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Ruiz-Ortiz M, Sánchez-Fernández C, Sánchez-Fernández JJ, Mateos-de-la-Haba L, Barreiro-Mesa L, Ogayar-Luque C, Romo-Peñas E, Delgado-Ortega M, Rodríguez-Almodóvar A, Esteban-Martínez F, López-Aguilera J, Carrasco-Ávalos F, Castillo-Domínguez JC, Anguita-Sánchez M, Pan M, Mesa-Rubio D. Long-Term Prognostic Impact of Sex in Patients with Chronic Coronary Syndrome: A 17-Year Prospective Cohort Study. J Womens Health (Larchmt) 2023; 32:63-70. [PMID: 36459621 DOI: 10.1089/jwh.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Women and men with chronic coronary syndrome (CCS) have different clinical features and management, and studies on mid-term prognosis have reported conflicting results. Our objective was to investigate the impact of the female sex in the prognosis of the disease in the very long term. Methods and Results: We investigated differential features and very long-term prognosis in 1268 consecutive outpatients with CCS (337 [27%] women and 931 [73%] men). Women were older than men, more likely to have hypertension, diabetes, angina, and atrial fibrillation, and less likely to be exsmoker/active smoker and to have been treated with coronary revascularization (p < 0.05 for all). The prescription of statins, antiplatelets, and betablockers was similar in both groups. After up to 17 years of follow-up (median = 11 years, interquartile range = 4-15 years), cumulative incidences of acute myocardial infarction (10.2% vs. 11.8%) or stroke (11% vs. 10%) at median follow-up were similar, but the risks of major cardiovascular events (acute myocardial infarction, stroke, or cardiovascular death, 41.2% vs. 33.6%), hospital admission for heart failure (20.9% vs. 11.9%), or cardiovascular death (32.3% vs. 22.1%) were significantly higher for women (p < 0.0005), with a nonsignificant trend to higher overall mortality (45.2% vs. 39.1%, p = 0.07). However, after multivariate adjustment, all these differences disappeared. Conclusion: Although women and men with CCS presented a different clinical profile, and crude rates of major cardiovascular events, heart failure and cardiovascular death were higher in women, female sex was not an independent prognostic factor in this study with up to 17 years of follow-up.
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Affiliation(s)
- Martín Ruiz-Ortiz
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
| | | | | | | | | | | | - Elías Romo-Peñas
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain
| | - Mónica Delgado-Ortega
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
| | | | | | - José López-Aguilera
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
| | | | - Juan C Castillo-Domínguez
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
| | - Manuel Anguita-Sánchez
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
| | - Manuel Pan
- Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
| | - Dolores Mesa-Rubio
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Institute for Biomedical Research of Cordoba, IMIBIC, Cordoba, Spain
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Zhang J, Hao JY, Jing R, Liu JJ, Di CY, Lu YJ, Gao P, Wang YJ, Yang RF, Lin WH. Current trends in optimal medical therapy after PCI and its influence on clinical outcomes in China. BMC Cardiovasc Disord 2021; 21:258. [PMID: 34039268 PMCID: PMC8157424 DOI: 10.1186/s12872-021-02052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Limited data were available on the current trends in optimal medical therapy (OMT) after PCI and its influence on clinical outcomes in China. We aimed to evaluate the utilization and impact of OMT on the main adverse cardiovascular and cerebrovascular events (MACCEs) in post-PCI patients and analyzed the factors predictive of OMT after discharge. Methods We collected data from 3812 individuals from 2016.10 to 2017.09 at TEDA International Cardiovascular Hospital. They were classified into an OMT group and a non-OMT group according to their OMT status, which was defined as the combination of dual antiplatelet therapy, statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after PCI. Multivariable Cox regression models were developed to assess the association between OMT and MACCEs, defined as all-cause mortality, nonfatal myocardial infarction, stroke, and target vessel revascularization. A logistic regression model was established to analyze the factors predictive of OMT. Results Our results revealed that the proportion of patients receiving OMT and its component drugs decreased over time. A total of 36.0% of patients were still adherent to OMT at the end of follow-up. Binary logistic regression analysis revealed that baseline OMT (P < 0.001, OR = 52.868) was the strongest predictor of OMT after PCI. The Cox hazard model suggested that smoking after PCI was associated with the 1-year risk of MACCE (P = 0.001, HR = 2.060, 95% CI 1.346–3.151), while OMT (P = 0.001, HR = 0.486, 95% CI 0.312–0.756) was an independent protective factor against postoperative MACCEs. Conclusions There was still a gap between OMT utilization after PCI and the recommendations in the evidence-based guidelines. Sociodemographic and clinical factors influence the application of OMT. The management of OMT and smoking cessation after PCI should be emphasized.
