In addition to determining the incidence, mortality, and morbidity associated with acute myocardial infarction (AMI), REGICOR has established the prevalence of cardiovascular risk factors in the study area and the level of control that has been achieved.
Between 1994 and 1996, the first cross-cutting REGICOR study analyzed other aspects in addition to the classic cardiovascular risk factors. These included physical activity, diet, genetics, and various biochemical factors related to inflammation and oxidation. A random sample of 1748 residents of Girona province was drawn from census data in two stages: first, from 33 communities, and second, from the population aged 25 to 74 years, stratified by age and sex. The response rate was 72%. Between May 1999 and October 2001, a new cohort of 3056 participants from 17 communities in Girona was selected by the same recruitment process and achieved similar measures. Finally, between 2003 and 2006 another representative sample of 6500 people was drawn from Girona, Sarrià and Celrà for the HERMES study, recently completed in collaboration with primary care professionals from Girona. The HERMES response rate was 71%.
These cross-cutting studies have allowed us to analyze trends in the prevalence of cardiovascular risk factors in our population. In addition, we have been able to design various studies of the association between risk factors and cardiovascular diseases, using AMI cases from the Girona registry and population controls.
In addition to the classic cardiovascular risk factors (diabetes, hypertension, dyslipidemia and tobacco use), other biochemical biomarkers have also been studied, including lipid profile, insulin resistance, oxidation, inflammation, hemostasis, and endothelial, cardiac and hemodynamic function, among others. The study uses LUMINEX X-Map/X-Mag technology to measure multiple biomarkers at the same time.
Cohort studies are also underway, with 10-year follow-up of participants recruited in the cross-cutting studies. These should provide information about the incidence of cardiovascular diseases and allow us to verify the precision of the cardiovascular risk functions adapted for this population by REGICOR investigators in recent years. Specifically, a study of the incidence of silent AMI uses imaging techniques to examine participants who have this diagnosis based on electrocardiography but who deny ever having had any type of cardiovascular event.
In 2007, REGICOR began a collaboration with the Centre for Environmental Epidemiology Research (CREAL) to reexamine participants in the 2000 crosscutting study, in an effort to determine whether there is a relationship between intima-media thickness of the carotid artery and exposure to air pollution (REGICOR-2000-AIR).
In addition to intima-media thickness of the carotid artery, other markers of subclinical arteriosclerosis are also available, such as ankle-brachial index (ABI) and endothelial dysfunction. The latter is assessed by laser Doppler echography as post-ischemic reactive hyperemia (IRH), the increased blood flow after an ischemic event, measured at suprasystolic pressure with a sphygmomanometer.
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