[Circadian rhythm and blood pressure in patients with ambulatory blood pressure monitoring and its relationship with the risk of cardiovascular events]

INTRODUCTION

Cardiovascular diseases are the group of diseases that cause most deaths worldwide, being arterial hypertension the modifiable risk factor that mostly predisposes to other cardiovascular diseases development. In this regard, ambulatory blood pressure monitoring (ABPM) lets to detect the different changes in blood pressure throughout 24h, known as circadian patterns (dipper, non-dipper, riser or extreme dipper). There may be an association between these patterns and cardiovascular risk, so this study aims to compare cardiovascular risk using the 2 validated scales REGICOR and SCORE in patients with different circadian patterns using ABMP.

MATERIAL AND METHODS

Retrospective study of hypertensive patients with ABMP registered between 2015 and 2021 in Alcázar de San Juan and Madridejos. Data were collected from clinical history (arterial hypertension, BMI, comorbidities, and smoking habits) and ABPM records, as well as sociodemographic and analytical variables, cardiovascular risk scales (REGICOR and SCORE) and circadian rhythm variables (dipper, extreme dipper, non-dipper and rise pattern).

RESULTS

Two hundred and sixty-nine patients (46.5% female, 64.3±12.6 years old) were included. There were 38.3% with dipper pattern, 10% extreme dipper, 33.1% non-dipper and 18.6% riser. Patients with riser pattern showed higher score on the REGICOR and SCORE scales (34 and 68%, respectively). A significant correlation was established between both scales (Spearman rho: 0.589; p<0.001), but with poor concordance (kappa=0.348 [95% CI 0.271-0.425]).

CONCLUSION

ABMP has turned into a very useful tool in the diagnosis and treatment of arterial hypertension. In addition, the circadian patterns of these patients may correlate to the choice of an adequate treatment and correct follow-up.

[Diabetes and women, why are we different?]

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes.

Cardiovascular risk assessment in inflammatory bowel disease with metabolic dysfunction-associated steatotic liver disease

BACKGROUND AND AIMS

Inflammatory bowel disease (IBD) has been reported to increase the risk of early atherosclerosis even in young patients. Moreover, metabolic dysfunction-associated steatotic liver disease (MASLD), which has been linked to IBD, is a well-recognized but underdiagnosis entity related to cardiovascular risk. We analyze the impact of MASLD in IBD patients' cardiovascular risk through both advanced lipoprotein profile sorted by nuclear magnetic resonance spectroscopy, and carotid artery intima-media thickness (CIMT).

METHODS

Cross-sectional cohort study which involves 941 IBD adult outpatients. Of them, 50 patients with IBD who met criteria for MASLD and 50 with IBD without MASLD, matched by sex and age were included. Alterations in CIMT were evaluated considering abnormal measures above the 75th percentile adjusted for sex and age. Specific advanced lipoprotein profile was also carried out.

RESULTS

Most of the patients had an abnormal CIMT (58%). MASLD (OR=5.05, CI 95%=1.71-14.92) and female sex (OR=3.32, CI 95%=1.03-10) were significantly associated with CIMT alterations. Dense LDL particles (with high cholesterol composition in general cohort (OR=3.62, 95% CI=1.07-12.19) and high triglycerides density in young subgroup (OR=6.25, 95% CI=1.04-50) but not total LDL cholesterol were associated with CIMT alterations.

CONCLUSIONS

MASLD and female sex are associated with early atherosclerosis in IBD patients. Dense LDL particle in combination with vascular imaging findings should be evaluated as non-invasive tools in the management of cardiovascular risk in IBD patients.

[Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]

INTRODUCTION AND OBJECTIVES

Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension.

METHODS

Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed.

RESULTS

In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction.

CONCLUSIONS

The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care

OBJECTIVE

To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM).

MATERIAL AND METHODS

Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5μIU/mL.

RESULTS

156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%).

CONCLUSIONS

Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.

Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.

The value of waist circumference as a preditor of cardiovascular risk in adult patients with classic phenylketonuria

BACKGROUND AND AIMS

We aimed to evaluate the differences in some cardiovascular risk (CVR) factors between adult patients without and with phenylketonuria (PKU) and to explore the correlation between waist circumference (WC) and body mass index (BMI) with the previous variables.

METHODS

This was an observational case-control study that included patients older than 18 years with a diagnosis of classic PKU. The controls were age- and sex-matched individuals. We collected demographic, epidemiological, clinical, and laboratory variables, including WC, BMI, and lipid profile parameters.

RESULTS

A total of 72 patients (25 controls and 47 cases) were included with a mean age of 36 years, of which 45 (62%) were women. Adult PKU patients showed lower high-density lipoprotein cholesterol (HDL-c) and higher triglyceride (TG) levels than the control group. We found an association between WC and uric acid (B=0.024, P=0.013, 95%CI: 0.005-0.043), TG (B=0.768, P=0.024, 95%CI: 0.107-1.428), and HDL-c (B=-0.254, P=0.026, 95%CI: -0.477 to (-0.032)) levels in PKU patients. However, we did not find any trend between WC and uric acid, TG and HDL-c levels that reached statistical significance (P<0.05) in patients without PKU.

CONCLUSIONS

Waist circumference rather than BMI may better represent the CVR in patients with PKU.

Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

BACKGROUND

People with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists).

METHODS

A committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only).

RESULTS

IDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation.

CONCLUSION

Our findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.

