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Montiel AM, Ruiz-Esteban P, Del Río AD, Valdivielso P, Chaparro MÁS, Olveira C. Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype. Sci Rep 2024; 14:9687. [PMID: 38678074 DOI: 10.1038/s41598-024-60406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has a high prevalence and a major impact on health-related quality of life (HRQL). COPD exacerbations are an important cause of morbidity and mortality, affecting cardiovascular risk, and are associated with poorer health status. The aim of this study was to assess the association between cardiovascular risk (CVR) and HRQL, according to exacerbator or non-exacerbator phenotype. We undertook a cross-sectional, observational, descriptive study of 107 patients with COPD. Patients with two or more moderate exacerbations or one severe exacerbation in the previous year were considered as exacerbators. The CVR was calculated with the Framingham scale and SCORE (Systematic Coronary Risk Evaluation) and the HRQL was assessed with the generic questionnaire Short Form-36 Health Survey (SF-36), the St George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). Statistical analysis was done with SPSS version 26.0 for Windows. The SF-36 and the SGRQ showed lower values for the exacerbator phenotype, indicating a poorer quality of life. The CAT questionnaire showed values above 10 for the exacerbator phenotype, and lower values in the non-exacerbator group. After categorizing the sample according to their median age (65 years), we found a greater deterioration in HRQL in patients under 65 years of age according to the SF-36, the SGRQ and the CAT. We also detected differences in HRQL between non-exacerbator patients with a high CVR according to the Framingham (≥ 20%) and SCORE (≥ 5%) scales compared to those without this risk. A tendency towards worse HRQL was observed in non-exacerbator patients with a high CVR, which was statistically significant for the SGRQ impact domain on the SCORE scale. The CAT also showed a worse quality of life in non-exacerbator patients with a high CVR, which was significant in the Framingham model (Framingham high risk 8.41 vs non-high risk 6.05, p < 0.01). These differences were not observed in exacerbator patients. Our findings confirm that a high CVR influences HRQL in patients with COPD, especially in non-exacerbator patients with a high CVR, measured according to the SGRQ and the CAT.
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Affiliation(s)
- Ana Muñoz Montiel
- Pulmonology Service. Monographic COPD Office, Regional University Hospital of Malaga, University of Malaga, Malaga, Spain
| | - Pedro Ruiz-Esteban
- Nephrology Department, The Biomedical Research Institute of Malaga (IBIMA-Plataforma BIONAND), Regional University Hospital of Malaga, University of Malaga, RICORS2040 (RD21/0005/0012), Malaga, Spain.
| | - Adolfo Doménech Del Río
- Pulmonology Service. Monographic COPD Office, Regional University Hospital of Malaga, University of Malaga, Malaga, Spain
| | - Pedro Valdivielso
- Laboratory of Lipids and Atherosclerosis, Medico-Sanitarias Research Center (IBIMA), University of Malaga, Malaga, Spain
- Internal Medicine, University Hospital Virgen de La Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand, University of Malaga, Malaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine, University Hospital Virgen de La Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand, University of Malaga, Malaga, Spain
| | - Casilda Olveira
- Pulmonology Service, Regional University Hospital of Malaga, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand, University of Malaga, Malaga, Spain
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Mostaza JM, Pintó X, Armario P, Masana L, Real JT, Valdivielso P, Arrobas-Velilla T, Baeza-Trinidad R, Calmarza P, Cebollada J, Civera-Andrés M, Cuende Melero JI, Díaz-Díaz JL, Espíldora-Hernández J, Fernández Pardo J, Guijarro C, Jericó C, Laclaustra M, Lahoz C, López-Miranda J, Martínez-Hervás S, Muñiz-Grijalvo O, Páramo JA, Pascual V, Pedro-Botet J, Pérez-Martínez P, Puzo J. SEA 2024 Standards for Global Control of Vascular Risk. Clin Investig Arterioscler 2024:S0214-9168(24)00017-2. [PMID: 38490888 DOI: 10.1016/j.arteri.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
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Affiliation(s)
- José María Mostaza
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España.