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Affiliation(s)
- Jian Zhang
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jing-Yan Hao
- College of Clinical Cardiovascular Disease, Tianjin Medical University, Tianjin, China
| | - Rui Jing
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jing-Jing Liu
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Cheng-Ye Di
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Yu-Jie Lu
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Peng Gao
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Ya-Jie Wang
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Rui-Fei Yang
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Wen-Hua Lin
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
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Sánchez Fernández JJ, Ruiz Ortiz M, Ogayar Luque C, Cantón Gálvez JM, Romo Peñas E, Mesa Rubio D, Delgado Ortega M, Castillo Domínguez JC, Anguita Sánchez M, López Aguilera J, Carrasco Ávalos F, Pan Álvarez-Ossorio M. Long-term Survival in a Spanish Population With Stable Ischemic Heart Disease. The CICCOR Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:827-834. [PMID: 30268655 DOI: 10.1016/j.rec.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Data are lacking on the long-term prognosis of stable ischemic heart disease (SIHD). Our aim was to analyze long-term survival in patients with SIHD and to identify predictors of mortality. METHODS A total of 1268 outpatients with SIHD were recruited in this single-center prospective cohort study from January 2000 to February 2004. Cardiovascular and all-cause death during follow-up were registered. All-cause and cardiovascular mortality rates were compared with those in the Spanish population adjusted by age, sex, and year. Predictors of these events were investigated. RESULTS The mean age was 68±10 years and 73% of the patients were male. After a follow-up lasting up to 17 years (median 11 years), 629 (50%) patients died. Independent predictors of all-cause mortality were age (HR, 1.08; 95%CI, 1.07-1.11; P <.001), diabetes (HR, 1.36; 95%CI, 1.14-1.63; P <.001), resting heart rate (HR, 1.01; 95%CI, 1.00-1.02; P <.001), atrial fibrillation (HR, 1.61; 95%CI, 1.22-2.14; P=.001), electrocardiographic changes (HR, 1.23; 95%CI, 1.02-1.49; P=.02) and active smoking (HR, 1.85; 95%CI, 1.31-2.80; P=.001). All-cause mortality and cardiovascular mortality rates were significantly higher in the sample than in the general Spanish population (47.81/1000 patients/y vs 36.29/1000 patients/y (standardized mortality rate, 1.31; 95%CI, 1.21-1.41) and 15.25/1000 patients/y vs 6.94/1000 patients/y (standardized mortality rate, 2.19; 95%CI, 1.88-2.50, respectively). CONCLUSIONS The mortality rate was higher in this sample of patients with SIHD than in the general population. Several clinical variables can identify patients at higher risk of death during follow-up.
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Affiliation(s)
| | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - Elías Romo Peñas
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Dolores Mesa Rubio
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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4
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Sánchez Fernández JJ, Ruiz Ortiz M, Ogayar Luque C, Cantón Gálvez JM, Romo Peñas E, Mesa Rubio D, Delgado Ortega M, Castillo Domínguez JC, Anguita Sánchez M, López Aguilera J, Carrasco Ávalos F, Pan Álvarez-Ossorio M. Supervivencia a largo plazo de una población española con cardiopatía isquémica estable: el registro CICCOR. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cordero A, Rodriguez Padial L, Batalla A, López Barreiro L, Torres Calvo F, Castellano JM, Ruiz E, Bertomeu-Martínez V. Optimal pharmacological treatment and adherence to medication in secondary prevention of cardiovascular events in Spain: Results from the CAPS study. Cardiovasc Ther 2017; 35. [PMID: 27957818 DOI: 10.1111/1755-5922.12240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 09/26/2016] [Accepted: 12/02/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Despite the large amount of evidence supporting the use of antiplatelet agents, beta-blockers, angiotensin antagonists, and lipid-lowering statins in patients with stable coronary artery disease, several studies have documented underprescription of optimal medical treatment (OMT) in Spain. AIMS The present study aimed to describe the current trend of pharmacological prescription in secondary prevention treatment for cardiovascular diseases (CVDs) in a Spanish cohort. METHODS This study was a multicenter, observational, cross-sectional study (CAPS study, FER-CAR-2014-01) in the context of only one visit. Adherence levels to the prescribed medication, the reasons for not prescription of each medication, the existence of possible associations between sociodemographic features, different CVDs, and different drugs with treatment compliance were also analyzed in patients who have suffered cardiovascular effects. RESULTS Six hundred and twelve patients (68.5±10.7 years old; 78% males) were included. OMT was prescribed in 40.8% of the patients. The main reason for not prescribing was due to the physician's discretion. Adherence to medication, measured by the Morisky-Green questionnaire, was 45.8%, and it was positively related to the presence of coronary events (OR 1.80; 95% CI: 1.05-3.21) but not with any drug type. Moreover, a higher educational background implied a higher percentage of adherence to medication. Finally, nonadherent patients were prescribed more daily medicine intakes. CONCLUSIONS Low adherence to guideline-oriented treatment as well as low adherence to medication was found by a self-reported questionnaire. Enhancing adherence to guideline-recommended therapy and reducing treatment complexity seem to be reasonable strategies to improve adherence to secondary prevention medications.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | | | - Alberto Batalla
- Department of Cardiology, Clínica Cardiológica Dr. Batalla, Gijón, Spain
| | - Luis López Barreiro
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, grupo HM, Hospital Universitario Monteprincipe, Madrid, Spain
| | - Francisco Torres Calvo
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, grupo HM, Hospital Universitario Monteprincipe, Madrid, Spain
| | - Jose M Castellano
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, grupo HM, Hospital Universitario Monteprincipe, Madrid, Spain
| | - Emilio Ruiz
- Medical Department, Ferrer, Barcelona, Spain
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Cordero A, Galve E, Bertomeu-Martínez V, Bueno H, Fácila L, Alegría E, Cequier Á, Ruiz E, González-Juanatey JR. Tendencias en factores de riesgo y tratamientos de pacientes con cardiopatía isquémica estable atendidos en consultas de cardiología entre 2006 y 2014. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cucalon Arenal J, Buisac Ramón C, Marin Ibáñez A, Castan Ruiz S, Blay Cortes M, Barrasa Villar J. Control de los principales factores de riesgo cardiovascular de la cardiopatía isquémica en prevención secundaria en Aragón: estudio COCINA. HIPERTENSION Y RIESGO VASCULAR 2016; 33:7-13. [DOI: 10.1016/j.hipert.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/21/2015] [Accepted: 09/09/2015] [Indexed: 10/22/2022]
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8
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Cordero A, Galve E, Bertomeu-Martínez V, Bueno H, Fácila L, Alegría E, Cequier Á, Ruiz E, González-Juanatey JR. Trends in Risk Factors and Treatments in Patients With Stable Ischemic Heart Disease Seen at Cardiology Clinics Between 2006 and 2014. ACTA ACUST UNITED AC 2015; 69:401-7. [PMID: 26631917 DOI: 10.1016/j.rec.2015.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Chronic ischemic heart disease is the most prevalent of all cardiovascular diseases. Patients are at high risk of complications. In recent decades, changes may have occurred in the clinical characteristics of the disease, its treatment and control of risk factors. METHODS A direct comparison of 2 national registries of patients with chronic ischemic heart disease carried out in 2006 (n=1583) and 2014 (n=1110). RESULTS We observed statistically significant differences between the 2 registries, with a higher percentage of men and smokers in the 2014 registry, but a lower prevalence of diabetes mellitus and hypertension. Heart failure and stroke were more prevalent in the 2006 registry. Patients in the 2014 registry had better results for lipid profile, blood glucose, creatinine, and glomerular filtration rate. We observed higher use of recommended drugs for secondary prevention and an increased percentage of patients receiving optimal medical therapy, from 32.5% to 49.5% (P<.01). Use of high-intensity statin doses also increased from 10.5% to 42.8% (P<.01). We found better control of some risk factors (improved dyslipidemia, heart rate, and blood glucose in patients with diabetes) but worse blood pressure control. CONCLUSIONS The clinical profile of patients with chronic ischemic heart disease is similar in the 2 registries. There has been an improvement in patients' medical therapy and dyslipidemia control, blood glucose, and heart rate, but there is still much room for improvement in the control of other cardiovascular risk factors.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
| | - Enrique Galve
- Departamento de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Vicente Bertomeu-Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Héctor Bueno
- Departamento de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Lorenzo Fácila
- Departamento de Cardiología, Hospital General de Valencia, Valencia, Spain
| | - Eduardo Alegría
- Departamento de Cardiología, Policlínica Gipuzkoa, San Sebastián, Guipúzcoa, Spain
| | - Ángel Cequier
- Departamento de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Ruiz
- Departamento Médico, Laboratorios Ferrer, Barcelona, Spain
| | - José Ramón González-Juanatey
