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    Manuel Gomez-marcos

    BackgroundA more complete assessment of coronary artery disease (CAD) can be performed by coronary computed tomography angiography (CCTA). The aim was to assess the prevalence, distribution and characteristics of coronary artery disease... more
    BackgroundA more complete assessment of coronary artery disease (CAD) can be performed by coronary computed tomography angiography (CCTA). The aim was to assess the prevalence, distribution and characteristics of coronary artery disease (CAD) and the reclassification of cardiovascular risk by CCTA in an asymptomatic Spanish population.DesignWe included, in a cross‐sectional study, 501 random subjects from asymptomatic population, aged 35 and 75. Risk factors, target organ damage and cardiovascular risk were assessed. CCTA was offered to measure the coronary artery calcium score(CACS), segment involvement score(SIS) and segment stenosis score(SSS). The offer was accepted by 220 subjects (44%), with a mean age of 58 ± 14 years, 56% of them male.ResultsThe mean CACS was 119.6 ± 381.7 (median (IQR) (0 (0‐61.55))), with higher scores in males (191.9 ± 493.1) than females (26.1 ± 73.3; P < .01). CCTA revealed coronary atherosclerosis in 89 cases, 40% (CI95%:34%‐46%) in global, 51% in male and 25% in female, of which 13 had obstructive lesions (5.9%). Mean SIS was 1.5 ± 2.5 and SSS 1.2 ± 3.1. When the CACS was included in the CAD risk scale, there was a reclassification of 24%, and when using the SIS percentile, it was 38%, with a 9% increase in risk in both cases.ConclusionsThe prevalence of CAD in asymptomatic Spanish population was 40%, with greater proportion among males. The incorporation of CACS and SIS in the assessment of cardiovascular risk allows reclassifying subjects who are at low or moderate risk and thus identify those with high cardiovascular risk and also the other way.
    The aim of this study was to analyse the association of diet with arterial stiffness and vascular ageing in a Caucasian population with intermediate cardiovascular risk. We recruited 2475 individuals aged 35–75 years with intermediate... more
    The aim of this study was to analyse the association of diet with arterial stiffness and vascular ageing in a Caucasian population with intermediate cardiovascular risk. We recruited 2475 individuals aged 35–75 years with intermediate cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500® device. Vascular ageing was defined in two steps. Step 1: The 20 individuals who presented kidney disease, peripheral arterial disease, or heart failure were classified as early vascular ageing (EVA). Step 2: The individuals with percentiles by age and sex above the 90th percentile of baPWV among the participants of this study were classified as EVA, and the rest of the individuals were classified as non-EVA. The diet of the participants was analysed with two questionnaires: (1) the diet quality index (DQI) questionnaire and (2) the Mediterranean diet (MD) adherence questionnaire. The mean age of the sample was 61.34 ± 7.70 years, and 61.60% were men. A...
    PURPOSE To assess whether subjects with Philadelphia negative myeloproliferative neoplasms (Ph-MPNs) show differences in the presence of vascular, cardiac or renal target organ damage (TOD) and other vascular function parameters as... more
    PURPOSE To assess whether subjects with Philadelphia negative myeloproliferative neoplasms (Ph-MPNs) show differences in the presence of vascular, cardiac or renal target organ damage (TOD) and other vascular function parameters as compared to individuals without this condition. METHODS An observational study was conducted. Fifty-seven subjects diagnosed with Ph-MPNs used as cases and 114 subjects without Ph-MPNs as controls. We matched the subjects with and without Ph-MPNs using the propensity scores in a 1:2 ratio using the variables gender, type 2 diabetes mellitus, high blood pressure, hyperlipidaemia and smoking. Vascular, cardiac and renal TOD were established according to the criteria of the European Society of Hypertension and Cardiology guidelines. Arterial stiffness was also assessed using the cardio-ankle vascular index (CAVI). RESULTS Mean age was 63.50±11.70 and 62.90±8.32 years in subjects with and without Ph-MPNs, 32 females (56%) in the first group and 62 (54%) in the second. Subjects with Ph-MPNs have a higher percentage of carotid injury than subjects without Ph-MPNs (35.1% vs. 21.1%) and higher albumin/creatinine ratio. In the logistic regression analysis, subjects with Ph-MPNs had an OR=2.382 (IC95% 1.066-5.323) for carotid injury versus those without haematological disease. CONCLUSIONS Subjects with Ph-MPNs have twice the risk of by carotid injury than those without haematological disease.
