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Abbes H, Zubiaur P, Soria-Chacartegui P, de la Torre T, Villapalos-García G, Candau C, Rodríguez-Lopez A, González-Iglesias E, Aldama M, Navares-Gomez M, Omezzine A, Ochoa D, Abad-Santos F. SLCO1B1 and ABCG2 genotype-informed phenotypes are related to variation in ramipril exposure. Basic Clin Pharmacol Toxicol 2024. [PMID: 39011815 DOI: 10.1111/bcpt.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/13/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024]
Abstract
Ramipril is an angiotensin-converting enzyme inhibitor used for hypertension and heart failure management. To date, scarce literature is available on pharmacogenetic associations affecting ramipril. The goal of this study was to investigate the effect of 120 genetic variants in 34 pharmacogenes (i.e., genes encoding for enzymes like CYPs or UGTs and transporters like ABC or SLC) on ramipril pharmacokinetic variability and adverse drug reaction (ADR) incidence. Twenty-nine healthy volunteers who had participated in a single-dose bioequivalence clinical trial of two formulations of ramipril were recruited. A univariate and multivariate analysis searching for associations between genetic variants and ramipril pharmacokinetics was performed. SLCO1B1 and ABCG2 genotype-informed phenotypes strongly predicted ramipril exposure. Volunteers with the SLCO1B1 decreased function (DF) phenotype presented around 1.7-fold higher dose/weight-corrected area under the curve (AUC/DW) than volunteers with the normal function (NF) phenotype (univariate p-value [puv] < 0.001, multivariate p-value [pmv] < 0.001, β = 0.533, R2 = 0.648). Similarly, volunteers with ABCG2 DF + poor function (PF) phenotypes presented around 1.6-fold higher AUC/DW than those with the NF phenotype (puv = 0.011, pmv < 0.001, β = 0.259, R2 = 0.648). Our results suggest that SLCO1B1 and ABCG2 are important transporters to ramipril pharmacokinetics, and their genetic variation strongly alters its pharmacokinetics. Further studies are required to confirm these associations and their clinical relevance.
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Affiliation(s)
- Houwaida Abbes
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- Biochemistry Department, LR12SP11, Sahloul University Hospital, Sousse, Tunisia
- Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Paula Soria-Chacartegui
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Tamara de la Torre
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Gonzalo Villapalos-García
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Carmen Candau
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Andrea Rodríguez-Lopez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Eva González-Iglesias
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Marina Aldama
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Marcos Navares-Gomez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Asma Omezzine
- Biochemistry Department, LR12SP11, Sahloul University Hospital, Sousse, Tunisia
- Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Araujo-Castro M, Ruiz-Sánchez JG, Parra Ramírez P, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, López Lazareno N, Torregrosa Quesada ME, Gorrin Ramos J, Oriola J, Poch E, Oliveras A, Méndez Monter JV, Gómez Muriel I, Bella-Cueto MR, Mercader Cidoncha E, Runkle I, Hanzu FA. Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism. Endocrine 2024; 85:99-121. [PMID: 38448679 DOI: 10.1007/s12020-024-03751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension (HT), and is associated with a higher cardiometabolic risk than essential HT. However, PA remains underdiagnosed, probably due to several difficulties clinicians usually find in performing its diagnosis and subtype classification. The aim of this consensus is to provide practical recommendations focused on the prevalence and the diagnosis of PA and the clinical implications of aldosterone excess, from a multidisciplinary perspective, in a nominal group consensus approach by experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology, Spanish Association of Surgeons (AEC).
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., Madrid, Spain.
| | - Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department. Hospital Universitario Fundación Jiménez Díaz, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM), Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | | | | | | | - Nieves López Lazareno
- Biochemical Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Gorrin Ramos
- Biochemical department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Josep Oriola
- Biochemistry and Molecular Genetics Department, CDB. Hospital Clínic. University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department. Hospital Clinic, IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Anna Oliveras
- Nephrology Department. Hospital del Mar, Universitat Pompeu Fabra, Barcelona, ES, Spain
| | | | | | - María Rosa Bella-Cueto
- Pathology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell, Barcelona, Spain
| | - Enrique Mercader Cidoncha
- General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Fellow European Board of Surgery -Endocrine Surgery, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic. IDIBAPS. University of Barcelona, Barcelona, Spain.
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3
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Cavero-Redondo I, Saz-Lara A, Lugones-Sánchez C, Pozuelo-Carrascosa DP, Gómez-Sánchez L, López-Gil JF, García-Ortiz L, Bruno RM, Gómez-Marcos MÁ. Comparative effect of antihypertensive drugs in improving arterial stiffness in adults with hypertension (RIGIPREV study). A network meta-analysis. Front Pharmacol 2023; 14:1225795. [PMID: 37724181 PMCID: PMC10505405 DOI: 10.3389/fphar.2023.1225795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Aims: To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis approach. Methods: A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity [PWV] and augmentation index [AIx]) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length. Results: Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx. Conclusion: Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination. Systematic Review Registration: PROSPERO (CRD42021276360).
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Affiliation(s)
- Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
- Health and Social Research Center, Universidad de Castilla- La Mancha, Cuenca, Spain
| | - Alicia Saz-Lara
- INSERM U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou—APHP, Paris, France
| | | | - Diana P. Pozuelo-Carrascosa
- INSERM U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou—APHP, Paris, France
| | | | - José Francisco López-Gil
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
- INSERM U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou—APHP, Paris, France
| | - Luis García-Ortiz
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rosa Maria Bruno
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Bentué-Martínez C, Mimbrero MR, Zúñiga-Antón M. Spatial patterns in sociodemographic factors explain to a large extent the prevalence of hypertension and diabetes in Aragon (Spain). Front Med (Lausanne) 2023; 10:1016157. [PMID: 36760398 PMCID: PMC9905822 DOI: 10.3389/fmed.2023.1016157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction The global burden of multi-morbidity has become a major public health challenge due to the multi stakeholder action required to its prevention and control. The Social Determinants of Health approach is the basis for the establishment of health as a cross-cutting element of public policies toward enhanced and more efficient decision making for prevention and management. Objective To identify spatially varying relationships between the multi-morbidity of hypertension and diabetes and the sociodemographic settings (2015-2019) in Aragon (a mediterranean region of Northeastern Spain) from an ecological perspective. Materials and methods First, we compiled data on the prevalence of hypertension, diabetes, and sociodemographic variables to build a spatial geodatabase. Then, a Principal Component Analysis (PCA) was performed to derive regression variables, i.e., aggregating prevalence rates into a multi-morbidity component (stratified by sex) and sociodemographic covariate into a reduced but meaningful number of factors. Finally, we applied Geographically Weighted Regression (GWR) and cartographic design techniques to investigate the spatial variability of the relationships between multi-morbidity and sociodemographic variables. Results The GWR models revealed spatial explicit relationships with large heterogeneity. The sociodemographic environment participates in the explanation of the spatial behavior of multi-morbidity, reaching maximum local explained variance (R2) of 0.76 in men and 0.91 in women. The spatial gradient in the strength of the observed relationships was sharper in models addressing men's prevalence, while women's models attained more consistent and higher explanatory performance. Conclusion Modeling the prevalence of chronic diseases using GWR enables to identify specific areas in which the sociodemographic environment is explicitly manifested as a driving factor of multi-morbidity. This is step forward in supporting decision making as it highlights multi-scale contexts of vulnerability, hence allowing specific action suitable to the setting to be taken.
