A. Graciani - Academia.edu (original) (raw)

Papers by A. Graciani

This study examined the association between sleep quality and the metabolic syndrome and whether ... more This study examined the association between sleep quality and the metabolic syndrome and whether if it is independent of sleep duration and if it can be explained by lifestyles linked to sleep quality. Cross-sectional study conducted from 2008 to 2010 with 10 342 individuals representative of the population aged ≥18 years in Spain. Poor sleep quality was ascertained through self-reported difficulty falling asleep, difficulty maintaining sleep and sleeping pill consumption. Metabolic syndrome was defined according to the recent harmonized definition. Analyses were conducted with logistic regression and adjusted for the main confounders. Difficulty falling asleep was associated with higher frequency of metabolic syndrome after adjustment for sociodemographic variables, lifestyle and diagnosed morbidity [odds ratio (OR) = 1.25; 95% confidence interval (CI) = 1.06-1.47]. The association was slightly attenuated after further adjusting for sleep duration (OR = 1.23; 95% CI = 1.04-1.46) and held after additional adjustment for energy intake, adherence to a Mediterranean dietary pattern, energy spent in physical activity and time watching TV (OR = 1.20; 95% CI = 1.01-1.42). No associations were found between metabolic syndrome and other sleep quality indicators. Difficulty falling asleep was associated with high blood pressure in the fully adjusted analyses (OR = 1.17; 95% CI = 1.00-1.37) but not with the rest of components of metabolic syndrome. Difficulty falling asleep is associated with metabolic syndrome and, in particular, with high blood pressure. This association is independent of sleep duration and is not due to lifestyles related to poor sleep. This finding should be replicated in prospective studies using objective sleep measures; also, the influence of antihypertensive and lipid-lowering drug treatment on this association should be further studied.

Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized de... more Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized definition and that of premorbid metabolic syndrome, which consists of metabolic syndrome without diabetes mellitus or cardiovascular disease. Moreover, their regional distributions and clinical management are unknown. The present study examined the distributions and clinical management of both syndromes in Spain. Methods: This cross-sectional study was performed from 2008 to 2010 in 11 149 representative individuals of the Spanish population aged 18 years or older. Data were obtained through standardized physical examination, and analytical measurements were done in a central laboratory. Results: The prevalences (95% confidence interval) of metabolic syndrome and premorbid metabolic syndrome were 22.7% (21.7%-23.7%) and 16.9% (16.0%-17.8%), respectively. The frequency of both syndromes increased with age and was higher in men than in women up to 65 years; above this age, the frequency was higher in women. The communities of the south of Spain and the Balearic and Canary islands had the highest prevalence of both syndromes, in some regions reaching double that of the community with the lowest prevalence. About one third of patients with premorbid metabolic syndrome reported that they had not received health recommendations to improve their lifestyles; of those that did receive advice, adherence was low, particularly for reducing weight (31.9%) and salt intake (38.3%). Conclusions: The prevalence of metabolic syndrome is high in Spain and considerable geographical differences exist in its distribution. There is substantial room for improvement in the clinical management of premorbid metabolic syndrome. ß 2013 Sociedad Españ ola de Cardiología. Published by Elsevier Españ a, S.L. All rights reserved. Magnitud y manejo del síndrome metabó lico en Españ a en 2008-2010: Estudio ENRICA Palabras clave: Síndrome metabó lico Enfermedad cardiovascular Diabetes mellitus Hipertensió n Obesidad abdominal R E S U M E N

American journal of hypertension, 2006

Background: This study examines the relationship between awareness, treatment and control of hype... more Background: This study examines the relationship between awareness, treatment and control of hypertension, and health-related quality of life (HRQL) among older adults in Spain.