    Cardiovascular diseases are associated to risk factors as obesity, hypertension and diabetes. The transforming growth factor-β1 receptors ALK1 and endoglin regulate blood pressure and vascular homeostasis. However, no studies relate the... more
    Cardiovascular diseases are associated to risk factors as obesity, hypertension and diabetes. The transforming growth factor-β1 receptors ALK1 and endoglin regulate blood pressure and vascular homeostasis. However, no studies relate the association of ALK1 and endoglin polymorphisms with cardiovascular risk factors. We analysed the predictive value of the ALK1 and endoglin polymorphisms on cardiovascular target organ damage in hypertensive and diabetic patients in 379 subjects with or without hypertension and diabetes in a Primary Care setting. The ALK1 rs2071219 polymorphism (AA genotype) is associated with a lower presence of diabetic retinopathy and with the absence of altered basal glycaemia. Being carrier of the ALK1 rs3847859 polymorphism (G allele) is associated with lower basal heart rate and with higher LDL-cholesterol levels. The endoglin rs3739817 polymorphism (AA genotype) is associated with higher levels of LDL-cholesterol, and being carrier of the endoglin rs10987759 p...
    During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal... more
    During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women daily on body composition. We conducted a 6-month, two-arm randomised, controlled trial. Postmenopausal women (57·2 (sd 3·6) years, n 132) were recruited in primary care clinics. Participants in the control group (CG) did not receive any intervention. Those of the intervention group (IG) received 10 g daily of 99 % cocoa chocolate in addition to their habitual diet for 6 months. This quantity comprises 247 kJ (59 kcal) and 65·4 mg of polyphenols. The primary outcomes were the between-group differences in body composition variables, measured by impendancemetry at the end of the study. The main effect of the intervention showed a favourable reduction in the IG with respect to the CG in body fat mass (–0·63 kg (95 % CI –1·15, –0·11), P = 0·019; ...
    This study determined the relationship between self-reported and objective measurements of physical activity with adiposity markers in a random sample of community-dwelling older adults. The sample included 439 individuals over 65 years... more
    This study determined the relationship between self-reported and objective measurements of physical activity with adiposity markers in a random sample of community-dwelling older adults. The sample included 439 individuals over 65 years (age 71.1 ± 7.8; 54.2% women). Regular physical activity information was collected using self-reported (questionnaire, 7-day-PAR) and objective measurements (accelerometer ActiGraph GT3X) over 7 days. Anthropometric parameters included body mass index, body fat percentage, and waist circumference. The number of patients considered active was 28% according to the results of 7-day PAR, and 69% according to objective measures of accelerometry. With every daily increase of 10 min of sedentary activity, the BMI, body fat percentage, and waist circumference values increased by 0.04 units, 0.14%, and 0.14 cm, respectively. According to the accelerometry data, being active was a protective factor for presenting obesity criteria (OR = 0.34, CI 95% 0.19–0.59)....
    Eur J Clin Invest 2012; 42 (5): 548–556Background  Osteoprotegerin (OPG), a secreted member of the tumour necrosis factor receptor superfamily of cytokines, has been associated with endothelial dysfunction. We studied in type 2 diabetic... more
    Eur J Clin Invest 2012; 42 (5): 548–556Background  Osteoprotegerin (OPG), a secreted member of the tumour necrosis factor receptor superfamily of cytokines, has been associated with endothelial dysfunction. We studied in type 2 diabetic and/or hypertensive patients the relationship between serum OPG and vascular alterations associated with these pathologies.Materials and methods  We analysed 191 consecutive patients (52 with type 2 diabetes and 139 hypertensive nondiabetic patients) and 54 healthy controls. We assessed the relationship of OPG serum levels measured by ELISA with basal glycaemia, glycosylated haemoglobin, blood pressure, endothelial dysfunction (assessed by pulse wave velocity), retinopathy (by Keith‐Wagener classification), left ventricular hypertrophy (by Cornell index), cardiovascular risk and target organs (heart, vascular, kidney) damage.Results  Serum OPG levels were higher in either hypertensive or diabetic patients and in patients with non‐dipper and riser cir...