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Affiliation(s)
- Carmen Bentué-Martínez
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,*Correspondence: Carmen Bentué-Martínez, ✉
| | - Marcos Rodrigues Mimbrero
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain
| | - María Zúñiga-Antón
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain,Health Research Institute of Aragon, Zaragoza, Spain
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5
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Martinez-Martin FJ, Kuzior A, Hernandez-Lazaro A, de Leon-Durango RJ, Rios-Gomez C, Santana-Ojeda B, Perez-Rivero JM, Fernandez-Trujillo-Comenge PM, Gonzalez-Diaz P, Arnas-Leon C, Acosta-Calero C, Perdomo-Herrera E, Tocino-Hernandez AL, Del Sol Sanchez-Bacaicoa M, Del Pino Perez-Garcia M. Incidence of hypertension in young transgender people after a 5-year follow-up: association with gender-affirming hormonal therapy. Hypertens Res 2023; 46:219-225. [PMID: 36229533 DOI: 10.1038/s41440-022-01067-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 02/03/2023]
Abstract
In order to assess the risk of hypertension development, we performed a retrospective analysis of the clinical records of consecutive transgender patients who began gender-affirming hormonal therapy in our Outpatient Gender Identity Clinic with <30 years of age and had a follow-up >5 years. 149 transgender women treated with estradiol and 153 transgender men treated with testosterone were included; 129 of the transgender women received also androgen blockers (54 spironolactone, 49 cyproterone acetate and 26 LHRH agonists). The annual incidence of hypertension in young transgender men (1.18%) seemed comparable to that of the general population. In young transgender women, it seemed higher (2.14%); we found that the choice of androgen blocker had a remarkable effect, with a highly significant increase in patients treated with cyproterone acetate (4.90%) vs. the rest (0.80%); the adjusted hazard-ratio was 0.227 (p = 0.001). Correlation, logistic regression and mediation analyses were performed for the associations of the available clinical variables with the increase in systolic blood pressure and the onset of hypertension, but besides the use of cyproterone acetate, only the ponderal gain was found significant (Spearman's r: 0.361, p < 0.001); with a 36.7% mediation effect (31.2-42.3%). Cyproterone acetate has additional known risks, such as meningioma; although we cannot conclusively prove that it has a role in the development of hypertension, we conclude that the use of cyproterone acetate for this indication should be reconsidered.
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Affiliation(s)
- Francisco Javier Martinez-Martin
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain. .,Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain.
| | - Agnieszka Kuzior
- Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Alba Hernandez-Lazaro
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Ricardo Jose de Leon-Durango
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Carlos Rios-Gomez
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Borja Santana-Ojeda
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | | | - Paula Maria Fernandez-Trujillo-Comenge
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Paula Gonzalez-Diaz
- Emergency Medicine Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Claudia Arnas-Leon
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain.,Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Carmen Acosta-Calero
- Cardiology Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
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6
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Cabañero-Navalon MD, Garcia-Bustos V, Nuñez-Beltran M, Císcar Fernández P, Mateu L, Solanich X, Carrillo-Linares JL, Robles-Marhuenda Á, Puchades-Gimeno F, Pelaez Ballesta A, López-Osle N, Torralba-Cabeza MÁ, Bielsa Masdeu AM, Diego Gil J, Tornador Gaya N, Pascual Castellanos G, Sánchez-Martínez R, Barragán-Casas JM, González-García A, Patier de la Peña JL, López-Wolf D, Mora Rufete A, Canovas Mora A, Forner Giner MJ, Moral Moral P. Current clinical spectrum of common variable immunodeficiency in Spain: The multicentric nationwide GTEM-SEMI-CVID registry. Front Immunol 2022; 13:1033666. [PMID: 36389743 PMCID: PMC9650514 DOI: 10.3389/fimmu.2022.1033666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/11/2022] [Indexed: 08/22/2023] Open
Abstract
Common variable immunodeficiency (CVID) constitutes a heterogenic group of primary immunodeficiency disorders with a wide-ranging clinical spectrum. CVID-associated non-infectious morbidity constitutes a major challenge requiring a full understanding of its pathophysiology and its clinical importance and global variability, especially considering the broad clinical, genetic, and regional heterogeneity of CVID disorders. This work aimed to develop a nationwide, multicenter, retrospective study over a 3-year period describing epidemiological, clinical, laboratory, therapeutic, and prognostic features of 250 CVID patients in Spain. The mean diagnostic delay was around 10 years and most patients initially presented with infectious complications followed by non-infectious immune disorders. However, infectious diseases were not the main cause of morbimortality. Non-infectious lung disease was extraordinarily frequent in our registry affecting approximately 60% of the patients. More than one-third of the patients in our cohort showed lymphadenopathies and splenomegaly in their follow-up, and more than 33% presented immune cytopenias, especially Evans' syndrome. Gastrointestinal disease was observed in more than 40% of the patients. Among biopsied organs in our cohort, benign lymphoproliferation was the principal histopathological alteration. Reaching 15.26%, the global prevalence of cancer in our registry was one of the highest reported to date, with non-Hodgkin B lymphoma being the most frequent. These data emphasize the importance of basic and translational research delving into the pathophysiological pathways involved in immune dysregulation and diffuse lymphocytic infiltration. This would reveal new tailored strategies to reduce immune complications, and the associated healthcare burden, and ensure a better quality of life for CVID patients.
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Affiliation(s)
| | - Victor Garcia-Bustos
- Department of Internal Medicine, University and Polytechnic Hospital LaFe, Valencia, Spain
| | - Maria Nuñez-Beltran
- Department of Internal Medicine, University and Polytechnic Hospital LaFe, Valencia, Spain
| | | | - Lourdes Mateu
- Department of Internal Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Xavier Solanich
- Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain
| | | | | | | | - Ana Pelaez Ballesta
- Department of Internal Medicine, Rafael Méndez University Hospital, Murcia, Spain
| | - Nuria López-Osle
- Department of Internal Medicine, Cruces University Hospital, Bizkaia, Spain
| | | | | | - Jorge Diego Gil
- Department of Internal Medicine, University Hospital October 12, Madrid, Spain
| | - Nuria Tornador Gaya
- Department of Internal Medicine, University General Hospital of Castellón, Castellón, Spain
| | | | | | | | - Andrés González-García
- Department of Internal Medicine, Santiago Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Daniel López-Wolf
- Department of Internal Medicine, University Hospital Alcorcón Foundation, Madrid, Spain
| | - Antonia Mora Rufete
- Department of Internal Medicine, General University Hospital of Elche, Alicante, Spain
| | - Alba Canovas Mora
- Department of Internal Medicine, General University Hospital of Elche, Alicante, Spain
| | | | - Pedro Moral Moral
- Department of Internal Medicine, University and Polytechnic Hospital LaFe, Valencia, Spain
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Cardiometabolic and Nutritional Morbidities of a Large, Adult, PKU Cohort from Andalusia. Nutrients 2022; 14:nu14061311. [PMID: 35334968 PMCID: PMC8952233 DOI: 10.3390/nu14061311] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
The establishment of national neonatal screening systems has resulted in improved quality of life and life expectancy in patients with phenylketonuria (PKU). This has led to the development of multidisciplinary treatment units for adult patients with PKU. We present a retrospective descriptive study of a cohort of 90 adult patients (>16 years) with PKU under active follow-up in two reference centers in Andalusia. We analyzed disease severity, treatment type, demographic variables, cardiovascular risk factors, vitamin and hormone profiles, and bone metabolism. The median (interquartile range)age was 29 (23−38) years, 47 (52.2%) were women and 43 (47.8%) were men. Eighty (88.9%) had classical PKU, five (5.6%) moderate PKU, and five (5.6%) mild PKU. Diagnosis was by neonatal screening in 62 (68.9%) of the patients. The rest had late diagnosis. Treatment with sapropterin was given to 18 (20%) patients and diet and nutrition therapy to 72 (80%). There was adequate metabolic control according to Phe levels in 43 (47.78%) patients. Body mass index was 26.61 (22.7−31.1) kg/m2. Twenty-six (29.2%) patients had obesity, 7 (7.9%) hypertension, 2 (2.2%) type 2 diabetes, 26 (28.89%) dyslipidemia, 14 (15.6%) elevated total cholesterol, 9 (15.8%) decreased high-density lipoprotein cholesterol and 16 (17.8%) hypertriglyceridemia. Seven (10.3%) patients had osteoporosis and 28 (41.17%) osteopenia. Twenty-six (30.6%) had vitamin D (25OH) deficiency and four (4.5%) vitamin B12 deficiency. Although we observed no differences with most vascular risk factors, we found a high prevalence of obesity in relation to the age of the cohort. A continued evaluation of comorbidities in these patients is therefore needed, despite adequate metabolic control.