- Departamento de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Atención al alta en pacientes con síndrome coronario agudo y control de la dislipidemia en la práctica clínica en España: Estudio SINCOPA. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 27:272-9. [DOI: 10.1016/j.arteri.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
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10
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Garcia-Moll X. Luces y (algunas) sombras en el manejo del síndrome coronario agudo en España: el estudio DIOCLES. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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11
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Garcia-Moll X. Lights and (Some) shadows in the management of acute coronary syndrome in Spain: the DIOCLES Study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:85-86. [PMID: 25555534 DOI: 10.1016/j.rec.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Xavier Garcia-Moll
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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González-Pliego JA, Gutiérrez-Díaz GI, Celis A, Gudiño-Amezcua DA. [Registry of non-ST elevation acute coronary syndromes in a tertiary hospital (RESCATA-SEST registry)]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:92-9. [PMID: 24793555 DOI: 10.1016/j.acmx.2013.11.006] [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: 03/26/2013] [Revised: 09/24/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To describe the clinical-epidemiologic profile and the process of care of the non-ST elevation acute coronary syndromes in a tertiary hospital. METHOD We analyzed the clinical information, the risk stratification and diagnostic methods, the revascularization therapy and the prescription trends at discharge, of patients with non-ST elevation acute coronary syndromes cared for in one year. RESULTS Two hundred and eighty-three patients with mean age of 58 years were included (63% men). The largest number of non-ST elevation acute coronary syndromes (88.6%) was found between 50 to 59 years of age. The most common risk factor was hypertension; 82.5% of the patients had a low-intermediate TIMI score; residual ischemia was demonstrated in 37% and coronary obstructions were seen in 80 patients (70%). In 90%, a percutaneous coronary intervention was performed, mainly with drug-eluting Stents (87.5%). At discharge, even though antiplatelet agents and statins were prescribed in more than 90%, other drugs were indicated in a few more than 50% of patients. CONCLUSIONS In this population, non-ST elevation acute coronary syndromes predominates in relatively young men, often with hypertension. To stratify risk, to look for residual ischemia and to revascularize with drug-eluting stents are common practices, but the evidence-based guidelines compliance is still suboptimal.
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Affiliation(s)
- José Angel González-Pliego
- Departamento de Cardiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
| | - Gonzalo Israel Gutiérrez-Díaz
- Departamento de Cardiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Alfredo Celis
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Diego Armando Gudiño-Amezcua
- Departamento de Cardiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
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Royo-Bordonada MÁ, Lobos JM, Brotons C, Villar F, de Pablo C, Armario P, Cortés O, Gil Nuñez A, Lizcano Á, de Santiago A, Sans S. El estado de la prevención cardiovascular en España. Med Clin (Barc) 2014; 142:7-14. [DOI: 10.1016/j.medcli.2012.09.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/24/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022]
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14
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Zhang JW, Zhou YJ, Yang Q, Yang SW, Nie B, Xu XH. Impact of chronic obstructive pulmonary diseases on outcomes and hospital days after percutaneous coronary intervention. Angiology 2012; 64:430-4. [PMID: 22942128 DOI: 10.1177/0003319712458145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is common in patients undergoing percutaneous coronary intervention (PCI), but the impact of COPD on outcomes after PCI has received limited attention. Consecutive patients with coronary heart disease (n = 5155) undergoing PCI were enrolled in this study; 645 patients (73% men) aged 68.4 ± 13.2 years had COPD and 4510 patients (71% men) aged 64.7 ± 12.1 years did not. During the in-hospital period after PCI, the patients with COPD experienced a significantly higher incidence of angina (P < .001), arrhythmias (P < .001), and composite major adverse cardiac events (MACEs; P < .001) and longer hospital stay (P < .001) than those without COPD. Additionally, severity of COPD (measured by pulmonary function tests) was associated with increased composite MACE (P < .001) and hospital stay (P < .001) after PCI. In conclusion, COPD is associated with significantly increased composite MACE and hospital stay in patients after PCI. Increasing severity of COPD is associated with increased composite MACE and hospital stay after PCI.
