1
|
Barrios V, Escobar C, Arrarte V, García E, Fernández MR, Rincón LM, Roldán C. First national registry on the effectiveness and safety of evolocumab in clinical practice in patients attended in cardiology in Spain. The RETOSS-CARDIO study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2020; 32:231-241. [PMID: 32605806 DOI: 10.1016/j.arteri.2020.05.002] [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: 12/26/2019] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To present the first registry used to analyse the clinical profile of patients treated with evolocumab in Spain, including the effectiveness on the lipid profile and safety in the «real world» setting. METHODS Multicentre, retrospective, and observational study of patients starting treatment with evolocumab from February 2016 to May 2017 in clinical practice in Spanish cardiology units. RESULTS A total of 186 patients (mean age 60.3 ± 9.8 years were included, 35.5% with familial hypercholesterolaemia, and 94.1% with a previous cardiovascular event) from 31 cardiology units. Baseline lipid profile: Total cholesterol 219.4 ± 52.2 mg/dL, LDL-cholesterol 144.0 ± 49.0mg/dL, HDL-cholesterol 47.7 ± 13.0mg/dL, and triglycerides 151.0 ± 76.2mg/dL. At the time of initiating evolocumab, 53.8% of patients were taking statins (50% had partial or total intolerance to statins), and 51.1% ezetimibe. In all cases, the dose of evolocumab used was 140 mg, mainly every 2 weeks (97.3%). Evolocumab compliance was high (92.3%). Treatment with evolocumab was interrupted in 6 patients (3.2%), with only 1 (0.5%) due to a probable side effect. Evolocumab significantly reduced total cholesterol (30.9% at week 2, and 39.3% at week 12; P<.001), LDL cholesterol (44.4% and 57.6%, respectively; P<.001), and triglycerides (14.8% and 5.2%, respectively; P<001), with no significant changes in HDL-cholesterol (6.7% and 2.0%; P=.14). CONCLUSIONS In clinical practice, evolocumab is associated with reductions in LDL cholesterol, with nearly 60% after 12 weeks of treatment, and with low rates of interruptions due to side effects and high medication compliance. These results are consistent with those reported in randomised clinical trials.
Collapse
Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Vicente Arrarte
- Servicio de Cardiología, Hospital General Universitario, Alicante, España
| | - Eusebio García
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, España
| | | | - Luis Miguel Rincón
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | | |
Collapse
|
2
|
Cervantes CE, Merino JL, Barrios V. Edoxaban for the prevention of stroke in patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2019; 17:319-330. [DOI: 10.1080/14779072.2019.1598263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Carlos Escobar Cervantes
- Cardiology Service, Unidad de electrofisiología cardíaca robotizada, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Merino
- Cardiology Service, Unidad de electrofisiología cardíaca robotizada, Hospital Universitario La Paz, Madrid, Spain
| | | |
Collapse
|
3
|
Barrios V, Escobar C. Improving cardiovascular protection: focus on a cardiovascular polypill. Future Cardiol 2016; 12:181-96. [DOI: 10.2217/fca.15.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lack of adherence may explain, at least in part, the poor cardiovascular risk factors control observed in patients with ischemic heart disease, increasing the risk of developing new events. Polypill improves medication adherence, which may actually reduce blood pressure and LDL cholesterol compared with the drugs given separately. The fixed combination of acetylsalicylic acid 100 mg + ramipril 2.5, 5, or 10 mg + either simvastatin 40 mg or atorvastatin 20 mg is the unique cardiovascular polypill that has been registered in 22 countries worldwide. The polypill-containing simvastatin has been specifically tested in a clinical trial including only patients with ischemic heart disease. The FOCUS study showed that patients treated with the polypill showed a higher adherence compared with those receiving separate medications.