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Bellvitge, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición (CIBERobn), Fundación para la Investigación y Prevención de las Enfermedades Cardiovasculares (FIPEC), Universidad de Barcelona, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Pedro Armario
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo (UVASMET), Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Universitat Rovira i Virgili, Tarragona, España
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Pedro Valdivielso
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España
| | - Teresa Arrobas-Velilla
- Laboratorio de Nutrición y RCV, UGC de Bioquímica clínica, Hospital Virgen Macarena, Sevilla, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Jesús Cebollada
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Miguel Civera-Andrés
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - José I Cuende Melero
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - José L Díaz-Díaz
- Sección de Medicina Interna, Unidad de Lípidos y Riesgo Cardiovascular, Hospital Abente y Lago Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - Javier Espíldora-Hernández
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España; Unidad de Lípidos y Unidad Asistencial de Hipertensión Arterial- Riesgo Vascular (HTA-RV), UGC Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Jacinto Fernández Pardo
- Servicio de Medicina Interna, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Murcia, España
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorón, España
| | - Carles Jericó
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Martín Laclaustra
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Lahoz
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España
| | - José López-Miranda
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Sergio Martínez-Hervás
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Ovidio Muñiz-Grijalvo
- Servicio de Medicina Interna, UCERV, UCAMI, Hospital Virgen del Rocío de Sevilla, Sevilla, España
| | - Juan A Páramo
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España; Servicio de Hematología, Clínica Universidad de Navarra, Navarra, España; Laboratorio Aterotrombosis, CIMA, Universidad de Navarra, Pamplona, España
| | - Vicente Pascual
- Centro de Salud Palleter, Universidad CEU-Cardenal Herrera, Castellón, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Pérez-Martínez
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - José Puzo
- Servicio de Bioquímica Clínica, Unidad de Lípidos, Hospital General Universitario San Jorge de Huesca, Huesca, España; Departamento de Medicina, Universidad de Zaragoza, Zaragoza, España
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Fernández-Labandera Ramos C, Moral I, Brotons C, Quevedo Aguado L, Coca Prieto I, Valdivielso P, Sánchez Chaparro MÁ. Validation of the IberScore model in a primary care population. Clin Investig Arterioscler 2024:S0214-9168(23)00118-3. [PMID: 38220535 DOI: 10.1016/j.arteri.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND This study aimed to validate the IberScore cardiovascular risk model in a population attended in the primary care setting. METHODS A cohort of patients with no history of cardiovascular disease visited in a primary care center during the years 2008 and/or 2009 and followed up until 2018 was selected. Cardiovascular risk was calculated with the IberScore formula for all the subjects of the cohort and the model was calibrated, graphically represented by risk deciles the proportion of expected events and proportion of observed events at 10-year follow-up, stratified by sex. The area under the ROC curve was calculated to assess the discrimination of the model. RESULTS A total of 10,085 patients visited during the years 2008 and/or 2009 were included in the study. Men showed a mean 10-year risk of suffering a fatal or non-fatal cardiovascular events according to IberScore of 17.07% (SD 20.13), with a mean estimated vascular age of more than 4 years higher than the biological age; while women had a mean 10-year risk of 7.91% (SD 9.03), with an estimated vascular age of more than 2 years above the biological age. The area under the ROC curve showed a discrimination index of the model of 0.86 (95% CI 0.84-0.88) in men and 0.82 (95% CI 0.79-0.85) in women. CONCLUSION IberScore model discriminates well in the population attended in primary care but the model overestimates the risk.
