Jaume Marrugat, epidemiologist: “If you can’t stop looking at the screen for a couple of hours, you have a problem” | Health & Wellness | The USA Print

The epidemiologist Jaume Marrugat (Barcelona, ​​68 years old) is a kind of sentinel of cardiovascular health. A lookout for heart disease, its risk factors and how to prevent it. More than 30 years ago he gave birth to the Regicor (Gironí del Cor Registry, in Catalan), a research project with a cohort of 23,000 Girona residents to study cardiovascular diseases. “We found that in southern Europe we had slightly lower incidence and mortality from heart disease than in northern European countries. We also saw that women who had a heart attack were identified too late and this could not be attributed only to age, but rather it was a problem of recognition of the disease”, he recalls.

Those findings, he says, had a great impact on global research. From them, some things were discovered —such as the influence of the Mediterranean diet on cardiovascular health— and others were corrected: “We penetrated the medical community to make it known [que los infartos en mujeres se detectaban demasiado tarde] and we have verified that, in the last 30 years, substantial improvements have been achieved: mortality and complications in women with a heart attack are practically the same as those of men”.

Despite the improvement, Marrugat, who is a researcher at the Hospital del Mar Medical Research Institute, continues to closely monitor cardiovascular diseases in the population. In fact, he is about to plunge into another ambitious project to determine the genetic risk of suffering from these ailments: the Carlos III Health Institute has granted him a grant of almost five million euros to carry out the complete genomic analysis of a cohort of more than 100,000 people.

Ask. What are you going to do with so much money?

Answer. Work a lot. Genetic studies, that is, the association between genetic characteristics and a disease, such as coronary artery disease, are very expensive. And also, if you want to do it well, you need to include a lot of people. We have taken advantage of the fact that, as an epidemiologist, I know of many groups in Spain that already had organized cohorts and were analyzed, but that no one had put them together: together, they reach 170,000 people, of which 101,000 still have frozen DNA.

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Q. What’s the plan? What are they going to do?

R. First, join all the data, all the variables. Then, of the people who keep DNA, not all of them have had DNA extracted from the cell and it must be removed. We will send this to the National Center for Genomics, which is in Galicia, and we will send them batches of samples. They will return to us the genomic result of more than four million genetic characteristics of each individual.

Q. What do they expect to find?

R. That is the most exciting part because the idea we have is, first, to verify that what has been discovered up to now we have also found. Second, we know that each region of the world has different genetic characteristics and, therefore, what we find in our region will be important to us because it will allow us to personalize medicine: we can make a genetic determination chip that allows us to know what the profile is genetic that a person has and say: you, with this genetic profile and here, have this risk of developing these heart diseases.

Q. Will it be possible to know if a person is going to suffer a heart attack?

R. For example. But this is probabilistic, not deterministic. We now have diagnostic tests that, with a dozen genetic characteristics, can fairly accurately predict who is at high or low genetic risk. But having a high genetic risk doesn’t necessarily mean you’re going to have a heart attack at 50 or 60, just that it greatly increases your risk. So, it will depend a lot on you because 50% is genetic, but the other 50% are other risk factors.

I worry about children living a life of screens, because that replaces exercise

Q. What other variables play against?

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R. There are the risk factors that doctors address, such as high blood pressure, cholesterol, and diabetes. But then there are all those related to lifestyle: diet, physical activity and also socioeconomic status. The latter is a very important determinant of cardiovascular diseases and is highly determined by the educational level, where you are born: the socioeconomic level, in some way, is associated with knowledge and the ability to understand the risks.

Q. There is more?

R. There is also another factor that we take little into account, which is air pollution and then there are addictions: tobacco is the first, but we have others that give us a bad life and lead us to a sedentary lifestyle. For example, addiction to screens. We are concerned that younger people, children, start living a life on screens from a very young age because living that life on screens replaces going out, playing football, going for a run or exercising. If we lose the habit of exercising too early in life, we won’t get it back.

Q. Is addiction to screens a new cardiovascular risk factor?

R. very clear Screen addiction can be an important cardiovascular risk factor when associated with a sedentary lifestyle and poor diet.