Observational study of patients from a Lipid Unit on lipid-modifying therapy for primary and secondary prevention: ULFI Study

OBJECTIVES

To evaluate the achievement of low-density lipoprotein cholesterol (LDLc) goals established by the 2019 European Guidelines for the Management of Dyslipidemias and 2021 Cardiovascular Disease Prevention Guidelines, describe the lipid-lowering treatment received, analyze the achievement of goals according to the lipid-lowering treatment received and study the factors associated with therapeutic success.

DESIGN

Observational study that included 185 patients of both sexes aged 18 or over undergoing lipid-lowering treatment for primary or secondary prevention, attended at the Lipid Unit.

RESULTS

62.1% of the patients had a very high cardiovascular risk (CVR) according to the 2019 guidelines, and 60.5% according to the 2021 guidelines. Of the total cases, 22.7% achieved adequate control of LDLc according to the 2019 guidelines and 20% according to the 2021 guidelines. 47.6% of the patients received very high intensity lipid-lowering treatment, and 14.1% received extremely high intensity lipid-lowering treatment. 76% of subjects with very high CVR on extremely high intensity lipid-lowering treatment achieved the therapeutic objectives of both guides. In the multivariate analysis, factors associated with therapeutic success were the presence of arteriosclerotic cardiovascular disease, the intensity of lipid-lowering treatment, diabetes mellitus, and low to moderate alcohol consumption.

CONCLUSIONS

Dyslipidemia control is improvable. High or extremely high intensity lipid-lowering treatments can contribute to optimizing control of patients with higher CVR.

Long-term treatment persistence and maintained reduction of LDL-cholesterol levels with evolocumab over 30 months: Results from the Spanish cohort of the European prospective HEYMANS study

AIMS

Limited data exist on low-density lipoprotein-cholesterol (LDL-C) level variability or long-term persistence with the monoclonal antibody evolocumab in routine clinical practice. HEYMANS (NCT02770131) is the first multi-country, multicenter, observational study of European patients initiating evolocumab as part of their routine clinical management, based on local reimbursement criteria (overall data recently published). The aim of this analysis is to describe clinical characteristics, baseline and changes in LDL-C levels, treatment patterns and persistence to evolocumab over 30 months in the Spanish cohort using data from the HEYMANS Registry.

METHODS

HEYMANS was a prospective study of adult patients (≥18 years) who received at least one dose of evolocumab. A total of 1951 patients were enrolled from 12 countries and were followed up for 30 months after evolocumab initiation. Data were collected for 6 months before evolocumab initiation and up to 30 months thereafter. The Spanish cohort included patients who started evolocumab in routine clinical practice from March 2016 to September 2019. Demographic and clinical characteristics, lipid-lowering therapies (LLT), and lipid levels were collected.

RESULTS

In total, 201 patients were included in the Spanish cohort. Median follow-up (Q1-Q3) was 30.0 (12-30) months. A total of 61.7% of patients were men and the mean (standard deviation) age was 59.5 (10.8) years. Most patients (68.7%) had experienced a prior cardiovascular event, 45.3% had coronary artery disease or stable angina, and 60.2% had a diagnosis of familial hypercholesterolemia. Overall, 57.7% of patients were receiving treatment with statins, most of them with high-intensity statins (85.3%); 45.8% of patients were intolerant to statins, and 26.4% of patients did not receive any LLT. At baseline, median (Q1-Q3) LDL-C levels were 151 (123-197) mg/dL. After 3 months of treatment, baseline LDL-C decreased by 66% to a median of 50 (30-83) mg/dL and these levels were maintained over time, with a median LDL-C of 55 (40-99) mg/dL at 30 months. At months 10-12 of treatment, LDL-C levels<55mg/dL were achieved by 56.3% of patients. LDL-C levels<70mg/dL were achieved by 70.1% of patients, and a lowering of LDL-C levels ≥50% was achieved by 76.8% of patients. The percentage of patients on evolocumab treatment was 95% at 12 months and 93% at 30 months.

CONCLUSIONS

In the Spanish cohort in routine clinical practice, evolocumab therapy provided a reduction in LDL-C levels consistent with that reported in previous clinical trials, which was sustained during 30 months of follow-up. Treatment with evolocumab was started at LDL-C levels 50% higher than those recommended by The Spanish Society of Arteriosclerosis and the Therapeutic Positioning Report. The probability of achieving the 2019 ESC/EAS LDL-C goals would improve with combination therapy and also with a lower LDL-C threshold when starting evolocumab. Persistence to evolocumab remained high during follow-up, with a very low percentage of discontinuation (5% at 12 months; 7% at 30 months).

Doctors' perception of red wine consumption and cardiovascular health

INTRODUCTION

The consumption of red wine has historically been associated with a reduction in cardiovascular risk, with sometimes controversial scientific evidence.

METHOD

A survey was carried out via whatsapp dated 09/01/22 to a cohort of doctors from the province of Malaga, asking about possible healthy red wine consumption habits, differentiating: never, 3-4 glasses per week, 5 -6 weekly drinks and one daily drink.

RESULTS

A total of 184 physicians answered, with a mean age of 35 years ± 11.1, of which 84 (45.6%) were women, distributed in different specialties, the majority being internal medicine with 52 (28.2%). The most frequently chosen option was D (59.2%), followed by A (21.2%), C (14.7%) and B (5%).