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Cardiometabolic Health Status, Ethnicity and Health-Related Quality of Life (HRQoL) Disparities in an Adult Population: NutrIMDEA Observational Web-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052948. [PMID: 35270641 PMCID: PMC8910247 DOI: 10.3390/ijerph19052948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/24/2022]
Abstract
Precision public health supported on online tools is increasingly emerging as a potential strategy to achieve health promotion and disease prevention. Our aim was to assess the relationships of sociodemographic variables, anthropometric data, dietary habits and lifestyle factors with health-related quality of life (HRQoL), cardiometabolic health status and ethnicity in an online recruited adult population (NutrIMDEA Study). NutrIMDEA Study is a web-based cross-sectional survey that included 17,333 adults. Self-reported sociodemographic characteristics, anthropometric data, clinical and family history of cardiometabolic illnesses, dietary habits, lifestyle factors and HRQoL features were collected. Diseased individuals showed significative poorer MedDiet and worse HRQoL than those in the healthy cardiometabolic status group (p < 0.05). In comparison, European/Caucasian individuals reported a significantly better HRQoL, higher MedDiet and HRQoL values compared with those of other ethnicities (p < 0.05). We obtained a total of 16.8% who reported poor/fair, 56.5% good and 26.6% very good/excellent HRQoL. Respondents with very good/excellent HRQoL showed lower BMI, greater adherence to a Mediterranean diet (MedDiet) and higher physical activity. The results suggest the presence of interactions between the mental and physical components of HRQoL with obesity, sedentarism and dietary intake, which were dependent on disease status and ethnicity. Online HRQoL assessment could contribute to wider implementation of precision public health strategies to promote health targeted interventions with policy implications to community health promotion.
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9
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Rodríguez Donoso J, Martín Ramos E, Aparicio Velasco J, Fonte Eliozondo L, Muñoz Críspulo E, Ruiz Arribas C. [Abdominal aortic aneurysm ultrasound screening in men with risk factors in Primary Care]. Aten Primaria 2022; 54:102234. [PMID: 34920344 PMCID: PMC8685991 DOI: 10.1016/j.aprim.2021.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE to describe the implantation of ultrasound screening for Abdominal Aortic Aneurysm (AAA) in our healthcare district in men from 65 to 79 years of age who have had an identifiable risk factor for developing AAA, such as smoking or a history thereof, hypertension, family history of aneurysms, aneurysms in other locations and clinical atherosclerosis, acute myocardial infarction, intermittent claudication, or stroke. Analyse the performance of said screening. SETTING Primary Care. PARTICIPANTS AND INTERVENTIONS 656 patients were screened, representing 40% of the target population of 1,658 patients. The remaining part of the target population could not be screened because of the outbreak of the COVID-19 pandemic. 608 ultrasound examinations were performed. MAIN MEASUREMENTS coverage of the screening programme, prevalence of abdominal aortic aneurysms, prevalence of smoking and other risk factors in patients with/without aneurysms. RESULTS 19 patients with ectatic aorta (25-29mm) and 11 with abdominal aortic aneurysms (1.81%) were found. 5 were active smokers (45%, compared to 20% in the entire sample) and 6 were former smokers. None of the aneurysm patients were non-smokers. 7 of them were hypertensive. CONCLUSIONS The prevalence of aneurysms in our sample was 2.6%, which was lower than expected. The wide use of ultrasound and its progressive generalisation in the Primary Care setting should lead to a decrease in the number of undiagnosed AAA.
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Arterial hypertension assessment in a population with chronic myeloid leukemia. Sci Rep 2021; 11:14637. [PMID: 34282224 PMCID: PMC8289992 DOI: 10.1038/s41598-021-94127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment of chronic myeloid leukaemia (CML) is based on tyrosine kinase inhibitors (TKI), whose introduction in 2001 improved the survival rate after 5 years from 40 to 90%. The longevity increase has been accompanied by a higher incidence of cardiovascular events (CVE) that can be explained due to the sum of cardiovascular risk factors (CVRF) together with the secondary effects of the TKI. The effect of the TKI over the blood pressure control is still unknown. An observational cross-sectional study of patients with CML under treatment with TKI (imatinib, dasatinib and nilotinib) was conducted. Blood pressure was analyzed through sphygmomanometer and 24-h ambulatory blood pressure monitoring (ABPM). A total of 73 patients were included, 57 treated with a single line of treatment. 32.9% of the total of individuals under this study showed uncontrolled blood pressure according to the ABPM. The factors related to uncontrolled BP were overweight, dyslipidemia, alcohol use, pulse wave velocity a high/very high cardiovascular risk. The subjects who received treatment with nilotinib did present worse control of their blood pressure in ABPM than those treated with imatinib and dasatinib (p = 0.041). This finding could indicate that an uncontrolled blood pressure is implied in the pro-inflammatory and pro-atherogenic mechanism underlying the development of the cardiovascular disease in those patients under treatment with nilotinib. The ABPM is a useful tool in the diagnosis and treatment of HT, being the reason why it should be included in the assessment of patients with CML whose HT diagnosis proves uncertain.
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Forés R, Manresa JM, López-Lifante VM, Heras A, Delgado P, Vázquez X, Ruiz S, Alzamora MT, Toran P. Relationship between Retinal Microvasculature, Cardiovascular Risk and Silent Brain Infarction in Hypertensive Patients. Diagnostics (Basel) 2021; 11:diagnostics11060937. [PMID: 34073652 PMCID: PMC8224683 DOI: 10.3390/diagnostics11060937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The aims of this study are to analyze the role of artery-vein ratio AVR assessment using VesselMap 2 software (Imedos Systems) and cardiovascular risk evaluation by means of REGICOR in the prediction of silent brain infarction (SBI) in middle-age hypertensive patients from the ISSYS study. Material and Methods: A cross-sectional study with 695 patients with hypertension aged 50 to 70 years who participated in the project Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study (ISSYS), was conducted in two Primary Care Centres of Barcelona. Participants agreed to a retinography and an MRI to detect silent brain infarction (SBI). The IMEDOS software was used for the semiautomatic caliber measurement of retinal arteries and veins, and the AVR was considered abnormal when <0.66. The REGICOR score was calculated for all patients. Results: Multivariate logistic regression analysis was used to evaluate the impact of AVR and REGICOR scores on SBI. The OR (odds ratio) for a high REGICOR score and an abnormal AVR were 3.16 and 4.45, respectively. When analysing the interaction of both factors, the OR of an abnormal AVR and moderate REGICOR score was 3.27, whereas with a high REGICOR score it reached 13.07. Conclusions: The measurement of AVR in patients with hypertension and with a high REGICOR score can contribute to the detection of silent brain infarction.
