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Cordero A, Carrillo P, López-Palop R. Letter by Cordero et al Regarding Article, "Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator". Circulation 2016; 134:e700-e701. [PMID: 27956406 DOI: 10.1161/circulationaha.116.025304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cordero A, Carrillo P, Frutos A, López-Palop R. Does Implementation of the Infarction Code Lead to Changes in the Treatment and Prognosis of Patients With Non-ST Elevation Acute Coronary Syndrome? Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:1237. [PMID: 28134098 DOI: 10.1016/j.rec.2016.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
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Cordero A, Carrillo P, Frutos A, López-Palop R. ¿La implantación del código infarto implica cambios en el tratamiento y el pronóstico de los pacientes con síndrome coronario agudo sin elevación del ST? Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Núñez J, Llàcer P, Bertomeu-González V, Bosch MJ, Merlos P, García-Blas S, Montagud V, Bodí V, Bertomeu-Martínez V, Pedrosa V, Mendizábal A, Cordero A, Gallego J, Palau P, Miñana G, Santas E, Morell S, Llàcer A, Chorro FJ, Sanchis J, Fácila L, Núñez J, Garcia-Blas S, Sanchis J, Bodí V, Santas E, Olivares M, Bonanad C, Bondanza L, Llàcer A, Chorro FJ, Bosch MJ, Merlos P, Gallego J, Palau P, Llàcer P, Mendizabal A, Miñana G, Pedrosa V, Salvador M, Camps A, Salvador G, Bertomeu-González V, Bertomeu-Martínez V, Cordero A, Moreno J, Quiles J, López Pineda A, Fácila L, Montagud V, Fonfria R, Jareño MT, Belchi J, Rumiz E, Morell S. Carbohydrate Antigen-125–Guided Therapy in Acute Heart Failure. JACC-HEART FAILURE 2016; 4:833-843. [DOI: 10.1016/j.jchf.2016.06.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/31/2022]
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Galve E, Cordero A, Cequier Á, González-Juanatey JR. Insufficient Lipid Control in Patients With Coronary Artery Disease: An Unresolved Problem. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:997. [PMID: 27623492 DOI: 10.1016/j.rec.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
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Galve E, Cordero A, Cequier Á, González-Juanatey JR. Insuficiente control de parámetros lipídicos en pacientes con enfermedad coronaria: un problema por resolver. Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Galve E, Cordero A, Cequier A, Ruiz E, González-Juanatey JR. Grado de control lipídico en pacientes coronarios y medidas adoptadas por los médicos. Estudio REPAR. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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López-Palop R, Carrillo P, Agudo P, Cordero A, Frutos A, Mashlab S, Martínez R, El Amrani A, Ramos D. Factors Associated With Errors in Visual Estimation of the Functional Significance of Coronary Lesions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:657-663. [PMID: 27068021 DOI: 10.1016/j.rec.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/03/2015] [Indexed: 06/05/2023]
Abstract
UNLABELLED INTRODUCTION AND OBJECTIVES Visual angiographic assessment continues to be used when decisions are made on whether to revascularize ambiguous coronary lesions. Multiple factors, other than the degree of stenosis, have been associated with the functional significance of a coronary lesion. The aim of this study was to investigate the ability of interventionists to visually predict the functional significance of a coronary lesion and the clinical and angiographic characteristics associated with errors in prediction. METHODS We conducted a concordance study of the functional significance of coronary lesions predicted by experienced interventionists and fractional flow reserve values measured by intracoronary pressure wire in 665 intermediate lesions (40%-70% diameter stenosis) in 587 patients. We determined which factors were independently associated with errors in prediction. RESULTS There was disagreement between the predicted fractional flow reserve value of ≤ 0.80 and the observed value in 30.1% of the lesions (overestimation: 11.3%; underestimation, 18.8%). Stent location in an artery other than the anterior descending artery or in a bifurcation was associated with overestimation. Male sex, severe calcification, and a greater myocardial territory distal to the lesion were significantly associated with the functional significance of the underestimated lesion. CONCLUSIONS Even when taking into account angiographic and clinical characteristics, there is a high rate of disagreement between visual estimation and direct measurement of intermediate coronary stenosis in relation to its functional significance. Specific angiographic and clinical characteristics are associated with an increased tendency to overestimate or underestimate the significance of lesions.