CONCLUSIONS

More than half of the doctors surveyed recommended zero consumption, and only 20% indicated that a daily drink could be healthy in non-drinkers.

[Lower urinary tract symptoms in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life]

OBJETIVES

To determine the prevalence of erectile lower urinary tract symptoms in hypertensive patients, cardiovascular risk and the impact on quality of life.

MATERIAL AND METHODS

Setting: Health Center (Vilagarcia, Pontevedra).

PERIOD

April 2015-June 2017.

INCLUSION CRITERIA

Hypertensive patient with informed consent.

MEASUREMENTS

sociodemographic variables, toxic habits, comorbidity, blood pressure, cardiovascular risk, analytical and examination parameters. Questionaries: International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF-15) and quality of life in arterial hypertension (MINICHAL).

SAMPLE SIZE

n=262 (± 6% accuracy, 95% confidence).

STATISTICAL ANALYSIS

Bivariate and multivariate statistical analysis. Informed consent and ethics committee approval were obtained (2024/237) RESULTS: The mean age was 65.84 (12.70), and mean hypertension duration of 13.25 (9.84) years. 76.7% reported lower tract urinary symptoms, 91.6% being mild. The bivariate analysis showed an association with the variables: age, educational level, profession, work activity, tobacco, benign prostatic hypertrophy, years of diagnosis, concomitant medication, Framingham-Wilson score, electrocardiogram, glycated hemoglobin, glomerular filtration (Crockroft-Gault), LDL-cholesterol, somatic manifestations (MINICHAL), erectile dysfunction. The multivariate analysis showed increased risk with:abdominal obesity, pathological electrocardiogram, high risk of Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents and decreased with not smoking and use diuretics.

CONCLUSIONS

Three quarters of hypertensive men presented lower urinary tract symptoms, increasing the risk of cardiovascular disease early according to the Framingham-Wilson score. Other predictive factors were: abdominal obesity, tobacco, pathological electrocardiogram, high Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents.

[Therapeutic adherence of patients with cardiovascular risk in primary care. REAAP project]

OBJECTIVE

To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement.

MATERIAL AND METHODS

A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics.

RESULTS

Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients' therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations.

CONCLUSIONS

There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves.

Hypercholesterolaemia control in Spain: The same situation with different regional realities

INTRODUCTION AND OBJECTIVE

The cardiovascular prevention strategy by autonomous communities can be variable since the competences in health are transferred. The objective of the study was to determine the degree of dyslipidaemia control and the lipid-lowering pharmacological therapy used in patients at high/very high cardiovascular risk (CVR) by autonomous communities.

METHODS

Observational, cross-sectional, descriptive study based on a consensus methodology. Information on the clinical practice of 145 health areas belonging to 17 Spanish autonomous communities was collected through face-to-face meetings and questionnaires administered to the 435 participating physicians. Furthermore, aggregate non-identifiable data were compiled from 10 consecutive dyslipidaemic patients that each participant had recently visited.

RESULTS

Of the 4010 patients collected, 649 (16%) had high and 2458 (61%) very high CVR. The distribution of the 3107 high/very high CVR patients was balanced across regions, but there were inter-regional differences (P<.0001) in the achievement of target LDL-C <70 and <55mg/dL, respectively. High-intensity statins in monotherapy or in combination with ezetimibe and/or PCSK9 inhibitors were used in 44, 21 and 4% of high CVR patients, while in those at very high CVR it rose to 38, 45 and 6%, respectively. The use of these lipid-lowering therapies at national level was significantly different between regions (P=.0079).

CONCLUSIONS

Even though the distribution of patients at high/very high CVR was similar between autonomous communities, inter-territorial differences were identified in the degree of achievement of LDL cholesterol therapeutic goal and use of lipid-lowering therapy.

Accuracy of visceral adiposity indices and lipid accumulation products in the identification of adults at high cardiovascular risk

INTRODUCTION

The lipid accumulation product (LAP) and visceral adipose index (VAI) are clinical markers of visceral obesity and were proposed as simple tools to estimate cardiovascular risk and mortality. The objective of this study was to analyze the accuracy of the VAI and LAP for high cardiovascular risk patients.

METHODS

A cross-sectional observational study of accuracy was carried out in 193 patients of both sexes. In addition to the variables VAI and LAP, presence of comorbidities, education, level of physical activity and anthropometric data were obtained. Cardiovascular risk was determined by the Framingham score.

RESULTS

No significant difference was observed in the sample in gender distribution (44.6% women; 55.4% men), 24.4% had low cardiovascular risk, 48.7% intermediate risk and 26.9% high cardiovascular risk. Linear regression analysis showed that VAI and LAP explain, respectively, only 2.4% and 5.2% of the variation in cardiovascular risk expressed by the Framingham score. The analysis of areas under the curve (AUC) for receiver operating characteristic (ROC) indicated a significant effect only of LAP to diagnose individuals with high cardiovascular risk, but with low sensitivity and specificity.

CONCLUSION

Our results indicate that VAI and LAP explain only a small percentage of the variation in the Framingham cardiovascular risk score. LAP index still deserves more attention in a cohort study, because, even with the limitations of a cross-sectional study, we observed an acceptable sensitivity for it so that the LAP can be used as a screening criterion for requesting more accurate tests.

Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study

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.