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Affiliation(s)
- Rosa Forés
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
- Correspondence: ; Tel.: +34-934662096
| | - Josep M. Manresa
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
| | - Victor M. López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Palau Healthcare Centre, Palau-Solità Plegamans, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08124 Barcelona, Spain
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Vall D’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Dementia Unit, Neurology Service, Vall D’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Xose Vázquez
- Hospital Municipal de Badalona, Badalona Serveis Assistencials, Secció d’Oftalmologia, Badalona, 08911 Barcelona, Spain;
| | - Susana Ruiz
- Germans Trias i Pujol University Hospital, Badalona, 08916 Barcelona, Spain;
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
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A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness of a Polyphenolic Extract ( Hibiscus sabdariffa and Lippia citriodora) for Reducing Blood Pressure in Prehypertensive and Type 1 Hypertensive Subjects. Molecules 2021; 26:molecules26061783. [PMID: 33810049 PMCID: PMC8005037 DOI: 10.3390/molecules26061783] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/02/2023] Open
Abstract
Hypertension is an important factor of cardiovascular diseases and contributes to their negative consequences including mortality. The World Health Organization estimated that 54% of strokes and 47% of cases of ischemic heart illness are related to high blood pressure. Recently, Hibiscus sabdariffa (HS) and Lippia citriodora (LC) have attracted scientific interest, and they are recognized for their high content of polyphenols as these may prevent several disease factors, such as hypertension. The aim of the present study is to determine if supplementation with an HS-LC blend (MetabolAid®) may be effective for the treatment of type 1 hypertensive sedentary populations. A total of 80 type 1 hypertensive subjects of both sexes were included in the study and were treated with placebo or the HS-LC extract, and both groups were treated over 84 days. The blood pressure (diastolic, systolic, and pulse pressure) was measured throughout the day, for each of the days of the study duration and determined using Ambulatory Blood Pressure Monitoring (ABPM). Physical activity was determined throughout the study to ensure similar conditions related to exercise. The results showed the capacity for reducing the blood pressure parameters in the case of the HS-LC extract. The daily consumption of the HS-LC extract but not the placebo over 84 days was able to reduce the daytime parameters related to blood pressure. The most remarkable results were observed in the measurements performed during the daytime, especially in the systolic blood pressure showing statistically significant variation.
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13
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Buendía-Martínez J, Barreda-Sánchez M, Rodríguez-Peña L, Ballesta-Martínez MJ, López-González V, Sánchez-Soler MJ, Serrano-Antón AT, Pérez-Tomás ME, Gil-Ferrer R, Avilés-Plaza F, Glover-López G, Carazo-Díaz C, Guillén-Navarro E. Health impact of acute intermittent porphyria in latent and non-recurrent attacks patients. Orphanet J Rare Dis 2021; 16:106. [PMID: 33639982 PMCID: PMC7913433 DOI: 10.1186/s13023-021-01742-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute intermittent porphyria (AIP) is a genetic disease characterized by acute neurovisceral attacks. Long-term clinical conditions, chronic symptoms and impaired health related quality of life (HRQoL) have been reported during non-attack periods but mainly in patients with recurrent attacks. Our aim was to investigate these aspects in sporadic AIP (SA-AIP) and latent AIP (L-AIP) patients. Fifty-five participants, 27 SA-AIP (< 4 attacks/year) and 28 L-AIP patients with a prevalent founder mutation from Spain were included. Medical records were reviewed, and individual interviews, physical examinations, biochemical analyses, and abdominal ultrasound scans were conducted. HRQoL was assessed through an EQ-5D-5L questionnaire. A comparative study was made between SA-AIP and L-AIP patients. RESULTS The earliest long-term clinical condition associated with SA-AIP was chronic kidney disease. Chronic symptoms were reported in 85.2 % of SA-AIP and 46.4 % of L-AIP patients. Unspecific abdominal pain, fatigue, muscle pain and insomnia were significantly more frequent in SA-AIP than in L-AIP patients. The EQ-5D-5L index was lower in SA-AIP (0.809 vs. 0.926, p = 0.0497), and the impact of "pain", "anxiety-depression" and "mobility" was more intense in the EQ-5D-5L domains in SA-AIP than in L-AIP subjects and the general Spanish population. CONCLUSIONS AIP remains a chronically symptomatic disease that adversely affects health and quality of life, even in patients with low rate of acute attacks. We suggest a regular monitoring of patients with symptomatic AIP regardless of their attack rate or the time since their last attack, with proper pain management and careful attention to kidney function.
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Affiliation(s)
- Juan Buendía-Martínez
- Servicio de Neurología, Hospital General Universitario Morales Meseguer, Av Marqués de los Vélez, s/n, 30008, Murcia, Spain. .,Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain.
| | - María Barreda-Sánchez
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.,Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Lidya Rodríguez-Peña
- Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain
| | - María Juliana Ballesta-Martínez
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.,Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain.,Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain.,CIBERER-ISCIII, Madrid, Spain
| | - Vanesa López-González
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.,Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain.,CIBERER-ISCIII, Madrid, Spain.,Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Facultad de Medicina, Universidad de Murcia (UMU), Murcia, Spain
| | - María José Sánchez-Soler
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.,Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain.,Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain.,CIBERER-ISCIII, Madrid, Spain
| | - Ana Teresa Serrano-Antón
- Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain.,Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Facultad de Medicina, Universidad de Murcia (UMU), Murcia, Spain
| | - María Elena Pérez-Tomás
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Remedios Gil-Ferrer
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.,Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain
| | | | - Guillermo Glover-López
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.,CIBERER-ISCIII, Madrid, Spain.,Centro de Bioquímica y Genética Clínica, HCUVA, Murcia, Spain
| | - Carmen Carazo-Díaz
- Applied Statistical Methods in Medical Research Group, UCAM, Murcia, Spain
| | - Encarna Guillén-Navarro
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain. .,Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Ctra. Madrid-Cartagena s/n., CP 30120, El Palmar (Murcia), Spain. .,CIBERER-ISCIII, Madrid, Spain. .,Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Facultad de Medicina, Universidad de Murcia (UMU), Murcia, Spain.
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Lladó A, Froelich L, Khandker RK, Roset M, Black CM, Lara N, Chekani F, Ambegaonkar BM. Assessing the Progression of Alzheimer's Disease in Real-World Settings in Three European Countries. J Alzheimers Dis 2021; 80:749-759. [PMID: 33579841 PMCID: PMC8075403 DOI: 10.3233/jad-201172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There exists considerable variation in disease progression rates among patients with Alzheimer's disease (AD). OBJECTIVE The primary objective of this observational study is to assess the progression of AD by characterizing cognitive, functional, and behavioral changes during the follow-up period between 6 and 24 months. METHODS A longitudinal prospective study with community-dwelling patients with an established clinical diagnosis of AD of mild to moderate severity was conducted in Germany, Spain and the UK. A sample of 616 patients from 69 sites was included. RESULTS Patients had a mean of 1.9 years (SD = 1.9) since AD diagnosis at study inclusion. Cognitive symptoms were reported to have first occurred a mean of 1.1 years (SD = 1.7) prior to AD diagnosis and 1.4 (SD = 1.8) years prior to AD treatment. Patients initially diagnosed with mild and moderate AD spent a median (95%CI) of 3.7 (2.8; 4.4) and 11.1 (6.1, 'not reached') years until progression to moderate and severe AD, respectively, according to the Mini-Mental State Examination (MMSE) scores. A mixed model developed for cognitive, functional, and neuropsychiatric scores, obtained from study patients at baseline and during follow-up period, showed progressive deterioration of AD patients over time. CONCLUSION The study showed a deterioration of cognitive, functional, and neuropsychiatric functions during the follow-up period. Cognitive deterioration was slightly faster in patients with moderate AD compared to mild AD. The duration of moderate AD can be overestimated due to the use of retrospective data, lack of availability of MMSE scores in clinical charts and exclusion of patients at time of institutionalization.
