1
|
Corredoira P, Marco-Benedi V, Cenarro A, Peribáñez S, Olmos S, Civeira F. Factors associated with the presence of tendon xanthomas in familial hypercholesterolemia. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00013-6. [PMID: 38185215 DOI: 10.1016/j.rec.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION AND OBJECTIVES Tendon xanthomas (TX) are lipid deposits highly specific to familial hypercholesterolemia (FH). However, there is significant variability in their presentation among FH patients, primarily due to largely unknown causes. Lipoprotein(a) is a well-established independent risk factor for atherosclerotic cardiovascular disease in the general population as well as in FH. Given the wide variability of lipoprotein(a) among FH individuals and the likelihood that TX may result from a proatherogenic and proinflammatory condition, the objective of this study was to analyze the size of TX in the Achilles tendons of FH participants and the variables associated with their presence, including lipoprotein(a) concentration. METHODS A cross-sectional study was conducted on 377 participants with a molecular diagnosis of heterozygous FH. Achilles tendon maximum thickness (ATMT) was measured using ultrasonography with standardized equipment and procedures. Demographic variables and lipid profiles were collected. A multivariate linear regression model using a log-Gaussian approach was used to predict TX size. Classical cardiovascular risk factors and lipoprotein(a) were included as explanatory variables. RESULTS The mean low-density lipoprotein cholesterol level was 277mg/dL without lipid-lowering treatment, and the median ATMT was 5.50mm. We demonstrated that age, sex, low-density lipoprotein cholesterol, and lipoprotein(a) were independently associated with ATMT. However, these 4 variables did not account for most the interindividual variability observed (R2=0.205). CONCLUSIONS TX, a characteristic hallmark of FH, exhibit heterogeneity in their presentation. Interindividual variability can partially be explained by age, male sex, low-density lipoprotein cholesterol, and lipoprotein(a) but these factors account for only 20% of this heterogeneity.
Collapse
Affiliation(s)
- Pablo Corredoira
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Victoria Marco-Benedi
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana Cenarro
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
| | - Sonia Peribáñez
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Salvador Olmos
- Instituto Universitario de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Fernando Civeira
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
| |
Collapse
|
2
|
Názara C, Argüeso RM, Pedro-Botet J, Pintó X, Millán J, Pena Seijo M, Fernández PA, Eugenia Ameneiros M, Del Alamo A, Rodríguez A, Díaz-Peromingo JA, Vázquez Freire MR, Muñiz J, Pérez-Castro TR, Díaz-Díaz JL, Pose Reino A. Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study. Clin Investig Arterioscler 2023; 35:178-184. [PMID: 36717323 DOI: 10.1016/j.arteri.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. METHODS Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. RESULTS The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. CONCLUSIONS The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.
Collapse
Affiliation(s)
- Carlos Názara
- Centro de Atención Primaria de Marín, Marín, Pontevedra, España
| | - Rosa M Argüeso
- Servicio de Endocrinología y Nutrición, Hospital Universitario Lucus Augusti, Lugo, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar; Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Bellvitge, CiberObn, Idibell, Fipec, Universidad de Barcelona, Barcelona, España
| | - Jesús Millán
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón; Facultad de Medicina Universidad Complutense, Madrid, España
| | - Marta Pena Seijo
- Fundación Pública Urgencias Sanitarias de Galicia-061, Santiago de Compostela, A Coruña, España
| | - Pablo A Fernández
- Servicio de Endocrinología y Nutrición, Hospital de Montecelo, Pontevedra, España
| | - M Eugenia Ameneiros
- Servicio de Medicina Interna, Hospital Arquitecto Marcide, Ferrol, A Coruña, España
| | | | - Avelino Rodríguez
- Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - José Antonio Díaz-Peromingo
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | | | - Javier Muñiz
- Universidad de A Coruña, Grupo de Investigación Cardiovascular (GRINCAR), Instituto Universitario de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España
| | - Teresa R Pérez-Castro
- Universidad de A Coruña, Grupo de Investigación Cardiovascular (GRINCAR), Instituto Universitario de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España
| | - José Luis Díaz-Díaz
- Unidad de Lípidos y Riesgo Cardiovascular Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña, A Coruña, España.
| | - Antonio Pose Reino
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| |
Collapse
|
3
|
Pavía-López AA, Alcocer-Gamba MA, Ruiz-Gastelum ED, Mayorga-Butrón JL, Mehta R, Díaz-Aragón FA, Aldrete-Velasco JA, López-Juárez N, Cruz-Bautista I, Chávez-Mendoza A, Secchi-Nicolás NC, Guerrero-Martínez FJ, Cossio-Aranda JE, Mendoza-Zubieta V, Fanghänel-Salmon G, Valdivia-Proa M, Olmos-Domínguez L, Aguilar-Salinas CA, Dávila-Maldonado L, Vázquez-Rangel A, Pavia-Aubry V, Nava-Hernández MDLA, Hinojosa-Becerril CA, Anda-Garay JC, Ríos-Ibarra MODL, Berni-Betancourt AC, López-Cuellar J, Araiza-Garaygordobil D, Rivera-Reyes R, Borrayo-Sánchez G, Tapia-Hernández M, Cano-Nigenda CV, Guerra-López A, Elías-López J, Figueroa-Morales MA, Montaño-Velázquez BB, Velasco-Hidalgo L, Rodríguez-Lozano AL, Pimentel-Hernández C, Baquero-Hoyos MM, Romero-Moreno F, Rodríguez-Vega M. Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica. Arch Cardiol Mex 2022; 92:1-62. [PMID: 35275904 PMCID: PMC9290432 DOI: 10.24875/acm.m22000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
ANTECEDENTES Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.