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Affiliation(s)
- Jian Wei Zhang
- Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
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15
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Actitud y eficacia de los cardiólogos frente al tabaquismo de los pacientes tras un síndrome coronario agudo. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2012.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Utilización de tratamientos cardiovasculares preventivos y consecución de objetivos terapéuticos en pacientes con enfermedad arterial periférica. Rev Esp Cardiol 2012; 65:713-8. [DOI: 10.1016/j.recesp.2012.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/17/2012] [Indexed: 01/02/2023]
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17
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Estudio de la angina estable en España y su impacto en la calidad de vida del paciente. Registro AVANCE. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2012.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cordero A, Bertomeu-Martínez V, Mazón P, Cosín J, Galve E, Lekuona I, de la Guía F, Gonzalez-Juanatey JR. Attitude and efficacy of cardiologists with respect to smoking in patients after acute coronary syndromes. ACTA ACUST UNITED AC 2012; 65:719-25. [PMID: 22739551 DOI: 10.1016/j.rec.2012.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 03/04/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Smoking is one of the most prevalent risk factors in acute coronary syndrome patients. The aim of this study was to assess the attitudes of cardiologists to the smoking habits of these patients METHODS A prospective multicenter registry of acute coronary syndrome patients. The primary endpoint was defined as smoking abstinence and the secondary endpoint as the incidence of all-cause mortality or nonfatal myocardial infarction. RESULTS The study population included 715 patients; 365 were current smokers. During follow-up (median, 375.0 days [interquartile range, 359.3-406.0 days]), 110 patients (30.6%) received smoking cessation support (19.7% at hospital discharge and 37.6% at month 3), specialized units and varenicline being the strategies most frequently used. No clinical differences were observed between patients who received smoking cessation support and those who did not, except for a higher prevalence of previous coronary heart disease in those who received support. In the multivariate analysis, the only variable independently associated with receiving smoking cessation support was previous coronary heart disease (odds ratio=3.16; 95% confidence interval, 1.64-6.11; P<.01). The abstinence rate was 72.3% at month 3 and 67.9% at 1 year; no differences were observed between the patients who received smoking cessation support and those who did not. During follow-up, a nonsignificant trend toward a lower incidence of the secondary endpoint was observed among the patients who were smokers at the time of acute coronary syndrome and who achieved abstinence (P=.07). CONCLUSIONS Use of smoking cessation support strategies is limited in acute coronary syndrome patients and is more widespread among those with previous coronary heart disease.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
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Borrás X, Garcia-Moll X, Gómez-Doblas JJ, Zapata A, Artigas R. Stable angina in Spain and its impact on quality of life. The AVANCE registry. ACTA ACUST UNITED AC 2012; 65:734-41. [PMID: 22739550 DOI: 10.1016/j.rec.2012.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 03/04/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Mortality from acute coronary syndrome has fallen but a substantial number of chronic patients remain symptomatic. The present study was designed to determine the clinical characteristics and therapeutic treatment of patients with stable angina and its impact on their quality of life. METHODS A cross-sectional, multicenter, observational study of 2039 patients with stable angina attended in outpatient clinics was performed. Data were collected on clinical variables and on the subjective perception of the severity of angina and the resulting limitations. Patients completed questionnaires on their perception of severity and quality of life. RESULTS We analyzed data on 2024 patients; 73% were men (mean age 68[10] years). Some 50.3% were asymptomatic (<1 angina attack per week in the previous 4 weeks), 39.2% reported 1-3 attacks per week and 10.5% reported >3 attacks per week; 66% had previously undergone revascularization, and 59% of these developed recurrent angina. Patients rated the severity of their condition higher than did their physicians (4.5 [2.5] vs 4.3 [2.3]; P=.002). Physicians' and patients' perceptions of the repercussions of angina showed little concordance (kappa<0.3). The patients believed their condition was much more severe, more debilitating, and had a greater negative impact on their quality of life. CONCLUSIONS A high proportion of patients with stable angina remains symptomatic and their quality of life is impaired. Their perception of the condition is worse than that of their physicians.