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Affiliation(s)
| | - Lutz Froelich
- Department of Gerontopsychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Nuria Lara
- IQVIA, Real World Solutions, Barcelona, Spain
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15
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Martínez-Del Río J, Piqueras-Flores J, Nieto-Sandoval Martín de la Sierra P, Negreira-Caamaño M, Águila-Gordo D, Mateo-Gómez C, Salas-Bravo D, Rodríguez-Martínez M. Comparative analysis between the use of renin-angiotensin system antagonists and clinical outcomes of hospitalized patients with COVID-19 respiratory infection. MEDICINA CLINICA (ENGLISH ED.) 2020; 155:473-481. [PMID: 33209988 PMCID: PMC7659923 DOI: 10.1016/j.medcle.2020.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Hypertension has been associated with worse outcomes in patients with COVID-19 infection, so concerns have been raised about the possibility that inhibitors of the renin-angiotensin system (RAS) could influence the prognosis of these patients. METHODS This is an observational study of 921 consecutive patients admitted with COVID-19 respiratory infection to Hospital General Universitario Ciudad Real from March 1 to April 30, 2020. Following data were collected including patient demographic information, medical history, clinical characteristics, laboratory data, therapeutic interventions during the hospitalization and clinical outcomes. RESULTS The mean age was 78 years, and 59.2% of patients had a history of hypertension. Patients with previous treatment with RAS inhibitor (42.4%) showed lower risk of the primary composite endpoint (mortality or need for invasive mechanical ventilation). Treatment with RAS inhibitor (both outpatient treatment and during hospitalization) had neither effect on mortality nor need for invasive ventilation. There were no differences in time-to-event analysis between groups. CONCLUSIONS RAS inhibitor treatment prior to admission in patients with COVID-19 respiratory infection was associated with lower risk of the primary composite endpoint and did not show neither impact on mortality nor need for invasive mechanical ventilation, even if these drugs were prescribed during hospitalization.
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Affiliation(s)
- Jorge Martínez-Del Río
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Jesús Piqueras-Flores
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Daniel Águila-Gordo
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Cristina Mateo-Gómez
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Daniel Salas-Bravo
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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16
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Martínez-Del Río J, Piqueras-Flores J, Nieto-Sandoval Martín de la Sierra P, Negreira-Caamaño M, Águila-Gordo D, Mateo-Gómez C, Salas-Bravo D, Rodríguez-Martínez M. [Comparative analysis between the use of renin-angiotensin system antagonists and clinical outcomes of hospitalized patients with COVID-19 respiratory infection]. Med Clin (Barc) 2020; 155:473-481. [PMID: 32782110 PMCID: PMC7381916 DOI: 10.1016/j.medcli.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Hypertension has been associated with worse outcomes in patients with COVID-19 infection, so concerns have been raised about the possibility that inhibitors of the renin-angiotensin system (RAS) could influence the prognosis of these patients. METHODS This is an observational study of 921 consecutive patients admitted with COVID-19 respiratory infection to Hospital General Universitario Ciudad Real from March 1 to April 30, 2020. Following data were collected including patient demographic information, medical history, clinical characteristics, laboratory data, therapeutic interventions during the hospitalization and clinical outcomes. RESULTS The mean age was 78years, and 59.2% of patients had a history of hypertension. Patients with previous treatment with RAS inhibitor (42.4%) showed lower risk of the primary composite endpoint (mortality or need for invasive mechanical ventilation). Treatment with RAS inhibitor (both outpatient treatment and during hospitalization) had neither effect on mortality nor need for invasive ventilation. There were no differences in time-to-event analysis between groups. CONCLUSIONS RAS inhibitor treatment prior to admission in patients with COVID-19 respiratory infection was associated with lower risk of the primary composite endpoint and did not show neither impact on mortality nor need for invasive mechanical ventilation, even if these drugs were prescribed during hospitalization.
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Affiliation(s)
- Jorge Martínez-Del Río
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - Jesús Piqueras-Flores
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | | | - Daniel Águila-Gordo
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Cristina Mateo-Gómez
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Daniel Salas-Bravo
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Orozco-Beltrán D, Brotons Cuixart C, Alemán Sánchez JJ, Banegas Banegas JR, Cebrián-Cuenca AM, Gil Guillen VF, Martín Rioboó E, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2020 update]. Aten Primaria 2020; 52 Suppl 2:5-31. [PMID: 33388118 PMCID: PMC7801219 DOI: 10.1016/j.aprim.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022] Open
Abstract
The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: Epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; Cardiovascular (CV) risk tables and recommendations for the calculation of CV risk; Main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; Indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation. The quality of testing and the strength of the recommendation are included in the main recommendations.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Unidad de Investigación CS Cabo Huertas, Departamento San Juan de Alicante, Departamento de Medicina Clínica. Universidad Miguel Hernández, España.
| | | | | | | | | | | | - Enrique Martín Rioboó
- Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC Hospital Reina Sofía. Unidad de gestión clínica Poniente. Distrito sanitario Córdoba Guadalquivir, Córdoba, España
| | - Jorge Navarro Pérez
- Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Instituto de Investigación INCLIVA, Valencia, España
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Jurado A, Martín MC, Abad-Molina C, Orduña A, Martínez A, Ocaña E, Yarce O, Navas AM, Trujillo A, Fernández L, Vergara E, Rodríguez B, Quirant B, Martínez-Cáceres E, Hernández M, Perurena-Prieto J, Gil J, Cantenys S, González-Martínez G, Martínez-Saavedra MT, Rojo R, Marco FM, Mora S, Ontañón J, López-Hoyos M, Ocejo-Vinyals G, Melero J, Aguilar M, Almeida D, Medina S, Vegas MC, Jiménez Y, Prada Á, Monzón D, Boix F, Cunill V, Molina J. COVID-19: age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study. IMMUNITY & AGEING 2020; 17:22. [PMID: 32802142 PMCID: PMC7426672 DOI: 10.1186/s12979-020-00194-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023]
Abstract
Background The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor. Results In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course. Conclusions Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease.