Albuminuria and cardiovascular risk

Cardiovascular risk (CVR) estimation is a fundamental tool for guiding therapy. Albuminuria indicates target organ damage in an accessible, economic and non-invasive manner. Improves high-risk patient identification, especially in chronic kidney disease (CKD) and diabetes mellitus (DM). In addition, anti-albuminuric treatments may improve CVR. This would position albuminuria as a guide and therapeutic objective. Although the capacity of albuminuria as an epidemiological CVR marker in specific populations (hypertension, CKD, DM) is accepted, its profile as a risk marker in the general population and as a therapeutic target is controversial. There is ambiguous evidence regarding its predictive capacity, added to the fact that treatments such as SLGT2 blockers reduce CVR events regardless of albuminuria presence or magnitude. This review analyzes the available evidence on albuminuria as a CVR marker, a treatment goal and therapeutic guide.

Peripheral arterial disease in hemodialysis patients 10 years later

BACKGROUND AND OBJECTIVE

Patients with chronic kidney disease (CKD) on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in HD patients that have received treated early and compare them with a cohort of our center already reported.

MATERIAL AND METHODS

Retrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale.

RESULTS

Initially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ± 16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20-57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD). The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ± 3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic. Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp β: 2.17; P = 0.011; CI (1.19-3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp β: 1.73; P = 0.006; CI (1.17-2.56).

CONCLUSIONS

A significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69, ≥70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Prevalence of diabetes, epidemiological characteristics and vascular complications

OBJECTIVE

To estimate prevalence of diabetes in outpatient care and to describe its epidemiological characteristics, comorbidities, and related vascular complications.

METHODS

Observational cross-sectional study which included all adults affiliated from a private insurance health plan on March 2019, at Hospital Italiano de Buenos Aires, from Argentina.

RESULTS

The global prevalence of diabetes resulted in 8.5% with 95% CI 8.3-8.6 (12,832 out of a total of 150,725 affiliates). The age stratum with the highest prevalence was the group between 65 and 80 years old with 15.7% (95% CI 15.3-16.1). People with diabetes had a mean age of 70 years (SD 14), 52% were women, and the most frequently associated cardiovascular risk factors were: dyslipidaemia (88%), arterial hypertension (74%) and obesity (55%). In relation to metabolic control, 60% had at least one glycosylated hemoglobin measured in the last year, 70% of which were less than 7%. Almost 80% have LDL measured at least once in the last 2 years, 55% of them had an LDL value equal to or less than 100 mg/dl. The macrovascular complications present in order of frequency were: acute myocardial infarction (11%), cerebrovascular accident (8%) and peripheral vascular disease (4%); while the microvascular complications were found to be diabetic neuropathy (4%) and retinopathy (2%). 7% had diabetic foot, with less than 1% amputations.

CONCLUSION

Diabetes represents a prevalent problem, even in elderly patients. This population continues to present a high cardiovascular risk, with little compliance with therapeutic goals.

GALIPDIA study: Reaching lipid targets in a population with type 2 diabetes (T2DM) from the Northwest of Spain

AIM

To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM).

METHODS

Multicentre retrospective cross-sectional study, conducted in 380 adults with T2DM and dyslipidaemia in 7 Spanish health areas.

INCLUSION CRITERIA

minimum follow-up of one year in Endocrinology Units, at least one visit in 2020 and a lipid profile measurement in the last 3 months.

EXCLUSION CRITERIA

familial hypercholesterolaemia, recent hospitalisation, active oncological pathology and dialysis.

RESULTS

According to the 2016 and 2019 guidelines the majority of patients were classified as being at very high cardiovascular risk (86.8% vs. 72.1%, respectively). LDL-c compliance was adequate in 62.1% of patients according to the 2016 guidelines and 39.7% according to the 2019 guidelines (p<0.001). Clinical conditions such as history of cardiovascular disease and therapy-related aspects (use of statins, especially high-potency statins, combination therapies and good adherence) were significantly associated with greater achievement of lipid targets.

CONCLUSION

There is a discrepancy between dyslipidaemia guideline recommendations and the reality of lipid control in patients with T2DM, despite most of these patients being at very high cardiovascular risk. Strategies to optimise lipid-lowering treatments need to be implemented.

Cardiovascular disease risk in the transgender population

This review summarizes the impact of gender affirming hormone therapy used in the transgendered population and the classic and emerging risk factors on cardiovascular outcomes and surrogate markers of cardiovascular health. There is a growing body of evidence that people who are transgender and gender diverse are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Previously, disparities have been reported in cardiovascular morbidity and mortality across this group as a result of a higher prevalence of non-healthy life style. However, recent research suggests that there are additional factors playing a role in this differences: there is the hypothesis that the excess of cardiovascular morbility and mortality has been driven by psychosocial stressors across the lifespan at multiple levels, as structural violence (e.g., discrimination, lack of affordable housing, lack of access to health care, etc.). Lack of information and research in this population is an important limitation; therefore, a multifaceted approach that integrates best practice into research, health promotion and cardiovascular care for this understudied and growing population is clearly needed.