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López-Palop R, Carrillo P, Agudo P, Cordero A, Frutos A, Mashlab S, Martínez R, El Amrani A, Ramos D. Factores asociados al error en la estimación visual de la importancia funcional de lesiones coronarias. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2015.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Galve E, Cordero A, Cequier A, Ruiz E, González-Juanatey JR. Degree of Lipid Control in Patients With Coronary Heart Disease and Measures Adopted by Physicians. REPAR Study. ACTA ACUST UNITED AC 2016; 69:931-938. [PMID: 27178117 DOI: 10.1016/j.rec.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/01/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Lipid control is insufficient in patients with coronary heart disease but this situation may be improving with the implementation of the latest clinical practice guidelines. The aim of this study was to analyze whether target values of low-density lipoprotein cholesterol are achieved and to identify associated factors and physicians' attitudes to deficient control. METHODS We conducted a national, multicenter, prospective, observational study of 1103 patients with stable coronary heart disease, analyzing lipid values and a broad set of clinical variables. The statistical analysis involved a binary logistic regression model using backward stepwise elimination. RESULTS Low-density lipoprotein cholesterol was < 70 mg/dL in only 26% of patients, even though 95.3% were receiving cholesterol-lowering agents, 45% of which were high-intensity therapies. Independent predictors of low-density lipoprotein cholesterol < 70 mg/dL were diabetes mellitus, wholegrain bread, shorter history of dyslipidemia, and, especially, high-intensity cholesterol-lowering therapies. Physicians increased therapy in only 26% of poorly controlled patients. The main predictor of increased therapy was low-intensity baseline therapy (odds ratio=5.05; 95% confidence interval, 3.3-9.2). A more proactive approach was observed in older physicians (P=.019) and longer physician practice (P=.02). CONCLUSIONS Despite the new guidelines, only 26% of patients with coronary heart disease have adequate lipid control. In 70% of patients, physicians continue the same therapy, even though high-intensity cholesterol-lowering therapies are a key factor in good control.
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Cordero A, Galve E, Bertomeu-Martínez V, Bueno H, Fácila L, Alegría E, Cequier Á, Ruiz E, González-Juanatey JR. Tendencias en factores de riesgo y tratamientos de pacientes con cardiopatía isquémica estable atendidos en consultas de cardiología entre 2006 y 2014. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Royo-Bordonada MA, Lobos Bejarano JM, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles RM, Maiques A, Lizcano Á, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines. Neurologia 2016; 31:195-207. [PMID: 23969295 DOI: 10.1016/j.nrl.2013.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 11/20/2022] Open
Abstract
Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.
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Cordero A, López-Palop R, Carrillo P, Frutos A, Miralles S, Gunturiz C, García-Carrilero M, Bertomeu-Martínez V. Changes in Acute Coronary Syndrome Treatment and Prognosis After Implementation of the Infarction Code in a Hospital With a Cardiac Catheterization Unit. ACTA ACUST UNITED AC 2016; 69:754-9. [PMID: 26979766 DOI: 10.1016/j.rec.2015.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome. METHODS A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol. RESULTS The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications. CONCLUSIONS After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.
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Cordero A, Galve E, Bertomeu-Martínez V, Bueno H, Fácila L, Alegría E, Cequier Á, Ruiz E, González-Juanatey JR. Trends in Risk Factors and Treatments in Patients With Stable Ischemic Heart Disease Seen at Cardiology Clinics Between 2006 and 2014. ACTA ACUST UNITED AC 2015; 69:401-7. [PMID: 26631917 DOI: 10.1016/j.rec.2015.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Chronic ischemic heart disease is the most prevalent of all cardiovascular diseases. Patients are at high risk of complications. In recent decades, changes may have occurred in the clinical characteristics of the disease, its treatment and control of risk factors. METHODS A direct comparison of 2 national registries of patients with chronic ischemic heart disease carried out in 2006 (n=1583) and 2014 (n=1110). RESULTS We observed statistically significant differences between the 2 registries, with a higher percentage of men and smokers in the 2014 registry, but a lower prevalence of diabetes mellitus and hypertension. Heart failure and stroke were more prevalent in the 2006 registry. Patients in the 2014 registry had better results for lipid profile, blood glucose, creatinine, and glomerular filtration rate. We observed higher use of recommended drugs for secondary prevention and an increased percentage of patients receiving optimal medical therapy, from 32.5% to 49.5% (P<.01). Use of high-intensity statin doses also increased from 10.5% to 42.8% (P<.01). We found better control of some risk factors (improved dyslipidemia, heart rate, and blood glucose in patients with diabetes) but worse blood pressure control. CONCLUSIONS The clinical profile of patients with chronic ischemic heart disease is similar in the 2 registries. There has been an improvement in patients' medical therapy and dyslipidemia control, blood glucose, and heart rate, but there is still much room for improvement in the control of other cardiovascular risk factors.