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Affiliation(s)
- Aurora Jurado
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - María C Martín
- Centro de Hemoterapia y Hemodonación de Castilla y León, Paseo de Filipinos s/n, 47007 Valladolid, Spain
| | - Cristina Abad-Molina
- Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain
| | - Antonio Orduña
- Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Esther Ocaña
- Laboratory Unit. Complejo Hospitalario, Jaén, Spain
| | - Oscar Yarce
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Ana M Navas
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Antonio Trujillo
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Luis Fernández
- Laboratoy of Immunology and Genetics. Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Esther Vergara
- Laboratoy of Immunology and Genetics. Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | - Bibiana Quirant
- Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain
| | | | - Manuel Hernández
- Department of Immunology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Juana Gil
- Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Sergi Cantenys
- Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Gema González-Martínez
- Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - María T Martínez-Saavedra
- Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ricardo Rojo
- Department of Immunology, Complejo Hospitalario, La Coruña, Spain
| | | | - Sergio Mora
- Laboratory Unit. Hospital General, Alicante, Spain
| | - Jesús Ontañón
- Laboratory Unit. Hospital General Universitario, Albacete, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Gonzalo Ocejo-Vinyals
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Josefa Melero
- Department of Immunology, Hospital Infanta Cristina, Badajoz, Spain
| | - Marta Aguilar
- Department of Immunology, Hospital Infanta Cristina, Badajoz, Spain
| | - Delia Almeida
- Laboratory Unit. Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Silvia Medina
- Laboratory Unit. Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - María C Vegas
- Department of Immunology, Fundación Jiménez Díaz, Madrid, Spain
| | - Yesenia Jiménez
- Department of Immunology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Prada
- Department of Immunology, Hospital de Donostia, San Sebastián, Spain
| | - David Monzón
- Department of Immunology, Hospital de Donostia, San Sebastián, Spain
| | - Francisco Boix
- Department of Immunology, Hospital Clínico Universitario, Salamanca, Spain
| | - Vanesa Cunill
- Department of Immunology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Juan Molina
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
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Aguirre-Urizar JM, Alberdi-Navarro J, Lafuente-Ibáñez de Mendoza I, Marichalar-Mendia X, Martínez-Revilla B, Parra-Pérez C, Juan-Galíndez AD, Echebarria-Goicouria MÁ. Clinicopathological and prognostic characterization of oral lichenoid disease and its main subtypes: A series of 384 cases. Med Oral Patol Oral Cir Bucal 2020; 25:e554-e562. [PMID: 32388519 PMCID: PMC7338060 DOI: 10.4317/medoral.23576] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To clinicopathologically characterize the diagnosis of oral lichenoid disease (OLD) and its main subtypes: oral lichen planus (OLP) and oral lichenoid lesion (OLL), in order to correctly asses their prognosis. MATERIAL AND METHODS Ambispective cohort study of 384 patients with diagnosis of OLD, based on pre-established clinical and histopathological criteria. We have analysed 272 (70.8%) women and 112 (29.2%), whose mean age was 57.1+/-11.8 years (range 21-90); minimum follow-up time was 36 months. A specific protocol was designed for this study, where we gathered the data of each patient, including malignant transformation. RESULTS OLP was diagnosed in 229 cases (77.9%) and OLL in 85 (22.1%). Tobacco consumption was found in 20.3% of the patients and alcohol intake in 41.1%. Liver pathology was present in 10.7% of the cases, thyroid pathology in 11.5%, arterial hypertension in 15.6%, diabetes mellitus in 7.6%, psycho-emotional disorders in 33.3%, skin involvement in 12% and genital involvement in 4.9%. Ten patients (2.6%) developed an oral squamous cell carcinoma, 5 (1.7%) with OLP and 5 (5.9%) with OLL. CONCLUSIONS OLD is a potentially malignant disorder of the oral mucosa which has to be correctly diagnosed as either OLP or OLL, since the risk of malignancy of these subtypes is significantly different.
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Affiliation(s)
- J-M Aguirre-Urizar
- Department of Stomatology II University of the Basque Country (UPV/EHU) Barrio Sarriena sn. 48940. Leioa, Spain
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Plans E, Gullón P, Cebrecos A, Fontán M, Díez J, Nieuwenhuijsen M, Franco M. Density of Green Spaces and Cardiovascular Risk Factors in the City of Madrid: The Heart Healthy Hoods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4918. [PMID: 31817351 PMCID: PMC6950753 DOI: 10.3390/ijerph16244918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 12/11/2022]
Abstract
The aim of this study is to evaluate the relationship between the density of green spaces at different buffer sizes (300, 500, 1000 and 1500 m) and cardiovascular risk factors (obesity, hypertension, high cholesterol, and diabetes) as well as to study if the relationship is different for males and females. We conducted cross-sectional analyses using the baseline measures of the Heart Healthy Hoods study (N = 1625). We obtained data on the outcomes from clinical diagnoses, as well as anthropometric and blood sample measures. Exposure data on green spaces density at different buffer sizes were derived from the land cover distribution map of Madrid. Results showed an association between the density of green spaces within 300 and 500 m buffers with high cholesterol and diabetes, and an association between the density of green spaces within 1500 m buffer with hypertension. However, all of these associations were significant only in women. Study results, along with other evidence, may help policy-makers creating healthier environments that could reduce cardiovascular disease burden and reduce gender health inequities. Further research should investigate the specific mechanisms behind the differences by gender and buffer size of the relationship between green spaces and cardiovascular risk factors.
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Affiliation(s)
- Elena Plans
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; (E.P.); (A.C.); (M.F.); (J.D.); (M.F.)
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Pedro Gullón
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; (E.P.); (A.C.); (M.F.); (J.D.); (M.F.)
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA 19104, USA
| | - Alba Cebrecos
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; (E.P.); (A.C.); (M.F.); (J.D.); (M.F.)
| | - Mario Fontán
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; (E.P.); (A.C.); (M.F.); (J.D.); (M.F.)
- Servicio de Medicina Preventiva, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; (E.P.); (A.C.); (M.F.); (J.D.); (M.F.)
| | - Mark Nieuwenhuijsen
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), 08036 Barcelona, Spain;
- Department of Biomedicine, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; (E.P.); (A.C.); (M.F.); (J.D.); (M.F.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Darbà J, Marsà A. Patient characteristics and hospitalisation costs of spinal muscular atrophy in Spain: a retrospective multicentre database analysis. BMJ Open 2019; 9:e031271. [PMID: 31753879 PMCID: PMC6886931 DOI: 10.1136/bmjopen-2019-031271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To analyse the characteristics of patients diagnosed with spinal muscular atrophy in Spain, and to revise data on disease management and use of resources in both public and private healthcare centres. DESIGN A retrospective multicentre database analysis. SETTING 870 admission records registered between 1997 and 2015 with a diagnosis of spinal muscular atrophy were extracted from a Spanish claims database that includes hospital inpatient and outpatient admissions from 313 public and 192 private hospitals in Spain. RESULTS Admission files corresponded to 705 patients; 61.99% were males and 38.01% females. Average patient age was 37 years. Disease comorbidities registered during the admission consistently included hypertension, scoliosis and respiratory failures, all associated with the standard disease course. Regarding disease management at the hospital level, patients were mostly admitted through scheduled appointments (58.16%), followed by emergency admissions (41.72%), and into neurology services in 17% of the cases. Mean hospitalisation time was 10.45 days and in-hospital mortality reached 5.29%. The overall direct medical costs of spinal muscular atrophy were €291 525, excluding medication. The average annual cost per admission was €6274, with large variations likely to reflect disease complexity and that increases with length of stay. CONCLUSIONS The rarity of the disease difficulties the study of demographics and management; yet, an analysis of patient characteristics provides necessary information that can be used by governments to establish more efficient healthcare protocols. This study reflects the impact that individual needs and disease severity can have in disease burden calculations. Forthcoming decision-making policies should take into account medical costs and its variability, as well as pharmaceutical expenses and indirect costs. To our knowledge, this is the first study evaluating the use of healthcare resources of patients with spinal muscular atrophy in Spain.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research SL, Barcelona, Spain
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Jurić D, Pavličević I, Marušić A, Malički M, Buljan I, Šarotić V, Mrduljaš-Đujić N, Komparak A, Vujević M, De Micheli-Vitturi D, Šušnjar P, Puljiz T, Jerčić M, Leskur D, Marušić M. Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia. BMC FAMILY PRACTICE 2019; 20:10. [PMID: 30642264 PMCID: PMC6330736 DOI: 10.1186/s12875-019-0902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/02/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. CONCLUSION Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.