Cardiometabolic effects of direct-acting antivirals in patients with hepatitis C

Hepatitis C virus (HCV) has long been associated with several extrahepatic manifestations, including increased cardiovascular risk. The emergence of direct-acting antivirals (DAAs) has allowed us to evaluate the potential reversal of these manifestations after successful treatment. Therefore, many studies have provided significant takeaways regarding the positive effect of DAAs therapy on insulin resistance, type 2 diabetes mellitus, cardiovascular disease and atherosclerosis. In contrast, studies have shown detrimental effects on lipid metabolism and indeterminate results regarding renal function and uric acid metabolism. Nevertheless, as more and more patients achieve sustained virological response, the effects of HCV eradication on cardiometabolic processes will be extensively studied, allowing more reliable conclusions on the extent of extrahepatic outcomes.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global cardiovascular disease risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (steps 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After step 1, considering proceeding to the intensified goals of step 2 is mandatory, and this intensification will be based on 10-year cardiovascular disease risk, lifetime cardiovascular disease risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm ?SCORE2, SCORE2-OP? is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal cardiovascular disease events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according to different age groups (<50, 50-69, ≥70 years). Different flow charts of cardiovascular disease risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic cardiovascular disease, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention]

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

VNTR (CAG)n polymorphism of the ATXN2 gene and metabolic parameters of cardiovascular risk associated with the degree of obesity in the Amerindian population of Oaxaca

INTRODUCTION

The ATXN2 gene has a VNTR (CAG)n with locus in exon1. Long alleles within the normal range (22-29 repeats) are associated with severe obesity in people from the United Kingdom, Indonesia and the Caribbean.

OBJECTIVE

To analyse the influence of VNTR (CAG)n on metabolic profile in adults with obesity and pre-obesity, as well as to estimate its effect on the risk of developing diabetes.

METHODS AND MATERIAL

255 adults of Chinantec Amerindian ethnic origin were included, who underwent anthropometric and biochemical evaluation. The VNTR was amplified by end-point PCR and by 8% PAGE electrophoresis.

RESULTS

Differences were found in the waist/hip circumference index and body mass index in the carriers of genotypes different to the one homozygous for 22 repeats with a Student's t-test value of 0.0041 and 0.0334, respectively. We also found an association with a family history of chronic disease.

CONCLUSION

The VNTR of ATXN2 is associated with obesity in Mexican adults of Chinantec ancestry.

Application of the individualized objectives defined by the European 2019 lipid guidelines in patients with type 2 diabetes

BACKGROUND AND OBJECTIVE

Cardiovascular disease is one of the main complications of people with type 2 diabetes (T2D). The ESC/ESA 2019 lipid guide has led to a change in dyslipidemia control. We analyze the evolution of the lipid profile, the fulfillment of the low-density cholesterol (LDL-C) targets, how patients are classified and the impact of this guide on lipid control in T2D patients.

MATERIALS AND METHODS

A prospective cohort study from 2017 to 2020 from a cohort of 297 T2D out of a total of 1229 (95% confidence level). We classified patients according to their cardiovascular risk and whether they met or not their LDL-C goal.

RESULTS

Age 62.58±10.68 years; 52.79% men. Mean LDL-C levels 116.2 at baseline and 100.2mg/dL at 4 years (P<.001). They met their individualized LDL-C target after publication of the guide: 57 (21.67%). There were more controls who were under 65 years (57.9 vs. 36.9%; P<.01; RR 0.83), men (66.7 vs. 49.5%; P<.05; RR 0.86) and smokers (17.5 vs. 7.8%; P<.05). A percentage of 74.23 had a high cardiovascular risk and a target LDL-C<70mg/dL.

CONCLUSIONS

Since the publication of the ESC/ESA 2019 lipid guide, a decrease in LDL-C levels has been observed. Only one in 5 patients fulfill their individualized LDL-C target. Male patients, under 65 years of age and smokers presented an advantage in meeting their goal. Most T2D patients have a high cardiovascular risk, and the predominant LDL-C target is less than 70mg/dL.

[Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study]

OBJECTIVE

To know the vascular age (VA) of a sample of general population included in the RICARTO study.

PATIENTS AND METHOD

Epidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex.

RESULTS

1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE).

CONCLUSIONS

VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

Interpretation of clinical trials on the cardiovascular effects of hypoglycemic drugs in people with type 2 diabetes

Randomized clinical trials on the cardiovascular effects of hypoglycemic drugs on people with type 2 diabetes mellitus began more than fifty years ago. In the last decade, the emergence of new classes of hypoglycemic drugs has led to the development of randomized clinical trials to assess their cardiovascular safety. Known as Cardiovascular Outcome Trials, they have provided a lot of new information that needs to be critically appraised if the knowledge obtained is to be applicable in clinical practice. To this end, the current article first comments on the guidelines to which these trials have adhered, then reviews some concepts for improving their interpretation (such as different types of analyses, the definition of objectives and the evaluation of their results), and concludes by mentioning the new guidelines to which future trials designed to evaluate the safety of new hypoglycemic drugs should adhere.

Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: an epidemiological study

BACKGROUND AND OBJECTIVES

In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW.

METHODS

We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dL. We compared the demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype.

RESULTS

Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ± 4.88 vs. 29.2 ± 4.82 kg/m2; p < .001) and glycated hemoglobin levels (7.38 ± 1.2% vs. 7 ± 1.07%; p < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; p < .001), exercise (44.6 vs. 58.2%; p < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; p < .001).

CONCLUSIONS

The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study

OBJECTIVE

To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments.

METHODS

One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA).

RESULTS

We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; p = .039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; p = .006).

DISCUSSION

A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

Incorporation of biochemical parameters and diagnostic algorithms in the laboratory computer system for the early detection of lipid abnormalities from the lipid units

INTRODUCTION

The combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk.

