Abstract
Objetivo
Estimar el riesgo de accidente cerebrovascular (ACV) de la diabetes, en el contexto del síndrome metabólico (SM) o fuera de él, según los criterios de la Organización Mundial de la Salud (OMS) y del National Cholesterol Education Program (NCEP).
Diseño
Estudio multicéntrico y prospective de cohortes.
Emplazamiento
Atención primaria de salud.
Participantes
Sujetos de 55-85 años libres de ACV incluidos desde 1998 en una muestra poblacional aleatoria y representativa para el seguimiento del SM en Reus (Tarragona).
Mediciones principales
El riesgo de ACV se estimó con la escala de Framingham aplicando un algoritmo informático de cálculo automático y un diseño factorial por diagnósticos (diabetes y/o SM). Se comparó el riesgo teórico con la incidencia real de acontecimientos cerebrovasculares (1998-2003).
Resultados
Entre 728 sujetos (412 mujeres; edad media de 66 años; índice de masa corporal = 29), 457 (62,8%) no tenían diabetes ni SM, 93 (12,8%) con SM no tenían diabetes, 72 (9,9%) con diabetes no tenían SM y 106 (14,5%) presentaban ambas enfermedades (según criterios de la OMS). Según el NCEP, estas proporciones fueron del 60,7; el 14,8; el 7,8 y el 16,7%. El riesgo de ACV medio a 10 años para los 4 grupos (OMS/NCEP) fue: 8,4/9,1; 10,8/10,5; 18/17,3 y 18,8/19,1%, respectivamente. La incidencia acumulada de acontecimientos cerebrovasculares fue del 2,8; 1,4; 5,4 y 3,8% (OMS) y 2,5; 2,8; 3,5 y 5,8% (NCEP).
Conclusiones
El riesgo de ACV calculado mediante la fórmula de Framingham es muy elevado en sujetos con diabetes, con independencia de su integración en el SM. Es muy probable que la escala también sobredimensione este riesgo en la población española.
Palabras clave: Diabetes, Síndrome metabólico, Síndrome X, Enfermedad cerebrovascular, Riesgo cerebrovascular
Abstract
Objective
To estimate stroke risk for diabetes, isolated or associated to metabolic syndrome (MS) according WHO and National Cholesterol Education Program (NCEP)criteria.
Design
Multicentre and prospective cohort study.
Setting
Primary health care.
Participants
Subjects between 55-85 years-old without any evidence of stroke, included from 1998 in a random population sample for MS follow-up during routine practice in Reus (Tarragona, Spain).
Main measurements
Stroke risk was achieved using Framingham function by means of a computerized algorithm using a diagnostic factorial design (diabetes and/or MS). Theoretical stroke risk and cumulated incidence of stroke events (1998-2003) were compared.
Results
Among 728 subjects (412 women, mean age =66 years old, body mass index =29 kg/m2), 457 (62.8%) did not have diabetes, nor MS, 93 (12.8%) had MS without diabetes, 72 (9.9%) diabetes without MS, and 106 (14.5%) presented both conditions (WHO rules). According NCEP criteria were 60.7%, 14.8%, 7.8%, and 16.7%, respectively. Ten-year estimated stroke risk accounted for (WHO/NCEP) 8.4/9.1%, 10.8/10.5%, 18/17.3%, and 18.8/19.1%. Cumulated incidence for stroke events were: 2.8%, 1.4%, 5.4%, and 3.8% (WHO), and 2.5%, 2.8%, 3.5%, and 5.8%, respectively (NCEP).
Conclusions
Stroke risk scores were extremely increased among diabetic subjects irrespective to MS diagnose. The Framingham function probably overestimates stroke risk among Spanish individuals.
Key words: Diabetes, Metabolic Syndrome, X-Syndrome, Stroke, Stroke risk
Footnotes
Resúmenes presentados en congresos y reuniones científicas: XIII Congreso de la Sociedad Española de Medicina de Familia y Comunitaria. Barcelona, diciembre de 2003.
XVII Congreso de la Sociedad Española de Diabetes. Valencia, mayo de 2004. 64 Scientific Sessions. American Diabetes Association. Orlando (Florida, Estados Unidos), junio de 2004.
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