GUALLAR-CASTILLÓ N, PILAR, JON SAGARDUI-VILLAMOR , JOSÉ R. BANEGAS , AUXILIADORA GRACIANI , NÉ LI... more GUALLAR-CASTILLÓ N, PILAR, JON SAGARDUI-VILLAMOR , JOSÉ R. BANEGAS , AUXILIADORA GRACIANI , NÉ LIDA SCHMID FORNÉ S , ESTHER LÓ PEZ GARCÍA , AND FERNANDO RODRÍGUEZ-ARTALEJO. Waist circumference as a predictor of disability among older adults. Obesity. 2007;15:233-244.

Background & aims: This is the first study to systematically examine the behavioral factors that ... more Background & aims: This is the first study to systematically examine the behavioral factors that may explain the inverse association between education and abdominal obesity in adults. Methods: Cross-sectional study conducted among 3541 men and 3564 women representative of the population aged 25e64 years in Spain. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Analyzes were performed with logistic regression, with progressive adjustment for obesity-related behaviors. Results: The age-, sex-and town size-adjusted odds ratios for abdominal obesity were 1.69 in men and 1.85 in women among individuals with lowest versus highest education. After adjustment for all the studied behaviors, the odds ratio was reduced to 1.49 in men and to 1.45 in women. The factors with the largest contribution to the higher prevalence of abdominal obesity in individuals with lowest versus highest education were more time spent watching TV and less time spent in exercising, as well as a higher energy intake in women. Tobacco and alcohol consumption, physical activity at home, leisure walking, sedentary behaviors other than TV watching, and sleep duration did not explain the educational gradient in abdominal obesity. Conclusion: Watching TV, physical exercise and energy intake explain a substantial part of the inverse association between education and abdominal obesity.

Journal of Human Hypertension, 2002

Systolic blood pressure (SBP) is a more frequent cardiovascular risk factor than diastolic blood ... more Systolic blood pressure (SBP) is a more frequent cardiovascular risk factor than diastolic blood pressure (DBP), and has a greater impact on blood pressure staging, though this can vary with age, sex and country. Therefore this paper compares SBP and DBP in terms of community burden and impact on blood pressure staging, among Spain's middle-aged population. Data were drawn from a cross-sectional study on a representative sample of the Spanish population aged 35-64 years. Blood pressure was determined under standardised conditions, and was classified as per WHO-ISH and JNC-VI criteria. Prevalence of SBP у140 mm Hg was 34.1%, and that of DBP у90 mm Hg, 30.9%. A total of 12% of subjects had isolated systolic hypertension (ISH) and 8.7% had isolated diastolic hypertension (IDH). Of treated hypertensives, 31% had their SBP controlled and 34% their DBP controlled. Of subjects not undergoing antihypertensive drug therapy, 60.8% had congruent

Hypertension, 2012

Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of... more Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index <25 kg/m 2 , 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c <6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein <115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives. (Hypertension. 2012;60:898-905.)

European Journal of Clinical Nutrition, 2003

Objective: To present the current burden of mortality attributable to some of the main cardiovasc... more Objective: To present the current burden of mortality attributable to some of the main cardiovascular risk factors in adults in Spain. Methods: Mortality attributable to risk factors was calculated by combining their prevalence, the relative risks for death, and the number of deaths in Spain. Prevalence of hypertension (Z140/90 mmHg), tobacco smoking, excess weight (body mass index Z25 kg/m 2 ), and self-reported diabetes were based on representative samples of the Spanish population in the 1990s. The relative risks came from valid international studies. Results: About 14 000 total deaths (25% of all deaths) were attributable to hypertension in Spain's middle-aged population. A quarter of them were cardiovascular deaths. About 56 000 deaths were attributable to tobacco use in adults Z35 y (16% of all deaths). Two-thirds of them were deaths for: lung cancer (26.5%), chronic obstructive pulmonary disease (20.9%), coronary heart disease (12.8%), and stroke (9.2%). About 28 000 deaths (8.5% of all deaths) were attributable to excess weight in adults. Two-thirds of them were cardiovascular deaths. About 2800 cardiovascular deaths were attributable to diabetes in adults Z35 y (6% of all cardiovascular deaths). Conclusions: Mortality attributable to the risk factors studied is a major avoidable public health problem in Spain. The results presented are only illustrative but clearly show that there is considerable scope for prevention.