OBJECTIVES

To implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations.

MATERIAL AND METHODS

Study of the implementation of apolipoprotein B and lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramón Jiménez, Hospital Infanta Elena, and Hospital de Río Tinto during 2018 and 2019.

RESULTS

The 4diagnostic algorithms entered into the Laboratory Information System, showed a total of 9,985 patients with c-LDL>200mg/dl. The diagnostic algorithm was extended to include Apo B, with 8,182 determinations showing an apolipoprotein B>100mg/dl). A total of 747 lipoprotein (a) were determined, of which 30.65% were> 50mg/dl. More than 2/3 (71.80%) showed results compatible with small and dense LDL particles.

CONCLUSIONS

The implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of cardiovascular disease.

Real-life effect on the control of risk factors associated with initiation of the cardiovascular polypill created from equipotent drugs

OBJECTIVE

This work aims to analyze the impact of Spain's National Center for Cardiovascular Research (CNIC-Ferrer)'s cardiovascular (CV)-polypill on blood pressure (BP) and low-density lipoprotein cholesterol (cLDL) levels in patients in our healthcare area who previously took equipotent doses of statins and antihypertensives.

MATERIAL AND METHODS

All patients in our healthcare area (Santiago de Compostela, Spain) who, as of December 31, 2019, had an active prescription for the CV-polypill (CNIC-Ferrer) since January 16, 2015 were registered. The index date was the start date of the CV-polypill prescription. The drugs the patient had previously received for dyslipidemia and hypertension were analyzed, classifying them by their equivalent potency to atorvastatin and ramipril. Changes in cLDL and BP were analyzed by means of Student's t-test for paired samples.

RESULTS

We analyzed 547 patients with a mean age of 71.5 ± 11.5 years. The majority were men (60.6%). We observed a decrease in cLDL (-10.6 [95% CI: -7.0, -14.3], p < 0.001) in patients who started taking the CV-polypill who had previously taken equally potent doses of atorvastatin (n = 471). We documented a reduction in systolic BP (-3.7 [95% CI: -0.4, -6.9], p = 0.029) in patients who had previously taken equally potent doses of ramipril (n = 360). In 88 patients, the CV-polypill was started via equally potent doses of atorvastatin and ramipril, with a decrease in cLDL (-8.7 [95% CI: -3.8, -13.6], p = 0.001) and systolic BP (-3.6 [95% CI: -7.8, 0.5], p = 0.085).

CONCLUSIONS

The initiation of treatment with the CV-polypill in patients who previously received equally potent treatment with atorvastatin and ramipril was associated with a greater reduction in cLDL and systolic BP.

VNTR (CAG)n polymorphism of the ATXN2 gene and metabolic parameters of cardiovascular risk associated with the degree of obesity in the Amerindian population of Oaxaca

INTRODUCTION

The ATXN2 gene has a VNTR (CAG)n with locus in exon1. Long alleles within the normal range (22-29 repeats) are associated with severe obesity in people from the United Kingdom, Indonesia and the Caribbean.

OBJECTIVE

To analyse the influence of VNTR (CAG)n on metabolic profile in adults with obesity and pre-obesity, as well as to estimate its effect on the risk of developing diabetes.

METHODS AND MATERIAL

255 adults of Chinantec Amerindian ethnic origin were included, who underwent anthropometric and biochemical evaluation. The VNTR was amplified by end-point PCR and by 8% PAGE electrophoresis.

RESULTS

Differences were found in the waist/hip circumference index and body mass index in the carriers of genotypes different to the one homozygous for 22 repeats with a Student's t test value of 0.0041 and 0.0334, respectively. We also found an association with a family history of chronic disease.

CONCLUSION

The VNTR of ATXN2 is associated with obesity in Mexican adults of Chinantec ancestry.

Polyphenol intake and cardiovascular risk in the PREDIMED-Plus trial. A comparison of different risk equations

INTRODUCTION AND OBJECTIVES

Quantification of cardiovascular risk has been based on scores such as Framingham, Framingham-REGICOR, SCORE or Life's Simple 7 (LS7). In vitro, animal, and randomized clinical studies have shown that polyphenols may provide benefits to the vascular system and reduce the inflammatory response. However, some clinical-epidemiological studies have yielded inconsistent results. Our aim was to assess the possible association between intake of the various polyphenol classes and established cardiovascular scores.

METHODS

This cross-sectional analysis involved 6633 PREDIMED-Plus study participants. Food polyphenol content was estimated by a semiquantitative food frequency questionnaire, adjusted for total energy intake according to the residual method. The association between polyphenol intake and cardiovascular risk was tested using linear regression analyses.

RESULTS

Total polyphenol and flavonoid intake were directly and significantly associated only with the LS7 scale. Intake of lignans was directly and significantly associated with SCORE and LS7 scales, stilbene intake with SCORE, and phenolic acid intake with Framingham and Framingham-REGICOR scores. Other polyphenol classes were associated in a protective and significant manner in Framingham, SCORE and LS7 scores. In women, intake of all the polyphenol classes, except phenolic acids, showed a protective trend in the results of the Framingham, Framingham-REGICOR scores and LS7 scale.

CONCLUSIONS

An inverse association was found between consumption of the 'other polyphenols' class and, especially among women, with estimated cardiovascular risk. The results were similar to those of Framingham, Framingham-REGICOR and LS7 (after eliminating the diet component) and differed from those of SCORE, but the predictors included were limited in the latter case.

Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort

BACKGROUND AND AIMS

There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease.

METHODS

A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes.

RESULTS

After six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (three territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]).

CONCLUSIONS

The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.

Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus

OBJECTIVE

To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus.

METHODS

Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus» (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic.

RESULTS

Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05).

CONCLUSION

Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

Degree of lipid control in a Healthcare Management Area in patients at very high cardiovascular risk

INTRODUCTION

The latest cardiovascular risk guides, European and American, establish hard lipid control objectives, that suppose a therapeutic challenge for both, doctor and patient. The objective of this study is determine the degree of adequacy of low-density lipoprotein cholesterol levels (LDLc) presented by patients with very high cardiovascular risk in our healthcare area, with respect to European and American cardiovascular risk guidelines.

METHODS

This is an observational and retrospective study of 446 patients discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischemic stroke and peripheral arterial disease. We have defined a series of variables among which we want to highlight the levels of LDLc at admission, and its follow-up at discharge, in order to know the degree of lipid control according to current European guidelines, which set the threshold to consider optimal control in patients of very high cardiovascular risk, below 55mg/dl.

RESULTS

The revised data indicates a control of the patients in 36.6% according to the 2016 guidelines (LDLc <70mg/dl) and 14.8% according to the current 2019 guidelines (LDLc <55mg/dl), 75.3% of them received lipid lowering treatment. We have also found that the number of absolute events increases exponentially depending on the levels of LDLc, being more evident in patients with acute coronary syndrome.

CONCLUSIONS

In this study, we demonstrated that the adequacy of the vascular risk clinical practice guidelines is insufficient in the population with very high vascular risk, in line with other published studies, further studies would be needed to determine the causes. A solution to this problem could be collaboration with the Internal Medicine service that has been launched in our healthcare area in order to derivate patients to the Vascular Consultation whom could be beneficiated by the administration of the PCSK9 inhibitors.

Association between ideal cardiovascular health and telomere length in participants older than 55 years old from the SUN cohort

INTRODUCTION AND OBJECTIVES

Telomeres are noncoding regions located at the end of chromosomes and their shortening has been associated with risk factors and cardiovascular disease. The aim of this study was to evaluate the association between ideal cardiovascular health (Life's simple 7) and the odds of having short telomeres in a subsample of participants older than 55 years from the Seguimiento Universidad de Navarra (SUN) study.

METHODS

We included 886 participants older than 55 years (645 men and 241 women). Telomere length was measured using a real-time quantitative polymerase chain reaction. Cardiovascular health score was defined by the American Heart Association as a composite score of 7 key risk factors (smoking status, physical activity, diet, body mass index, blood pressure, total cholesterol, and fasting blood glucose) with 0 to 2 points for each factor. We categorized this score in tertiles as poor (0-9 points), intermediate (10-11 points) and ideal (12-14 points). The odds of having short telomeres was defined as telomere length below the 20th percentile.

RESULTS

Individuals with higher ideal cardiovascular health had a lower prevalence of having short telomeres (adjusted OR, 0.60; 95%CI, 0.34-1.05; P trend=.052). This association was statistically significant in men (adjusted OR, 0.37; 95%CI, 0.17-0.83; P trend=.025) but not in women.

CONCLUSIONS

An inverse association between cardiovascular health score and short telomeres was found especially for men older than 55 years in the SUN population. The SUN project was registered at ClinicalTrials.gov (Identifier: NCT02669602).

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery

BACKGROUND

The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥1 represent a risk factor for presenting these alterations.

MATERIAL AND METHODS

Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up.

RESULTS

476 patients were recruited, of whom 40.8% were ≥65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥1 was not associated with an increased risk of electrocardiographic abnormalities.

CONCLUSIONS

Patients ≥65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Interpretation of clinical trials on the cardiovascular effects of hypoglycemic drugs in people with type2 diabetes

Randomized clinical trials on the cardiovascular effects of hypoglycemic drugs on people with type2 diabetes mellitus began more than fifty years ago. In the last decade, the emergence of new classes of hypoglycemic drugs has led to the development of randomized clinical trials to assess their cardiovascular safety. Known as Cardiovascular Outcome Trials, they have provided a lot of new information that needs to be critically appraised if the knowledge obtained is to be applicable in clinical practice. To this end, the current article first comments on the guidelines to which these trials have adhered, then reviews some concepts for improving their interpretation (such as different types of analyses, the definition of objectives and the evaluation of their results), and concludes by mentioning the new guidelines to which future trials designed to evaluate the safety of new hypoglycemic drugs should adhere.

Update on smoking. Alternatives for the management of patients with cardiovascular risk

Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA.

[Improved office blood pressure control by automatic delayed-reading oscillometric device]

INTRODUCTION

Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used.

OBJECTIVE

To know the degree of BP control by clinical measurement.

MATERIAL AND METHODS

During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected.

RESULTS

102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension.

CONCLUSION

The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role.

Kidney and hypertension in older adults

Individuals over 65years are the fastest expanding population throughout the world, due to the increase in human life expectancy. This growing geriatric population, with increasingly associated chronic diseases, has relevant medical, social, and economic impact. Aging is characterized by progressive structural and functional changes in the kidney and in the cardiovascular system, leading to decline in renal function and hypertension. The purpose of this review is to describe the aging-related renal changes and blood pressure regulation during the aging process, their impact with regards to morbidity and mortality in these patients, and to summarize the most appropriate therapeutic approaches in these situations based on the particularities of this population group.