Q. What do you understand by excessive consumption or addiction to screens?

R. Surely, a psychologist or a psychiatrist would have more criteria than me to define it, but I think that one has to self-analyze and bear in mind that if at any time you feel anxious because you have not looked at the screen, that is a bad indicator. . That is, if you are not able to control it and you are constantly looking, if you cannot stop looking at the screen for a couple of hours, you have a problem.

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Q. There is a highly controversial recommendation regarding cardiovascular prevention: have a glass of wine with food. How do you see it?

R. This is a very complicated subject because it is mixed with the problem of addiction: there are people who become alcoholics and others who can drink a drink every month and nothing happens; Therefore, if you are addicted, you have a very serious problem. Another thing that is not debatable, moreover, is the scientific knowledge that we have of the effect of alcohol: any consumption, however small, increases general mortality and, even if it decreases a little in the case of cardiovascular disease, it is irrelevant because death decreases. cardiovascular, but it raises the digestive, for example. That is, in the end, global mortality does not stop rising. With one drink a day, the increased risk is small but significant: a person who drinks one drink a day lives less than a person who doesn’t drink. Now, everyone who does what they want in their lives, but I think that doctors are deontologically prohibited from recommending any type of alcohol consumption. And if a doctor does it, he is irresponsible.

Jaume Marrugat, at the facilities of the Barcelona Biomedical Research Park, where he has his office as a researcher at the Hospital del Mar Medical Research Institute.
Jaume Marrugat, at the facilities of the Barcelona Biomedical Research Park, where he has his office as a researcher at the Hospital del Mar Medical Research Institute. MASSIMILIANO MINOCRI

Q. Cardiovascular diseases continue to be the first cause of death in the world. Why isn’t this getting better?

R. It does get better, but very little by little. Because? Because we are not immortal and, in the end, what we are doing is delaying the appearance of this type of complications. But whoever has the predisposition, even if he takes very, very, very good care of himself, he probably won’t have a heart attack at 50 or 60, but perhaps he will at 90. What we have done is push [la enfermedad cardiovascular] at older ages.

Q. So, isn’t it doing so badly in terms of prevention?

R. Absolutely. We can be very happy. We would be more if there was nothing [de problemas cardiovasculares], but that is quite difficult. The health system, primary care, has done a lot for prevention. Assistance has greatly reduced mortality: in 1978, mortality from myocardial infarction of those who arrived at the hospital was 18% and currently it does not reach 4%. That is, if you have a heart attack and manage to get to the hospital, the probability that you will die is small. And I also believe that citizens have become more aware of the problem. We are getting better, but it continues to be the leading cause of death.

Q. Where is room for improvement?

R. We have to try to minimize the number of people who need assistance and this is done through prevention. I think we also have to deal with the issue of air pollution and we have to personalize prevention: this means taking into account individual factors such as, for example, the genetic profile, which is unique in each person and if you don’t know it and ignore it , you are missing an opportunity.

If a doctor recommends any type of alcohol, he is irresponsible.”

Q. With the covid pandemic, cardiologists warned that they were seeing very serious heart attacks. How much has the health crisis affected cardiovascular epidemiology?

R. What we know is that, suddenly, the number of cases dropped because people stayed at home for fear of going to the hospital: those who had a small heart attack, suffered it and nothing happened, but those large heart attacks are from people who they waited a long time. We also know that this virus caused cardiac lesions and there is a relationship: covid affects the heart for sure. Therefore, this type of affectation goes hand in hand with the coronary disease that existed in society and a mixture has been produced that is very difficult to clarify. We will have a couple of dark years left in the history of cardiovascular epidemiology. What is clear is that it has affected, in one way or another: those who had very small heart attacks have spent them at home and, probably, little by little they will be incorporated into secondary prevention because now, for the moment, they have stayed cornered there; and the most serious, will drag gravity for the rest of his life.

Q. Cardiovascular disease is one of the most studied medical areas, what do you need to know?

R. We still need to establish very well how the mechanisms of production of arteriosclerosis work and how we can modify the course of this pathology, of this fatty deposit in the arteries. Why are there people who reach 90 years of age and do not have any atherosclerotic lesion? We need to dig deeper into the mechanisms and understand what causes the cholesterol-removing capacity of the arteries to become unbalanced.

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