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Cordero A, Carrillo P, López-Palop R. Tras un síndrome coronario agudo, ¿qué bloqueador beta se debería dar, a quién y cuánto tiempo? Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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166
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Cordero A, Carrillo P, López-Palop R. Beta-blocker Use After an Acute Coronary Syndrome. Which one, in Whom, and for How Long? ACTA ACUST UNITED AC 2015; 68:1040-1. [PMID: 26385082 DOI: 10.1016/j.rec.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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167
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Cordero A, Fácila L, García-Carrilero M, Gunturiz C, Montagud V, Núñez J. Breakfast Habits in Patients Hospitalized for Acute Coronary Syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:814-5. [PMID: 26190544 DOI: 10.1016/j.rec.2015.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
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168
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Cordero A, Fácila L, García-Carrilero M, Gunturiz C, Montagud V, Núñez J. Hábitos dietéticos en el desayuno de pacientes que ingresan por síndrome coronario agudo. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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169
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Carrillo P, López-Palop R, Cordero A. Tomografía de coherencia óptica en angioplastia complicada. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2014.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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170
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Cordero A, Bertomeu-Martínez V, Mazón P, Fácila L, González-Juanatey JR. Erectile Dysfunction May Improve by Blood Pressure Control in Patients with High-Risk Hypertension. Postgrad Med 2015; 122:51-6. [DOI: 10.3810/pgm.2010.11.2223] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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171
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Mazón-Ramos P, Cordero A, González-Juanatey JR, Bertomeu Martínez V, Delgado E, Vitale G, Fernández-Anaya S. Control de factores de riesgo cardiovascular en pacientes diabéticos revascularizados: un subanálisis del estudio ICP-Bypass. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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172
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Núñez J, Merlos P, Fácila L, Llàcer P, Bosch MJ, Bertomeu-Martínez V, García-Blas S, Montagud V, Pedrosa V, Mendizábal A, Cordero A, Miñana G, Sanchis J, Bertomeu-González V. Efecto pronóstico de una estrategia terapéutica guiada por los valores del antígeno carbohidrato 125 (CHANCE-HF). Diseño del estudio. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Galve E, Cordero A, Bertomeu-Martínez V, Fácila L, Mazón P, Alegría E, Fernández de Bobadilla J, García-Porrero E, Martínez-Sellés M, González-Juanatey JR. Update in cardiology: vascular risk and cardiac rehabilitation. ACTA ACUST UNITED AC 2015; 68:136-43. [PMID: 25583549 DOI: 10.1016/j.rec.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/02/2014] [Indexed: 01/03/2023]
Abstract
As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case.
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Mazón-Ramos P, Cordero A, González-Juanatey JR, Bertomeu Martínez V, Delgado E, Vitale G, Fernández-Anaya S. Control of cardiovascular risk factors in revascularized patients with diabetes: a subanalysis of the ICP-Bypass study. ACTA ACUST UNITED AC 2014; 68:115-20. [PMID: 25224523 DOI: 10.1016/j.rec.2014.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/12/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This ICP-Bypass substudy analyzes the clinical characteristics and risk factor control of these patients. METHODS The analysis selected patients with type 2 diabetes who had participated in an earlier multicenter, observational, cross-sectional study (ICP-Bypass) conducted in 2293 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. RESULTS The mean age (standard deviation) of the 771 diabetic patients included in the analysis was 67.7 (9.6) years (71.4% men; mean time since revascularization, 3.5 years). Most (57.8%) were receiving treatment with oral hypoglycemics alone, whereas 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.1% (in 70%,<7.5%); 74.8% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5 mg/dL (in 73%, > 70 mg/dL). Among these patients, 93.6% were receiving statins and 18.7% a statin combined with ezetimib. A total of 78.1% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80 mmHg in 52% and < 140/90 mmHg in 93%. CONCLUSIONS Cardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets.
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Núñez J, Merlos P, Fácila L, Llàcer P, Bosch MJ, Bertomeu-Martínez V, García-Blas S, Montagud V, Pedrosa V, Mendizábal A, Cordero A, Miñana G, Sanchis J, Bertomeu-González V. Prognostic effect of carbohydrate antigen 125-guided therapy in patients recently discharged for acute heart failure (CHANCE-HF). Study design. ACTA ACUST UNITED AC 2014; 68:121-8. [PMID: 25623430 DOI: 10.1016/j.rec.2014.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Morbidity and mortality after admission for acute heart failure remain prohibitively high. In that setting, plasma levels of antigen carbohydrate 125 have shown to correlate with the severity of fluid overload and the risk of mortality and readmission. Preliminary data suggests a potential role of antigen carbohydrate 125 to guide therapy. The objective of this study is to evaluate the prognostic effect of an antigen carbohydrate 125-guided management strategy vs standard therapy in patients recently discharged for acute heart failure. METHODS This is a multicenter, randomized, single-blind, efficacy trial study of patients recently discharged from acute heart failure (< 180 days), New York Heart Association functional class II-IV and antigen carbohydrate 125 > 35 U/ml. A randomization scheme was used to allocate participants (in a 1:1 ratio) to receive therapy guided by antigen carbohydrate 125 (aiming to keep normal values) or standard treatment. Mainly, antigen carbohydrate 125-guided therapy is focused on the frequency of monitoring and titration of decongestive therapies and statins. As of December 10, 2013, there were 383 patients enrolled. The primary outcome was the composite of 1-year all-cause mortality or rehospitalization for acute heart failure. Analysis was planned to be intention-to-treat. CONCLUSIONS Discovering novel therapeutic strategies or finding better ways of optimizing established treatments have become a health care priority in heart failure. This study will add important knowledge about the potential of antigen carbohydrate 125 as a management tool for monitoring and titration of therapies where optimal utilization has not been well defined, such as diuretics and statins. TRIAL REGISTRATION ClinicalTrials.gov number: NCT02008110.
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