Short term cardiovascular risk in normotensive women after hypertensive pregnancy

INTRODUCTION

Hypertensive pregnancy was recognized as a risk factor of cardiovascular events. The aim of our study was to evaluate the short-term cardiovascular risk in normotensive females with previous hypertensive pregnancy.

MATERIAL AND METHODS

A prospective cohort study was conducted on 50 females with previous normotensive pregnancy and 50 females with previous hypertensive pregnancy. All patients were re-evaluated three months postpartum to be sure that they became normotensive. One year postpartum, all patients were subjected to renal function tests, urinary albumin/creatinine ratio for microalbuminuria, glycated hemoglobin, complete lipid profile, echocardiographic assessment of left ventricular mass index and carotid duplex for measurement of intimal-medial thickness, presence of carotid plaques and stenosis.

RESULTS

No significant difference between both groups regarding blood pressure level three months postpartum. No significant difference between both groups regarding serum creatinine. Patients with previous hypertensive pregnancy group had significantly higher microalbuminuria compared with previous normotensive pregnancy group (p=0.000). Serum LDL and triglycerides were significantly higher however HDL was significantly lower in those with previous hypertensive pregnancy, however all lipid profile measures were within normal range. No significant difference between both groups regarding left ventricular mass index and carotid intima-media thickness. No evidence of carotid plaques or stenosis in both groups.

CONCLUSIONS

Previous hypertensive pregnancy was associated with increased risk of microalbuminuria at short term level even after normalization of blood pressure post-partum. Longer period of follow up is required to establish the potential cardiovascular risk in these patients.

Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery

BACKGROUND

The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations.

MATERIAL AND METHODS

Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up.

RESULTS

476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities.

CONCLUSIONS

Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

[Management of patients with dyslipidaemia in Spain. The Cardio Right Care Control of cardiovascular risk project]

OBJECTIVE

To ascertain the opinion of physicians about diagnostic criteria, control targets, control rates, and therapeutic approach of patients with dyslipidaemia in Spain.

METHODS

A specific questionnaire was created about diagnostic criteria, control targets, control rates, lipid lowering therapies, and therapeutic inertia in patients with dyslipidaemia. Physicians completed the questionnaire online during a 4-month period.

RESULTS

A total of 959 questionnaires were collected from all over Spain. The most frequent scale to stratify cardiovascular risk is SCORE (54.9%), and guidelines from the European Society of Cardiology are the most common guidelines used (50.5%). The majority of patients are on primary prevention (57.7%), and 31.4% have a high-very high cardiovascular risk. More than 70% of investigators considered that the target among patients at very high risk and those in secondary prevention is an LDL cholesterol < 70 mg/dL. It is considered by 60.0% and 66.4% of investigators that their patients on primary and secondary prevention, respectively, achieve control targets. Statins are the most common lipid lowering drugs used, followed by ezetimibe. In the majority of cases, when a patient is not adequately controlled with statins, there is an increase in the dose or a change to another statin. Poor adherence to treatment and therapeutic inertia are the main reasons for poor LDL cholesterol control.

CONCLUSIONS

The Cardio Right Care CVR Control project allows those aspects to be identified, as well as areas of improvement in patients with dyslipidaemia in Spain.

Are the antidiabetic SGLT2 inhibitors a cardiovascular treatment?

The sodium-glucose co-transporter 2 inhibitors (SGLT2i) were first conceived to treat type 2 diabetes due to their hypoglycaemic effect. However, due to an increasing number of studies, SGLT2i are changing the way we treat, and understand, diabetes, and cardiovascular risk, in general. The EMPA-REG OUTCOME clinical trial, in 2015, showed for the first time that empagliflozine - a glucose lowering agent - lowers the risk of death from cardiovascular causes and death from any cause. Also, this SGLT2i lowered hospital admission for heart failure and delayed renal function worsening. From then on, other clinical trials with SGLT2i such as CANVAS (canagliflozin) and DECLARE-TIMI-58 (dapagliflozin) confirmed these positive effects. With a proven and non-related glucose-lowering effect on heart failure, overall death, cardiovascular death, and renal function, SGLT2i stands out among the rest of anti-diabetic drugs. Since its role in treating patients with heart failure and type 2 diabetes has been undoubtedly established, new studies are paving the way for non-diabetic patients as well. A potential paradigm shift is being witnessed and, probably, the dawn of a new field, cardio-endocrinology, which involves new and far-reaching pharmacological agents.

[Psychosocial stress, high blood pressure and cardiovascular risk]

Psychosocial stress can be the result of a wide variety of causes and circumstances. The experience of stress is often unique and experienced in a very personal way, although with common physiological responses. Predictably, it will increase in the modern world, which is subject to vertiginous social, cultural and technological changes. This review aims to determine the psychosocial factors that affect arterial hypertension (HT) and cardiovascular risk (CVR). Psychosocial stress more than doubles the risk of HT, the most related factors being post-traumatic stress disorder, anxiety and work stress. The factors that were most related to an increase in CVR were informal care, lower socioeconomic status, severe mental disorders, marital status, and post-traumatic stress disorder. Individual and collective psychosocial stress prevention strategies can be decisive in decreasing the prevalence of HT and CVR.