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Affiliation(s)
| | - Irene Moral
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Spain; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
| | - Carlos Brotons
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Spain; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
| | - Luis Quevedo Aguado
- Dirección de Gestión del Conocimiento y la Innovación, Ibermutua, MATEPSS 274, Madrid, Spain
| | | | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain; IBIMA-Plataforma BIONAND, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain; IBIMA-Plataforma BIONAND, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
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Espíldora-Hernández J, Martín-Cortés S, Benítez-Toledo MJ, Coca-Prieto I, Sánchez-Chaparro MÁ, Valdivielso P. Doctors' perception of red wine consumption and cardiovascular health. Clin Investig Arterioscler 2023; 35:290-293. [PMID: 37290999 DOI: 10.1016/j.arteri.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The consumption of red wine has historically been associated with a reduction in cardiovascular risk, with sometimes controversial scientific evidence. METHOD A survey was carried out via whatsapp dated 09/01/22 to a cohort of doctors from the province of Malaga, asking about possible healthy red wine consumption habits, differentiating: never, 3-4 glasses per week, 5 -6 weekly drinks and one daily drink. RESULTS A total of 184 physicians answered, with a mean age of 35 years ± 11.1, of which 84 (45.6%) were women, distributed in different specialties, the majority being internal medicine with 52 (28.2%). The most frequently chosen option was D (59.2%), followed by A (21.2%), C (14.7%) and B (5%). CONCLUSIONS More than half of the doctors surveyed recommended zero consumption, and only 20% indicated that a daily drink could be healthy in non-drinkers.
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Affiliation(s)
| | - Salvador Martín-Cortés
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | - Inmaculada Coca-Prieto
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Miguel Ángel Sánchez-Chaparro
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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Williams K, Tickler G, Valdivielso P, Alonso J, Vera-Llonch M, Cubells L, Acaster S. Symptoms and impacts of familial chylomicronemia syndrome: a qualitative study of the patient experience. Orphanet J Rare Dis 2023; 18:316. [PMID: 37817256 PMCID: PMC10565991 DOI: 10.1186/s13023-023-02927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Familial chylomicronemia syndrome (FCS) is a rare, hereditary, metabolic disorder. FCS causes high levels of triglycerides in the blood, which can lead to abdominal pain, xanthomas, and acute pancreatitis (AP). Volanesorsen, along with adherence to a very low-fat diet is used to reduce triglyceride levels in individuals with FCS. We aimed to understand the symptoms of FCS and their impact on health-related quality of life (HRQoL). METHODS Interviews were conducted with individuals with genetically confirmed FCS in the UK and Spain, some of whom had been treated with volanesorsen. Interview guides were developed with input from a patient advocacy group to explore the symptoms, impacts and management of FCS. Interviews were conducted by telephone and were recorded and transcribed. Data were analyzed using thematic analysis and saturation was recorded. RESULTS Seventeen interviews were conducted with individuals with FCS (aged 27-68 years), thirteen of whom were currently/previously treated with volanesorsen. Episodes of AP were the most impactful reported symptom, resulting in severe abdominal pain, nausea, vomiting, fever, bloating and appetite loss. Other symptoms and functional issues included abdominal pain, gastrointestinal symptoms, impaired cognitive function and fatigue. These had an impact on work, social activities, relationships and psychological wellbeing. These symptoms and impacts were illustrated in a conceptual model, including management strategies. The challenges of managing a low-fat diet and experience with volanesorsen were discussed. CONCLUSION Individuals with FCS experience a range of interrelated symptoms and functional limitations which impact their broader HRQoL. Treatments which alleviate symptoms and reduce the incidence of AP episodes have the potential to improve the HRQoL of these individuals.