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Affiliation(s)
- Diana Jurić
- Department of Pharmacology, University of Split School of Medicine, Šoltanska 2, Split, Croatia
| | - Ivančica Pavličević
- Department of Family Medicine, University of Split School of Medicine, Split, Croatia
- Family medicine practice, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Mario Malički
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ivan Buljan
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | | | - Nataša Mrduljaš-Đujić
- Department of Family Medicine, University of Split School of Medicine, Split, Croatia
- Family medicine practice, Postira, Croatia
| | | | | | | | | | | | | | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Matko Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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The Prevalence of Arterial Hypertension in Romanian Adult Population: Results from the Predatorr Study. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: PREDATORR is a national study designed to estimate the prevalence of diabetes mellitus, prediabetes, overweight, obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romanian adult population. The aim of present study was to estimate the prevalence, incidence, treatment and control in subjects from PREDATORR study.
Material and methods: This study included 2727 adults aged 20 – 79 years. Subjects were examined, and three measurements were performed at a time of at least one minute and the mean of blood pressure readings was recorded. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy.
Results: The prevalence of hypertension in Romanian adult population aged 20 – 79 years was 47.38% and was higher in men: 48.62% than women: 46.23%. The incidence of hypertension was: 10.7% in 20 – 39 years age group, 43.1% in 40 – 59 years age group and 75.1% in subjects aged ≥ 60 years. Among subjects with hypertension, 18.7% did not receive antihypertensive drug therapy, 27.7% received antihypertensive treatment in monotherapy, 34.7% were under double antihypertensive drugs and most of them (37.6%) received three or more antihypertensive drugs.
Conclusions: The prevalence of hypertension in Romania is high, possible explanations of this might be the unhealthy lifestyle and diet.
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Rodríguez MB, León-Regal M, Morejón-Giraldoni A. [Risk of high blood pressure in hyperreactive cardiovascular individuals.]. SALUD PUBLICA DE MEXICO 2018; 60:414-422. [PMID: 30137943 DOI: 10.21149/8965] [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: 07/21/2017] [Accepted: 01/26/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine the risk of high blood pressure in cardiovascular hyperreactive individuals identified by the isometric hand-held weight test. MATERIALS AND METHODS A prospective cohort study was conducted for 5 years, including a total of 419 individuals. Of them, 215 were normoreactive and 204 hyperreactive. The relative risk of hypertension in the hyperreactive individuals and the contribution of cardiovascular hyperreactivity to the development of high blood pressure were determined. The significance level was 0.05. RESULTS The frequency of new hypertension cases after five years was twice as high in the cohort of hyperreactive subjects compared to the cohort of normoreactive subjects (RR 2.23, 95%CI 1.42, 3.51). The cardiovascular hyperreactivity was the most important variable for predicting of the high blood pressure (OR: 2.73; 95%CI 1.59, 4.54). CONCLUSIONS Conclusions. Cardiovascular hyperreactive individuals have a higher risk of high blood pressure than normorreactive individuals.
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Corbatón-Anchuelo A, Martínez-Larrad MT, del Prado-González N, Fernández-Pérez C, Gabriel R, Serrano-Ríos M. Prevalence, Treatment, and Associated Factors of Hypertension in Spain: A Comparative Study between Populations. Int J Hypertens 2018; 2018:4851512. [PMID: 30186629 PMCID: PMC6112205 DOI: 10.1155/2018/4851512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/24/2018] [Indexed: 01/17/2023] Open
Abstract
The prevalence and related factors of hypertensive subjects according to the resident area (rural versus urban) were investigated in two population-based studies from Spain. Medical questionnaires were administered and anthropometrics were measured, using standardized protocols. Hypertension was diagnosed in pharmacology treated subjects or those with blood pressure (BP) ≥140/90 mm Hg. Regarding BP control, it was defined as under control if BP was <140/90 or <140/85 mm Hg in type 2 diabetic subjects. Information on educational status, social class, smoking habit, and alcohol intake was obtained. 3,816 subjects (54.38 % women) were included. Prevalence of diagnosed hypertension was higher in women and showed no differences according to the living area (men: urban 21.88 versus rural 21.92 %, p = 0.986; women: urban 28.73 versus rural 30.01 %, p = 0.540). Women living in rural areas and men with secondary or tertiary education levels had a lower probability of being BP uncontrolled (OR (95 % CI): 0.501 (0.258-0.970)/p=0.040, 0.245 (0.092-0.654)/p=0.005, and 0.156 (0.044-0.549)/p=0.004, respectively). Urban young men (31-45 years) and medium aged women (46-60 years) were less BP controlled than their rural counterparts (41.30 versus 65.79 %/p=0.025 and 35.24 versus 53.27 %/p=0.002, respectively).
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Affiliation(s)
- Arturo Corbatón-Anchuelo
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - María Teresa Martínez-Larrad
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | - Cristina Fernández-Pérez
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | - Manuel Serrano-Ríos
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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del Olmo-Garcia MI, Merino-Torres JF. GLP-1 Receptor Agonists and Cardiovascular Disease in Patients with Type 2 Diabetes. J Diabetes Res 2018; 2018:4020492. [PMID: 29805980 PMCID: PMC5902002 DOI: 10.1155/2018/4020492] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/24/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus is a chronic disease prevalence of which is high and continually growing. Cardiovascular disease continues to be the leading cause of death in patients with T2DM. The prevention of cardiovascular complications and the cardiovascular safety of treatments should be a primary objective when selecting treatment. Among all the drugs available, the compounds known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) appear to be not just innocuous in terms of CVD but indeed to be beneficial. GLP-1 RA actions not only translate on an improvement of well-known cardiovascular risk factors such as glycaemic control, dyslipidaemia, weight, or arterial hypertension but also might show benefits on endothelial function, coronary ischaemia, and heart failure. On the other hand, recent clinical trials aimed at studying cardiovascular episodes have been conducted with GLP-1 RAs. Only liraglutide and semaglutide have shown superiority in cardiovascular benefit compared with placebo. Although many of the mechanisms by which liraglutide and semaglutide produce a cardiovascular benefit are still unknown it would be desirable for these benefits to be incorporated into the therapeutic algorithms routinely used in clinical practice. The purpose of this review is to explore GLP-1 RA actions not only in cardiovascular risk factors (glucose, weight, and hypertension) but also the possible effects on established cardiovascular disease.
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Affiliation(s)
- María Isabel del Olmo-Garcia
- Mixed Endocrinology, Nutrition and Dietetics Research Unit, University Hospital La Fe, València, Spain
- Instituto de Investigación Sanitaria La Fe, València, Spain
- Spanish Clinical Research Network- (SCReN-) IIS La Fe, PT17/0017/0035, València, Spain
| | - Juan Francisco Merino-Torres
- Mixed Endocrinology, Nutrition and Dietetics Research Unit, University Hospital La Fe, València, Spain
- Instituto de Investigación Sanitaria La Fe, València, Spain
- Spanish Clinical Research Network- (SCReN-) IIS La Fe, PT17/0017/0035, València, Spain
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Roy A, Praveen PA, Amarchand R, Ramakrishnan L, Gupta R, Kondal D, Singh K, Sharma M, Shukla DK, Tandon N, Reddy KS, Krishnan A, Prabhakaran D. Changes in hypertension prevalence, awareness, treatment and control rates over 20 years in National Capital Region of India: results from a repeat cross-sectional study. BMJ Open 2017; 7:e015639. [PMID: 28706098 PMCID: PMC5734355 DOI: 10.1136/bmjopen-2016-015639] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite being one of the leading risk factors of cardiovascular mortality, there are limited data on changes in hypertension burden and management from India. This study evaluates trend in the prevalence, awareness, treatment and control of hypertension in the urban and rural areas of India's National Capital Region (NCR). DESIGN AND SETTING Two representative cross-sectional surveys were conducted in urban and rural areas (survey 1 (1991-1994); survey 2 (2010-2012)) of NCR using similar methodologies. PARTICIPANTS A total of 3048 (mean age: 46.8±9.0 years; 52.3% women) and 2052 (mean age: 46.5±8.4 years; 54.2% women) subjects of urban areas and 2487 (mean age: 46.6±8.8 years; 57.0% women) and 1917 (mean age: 46.5±8.5 years; 51.3% women) subjects of rural areas were included in survey 1 and survey 2, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES Hypertension was defined as per Joint National Committee VII guidelines. Structured questionnaire was used to measure the awareness and treatment status of hypertension. A mean systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg was defined as control of hypertension among the participants with hypertension. RESULTS The age and sex standardised prevalence of hypertension increased from 23.0% to 42.2% (p<0.001) and 11.2% to 28.9% (p<0.001) in urban and rural NCR, respectively. In both surveys, those with high education, alcohol use, obesity and high fasting blood glucose were at a higher risk for hypertension. However, the change in hypertension prevalence between the surveys was independent of these risk factors (adjusted OR (95% CI): urban (2.3 (2.0 to 2.7)) rural (3.1 (2.4 to 4.0))). Overall, there was no improvement in awareness, treatment and control rates of hypertension in the population. CONCLUSION There was marked increase in prevalence of hypertension over two decades with no improvement in management.
