Jaume Marrugat Epidemiologist: “If you can’t stop looking at a screen for a few hours, you have a problem” | Health and wellness

Epidemiologist Jaume Marrugat (Barcelona, ​​68 years old) is a kind of guardian of cardiovascular health. Research on heart disease, its risk factors, and how to prevent it. More than 30 years ago, Regicor (Gironí del Cor Registry, in Catalan) was born, a research project with a group of 23,000 people from Girona to study cardiovascular diseases. “We found that in southern Europe, our incidence of heart disease and mortality was slightly lower than in northern European countries. We also saw that women who had a heart attack were identified too late, and this could not only be attributed to advanced age, but was Trouble recognizing the disease,” she recalls.

These findings, he says, have had a major impact on global research. Among them, some have been discovered — such as the effect of the Mediterranean diet on cardiovascular health — and others have been corrected: “We hacked into the medical community to make it known.” [que los infartos en mujeres se detectaban demasiado tarde] And we have verified that in the past 30 years, substantial improvements have been made: mortality and complications in women who have had a heart attack are practically the same rates as in men.

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

Ask. What would you do with that much money?

Answer. I work a lot. Genetic studies, that is, the association between genetic characteristics and disease, such as coronary artery disease, are expensive. Also, if you want to do it well, you need to get a lot of people involved. We took advantage of the fact that, as an epidemiologist, I know several groups in Spain that had already organized groups and been analysed, but no one had put them together: together they reached 170,000 people, of which 101,000 still had frozen DNA. .

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s. What’s the plan? What will they do?

R was found. First, concatenate all the data, all the variables. Then, of the people who keep the DNA, not all of them have had the DNA extracted from the cell and have to be removed. We’ll send this to the National Center for Genomics, which is in Galicia, and we’ll send them batches of samples. They will give us back the genetic result of more than four million genetic traits for each individual.

s. What do they expect to find?

R was found. This is the most exciting part because the idea that we have is, first, to check that what we’ve discovered so far we’ve also discovered. Secondly, we know that every 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 identification chip that will let us know what genetic profile a person has and say: you, With this genetic profile and here, you have the risk of these heart diseases.

s. Will it be possible to find out if a person is going to have a heart attack?

R was found. For example. But this is probabilistic, not deterministic. We now have diagnostic tests that, with dozens of genetic characteristics, can predict fairly accurately who is at high or low genetic risk. But having a high genetic risk doesn’t necessarily mean you’ll have a heart attack by age 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 kids living a life of screens, because that takes the place of exercise

s. What other variables are you playing against?

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R was found. There are risk factors that doctors deal with, such as high blood pressure, cholesterol, and diabetes. But then there are all the lifestyle-related ones: diet, physical activity, as well as socioeconomic status. The latter is a very important determinant of cardiovascular disease and is determined to a large extent by the educational level, where you were born: the socioeconomic level, in a way, correlates with knowledge and the ability to understand risk.

s. there more?

R was found. There is also another factor that we do not take much into account, and that is air pollution and then there is addiction: tobacco is the first, but we have other factors that give us a bad life and lead us to a sedentary lifestyle. For example, addiction to screens. We are concerned that young people and children start living their lives on screens from a very early age because screen living replaces going out, playing football, running or playing sports. If we lose the exercise habit very early in life, we will never get it back.

s. Is addiction to screens a new risk factor for cardiovascular disease?

R was found. Very clear screen addiction can be a significant cardiovascular risk factor when associated with a sedentary lifestyle and poor diet.

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

R was found. Sure, a psychiatrist or psychiatrist would have more criteria than me for defining it, but I think one has to analyze oneself and keep in mind that if you ever feel anxious because you weren’t looking at a screen, that’s a bad sign. That is, if you can’t control it and you’re constantly looking up, if you can’t stop looking at the screen for a few hours, you have a problem.

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s. There is a very controversial recommendation regarding the prevention of cardiovascular disease: take a glass of wine with food. How do you see that?

R was found. This is a very complex subject because it is mixed with the problem of addiction: there are people who become addicted to alcohol and others who can drink a drink every month and nothing happens; So, if you are addicted, you have a very serious problem. Furthermore, something else that is not debatable is the scientific knowledge we have about the effect of alcohol: any consumption, however small, increases general mortality, and even if it decreases slightly in the case of cardiovascular disease, it is irrelevant because it decreases cardiovascular death rate but elevates the gastrointestinal tract eg. This means, after all, that the global death rate 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. Now, everyone can do whatever they want with their lives, but I think doctors are morally prohibited from recommending any kind of alcohol consumption. And if the doctor does this, then he is not responsible.

Jaume Marrugat, in the facilities of the Biomedical Research Park in Barcelona, ​​​​where his office is as a researcher at the Hospital del Mar Medical Research Institute.
Jaume Marrugat, in the facilities of the Biomedical Research Park in Barcelona, ​​​​where his office is as a researcher at the Hospital del Mar Medical Research Institute. Massimiliano Menocry

s. Cardiovascular diseases are still the number one cause of death in the world. Why isn’t this getting better?

R was found. It is really getting better, but little by little. because? Because we are not immortal, and in the end, what we do is delay the emergence of this kind of complexities. But if you’re prepared, even if you take very, very careful care, you probably won’t have a heart attack at 50 or 60, but you’ll probably have one at 90. What we did is stress [la enfermedad cardiovascular] at an older age.

s. So, isn’t that too bad in terms of prevention?

R was found. definitely. We can be very happy. We’d be more if nothing [de problemas cardiovasculares], but this is very difficult. The health system and primary care have done a lot for prevention. The aid significantly reduced the death rate: in 1978, deaths from myocardial infarction of those who arrived at the hospital were 18% and currently it does not reach 4%. That is, if you had a heart attack and made it to the hospital, the chance that you would die is small. I also believe that citizens are becoming more aware of the problem. We’re getting better, but it’s still the leading cause of death.

s. Where is there room for improvement?

R was found. We have to try to reduce the number of people who need help and that 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 and ignore them, you miss an opportunity.

If the doctor advises any kind of alcohol, he is not responsible.

s. With the Covid pandemic, cardiologists warned they were seeing very dangerous heart attacks. To what extent has the health crisis affected cardiovascular epidemiology?

R was found. What we do know is that the number of cases suddenly dropped because people stayed home for fear of going to the hospital: those who had small heart attacks they had and nothing happened, but those big heart attacks were from people who were having them. I waited so long. We also know that this virus has caused heart lesions and there is a connection: Corona virus definitely affects the heart. Therefore, this type of susceptibility goes hand in hand with the coronary artery disease that was present in the community, and a mixture that is difficult to explain has been produced. We will have a few dark years in the history of cardiovascular epidemiology. What is clear is that it has affected, one way or another: those who have had very small heart attacks have eliminated them at home, and perhaps little by little they will be integrated into secondary prevention because now, for the time being, they have stayed there trapped and the most dangerous, will drag gravity for the rest his life.

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

R was found. We still need to determine how well the mechanisms producing atherosclerosis work and how we can modulate the pathological course of these fatty deposits in the arteries. Why are there people who are 90 years old and have no atherosclerotic lesion? We need to delve deeper into the mechanisms and understand why the arteries’ ability to clear cholesterol is impaired.

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