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Affiliation(s)
| | | | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Virgen de la Victoria, University of Málaga and Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, CIBERESP, Pompeu Fabra University, Barcelona, Spain
| | | | - Laia Cubells
- Akcea Therapeutics, Avenida Ernest Lluch, 32 TCM 2 of 6.18, 08302, Mataró, Barcelona, Spain
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Camacho A, Ariza MJ, Amigó N, Macías Guillén P, Sánchez Chaparro MÁ, Valdivielso P. A case of hypocholesterolemia under study. Clin Investig Arterioscler 2023; 35:244-247. [PMID: 37302939 DOI: 10.1016/j.arteri.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
Primary hypocholesterolemia (or hypobetalipoproteinemia) is a rare disorder of lipoprotein metabolism that may be due to a polygenic predisposition or a monogenic disease. Among these, it is possible to differentiate between symptomatic and asymptomatic forms, in which, in the absence of secondary causes, the initial clinical suspicion is plasma ApoB levels below the 5th percentile of the distribution by age and sex. Here we describe the differential diagnosis of a case of asymptomatic hypocholesterolemia. We studied proband's clinical data, the lipid profile of the proband and her relatives and the clinical data of the family relevant to carry out the differential diagnosis. We performed a genetic study as the diagnostic test. The information obtained from the differential diagnosis suggested a heterozygous hypobetalipoproteinemia due to PCSK9 loss-of-function variants. The diagnostic test revealed, in the proband, the presence of a heterozygous PCSK9 frame-shift variant of a maternal origin. Plasma levels of LDL cholesterol and PCSK9 of the patient and her relatives were compatible with the segregation of the variant revealed. In conclusion, the diagnostic test performed confirmed the suspected diagnosis of the proband as asymptomatic familial hypobetalipoproteinemia due to a loss-of-function variant in the PCSK9 gene.
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Affiliation(s)
- Ana Camacho
- Servicio de Medicina Interna, Hospital Infanta-Elena, Huelva, España
| | - María José Ariza
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España.
| | - Nuria Amigó
- Biosfer Teslab Metabolomics Interdisciplinary Laboratory, Instituto de Investigación Sanitaria Pere Virgili (IISPV) , Reus, Tarragona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Patricia Macías Guillén
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España
| | - Miguel Ángel Sánchez Chaparro
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Pedro Valdivielso
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
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Pedro-Botet J, Plana N, Mostaza JM, Gómez-Doblas JJ, Fernández Olmo MR, Escobar Cervantes C, Díaz-Díaz JL, Campuzano Ruiz R, Valdivielso P, Cosín-Sales J. Hypercholesterolaemia control in Spain: The same situation with different regional realities. Clin Investig Arterioscler 2023; 35:219-225. [PMID: 37120368 DOI: 10.1016/j.arteri.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION AND OBJECTIVE The cardiovascular prevention strategy by autonomous communities can be variable since the competences in health are transferred. The objective of the study was to determine the degree of dyslipidaemia control and the lipid-lowering pharmacological therapy used in patients at high/very high cardiovascular risk (CVR) by autonomous communities. METHODS Observational, cross-sectional, descriptive study based on a consensus methodology. Information on the clinical practice of 145 health areas belonging to 17 Spanish autonomous communities was collected through face-to-face meetings and questionnaires administered to the 435 participating physicians. Furthermore, aggregate non-identifiable data were compiled from 10 consecutive dyslipidaemic patients that each participant had recently visited. RESULTS Of the 4010 patients collected, 649 (16%) had high and 2458 (61%) very high CVR. The distribution of the 3107 high/very high CVR patients was balanced across regions, but there were inter-regional differences (P<.0001) in the achievement of target LDL-C <70 and <55mg/dL, respectively. High-intensity statins in monotherapy or in combination with ezetimibe and/or PCSK9 inhibitors were used in 44, 21 and 4% of high CVR patients, while in those at very high CVR it rose to 38, 45 and 6%, respectively. The use of these lipid-lowering therapies at national level was significantly different between regions (P=.0079). CONCLUSIONS Even though the distribution of patients at high/very high CVR was similar between autonomous communities, inter-territorial differences were identified in the degree of achievement of LDL cholesterol therapeutic goal and use of lipid-lowering therapy.