    Background Endoglin is involved in the regulation of endothelial function, but there are no studies concerning its relation with hypertension- and diabetes-associated pathologies. Thus, we studied the relationship between plasma levels of... more
    Background Endoglin is involved in the regulation of endothelial function, but there are no studies concerning its relation with hypertension- and diabetes-associated pathologies. Thus, we studied the relationship between plasma levels of soluble endoglin and cardiovascular alterations associated with hypertension and diabetes. Methods We analyzed 288 patients: 64 with type 2 diabetes, 159 with hypertension and 65 healthy patients. We assessed the relationship of soluble endoglin plasma levels measured by enzyme-linked immunosorbent assay with basal glycemia, glycosylated hemoglobin, blood pressure, endothelial dysfunction (assessed by pressure wave velocity), hypertensive retinopathy (by Keith-Wagener classification), left ventricular hypertrophy (by Cornell and Sokolow indexes), cardiovascular risk and target organ (heart, vascular, kidney) damage. Results There are significant correlations between endoglin and glycemia, systolic blood pressure, pulse pressure, pressure wave veloc...
    Background Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. Objective This study aims to evaluate the long-term effectiveness (12 months) of... more
    Background Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. Objective This study aims to evaluate the long-term effectiveness (12 months) of a multicomponent mobile health intervention—combining a smartphone app, an activity tracker wristband, and brief counseling, compared with a brief counseling group only—on weight loss and improving body composition, physical activity, and caloric intake in Spanish sedentary adults with overweight or obesity. Methods We conducted a randomized controlled, multicenter clinical trial (Evident 3). A total of 650 participants were recruited from 5 primary care centers, with 318 participants in the intervention group (IG) and 332 in the control group (CG). All participants were briefly counseled about a healthy diet and physical activity at the baseline visit. For the 3-month intervention period, the IG received training to use the app to promote healthy l...
    The aim of this work was to analyse the association of the retinal arteriolar calibre and the arteriole/venule index (AV index) with vascular ageing in a general population without previous cardiovascular disease.
    Background Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve... more
    Background Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. Objective This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. Methods A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app t...
    Resumen Introduccion y objetivos Describir por primera vez valores de referencia del indice vascular corazon-tobillo (ICT), la velocidad de la onda de pulso brazo-tobillo (VOP-BT), la velocidad de la onda de pulso carotida-femoral... more
    Resumen Introduccion y objetivos Describir por primera vez valores de referencia del indice vascular corazon-tobillo (ICT), la velocidad de la onda de pulso brazo-tobillo (VOP-BT), la velocidad de la onda de pulso carotida-femoral (VOP-CF) y el indice de aumento central y establecer relacion con factores de riesgo cardiovascular en poblacion adulta espanola de 35 a 75 anos de edad sin enfermedad cardiovascular. Metodos Estudio descriptivo transversal. Mediante muestreo aleatorio estratificado por edad y sexo, se incluyo a 501 sujetos sin enfermedad cardiovascular, con una media de edad de 55,9 anos; el 50,3% eran mujeres. Mediante los dispositivos SphigmoCor y Vasera VS-1500 se realizaron las mediciones. Resultados Todas las medidas, excepto el indice de aumento central, mostraron valores mayores en varones, y aumentaron con la edad y la presion arterial. Los valores medios fueron: ICT, 8,01 ± 1,44; VOP-BT, 12,93 ± 2,68 m/s; VOP-CF, 6,53 ± 2,03 m/s e indice de aumento central, 26,84 ± 12,79. En el analisis de regresion multiple, la presion arterial media se asocio con las 4 medidas, la glucohemoglobina, con todas excepto el indice de aumento central, y el indice de masa corporal mostro asociacion inversa con el ICT. Por otro lado, la capacidad explicativa de la edad, el sexo y la presion arterial media es para la VOP-BT un 62%; la VOP-CF, un 49%; el ICT, un 54% y el indice de aumento central, un 38%. En la regresion logistica, la hipertension se asocio con el ICT (OR = 3,45), la VOP-BT (OR = 3,44), la VOP-CF (OR = 3,38) y el indice de aumento central (OR = 3,73). Conclusiones Todas las medidas de rigidez aumentan con la edad; el ICT y la VOP-CF presentan valores mayores en los varones y el indice de aumento central, en las mujeres, sin diferencias en la VOP-BT. Este estudio esta registrado en ClinicalTrials.gov. Identificador: NCT02623894.