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Affiliation(s)
- Xavier Borrás
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Short-term metabolic changes achieved by weight loss in hypertensive patients. Int J Cardiol 2011; 153:286-90. [DOI: 10.1016/j.ijcard.2010.08.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 07/13/2010] [Accepted: 08/17/2010] [Indexed: 10/19/2022]
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Cordero A, Morillas P, Bertomeu-González V, Quiles J, Soria F, Guindo J, Mazón P, Anguita M, Rodríguez-Padial L, González-Juanatey JR, Bertomeu-Martínez V. Pathological ankle-brachial index is equivalent of advanced age in acute coronary syndromes. Eur J Clin Invest 2011; 41:1268-74. [PMID: 21517830 DOI: 10.1111/j.1365-2362.2011.02533.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Age is one the factors associated with poor prognosis in acute coronary syndromes (ACS) and elderly patients are a high-risk collective with few parameters for mid-term cardiovascular stratification. We aimed to assess the predictive value of ankle-brachial index (ABI) in patients (> 75 years) for 1-year mortality after an ACS. MATERIALS AND METHODS Prospective, observational and multicentre study of ACS patients in whom ABI was assessed during hospitalization. RESULTS A total of 1·054 patients were included, mean age 66·6 (11·7) years from whom 26·6% were > 75 years. Elderly patients showed more history of cardiovascular disease and higher prevalence of all risk factors, except current smoking. Angiography and revascularization were performed less frequently in the elderly. Patients > 75 years showed higher presence of three vessel coronary disease and received fewer guideline-recommended treatments. Patients who died through the follow-up, mean time 387·9 ± 7·2 days, had lower ABI (0·73 ± 0·24 vs. 0·92 ± 0·22; P < 0·01), also in the elderly patients (0·73 ± 0·24 vs. 0·86 ± 0·23; P < 0·01). Cox regression analysis identified age > 75 years (HR: 2·30; IC 95% 1·26-4·18; P < 0·01) and ABI < 0·90 (HR: 3·58; IC 95% 1·80-7·15; P < 0·01) as risk factors for to 1-year mortality. Mortality was similar in elderly patients with ABI > 0·90 and young patients with ABI < 0·90; the worst prognosis was observed in elderly patients with ABI < 0·90 (HR: 10·01; 95% CI 3·74-27·15). CONCLUSIONS Elderly patients represent a relevant collective of patients with ACS and are treated less optimally. ABI predicts 1-year mortality after an ACS in elderly patients.
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Burden of systemic hypertension in patients admitted to cardiology hospitalization units. Am J Cardiol 2011; 108:1570-5. [PMID: 21871594 DOI: 10.1016/j.amjcard.2011.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/06/2011] [Accepted: 07/06/2011] [Indexed: 01/13/2023]
Abstract
Hypertension is 1 of the most prevalent cardiovascular risk factors; nevertheless, some studies have reported that the antecedent of hypertension does not impair prognosis in patients with established cardiovascular disease. The objective of this study was to describe the impact of hypertension on readmission and 1-year mortality in patients admitted to a single cardiology hospitalization unit. All consecutive hospitalizations in a single cardiology department through 10 months were included, and 1-year follow-up was performed. Clinical antecedents, risk factors, and main discharge diagnoses were collected. A total of 1,007 patients were included (mean age 71.1 ± 13.5 years). The antecedent of hypertension was present in 69.0%, and these patients had older mean age and higher prevalence of risk factors and previous cardiovascular disease. No differences in hospital discharge main diagnoses were observed according to the antecedent of hypertension. During a mean follow-up period of 404.82 ± 122.2 days, patients with hypertension had higher rates of rehospitalization for cardiac causes (31.1% vs 17.9%, p = 0.01) and of total (17.4% vs 9.3%, p <0.01) and cardiovascular (13.9% vs 5.9%, p <0.01) mortality. Multivariate analysis identified the antecedent of hypertension as an independent risk factor for cardiovascular readmission (hazard ratio 1.46, 95% confidence interval 1.10 to 1.98) and the combined end point of readmission or mortality (hazard ratio 1.45, 95% confidence interval 1.12 to 1.88); no independent association was observed for total mortality. In conclusion, hypertension was present in most patients admitted to a cardiology unit, and they had higher rates of rehospitalization and mortality at 1-year follow-up.
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Sicras-Mainar A, Fernández de Bobadilla J, Navarro-Artieda R, Martín I, Varela-Moreno C. [Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish population]. Rev Clin Esp 2011; 211:560-71. [PMID: 22088667 DOI: 10.1016/j.rce.2011.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/15/2011] [Accepted: 07/02/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the management of patients suffering acute coronary syndrome (ACS) and to determine its clinical and economic consequences in a Spanish population. METHODS A multicenter, retrospective claim database study including patient medical records from 6 primary care centers, two hospitals and two years of follow-up was carried out. Patients ≥30 years, suffering a first acute coronary syndrome (ACS), between 2003 and 2007, were included. Groups: acute coronary syndrome with and without ST segment elevation. VARIABLES socio-demographic, co-morbidities, metabolic syndrome (MS), biochemical parameters, drugs, cumulative incidence (total mortality and cardiovascular events (CVE: including myocardial infarction, stroke and peripheral artery disease) and total costs. STATISTICAL ANALYSIS logistic regression, Kaplan-Meier curves and ANCOVA; (P<.05). RESULTS A total of 1020 patients were included. Mean age: 69 years; males: 65%. Groups: ST segment elevation ACS (N=632; 62%). Co-morbidities: hypertension (56%), dyslipidemia (46%) and diabetes (38%). Prevalence of MS: 59% (CI 95%: 56-62%). All biochemical parameters had improved after two years of follow-up. The average total cost per patient was €14,069 (87% direct costs; 13% productivity loss costs). Direct costs: primary care (20%), specialty care (67%); hospitalization costs represented 63% of total costs. The average total cost for patients presenting more than one CVE was 22,750€ vs 12,380€ for those patients who suffered only one (P<.001). Cumulative incidence: total mortality 14%; CVE: 16%. CONCLUSIONS In the current clinical practice, and despite the clinical efforts carried out, patients with an ACS are still at a high risk of suffering further CVE, representing a high cost burden to the health care system.