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Affiliation(s)
- Ambuj Roy
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep A Praveen
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Ruby Gupta
- Public Health Foundation of India, Gurgaon, India
| | | | | | | | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Artyukhov IP, Grinshtein YI, Petrova MM, Shabalin VV, Ruf RR. Prevalence of arterial hypertension in the Krasnoyarsk Krai (Siberia, Russia). BMC Cardiovasc Disord 2017; 17:138. [PMID: 28549412 PMCID: PMC5446734 DOI: 10.1186/s12872-017-0559-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background To estimate the prevalence, awareness, treatment and control of arterial hypertension among adult inhabitants of Krasnoyarsk Krai using the data from Russian multicenter epidemiological study ESSE-RF (Epidemiological Survey of cardiovascular diSEases in different regions of the Russian Federation). Methods The study included 1603 subjects 25 to 64 years old selected by means of systemic multistage stratified randomization among urban and rural inhabitants of Krasnoyarsk Krai recruited between February 2014 and June 2014. Office blood pressure (BP) was measured twice with “Omron” automated BP device on the right arm in the sitting position in presence of medical personnel. Arterial hypertension (HTN) was defined as systolic BP of at least 140 mmHg and/or diastolic BP of at least 90 mmHg or self-reported previous elevated BP registration or use of antihypertensive treatment. Treatment efficacy was defined as percentage of patients achieved the target BP level among those who received antihypertensive medications, and HTN control as percentage of people achieved the target BP level among all hypertensives. Results The gender distribution was 652 males (39.4%) and 951 females (60.6%). The average level of systolic BP was 133.4 ± 0.5 mmHg, diastolic BP – 82.9 ± 0.3 mmHg. The average prevalence of HTN was estimated at 49.4% and appeared to be higher than similar parameter based on the data of 10 regions from the ESSE-RF study (44%). The average prevalence of HTN was estimated at 56.3% in males and 43.7% in females. The HTN prevalence in rural community was significantly higher in comparison with urban community (63.4 ± 2.4 vs. 44.2 ± 1.5%, p < 0.01). The average rate of HTN awareness in Krasnoyarsk Krai was 77.9% (average Russian value from ESSE-RF study was 73.1%). The average use of antihypertensive treatment, its efficacy and HTN control in Krasnoyarsk Krai were estimated at 59.5%, 31.6% and 18.8%, respectively. Conclusions Estimated prevalence of HTN in Krasnoyarsk Krai is higher than the average Russian parameter. The average HTN prevalence among men is higher than in women. The rural inhabitants are more likely to have hypertension compared with urban inhabitants. Despite high levels of HTN awareness and antihypertensive medication intake, the antihypertensive treatment efficacy in Krasnoyarsk Krai appeared to be lower in comparison with average Russian ESSE-RF values.
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Affiliation(s)
- I P Artyukhov
- Krasnoyarsk State Medical University named after prof. V. F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, 660022, St., 1. Partizan Zheleznyak, Krasnoyarsk, Russian Federation.
| | - Yu I Grinshtein
- Krasnoyarsk State Medical University named after prof. V. F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, 660022, St., 1. Partizan Zheleznyak, Krasnoyarsk, Russian Federation
| | - M M Petrova
- Krasnoyarsk State Medical University named after prof. V. F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, 660022, St., 1. Partizan Zheleznyak, Krasnoyarsk, Russian Federation
| | - V V Shabalin
- Krasnoyarsk State Medical University named after prof. V. F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, 660022, St., 1. Partizan Zheleznyak, Krasnoyarsk, Russian Federation
| | - R R Ruf
- Krasnoyarsk State Medical University named after prof. V. F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, 660022, St., 1. Partizan Zheleznyak, Krasnoyarsk, Russian Federation
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Jiménez-Trujillo I, González-Pascual M, Jiménez-García R, Hernández-Barrera V, de Miguel-Yanes JM, Méndez-Bailón M, de Miguel-Diez J, Salinero-Fort MÁ, Perez-Farinos N, Carrasco-Garrido P, López-de-Andrés A. Type 2 Diabetes Mellitus and Thoracic Aortic Aneurysm and Dissection: An Observational Population-Based Study in Spain From 2001 to 2012. Medicine (Baltimore) 2016; 95:e3618. [PMID: 27149499 PMCID: PMC4863816 DOI: 10.1097/md.0000000000003618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
To describe trends in the rates of discharge due to thoracic aortic aneurysm and dissection (TAAD) among patients with and without type 2 diabetes in Spain (2001-2012).We used national hospital discharge data to select all of the patients who were discharged from the hospital after TAAD. We focused our analysis on patients with TAAD in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or nondiabetic). Incidence was calculated overall and stratified by diabetes status. We divided the study period into 4 periods of 3 years each. We analyzed diagnostic and surgical procedures, length of stay, and in-hospital mortality.We identified 48,746 patients who were discharged with TAAD. The rates of discharge due to TAAD increased significantly in both diabetic patients (12.65 cases per 100,000 in 2001/2003 to 23.92 cases per 100,000 in 2010/2012) and nondiabetic patients (17.39 to 21.75, respectively). The incidence was higher among nondiabetic patients than diabetic patients in 3 of the 4 time periods.The percentage of patients who underwent thoracic endovascular aortic repair increased in both groups, whereas the percentage of patients who underwent open repair decreased. The frequency of hospitalization increased at a higher rate among diabetic patients (incidence rate ratio 1.14, 95% confidence interval [CI] 1.07-1.20) than among nondiabetic patients (incidence rate ratio 1.08, 95% CI 1.07-1.11). The in-hospital mortality was lower in diabetic patients than in nondiabetic patients (odds ratio 0.83, 95% CI 0.69-0.99).The incidence rates were higher in nondiabetic patients. Hospitalizations seemed to increase at a higher rate among diabetic patients. Diabetic patients had a significantly lower mortality, possibly because of earlier diagnoses, and improved and more readily available treatments.
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Affiliation(s)
- Isabel Jiménez-Trujillo
- From the Preventive Medicine and Public Health Teaching and Research Unit (IJ-T, MG-P, RJ-G, VH-B, PC-G, AL-D-A), Health Sciences Faculty, Rey Juan Carlos University, Alcorcon; Medicine Department (JMM-Y, MM-B), Hospital Gregorio Marañon; Pneumology Department (JDM-D), Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid; Dirección Técnica de Docencia e Investigación(MÁS-F), Gerencia Atención Primaria, Madrid; and Health Security Agency (NP-F), Ministry of Health. Madrid, Comunidad de Madrid, Spain
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