Age and Ageing, 2011

Background: research on the association between habitual sleep duration and quality in older adul... more Background: research on the association between habitual sleep duration and quality in older adults is scarce and has shown conflicting results. Moreover, no previous study has assessed the influence of health status on this association. Objectives: to examine the association between habitual duration and quality of sleep in older adults, and to test if this association varies with health status, as approximated by self-rated health, quality-of-life and functional limitation. Design: cross-sectional study with data collected by telephone interview. Setting: community-based study. Subjects: a total of 1,567 community-dwelling individuals aged ≥68 years in Spain. Methods: poor sleep quality was ascertained through nighttime complaints (sleeping-pill consumption, difficulty falling asleep, awakening during the night and early awakening), and daytime complaints (feeling unrested in the morning and daytime sleepiness). The analyses were adjusted for the main confounders, and were stratified by health status (self-rated health, health-related quality-of-life and functional limitation). Results: when compared with those sleeping 7-8 h, those who slept ≤6 h were more likely to report difficulty falling asleep [odds ratio (OR) 3.51; 95% confidence interval (CI) 2.37-5.20], frequent awakening during the night (OR 1.97; 95% CI 1.42-2.75), early awakening in the morning (OR 2.78; 95% CI 2.02-3.82) and feeling unrested in the morning (OR 1.73; 95% CI 1.18-2.54). Moreover, those who slept ≥9 h were more likely to report daytime sleepiness (OR 1.68; 95% CI 1.17-2.42). In stratified analyses, these associations generally did not vary with health status. Conclusions: in older adults, short sleep is associated with nighttime sleep complaints and feeling unrested in the morning, while long sleep is associated with daytime sleepiness.

This study examined the association between sleep quality and the metabolic syndrome and whether ... more This study examined the association between sleep quality and the metabolic syndrome and whether if it is independent of sleep duration and if it can be explained by lifestyles linked to sleep quality. Cross-sectional study conducted from 2008 to 2010 with 10 342 individuals representative of the population aged ≥18 years in Spain. Poor sleep quality was ascertained through self-reported difficulty falling asleep, difficulty maintaining sleep and sleeping pill consumption. Metabolic syndrome was defined according to the recent harmonized definition. Analyses were conducted with logistic regression and adjusted for the main confounders. Difficulty falling asleep was associated with higher frequency of metabolic syndrome after adjustment for sociodemographic variables, lifestyle and diagnosed morbidity [odds ratio (OR) = 1.25; 95% confidence interval (CI) = 1.06-1.47]. The association was slightly attenuated after further adjusting for sleep duration (OR = 1.23; 95% CI = 1.04-1.46) and held after additional adjustment for energy intake, adherence to a Mediterranean dietary pattern, energy spent in physical activity and time watching TV (OR = 1.20; 95% CI = 1.01-1.42). No associations were found between metabolic syndrome and other sleep quality indicators. Difficulty falling asleep was associated with high blood pressure in the fully adjusted analyses (OR = 1.17; 95% CI = 1.00-1.37) but not with the rest of components of metabolic syndrome. Difficulty falling asleep is associated with metabolic syndrome and, in particular, with high blood pressure. This association is independent of sleep duration and is not due to lifestyles related to poor sleep. This finding should be replicated in prospective studies using objective sleep measures; also, the influence of antihypertensive and lipid-lowering drug treatment on this association should be further studied.

Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized de... more Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized definition and that of premorbid metabolic syndrome, which consists of metabolic syndrome without diabetes mellitus or cardiovascular disease. Moreover, their regional distributions and clinical management are unknown. The present study examined the distributions and clinical management of both syndromes in Spain. Methods: This cross-sectional study was performed from 2008 to 2010 in 11 149 representative individuals of the Spanish population aged 18 years or older. Data were obtained through standardized physical examination, and analytical measurements were done in a central laboratory. Results: The prevalences (95% confidence interval) of metabolic syndrome and premorbid metabolic syndrome were 22.7% (21.7%-23.7%) and 16.9% (16.0%-17.8%), respectively. The frequency of both syndromes increased with age and was higher in men than in women up to 65 years; above this age, the frequency was higher in women. The communities of the south of Spain and the Balearic and Canary islands had the highest prevalence of both syndromes, in some regions reaching double that of the community with the lowest prevalence. About one third of patients with premorbid metabolic syndrome reported that they had not received health recommendations to improve their lifestyles; of those that did receive advice, adherence was low, particularly for reducing weight (31.9%) and salt intake (38.3%). Conclusions: The prevalence of metabolic syndrome is high in Spain and considerable geographical differences exist in its distribution. There is substantial room for improvement in the clinical management of premorbid metabolic syndrome. ß 2013 Sociedad Españ ola de Cardiología. Published by Elsevier Españ a, S.L. All rights reserved. Magnitud y manejo del síndrome metabó lico en Españ a en 2008-2010: Estudio ENRICA Palabras clave: Síndrome metabó lico Enfermedad cardiovascular Diabetes mellitus Hipertensió n Obesidad abdominal R E S U M E N

American journal of hypertension, 2006

Background: This study examines the relationship between awareness, treatment and control of hype... more Background: This study examines the relationship between awareness, treatment and control of hypertension, and health-related quality of life (HRQL) among older adults in Spain.

GUALLAR-CASTILLÓ N, PILAR, JON SAGARDUI-VILLAMOR , JOSÉ R. BANEGAS , AUXILIADORA GRACIANI , NÉ LI... more GUALLAR-CASTILLÓ N, PILAR, JON SAGARDUI-VILLAMOR , JOSÉ R. BANEGAS , AUXILIADORA GRACIANI , NÉ LIDA SCHMID FORNÉ S , ESTHER LÓ PEZ GARCÍA , AND FERNANDO RODRÍGUEZ-ARTALEJO. Waist circumference as a predictor of disability among older adults. Obesity. 2007;15:233-244.

Background & aims: This is the first study to systematically examine the behavioral factors that ... more Background & aims: This is the first study to systematically examine the behavioral factors that may explain the inverse association between education and abdominal obesity in adults. Methods: Cross-sectional study conducted among 3541 men and 3564 women representative of the population aged 25e64 years in Spain. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Analyzes were performed with logistic regression, with progressive adjustment for obesity-related behaviors. Results: The age-, sex-and town size-adjusted odds ratios for abdominal obesity were 1.69 in men and 1.85 in women among individuals with lowest versus highest education. After adjustment for all the studied behaviors, the odds ratio was reduced to 1.49 in men and to 1.45 in women. The factors with the largest contribution to the higher prevalence of abdominal obesity in individuals with lowest versus highest education were more time spent watching TV and less time spent in exercising, as well as a higher energy intake in women. Tobacco and alcohol consumption, physical activity at home, leisure walking, sedentary behaviors other than TV watching, and sleep duration did not explain the educational gradient in abdominal obesity. Conclusion: Watching TV, physical exercise and energy intake explain a substantial part of the inverse association between education and abdominal obesity.