Collapse
Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramon y Cajal, School of Medicine. University of Alcalá, Madrid, Spain
| | - Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, Spain
| |
Collapse
|
4
|
Inmigración y cardiopatía isquémica: una realidad muy actual. HIPERTENSION Y RIESGO VASCULAR 2014. [DOI: 10.1016/j.hipert.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
5
|
Barrios V, Escobar C, Zamorano JL. Searching the place of pitavastatin in the current treatment of patients with dyslipidemia. Expert Rev Cardiovasc Ther 2014; 11:1597-612. [DOI: 10.1586/14779072.2013.844546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
6
|
Barrios V, Coca A, Escobar C, Enrique R, Rincón LM. Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in clinical practice. Expert Rev Cardiovasc Ther 2014; 10:159-66. [DOI: 10.1586/erc.11.185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Brotons C, Cuende JI, Fernández Pardo J, Plana N, Moral I. [Ischaemic heart disease]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2013; 25:203-210. [PMID: 24238749 DOI: 10.1016/j.arteri.2013.10.003] [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: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 06/02/2023]
Abstract
In the year 2011, cardiovascular diseases were responsible of 31.2% of total deaths in Spain. The absolute number of cases of acute coronary syndrome in this year will be approximately 115,752 cases (95%CI: 114,822-116,687). The prevalence of stable angina in the population aged 25-74 years is 2.6% in men and 3.5% in women. Cardiovascular diseases were in the year 2011 the first cause of hospitalizations representing 14.1% of the total hospitalizations. Diagnose of ischaemic heart disease and acute myocardial infarction were responsible of 110,950 and 50,064 hospitalizations, respectively. In the year 2003, the hospitalization rate was 314 while in the year 2011 was 237 per 100,000, a reduction of 24.4%. The average cost of hospitalization due to ischaemic heart disease in 1997 was 3,093.7euros while in the year 2011 was 7,028.71euros. Cardiovascular mortality rates have decreased from 2007 to 2011, showing a relative reduction of 7% in women and 8% in men. With regard to myocardial infarction, it was observed a relative reduction of 17% in men and 20% in women. According to EUROASPIREIII survey done in 8,966 patients with ischaemic heart disease in Europe, 17% of patients were still smokers, 35% were obese, 56% has uncontrolled blood pressure, 51% has raised blood cholesterol and 25% were diabetics. With regard to drugs utilisation, 91% were treated with antiplatelets agents, 80% with beta blockers, 71% with ACE inhibitors/ARBs.
Collapse
Affiliation(s)
- Carlos Brotons
- Unidad de Investigación, Equip d'Atenció Primària Sardenya, Unidad Docente ACEBA, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España.
| | - José I Cuende
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial de Palencia, Palencia, España
| | - Jacinto Fernández Pardo
- Unidad de Hipertensión y Lípidos, Hospital General Universitario Reina Sofía, Murcia, España
| | - Nuria Plana
- Unitat de Investigació Clínica (UIC), Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Reus, Tarragona, España
| | - Irene Moral
- Unidad de Investigación, Equip d'Atenció Primària Sardenya, Unidad Docente ACEBA, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España
| |
Collapse
|
8
|
|
9
|
Barrios V, Escobar C. Rivaroxaban: a once-daily anticoagulant for the prevention of thromboembolic complications. Expert Rev Cardiovasc Ther 2013; 11:129-141. [DOI: 10.1586/erc.12.172] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
10
|
de la Peña A, Roca-Cusachs A, Suárez C, Bonet S. [Vascular risk in outpatient from Internal Medicine departments. MICARE Study]. Med Clin (Barc) 2012. [PMID: 23199827 DOI: 10.1016/j.medcli.2012.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The population attended in the Spanish Internal Medicine departments is of increasing age, but the prevalence of vascular risk factors and its degree of control are unknown, as well as the differences by type of hospital or consulting room. PATIENTS AND METHODS Epidemiologic, transversal and metacentric study in patients ≥ 18 years treated in outpatient Internal Medicine hospital. Two-hundred and ninety physicians from 17 Autonomic Communities participated in the study. The type of hospital or consulting room was also recorded. Blood pressure control was defined as <140/90 mm Hg (<130/80 mm Hg in diabetics or patients with vascular disease), LDL-cholesterol control when<130 mg/dl (<100mg/dl in diabetic or vascular disease) and diabetes control if glycated hemoglobin was<7%. RESULTS Data from 2,704 patients was collected (54% men) mean age (SD) 64,1 (14,5) years. Ninety-three percent of them had at least one cardiovascular risk factor: hypertension 73.9%, dyslipidemia 59.5%, abdominal obesity 43.4%, diabetes 39.5%. Fifty percent had some target organ damaged, 46.7% showed vascular disease and 71.2% a high or very high vascular risk. Control over risk factors was: hypertension 33.8%, cholesterol-LDL 40.8% and diabetes 50.7%. There were no differences between type of hospital or type of outpatient consultancy. CONCLUSIONS Over 90% of patients treated in outpatient consultancies of Internal Medicine departments present vascular risk factors, regardless of the type of hospital or type of consulting room. Risk factors control was poor.
