturados y monoinsaturados se ha implicado en una reducción de la incidencia de diabetes mellitus tipo 2 y dislipemia, aunque continúa el debate. La fibra dietética de cereales no refinados ha sido beneficiosa en la reducción del riesgo de diabetes. Entre los patrones dietéticos, la dieta mediterránea se ha visto relacionada con una menor incidencia de diabetes y con una reducción del riesgo de muerte. Estudios de intervención para la prevención de diabetes tipo 2 han propuesto dietas hipograsas (reduciendo grasa saturada y trans-), con alto aporte de fibra y con bajo índice glucémico. Ensayos clínicos han demostrado el beneficio de dietas con baja cantidad de carbohidratos, bajo índice glucémico y de las dietas mediterránea y DASH en la reducción de la dislipemia aterogénica. Actualmente no existe una buena evidencia para elegir dietas con restricción de carbohidratos. En cambio, distintas guías recomiendan dietas hipocalóricas con bajo contenido en grasas saturadas, grasas trans-, colesterol y azúcares a favor del consumo de frutas, verduras, cereales no refinados y pescado.
    Revista Española de Salud Pública 01/2007; · 0.71 Impact Factor
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    ABSTRACT: All patients who underwent a lower extremity amputation (LEAs) between January 1989 and December 2003 in Area 7, Madrid, were identified through operating theatre records. Vascular surgery department and Endocrinology service discharge records, and prescribing family doctors were used as secondary sources.According to Saint Vincent Declaration, a substantial decrease in LEAs and a later presentation were observed and related to a series of improvements in diabetic treatment. Despite these figures, a more substantial reduction in LEAs in diabetic people could be achieved with an earlier neuropathy screening, and intervention programes based on a continuing and well-structured education. The potential cost saving per 100.000 inhabitants and per year was estimated to be about 100.000 €.
    Endocrinología y Nutrición. 01/2006; 53(1).
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    ABSTRACT: The aim was to validate the Spanish version of the Self-Esteem and Relationship Questionnaire (SEAR), specific for patients with erectile dysfunction (ED), and based on the concept of self-esteem, for use in research and clinical practice in Spain. Observational, prospective, multisite, study comparing patients with ED (IIEF questionnaire score < 26 points), with a score (3/4) 16 points in the Self-Esteem domain of the SEAR questionnaire and undergoing treatment with sildenafil (group A), and healthy control subjects without ED. Patients with ED were assessed at baseline and after 3 months' treatment. Among 586 evaluable subjects (504 patients with ED and 82 health subjects) the questionnaire showed: a) adequate feasibility with a percentage of patients without response < 5%; b) adequate reliability with Cronbach alpha coefficients for the total and all domains (Sexual-Relationship, Confidence, Self-Esteem, and Overall-Relationship), of SEAR questionnaire, respectively: 0.92, 0.89, 0.84, 0.75, and 0.82 un patients, and 0.86, 0.80, 0.73, 0.56 and 0.74 un healthy subjects; c) adequate discriminatory validity between patients and healthy subjects (Mann-Whitney test, p < 0.0001), and between patients with vaying degrees of ED (Kruskall-Wallis test, p < 0.05); d) adequate convergent/divergent validity (correlations > 0.5 with the IIEF questionnaire and r > 0.3 and < 0.5 with Mental Health domain score of SF-12 questionnaire); e) adequate construct validity, obtaining 2 domains: Sexual-Relationship, and Confidence, and f) adequate sensitivity to clinical changes (SES: 2.1/SRM: 1.5/SEM: 4.4/MID: 13.1). Mark scores were estimated. The Spanish version of the SEAR questionnaire showed adequate and similar psychometric properties to those shown with the original English version.
    Medicina Clínica 11/2005; 125(15):565-73. · 1.40 Impact Factor

Publication Stats

277 Citations
93.79 Total Impact Points

Institutions

  • 1998–2014
    • Hospital Carlos III - Madrid
      Madrid, Madrid, Spain
  • 1995–2014
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
  • 2012
    • Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas
      Barcino, Catalonia, Spain
  • 1991–1993
    • Universidad de Salamanca
      Helmantica, Castille and León, Spain