    Background: This study evaluates the effectiveness of adding a diet smartphone application to standard counseling to modify dietary composition over the long term (12 months). Methods: A randomized, controlled, multicenter clinical trial... more
    Background: This study evaluates the effectiveness of adding a diet smartphone application to standard counseling to modify dietary composition over the long term (12 months). Methods: A randomized, controlled, multicenter clinical trial was conducted involving the participation of 833 subjects from primary care clinics (415 to the intervention (counseling + application) group (IG) and 418 to the control (counseling) group (CG)). Both groups were counseled about a healthy diet and physical activity. For the 3-month intervention period, the IG was also trained to use a diet smartphone application that involved dietary self-monitoring and tailored feedback. Nutritional composition was estimated using a self-reported food frequency questionnaire. Results: An analysis of repeated measures revealed an interaction between the group and the percentages of carbohydrates (p = 0.031), fats (p = 0.015) and saturated fats (p = 0.035) consumed. Both groups decreased their energy intake (Kcal) at...
    A body shape index (ABSI) has been introduced as a marker of the relationship between body composition and all-cause mortality. However, until now, the relationships between ABSI and vascular structure and function have not been... more
    A body shape index (ABSI) has been introduced as a marker of the relationship between body composition and all-cause mortality. However, until now, the relationships between ABSI and vascular structure and function have not been evaluated. The aim of this study was to investigate the association of ABSI with vascular structure and function in Spanish adults with intermediate cardiovascular risk. This cross-sectional study analyzed the data of 2354 subjects [age, 35–74 years (median, 62.0 years [range, 56.0–67.0 years]), 61.9% men] enrolled into the MediAte Risk management (MARK) study. ABSI was calculated by using the following formula: ABSI = waist circumference (m)/[body mass index2/3 × height (m)1/2)]. Vascular function was assessed by measuring cardio-ankle vascular index (CAVI) with the VaSera device and brachial ankle pulse wave velocity (baPWV) by using a validated equation. Vascular structure was assessed by measuring carotid intima-media thickness (IMT) by ultrasonography. ...
    Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. The aim of this study was to evaluate the long-term effectiveness of adding an app to... more
    Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. The aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes. A randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and a...
    To analyze the reliability and validity of a semiautomated tool for assessing retinal vessel caliber and to describe the relationship of measures taken to cardiovascular risk and target organ damage. A total of 210 patients aged 34-75... more
    To analyze the reliability and validity of a semiautomated tool for assessing retinal vessel caliber and to describe the relationship of measures taken to cardiovascular risk and target organ damage. A total of 210 patients aged 34-75 years were selected with retinography. Retinal photographs were digitized, and superior and inferior temporal vessels were measured in an area 0.5-1 disk diameter from the optic disc with semiautomated software [arteriole/venule index (AVIx) calculator]. AVIx was also estimated. Vascular damage was assessed using carotid intima-media thickness and pulse wave velocity, cardiac damage using Cornell voltage-duration product, renal damage using the glomerular filtration rate and microalbuminuria, and cardiovascular risk with the Framingham score. Interobserver intraclass correlation coefficient (ICC) ranged from 0.96 [95% confidence interval (CI) 0.94-0.97] to 0.99 (95% CI 0.98-0.99), and intraobserver ICC ranged from 0.97 (95% CI 0.94-0.98) to 0.99 (95% CI 0.99-0.99). In the Bland-Altman plot, the limit of interobserver agreement was -0.009 (0.066 to -0.086) in right AVIx and -0.001 (0.083 to -0.085) in left AVIx, whereas the limit of intraobserver agreement for overall AVIx was -0.005 (-0.057 to -0.047). Cardiovascular risk and albumin-creatinine ratio were higher in the first tertile of AVIx as compared with the other two (P < 0.05). In multiple regression, AVIx and venule caliber, but not artery caliber, behaved as predictors of cardiovascular risk and microalbuminuria. This tool showed a high intraobserver and interobserver reliability, and results of the validity analysis agree with those from large studies in estimation of cardiovascular risk and evaluation of target organ damage.