Journal of Human Hypertension, 2002

Systolic blood pressure (SBP) is a more frequent cardiovascular risk factor than diastolic blood ... more Systolic blood pressure (SBP) is a more frequent cardiovascular risk factor than diastolic blood pressure (DBP), and has a greater impact on blood pressure staging, though this can vary with age, sex and country. Therefore this paper compares SBP and DBP in terms of community burden and impact on blood pressure staging, among Spain's middle-aged population. Data were drawn from a cross-sectional study on a representative sample of the Spanish population aged 35-64 years. Blood pressure was determined under standardised conditions, and was classified as per WHO-ISH and JNC-VI criteria. Prevalence of SBP у140 mm Hg was 34.1%, and that of DBP у90 mm Hg, 30.9%. A total of 12% of subjects had isolated systolic hypertension (ISH) and 8.7% had isolated diastolic hypertension (IDH). Of treated hypertensives, 31% had their SBP controlled and 34% their DBP controlled. Of subjects not undergoing antihypertensive drug therapy, 60.8% had congruent

Hypertension, 2012

Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of... more Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index <25 kg/m 2 , 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c <6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein <115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives. (Hypertension. 2012;60:898-905.)

European Journal of Clinical Nutrition, 2003

Objective: To present the current burden of mortality attributable to some of the main cardiovasc... more Objective: To present the current burden of mortality attributable to some of the main cardiovascular risk factors in adults in Spain. Methods: Mortality attributable to risk factors was calculated by combining their prevalence, the relative risks for death, and the number of deaths in Spain. Prevalence of hypertension (Z140/90 mmHg), tobacco smoking, excess weight (body mass index Z25 kg/m 2 ), and self-reported diabetes were based on representative samples of the Spanish population in the 1990s. The relative risks came from valid international studies. Results: About 14 000 total deaths (25% of all deaths) were attributable to hypertension in Spain's middle-aged population. A quarter of them were cardiovascular deaths. About 56 000 deaths were attributable to tobacco use in adults Z35 y (16% of all deaths). Two-thirds of them were deaths for: lung cancer (26.5%), chronic obstructive pulmonary disease (20.9%), coronary heart disease (12.8%), and stroke (9.2%). About 28 000 deaths (8.5% of all deaths) were attributable to excess weight in adults. Two-thirds of them were cardiovascular deaths. About 2800 cardiovascular deaths were attributable to diabetes in adults Z35 y (6% of all cardiovascular deaths). Conclusions: Mortality attributable to the risk factors studied is a major avoidable public health problem in Spain. The results presented are only illustrative but clearly show that there is considerable scope for prevention.

Age and Ageing, 2011

Background: research on the association between habitual sleep duration and quality in older adul... more Background: research on the association between habitual sleep duration and quality in older adults is scarce and has shown conflicting results. Moreover, no previous study has assessed the influence of health status on this association. Objectives: to examine the association between habitual duration and quality of sleep in older adults, and to test if this association varies with health status, as approximated by self-rated health, quality-of-life and functional limitation. Design: cross-sectional study with data collected by telephone interview. Setting: community-based study. Subjects: a total of 1,567 community-dwelling individuals aged ≥68 years in Spain. Methods: poor sleep quality was ascertained through nighttime complaints (sleeping-pill consumption, difficulty falling asleep, awakening during the night and early awakening), and daytime complaints (feeling unrested in the morning and daytime sleepiness). The analyses were adjusted for the main confounders, and were stratified by health status (self-rated health, health-related quality-of-life and functional limitation). Results: when compared with those sleeping 7-8 h, those who slept ≤6 h were more likely to report difficulty falling asleep [odds ratio (OR) 3.51; 95% confidence interval (CI) 2.37-5.20], frequent awakening during the night (OR 1.97; 95% CI 1.42-2.75), early awakening in the morning (OR 2.78; 95% CI 2.02-3.82) and feeling unrested in the morning (OR 1.73; 95% CI 1.18-2.54). Moreover, those who slept ≥9 h were more likely to report daytime sleepiness (OR 1.68; 95% CI 1.17-2.42). In stratified analyses, these associations generally did not vary with health status. Conclusions: in older adults, short sleep is associated with nighttime sleep complaints and feeling unrested in the morning, while long sleep is associated with daytime sleepiness.