Hospital del Mar Research Institute Hospital del Mar Research Institute

Girona Heart Registry (REGICOR) Jaume Marrugat

The mission of the REGICOR Research Group is "to increase our knowledge of the magnitude of the populational problem of cardiovascular diseases, their molecular, cellular and environmental mechanisms, and design the best strategies for preventing them."

The ultimate goal of this knowledge is to significantly reduce the burden of this disease on society, creating tools -such as cardiovascular risk functions- that allow us to transfer the knowledge we acquire to clinical practice.

The REGICOR Group also has the mission of training new researchers in this area of knowledge.

Lines of research

The REGICOR research group follows the following lines of research:

Population Registry of Acute Myocardial Infarction and Clinical Epidemiology:

Milestones: The estimation of the incidence, mortality, and lethality of acute myocardial infarction (AMI) performed using a population register that follows a standardised WHO method, involving sociodemographic and clinical information from all cases of AMI among the approximately 600,000 inhabitants of the 6 counties within the Girona province (Alt Empordà, Baix Empordà, Garrotxa, Gironès, Pla de l'Estany, and La Selva) between 1990 and 2010.

The hospital registry created in 1978 includes all patients at the Josep Trueta University Hospital in Girona with a diagnosis of the first AMI, right up to the present day. The almost 40 years of data contained in this record have also allowed us to analyse the evolution in AMI patient management and treatment, as well as its prognostic factors. One of our clinical research group's most important roles involves looking at clinical epidemiology in cardiology; this has resulted in studies like PRIAMHO and PRIAMHO II, MASK, DAMOCLES, SAHARAN, IBERICA, and ATHOS.

Challenges for the next 3 years include: developing new methods for estimating the incidence of myocardial infarction in Catalonia based on hospital discharge data (minimum basic data set) and mortality rate, thanks to an agreement signed with AQUAS-PADRIS; exploitation of data from ATHOS, a project led by our group in the context of CIBERCV, which has collected information on more than 7,500 patients from 31 Spanish hospitals who suffer acute coronary syndrome, to generate scientific publications and validate evaluation functions for the results from the hospitals that will also be used by the AQUAS Results Centre.

Population Studies, Classic Risk Factors, and Molecular Biomarkers of Cardiovascular Risk:

Milestones: Through cross-sectional studies of more than 40 municipalities in Girona, we have established the prevalence of cardiovascular risk factors in these counties and their degree of control. The three studies conducted to date (1995 with 1,748 participants; 2000 with 3,056; and 2005 with 6,500) have had a combined response rate of 71%. In 2017 we received funding from PERIS (IMIM no. 11053) to review the participants in these three studies and extend the cohort to 3000 more participants (to complete 2019).

This has allowed us allowed us to analyse, in addition to classical cardiovascular risk factors, other aspects, such as physical activity and diet. In recent years we have focused on the study of HDL functionality and LDL atherogenicity, by means of cellular experiments, enzymatic techniques, and analysising the composition and oxidative status of the lipoprotein.

Other biochemical factors like inflammation and oxidation, as well as endothelial, cardiac, haemodynamic, and haemostatic function have been measured using LUMINEX X-Map / X-Mag technology. In 2005, and in the re-examination of participantsfrom 2010-13, we added the ankle-brachial pressure index (ABPI) measurements and the intima-media thickness (IMT) of the carotid artery. These cross-sectional studies have enabled us to determine trends in the prevalence of cardiovascular risk factors in our population. They have also allowed us to carry out various analyses of the association of risk factors and cardiovascular disease through case studies and controls, using AMI cases from the REGICOR hospital registry and population controls.

In 2007, we started to collaborate with the ISGlobal to re-examine participants from the 2000 transverse study and determine whether there was a relationship between the intima-media thickness of the carotid artery and exposure to air pollution (REGICOR-2000-AIR study).

Challenges for the next three years: we currently have two funded projects underway on the role of microRNAs in the development of 10-year ischemic cardiopathy in the general population.

Cardiovascular Risk Functions:

Milestones: The predictive equations of cardiovascular risk developed in Framingham, have been adapted for the Catalan population. Based on the adapted equation, easy-to-use tables were constructed for clinical practice. These contained the risks of heart attack at 10 years depending on the characteristics of the risk factors (cholesterol, blood pressure, smoking, diabetes, age, and gender). The tables have been validated in three subsequent cohort studies (the VERIFIES study, the REGICOR cohort, and the FRESCO study that combines 11 cohorts from various autonomous communities).

We have 3 operating patents that originated from our research, partly funded by ACCIO thanks to the incorporation of 9 coronary risk genotypes in the REGICOR risk function.

Challenges for the next three years: in the context of CIBERCV, where Jaume Marrugat, PI of the REGICOR group, heads up programme 3 on Cardiovascular epidemiology, we are planning to unite the databases of 22 cohorts from all over Spain in order to validate and improve the risk functions already developed and further adapt them to the needs of Iberian Peninsula communities. In addition, we continuously analyse the reclassification capacity of new biochemical and genetic biomarkers when they are incorporated into the risk functions we have developed.

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Jaume Marrugat(ELIMINAR)

93 316 07 33

93 316 07 96

Dr. Aiguader, 88
08003 Barcelona

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