Collapse
Affiliation(s)
| | - Marco A Alcocer-Gamba
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | | | - José L Mayorga-Butrón
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
| | - Roopa Mehta
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Filiberto A Díaz-Aragón
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Nitzia López-Juárez
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
- Sociedad Mexicana de Nutrición y Endocrinología, Ciudad de México, México
| | - Ivette Cruz-Bautista
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
- Sociedad Mexicana de Nutrición y Endocrinología, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Francisco J Guerrero-Martínez
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, Ciudad de México, México
| | | | | | - Guillermo Fanghänel-Salmon
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, Ciudad de México, México
| | | | - Luis Olmos-Domínguez
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | | - María de Los A Nava-Hernández
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | | | - Juan C Anda-Garay
- Colegio de Medicina Interna de México, Ciudad de México, México
- Hospital de especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | | - Romina Rivera-Reyes
- Sociedad Mexicana de Cardiología, Ciudad de México, México
- Facultad de Medicina, Universidad Autónoma de Querétaro, Qro., México
| | - Gabriela Borrayo-Sánchez
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
- Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | - Josué Elías-López
- Unidad Médica de Alta Especialidad Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Marco A Figueroa-Morales
- Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Bertha B Montaño-Velázquez
- Ibero American Agency for Development & Assessment of Health Technologies (A2DAHT), Ciudad de México, México
| | | | - Ana L Rodríguez-Lozano
- Departamento de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | | | | | - Mario Rodríguez-Vega
- Ibero American Agency for Development & Assessment of Health Technologies (A2DAHT), Ciudad de México, México
| |
Collapse
|
4
|
Guijarro C, Civeira F, López-Miranda J, Masana L, Pedro-Botet J, Pintó X, Valdivielso P, Mostaza JM. Situation in 2020 of the requirements for the use of PCSK9 inhibitors in Spain: Results of a national survey. Clin Investig Arterioscler 2021; 34:10-18. [PMID: 34656373 DOI: 10.1016/j.arteri.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
AIMS During 2019 and 2020 a series of meetings over the country were carried out, with the aim of explaining the methodology and criteria for the ellaboration of the recommendations on the use of iPCSK9, published by the Spanish Society of Atherosclerosis (SEA in Spanish). At the end of the meetings, a survey was conducted among the participants, in order to describe the prescription requirements of these drugs in the Spanish regions. METHODOLOGY Butterfly Project was developed by a scientific Committee of experts in lipids. After the ellaboration of the materials for the project, a train the trainers program was carried out, imparted by 17 experts who were the Project coordinators. Later, 16 regional workshops were performed, with the attendance of 169 medical doctors involved in the management of hipercolesterolemia. The attendants responded the survey, where they were asked different questions on the use of iPCSK9 on their clinical practice. RESULTS A high heterogeneity among centers regarding the requirements and difficulties for iPCSK9 prescription was revealed. Twenty one per cent of responders indicated to have low difficulties to prescribe iPCSK9 in their hospitals, whereas 78% found moderate or high difficulties. The difficulties came from burocracy- administrative aspects (18%), restrictions in the indication (41%) and both (38%). In general, the obstacles did not depend on the hospital level, neither the speciality, or the presence of lipid units, although the existance of lipid units was associated with a higher number of patients treated with iPCSK9. The factors which were associated with higher difficulty in the prescription were: the presence of an approval committee in the hospitals, the frequency in the revision of the treatment by hospital pharmacy, the temporal cadence of the prescription, the profile of patients seen and the criteria followed by the specialists for the prescription. CONCLUSION The results show important diferences in the treatment with iPCSK9 in the context of clinical practice in Spain. The analysis of these results will permit to make proposals regarding future actions addressed to reach the equity in the access to iPCSK9 in Spain, with the main aim of maximizing their potential benefit according to the patients profile.
Collapse
Affiliation(s)
- Carlos Guijarro
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Fernando Civeira
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
| | - José López-Miranda
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBEROBN, Córdoba, España
| | - Luis Masana
- Servicio de Medicina Interna, Hospital Universitario de Reus, Universidad Rovira i Virgili, IISPV, CIBERBEM, Reus, Tarragona, España
| | - Juan Pedro-Botet
- Servicio de Medicina Interna, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge-Idibell, Universidad de Barcelona, CIBEROBN, L' Hospitalet de Llobregat, Barcelona, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | | |
Collapse
|