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Open Access Study protocol

Aragon workers’ health study – design and cohort description

José A Casasnovas1, Victor Alcaide2, Fernando Civeira3, Eliseo Guallar1045*, Borja Ibañez46, Jesús Jiménez Borreguero47, Martin Laclaustra4, Montserrat León1, José Luis Peñalvo4, José M Ordovás489, Miguel Pocovi1112, Ginés Sanz4 and Valentín Fuster134

Author Affiliations

1 Cardiovascular Research Unit, Instituto Aragonés de Ciencias de la Salud (I + CS), Zaragoza, Spain

2 Prevention Depatment, General Motors Spain, Figueruelas, Spain

3 Lipids Unit and Molecular Research Laboratory, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de Salud (I + CS), Zaragoza, Spain

4 Department of Epidemiology, Atherothrombosis, and Imaging, National Center for Cardiovascular Research (CNIC), Madrid, Spain

5 Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument St., Room 2-639, Baltimore, MD, 21205, USA

6 Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain

7 Department of Cardiology, Hospital de la Princesa, Madrid, Spain

8 Nutrition and Genomics Laboratory, US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, USA

9 Madrid Institute for Advanced Studies on Food (IMDEA Food), Madrid, Spain

10 Department of Biochemistry, Molecular and Cell Biology, University of Zaragoza, Zaragoza, Spain

11 Department of Biochemistry, Molecular and Cell Biology, University of Zaragoza, Instituto Aragonés de Ciencias de la Salud (I + CS), Zaragoza, Spain

12 Centre for Biomedical Network Research on Rare Diseases (CIBERER), Zaragoza, Spain

13 Zena and Michael A. Wiener Cardiovascular Institute, and the Marie-Josee and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, New York, USA

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BMC Cardiovascular Disorders 2012, 12:45  doi:10.1186/1471-2261-12-45

Published: 19 June 2012



Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers’ Health Study (AWHS) to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to describe the study design, aims and baseline characteristics of participants in the AWHS.


Longitudinal cohort study based on the annual health exams of 5,400 workers of a car assembly plant in Figueruelas (Zaragoza, Spain). Study participants were recruited during a standardized clinical exam in 2009–2010 (participation rate 95.6%). Study participants will undergo annual clinical exams and laboratory assays, and baseline and triennial collection of biological materials for biobanking and cardiovascular imaging exams (carotid, femoral and abdominal ultrasonography, coronary calcium score, and ankle-arm blood pressure index). Participants will be followed-up for 10 years.


The average (SD) age, body mass index, and waist circumference were 49.3 (8.7) years, 27.7 (3.6) kg/m2 and 97.2 (9.9) cm, respectively, among males (N = 5,048), and 40.8 (11.6) years, 24.4 (3.8) kg/m2, and 81.9 (9.9) cm, among females (N = 351). The prevalence of overweight, obesity, current smoking, hypertension, hypercholesterolemia, and diabetes were 55.0, 23.1, 37.1, 40.3, 75.0, and 7.4%, respectively, among males, and 23.7, 8.3, 45.0, 12.1, 59.5, and 0.6%, respectively, among females. In the initial 587 study participants who completed all imaging exams (94.5% male), the prevalence of carotid plaque, femoral plaque, coronary calcium score >1 to 100, and coronary calcium score >100 was 30.3, 56.9, 27.0, and 8.8%, respectively. 67.7% of study participants had at least one plaque in the carotid or femoral arteries.


Baseline data from the AWHS show a high prevalence of cardiovascular risk factors and of sublinical atherosclerosis. Follow-up of this cohort will allow the assessment of subclinical atherosclerosis progression and the link of disease progression to traditional and emergent risk factors.