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Affiliation(s)
- A Sicras-Mainar
- Dirección de Planificación, Badalona Serveis Assistencials SA, Barcelona, España.
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Garcia-Moll X, Fácila L, Conthe P, Zapata A, Artigas R, Bertomeu V, González-Juanatey JR. [How beta-blockers are used in Spain? Analysis of limitations in their use in internal medicine and cardiology: CARACTER-BETA study]. Rev Esp Cardiol 2011; 64:883-90. [PMID: 21885180 DOI: 10.1016/j.recesp.2011.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/29/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Beta-blocker treatment has a class I indication, level of evidence A, in guidelines for the treatment of heart failure, ischemic heart disease, and atrial fibrillation. However, beta-blocker use continues to be less than optimal. In this study, beta blocker use in Spain is analyzed in patients with heart failure, ischemic heart disease, and atrial fibrillation. METHODS Observational, epidemiologic, cross-sectional, multicenter study including 1608 patients with heart failure, ischemic heart disease, and/or atrial fibrillation, recruited in 150 healthcare centers by cardiologists and internal medicine specialists. RESULTS Cardiologists enrolled 78.6% patients and internal medicine specialists 21.4%; 25.8% were recruited at hospital discharge and 74.2% at outpatient centers. Men accounted for 77% of the sample, and age was 68 (12) years. Of the total, 73% had ischemic heart disease, 42% heart failure, and 36% atrial fibrillation (multiresponse variable). Beta blockers were given to 82.8% of those consulting in cardiology compared to 71.6% of those treated in internal medicine (P<.0001). By pathology, the prescription rate was 85.1% of patients with ischemic heart disease, 77.0% of those with heart failure, and 72.4% of those with atrial fibrillation. Cardiology prescribed significantly more beta blockers for ischemic heart disease and heart failure than did internal medicine. Multivariate analysis showed that beta blocker use increased when the patient had ischemic heart disease, was treated by a cardiologist, and had dyslipidemia, stroke, and/or left ventricular hypertrophy. beta blocker use decreased with age and with a history of bronchospasm, asthma, bradycardia, chronic obstructive pulmonary disease, and/or intermittent claudication. CONCLUSIONS There is still room for improvement in beta blocker prescription in Spain for patients with ischemic heart disease, heart failure, and/or atrial fibrillation.
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Affiliation(s)
- Xavier Garcia-Moll
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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González-Juanatey JR, Cordero A, Vitale GC, González-Timón B, Mazón P, Bertomeu V. [Magnitude and characteristics of residual lipid risk in patients with a history of coronary revascularization: the ICP-bypass study]. Rev Esp Cardiol 2011; 64:862-8. [PMID: 21835533 DOI: 10.1016/j.recesp.2011.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Residual lipid risk has been defined as the excess of cardiovascular events observed in patients with adequate control of low-density lipoprotein cholesterol and has been mainly attributed to high-density lipoprotein cholesterol and triglycerides. The aim of our study was to describe the clinical features and the magnitude and characteristics associated with residual lipid risk in patients with a history of coronary revascularization. METHODS Multicenter, observational, cross-sectional study of patients with a history of coronary revascularization. Residual lipid risk was defined as the presence of high-density lipoprotein cholesterol <40 mg/dL and/or triglycerides >150 mg/dL in patients with low-density lipoprotein cholesterol <100 mg/dL. RESULTS We included 2292 patients with a mean age of 65.5 (12.4) years; 94.1% were receiving no statin therapy and 4.8% no lipid therapy. Statin-only therapy (74%) was the most common strategy, followed by combination with ezetimibe (17%). The prevalence of high-density lipoprotein cholesterol <40 mg/dL was 35.8%, hypertriglyceridemia 38.9%, and low-density lipoprotein cholesterol >100 mg/dL 44.9%; the residual lipid risk group included 29.9% of all patients. This patient group had a similar clinical profile except for slightly lower mean age, higher incidence of diabetes, and higher proportion of men. Multivariate analysis identified positive associations of diabetes and male sex with residual lipid risk; current smoking, male sex, and fibrate therapy were associated with high-density lipoprotein cholesterol <40 mg/dL; current smoking, abdominal obesity, and fibrate therapy were associated with hypertriglyceridemia. CONCLUSIONS In daily clinical practice, almost one-third of patients with a history of coronary revascularization have low-density lipoprotein cholesterol <100 mg/dL plus low high-density lipoprotein cholesterol and/or hypertriglyceridemia, a concept known as residual lipid risk.