Collapse
Affiliation(s)
- Andrés de la Peña
- Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, España.
| | | | | | | | | |
Collapse
|
11
|
Gijón-Conde T, Banegas J. Enfermedad cardiovascular en pacientes con hipertensión arterial: diferencias por género a partir de 100.000 historias clínicas. Rev Clin Esp 2012; 212:55-62. [DOI: 10.1016/j.rce.2011.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/28/2011] [Accepted: 07/11/2011] [Indexed: 11/16/2022]
|
12
|
Relevancia de la enfermedad arterial periférica en sujetos de edad avanzada. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Barrios V, Calderón A, Escobar C, de la Figuera M. Pacientes con fibrilación auricular asistidos en consultas de atención primaria. Estudio Val-FAAP. Rev Esp Cardiol 2012; 65:47-53. [DOI: 10.1016/j.recesp.2011.08.008] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/11/2011] [Indexed: 11/29/2022]
|
14
|
When office blood pressure measurement is not enough. Int J Cardiol 2010; 145:101. [DOI: 10.1016/j.ijcard.2009.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 05/24/2009] [Indexed: 11/22/2022]
|
15
|
Barrios V, Escobar C, Calderón A. Clinical profile and management of patients with hypertension and chronic ischemic heart disease according to BMI. Obesity (Silver Spring) 2010; 18:2017-22. [PMID: 20134413 DOI: 10.1038/oby.2010.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obesity is associated with numerous risk factors and comorbidities such as hypertension, metabolic syndrome, type 2 diabetes, and cardiovascular diseases. However, numerous studies have reported an obesity paradox; the overweight and obese patients with established cardiovascular disease have better prognosis than those with a BMI <25 kg/m(2). This study was designed to assess potential differences in the clinical profile and management of hypertensive outpatients with chronic ischemic heart disease in obese and lean patients that could explain these two apparently contradictory points. Overweight and obesity were defined as a BMI 25-29.9 kg/m(2) and ≥30 kg/m(2), respectively. Cardiovascular risk factors goals were considered according to European Society of Hypertension-European Society of Cardiology 2003, National Cholesterol Education Program Adult Treatment Panel III and American Diabetes Association 2005 guidelines. A sample of 2,024 patients (66.8 ± 10.1 years; 31.7% women) was included. Of these, 0.1% had a BMI <20 kg/m(2); 17.1% BMI 20-24.9 kg/m(2); 53.7% BMI 25-29.9 kg/m(2); 23.7% BMI 30-34.9 kg/m(2); 4.3% BMI 35-39.9 kg/m(2); and 1.1% BMI ≥40 kg/m(2). The subgroup of patients with BMI ≥30 kg/m(2) had a higher proportion of women, diastolic dysfunction, diabetes, dyslipidemia, left ventricular hypertrophy, and heart failure. There was an inverse relationship between risk factors control rates and BMI (all comparisons BMI 20-24.9 kg/m(2) vs. 25-29.9 kg/m(2) vs. ≥30 kg/m(2)): blood pressure (BP) control (51.7% vs. 42.4% vs. 29.2%, P < 0.001); low-density lipoprotein cholesterol (LDL-C) control (35.2% vs. 30.5% vs. 27.9%, P = 0.03) and diabetes control (38.6% vs. 27.6% vs. 22.2%, P = 0.023). In conclusion, in patients with hypertension and chronic ischemic heart disease, as BMI increases, the clinical profile worsens as well as risk factors control rates.
