LINES OF RESEARCH

Hospital register of patients with myocardial infarction

Of the three manifestations of ischaemic cardiopathy (Angina, sudden death, and myocardial infarction) the most clearly defined is that of myocardial infarction, since it requires admission to hospital, thereby facilitating detection. Between 1978 and 1988 patients suffering from an infarction for the first time were included. Since then patients with recurrent myocardial infarction have also been included.

The hospital registering of myocardial infarction in the Girona reference centre began with the study of the clinical aspects of myocardial infarction, assessing the prognostic factors that affect short or long term survival. The follow-up still continues after more than twenty-three years  Among the factors best studied are acetylsalicylic acid, thrombolysis, and sex.

 
Register by population of patients with myocardial infarction

Since 1988 the REGICOR study  has recorded  every  case of  myocardial infarction  among the population of Girona.   The methods are standard and consist of checking the records of admissions and the urgent cases dealt with by the hospitals in the area as well as checking the death certificates of Girona residents in order to detect suspected cases of myocardial infarction.

Included in the register are all myocardial infarction patients whether admitted or not into any of the hospitals in the area. The monitoring of the incidence of myocardial infarction in this area of some 600,000 inhabitants, well delimited both geographically and administratively, is the most suitable way of studying the impact of ischaemic cardiopathy on the population. This project has made it possible to determine the annual rates of incidence, of attacks, of mortality and lethality for myocardial infarction since 1988 and thus be able to establish trends.

Study of cardiovascular risk factors

In addition to knowing the rates of incidence, mortality and lethality for myocardial infarction it was necessary to know the prevalence of cardiovascular risk factors in the same zone in order to determine whether  its control was appropriate.

Between 1994 and 1996 the first transversal study was carried out. Apart from the classic cardiovascular risk factors, this study analysed such other aspects as physical activity, diet, biochemical factors of inflammation and oxidation, as well as genetic aspects. A total of 1,748 people from Girona and the surrounding area took part in the study, using a two-stage random sampling on data taken from the census: the first in 33 towns and the second with the participants between the ages of 25 and 74, classified by age and sex.   

Between May 1999 and October 2001 a new group of 3,500 people from 17 areas of Girona were examined using the same recruiting procedures and  similar measures.

Cardiovascular risk factors in Mediterranean Europe. Combined study of  Hospital, Epidemiological and Basic Primary Care. The predictive equations on cardiovascular risk developed in Framingham USA   provide poor estimates when applied to countries in Southern Europe. This fact has led to close co-operation between the REGICOR study group and the area of Primary Care, which has been very successful as far as international  publications and confluence of interest are concerned. 

The purpose of this project is to calculate the relative importance of each of the classic cardiovascular risk factors in risk prediction in Girona, starting from the data obtained from the sample of 1,748 people who took part in the study of risk factors carried out in Girona in 1994 and 1995. The participants in the study of  risk factors carried out in Girona in 1999-2001  will similarly be studied some time in the future.  A  follow-up study – 10 years after the first group and 5 years after the second - is to be carried out in 2006.

In addition we consider it necessary to add a supplementary population of some 10,000 participants in order to obtain the necessary number of cardiovascular cases needed to calculate the coefficients of the predictive functions with sufficient accuracy. This project will be completed with the HERMES study, begun in 2003 in collaboration with our colleagues at Primary Care Girona, which it will be necessary to prolong until recruitment has been extended to 7,000 subjects in 2006.

This project forms part of an Hispanic - North-American collaboration agreement with the Framingham Heart Study researchers, which has allowed the Framingham equation to be calibrated and adapted for use on the Girona population and, by extension, throughout  Spain.
In this way, and in collaboration with the ‘Catalan Health Institute’, the ‘Jordi Gol i Gurina Research Foundation’, and the ‘Medical Technology and Research Evaluation Agency’, it has been possible to carry out the VERIFICA study, the aim of which is to validate the REGICOR adaptation of the Framington equation calibration. This study has corroborated the validity of the adaptation and will be published in 2006.
We believe that this section represents a good example of collaboration between Primary Care and hospital research and specific research institutions like IMIM.