    To analyze the relationship of 24-h blood pressure variability (BPV) with vascular structure and function using the SD and the coefficient of variation (CV). A cross-sectional study was carried out in 344 hypertensive patients (aged... more
    To analyze the relationship of 24-h blood pressure variability (BPV) with vascular structure and function using the SD and the coefficient of variation (CV). A cross-sectional study was carried out in 344 hypertensive patients (aged 54.1±11.7 years, 59.6% men). BPV was estimated with the SD and CV over 24-h, both awake and sleep, by ambulatory blood pressure monitoring. Vascular structure and function were evaluated by the ambulatory arterial stiffness index (AASI), the pulse wave velocity (PWV) using SphygmoCor and the carotid intima-media thickness (IMT) as assessed by ultrasound. The systolic blood pressure (SBP) variability was greater than the diastolic blood pressure (DBP) variability using the SD and less using CV (P<0.001). SBP variability showed a positive correlation with the IMT, PWV and AASI. The CV of the DBP showed a positive correlation with the PWV and the AASI, whereas the SD of the DBP showed a negative correlation with the AASI. In the multiple regression analysis, after adjustment, the BPV measure that maintained their associations with the IMT was the CV of awake DBP and that with the PWV were the CV and the SD of 24-h and awake SBP/DBP. The AASI maintained the associations with the BPV measure in 24-h DBP, but not in SBP. The odds ratio of the SD and the CV for vascular damage varied between 1.182 and 1.276. BPV in hypertensive patients, as evaluated by both SD and CV, is associated with arterial stiffness as evaluated with the PWV. The ambulatory blood pressure monitoring is more accessible at the clinic than the PWV; therefore, the assessment of BPV (24-h, awake and sleep) may be useful for assessment of arterial stiffness.
    The purpose of this study was to analyse the relationship between sodium and potassium intake and vascular structure and function and to ascertain whether said relationship follows the pattern of a J-shaped curve. A cross-sectional study... more
    The purpose of this study was to analyse the relationship between sodium and potassium intake and vascular structure and function and to ascertain whether said relationship follows the pattern of a J-shaped curve. A cross-sectional study was carried out in a primary care setting. Three hundred fifty-one subjects from the Vasorisk study were included and ranged in age from 30 to 80 years (mean 54.8, SD 11.7); 219 (62.4%) were females. Sodium and potassium intake were evaluated by means of a food frequency questionnaire. Arterial stiffness was assessed according to pulse wave velocity (PWV), ambulatory arterial stiffness index (AASI, AASI_BPVR), and central and peripheral augmentation index (AIx). Carotid intima-media thickness (C-IMT) was evaluated by ultrasonography. Age was lower in the quartiles with the highest sodium intake (p < 0.05), and no difference was observed between the sexes. Mean C-IMT, CAIx, AASI and AASI_BPVR were higher in the quartiles with higher sodium intake (p < 0.05 for both AASI and AASI_BPVR). Sodium intake was negatively correlated with C-IMT (r = -0.121, p < 0.05), PWV (r = -0.114, p < 0.05), AASI and AASI_BPVR (r = -0.155, p < 0.01). Potassium intake was positively correlated with Cornell VDP (r = 0.119, p < 0.05), CAIx (r = 0.178, p < 0.01) and PAIx (r = 0.202, p < 0.01). After adjustment, the morphology of the relationship between arterial stiffness parameters and C-IMT with quartiles of sodium intake resembles a J-shaped curve. The relationship between central and peripheral AIx and C-IMT and potassium intake resembles a J-shaped curve. The relationship of sodium and potassium intake with vascular structure and function, as evaluated with C-IMT, PWV, AASI and peripheral and central AIx, resembles a J-shaped curve, which is similar to what has been proposed in the case of cardiovascular morbimortality.

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