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Affiliation(s)
- José Ramón González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
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Falces C, Andrea R, Heras M, Vehí C, Sorribes M, Sanchis L, Cevallos J, Menacho I, Porcar S, Font D, Sabaté M, Brugada J. Integración entre cardiología y atención primaria: impacto sobre la práctica clínica. Rev Esp Cardiol 2011; 64:564-71. [DOI: 10.1016/j.recesp.2011.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
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Factors Associated With Uncontrolled Hypertension in Patients With and Without Cardiovascular Disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.rec.2011.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cordero A, Bertomeu-Martínez V, Mazón P, Fácila L, Bertomeu-González V, Cosín J, Galve E, Núñez J, Lekuona I, González-Juanatey JR. [Factors associated with uncontrolled hypertension in patients with and without cardiovascular disease]. Rev Esp Cardiol 2011; 64:587-93. [PMID: 21640460 DOI: 10.1016/j.recesp.2011.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/04/2011] [Indexed: 01/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hypertension is one of the most prevalent and poorly controlled risk factors, especially in patients with established cardiovascular disease (CVD). The aim of this study was to describe the rate of blood pressure (BP) control and related risk factors. METHODS Multicenter, cross-sectional and observational registry of patients with hypertension recruited from cardiology and primary care outpatient clinics. Controlled BP defined as <140/90 mmHg. RESULTS 55.4% of the 10 743 patients included had controlled BP and these had a slightly higher mean age. Patients with uncontrolled BP were more frequently male, with a higher prevalence of active smokers, obese patients, and patients with diabetes. The rate of controlled BP was similar in patients with or without CVD. Patients with uncontrolled BP had higher levels of blood glucose, total cholesterol, low density lipoproteins and uric acid. Patients with uncontrolled BP were receiving a slightly higher mean number of antihypertensive drugs compared to patients with controlled BP. Patients with CVD were more frequently receiving a renin-angiotensin-aldosterone axis inhibitor: 83.5% vs. 73.2% (P<.01). Multivariate analysis identified obesity and current smoking as independently associated with uncontrolled BP, both in patients with or without CVD, as well as relevant differences between the two groups on other factors. CONCLUSIONS Regardless of the presence of CVD, 55% of hypertensive patients had controlled BP. Lifestyle and diet, especially smoking and obesity, are independently associated with lack of BP control. Full English text available from: www.revespcardiol.org.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, 3550 Sant Joan d'Alacant, Alicante, Spain.
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Royo Bordonada MÁ, Lobos Bejarano JM, Millán Núñez-Cortés J, Villar Álvarez F, Brotons Cuixart C, Camafort Babkowski M, Guijarro Herráiz C, de Pablo Zarzosa C, Pedro-Botet Montoya J, Santiago Nocito AD. Dislipidemias: un reto pendiente en prevención cardiovascular. Documento de consenso CEIPC/SEA. Med Clin (Barc) 2011; 137:30.e1-30.e13. [DOI: 10.1016/j.medcli.2011.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
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Borrás-Pérez X, Murga-Eizagaechevarría N. Novedades en cardiología clínica. La actitud del cardiólogo clínico ante los nuevos fármacos cardiovasculares. Rev Esp Cardiol (Engl Ed) 2011; 64 Suppl 1:73-80. [DOI: 10.1016/s0300-8932(11)70010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Novedades en el último año en el planteamiento terapéutico de la cardiopatía hipertensiva, de la cardiopatía isquémica y de la fibrilación auricular. Rev Clin Esp 2010; 210 Suppl 1:2-11. [DOI: 10.1016/s0014-2565(10)70002-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cordero A, Fácila L, Galve E, Mazón P. Novedades en hipertensión arterial y diabetes mellitus. Rev Esp Cardiol 2010; 63 Suppl 1:101-15. [DOI: 10.1016/s0300-8932(10)70144-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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