Collapse
Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain.
| | | | | |
Collapse
|
16
|
Barrios V, Escobar C, Murga N, Quijano JJ. Clinical profile and management of patients with chronic ischemic heart disease according to age in the population daily attended by cardiologists in Spain The ELDERCIC study. Eur J Intern Med 2010; 21:180-4. [PMID: 20493419 DOI: 10.1016/j.ejim.2010.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/10/2009] [Accepted: 01/11/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study was aimed to evaluate the differences according to age in the clinical profile and management of outpatients with chronic ischemic heart disease attended by cardiologists in Spain. METHODS Patients with an established diagnosis of chronic ischemic heart disease were included in this cross-sectional multicenter study. The age of 65 years was considered as the cut-off point for the present analysis. RESULTS A total of 1038 subjects were included, 524 of them (50.5%) >65 years. Patients >65 years had a lesser prevalence of smoking, a longer history of hypertension, a worse left ventricular ejection fraction and a higher prevalence of heart failure and renal insufficiency than younger subjects. The number of prescribed drugs was higher in patients >65 years (6.1+/-1.9 vs 5.7+/-2.1, p=0.004). Blood pressure control rate was lower in older patients (38.1% vs 46.5%, p=0.008). No significant differences were found either in LDL-cholesterol (42.4% vs 46.5%), or glycemic control rates (42.4% vs 41.4%), both p=NS. Diagnostic and therapeutic procedures were also compared in >65 vs < or =65 years, exercise test was performed in 51.5% vs 62.8% (p<0.0001); stress echocardiography in 18.3% vs 13.2% (p=0.027); coronary angiography in 38.6% vs 53.5% (p<0.0001); and coronary revascularization in 37.2% vs 46.9% (p=0.002), without significant differences in electrocardiogram, echocardiogram, or isotopic exams. CONCLUSIONS Older patients exhibited a worse clinical profile and a worse blood pressure control rate than the younger. However, diagnostic and therapeutic procedures appear to be frequently underused in the old patients.
Collapse
Affiliation(s)
- Vivencio Barrios
- Vivencio Barrios, Dept. of Cardiology, Hospital Ramón y Cajal, Ctra. Colmenar km 9.100, 28034 Madrid, Spain.
| | | | | | | |
Collapse
|
17
|
Barrios V, Escobar C, Echarri R. Atrial Fibrillation And Coronary Heart Disease:Fatal Attraction. J Atr Fibrillation 2009; 1:137. [PMID: 28496608 DOI: 10.4022/jafib.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 01/23/2009] [Accepted: 01/23/2009] [Indexed: 01/19/2023]
Abstract
In this manuscript, the profile and clinical management of hypertensive patients with chronic ischemic heart disease and atrial fibrillation (AF) is examined and whether high heart rate is associated with a different profile is determined. CINHTIA was a cross-sectional and multicenter survey aimed to define the clinical profile of hypertensive patients with chronic ischemic heart disease daily attended in Spain. Blood pressure, LDL-cholesterol and diabetes control rates were established according to ESHESC 2003, NCEP-ATP III and ADA 2005 guidelines, respectively. Out of the 2024 patients, 338 (16.7%) exhibited AF. The group of patients with AF was older and with higher prevalence of diabetes, organ damage and cardiovascular disease. Blood pressure (41.8% vs 34.5%, p=0.014) and diabetes (28.5% vs 20.9%,p=0.044) were worse controlled in patients with AF, with a trend to a lower control of LDL-cholesterol (31.2% vs 26.8%, p=0.093). When distributing patients with AF according to heart rate, except for smoking, left ventricular hypertrophy and peripheral arterial disease that were more frequent in those with higher heart rate, no significant differences were found in other risk factors or organ damage between groups. Blood pressure, glycemia and LDL-cholesterol were worse controlled in the subgroup with highest heart rate. In clinical practice, hypertensive patients with chronic ischemic heart disease and AF have a bad prognosis not only due to a worse clinical profile, but also due to lower risk factors control rates. In contrast with patients at sinus rhythm, higher heart rate was less related with a worse clinical profile in subjects with AF.
Collapse
|