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Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Núria Plana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Reus, Tarragona, España
| | - José María Mostaza
- Unidad de Lípidos y Arteriosclerosis, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, España
| | - Juan José Gómez-Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria-IBIMA CIBERCV, Málaga, España
| | | | | | | | - Raquel Campuzano Ruiz
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España
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Cobos A, Valdivielso P. Quo vadis, LDL cholesterol? Adv Lab Med 2023; 4:133-137. [PMID: 38075940 PMCID: PMC10701488 DOI: 10.1515/almed-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Andrés Cobos
- UGC de Laboratorio, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Departamento de Medicina y Dermatología, Universidad de Málaga e Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Málaga, Spain
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Cosín-Sales J, Campuzano Ruiz R, Díaz Díaz JL, Escobar Cervantes C, Fernández Olmo MR, Gómez-Doblas JJ, Mostaza JM, Pedro-Botet J, Plana Gil N, Valdivielso P. Impact of physician's perception about LDL cholesterol control in clinical practice when treating patients in Spain. Atherosclerosis 2023; 375:38-44. [PMID: 37245425 DOI: 10.1016/j.atherosclerosis.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS We aimed to understand the impact of physicians' perception about LDL-cholesterol (LDLc) control on the management of patients with dyslipidemia in Spain. METHODS We performed a cross-sectional and multicenter study, in which 435 healthcare professionals participated in face-to-face meetings, collecting qualitative and quantitative information related to hypercholesterolemia management. Additionally, aggregated anonymized data of the last 10 patients with hypercholesterolemia attended by each physician were collected. RESULTS A total of 4,010 patients (8%, 13%, 16% and 61% with low, moderate, high, and very high cardiovascular [CV] risk) were included. Physicians' perception was that 62% of their patients attained LDLc goals (66%, 63%, 61% and 56%, for low, moderate, high and very high CV risk, respectively). However, when looking into the data only 31% (vs 62% p<0.01) of patients attained the LDLc goals (47%, 36%, 22% and 25%, respectively). Overall, 33% of patients were taking high intensity statins, 32% statin/ezetimibe, 21% low/moderate intensity statins and 4% PCSK9 inhibitors. These numbers were 38%, 45%, 8% and 6% for very high risk patients and 44%, 21%, 21% and 4% for high CV risk patients. In 32% of patients, a change in lipid lowering therapy was performed after the visit, mainly combining statins/ezetimibe (55%). CONCLUSIONS In Spain, most patients with dyslipidemia do not achieve the recommended LDLc goals because of an insufficient intensification of lipid lowering therapy. On the one hand, this is in part due to physicians misperception on preventive LDLc control and the need for repeated advice to patient, and, on the other, to the lack of patient adherence.
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Affiliation(s)
- Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain.
| | | | - José Luis Díaz Díaz
- Department of Internal Medicine, Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | - Juan José Gómez-Doblas
- Department of Cardiology, Hospital Universitario Virgen de la Victoria-IBIMA CIBERCV, Málaga, Spain
| | | | | | - Núria Plana Gil
- Department of Vascular Medicina and Metabolism, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
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10
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Murcia Casas B, Carrillo Linares JL, Baquero Aranda I, Rioja Villodres J, Merino Bohórquez V, González Jiménez A, Rico Corral MÁ, Bosch R, Sánchez Chaparro MÁ, García Fernández M, Valdivielso P. Lansoprazole Increases Inorganic Pyrophosphate in Patients with Pseudoxanthoma Elasticum: A Double-Blind, Randomized, Placebo-Controlled Crossover Trial. Int J Mol Sci 2023; 24:ijms24054899. [PMID: 36902331 PMCID: PMC10003519 DOI: 10.3390/ijms24054899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Pseudoxanthoma elasticum (PXE) is characterized by low levels of inorganic pyrophosphate (PPi) and a high activity of tissue-nonspecific alkaline phosphatase (TNAP). Lansoprazole is a partial inhibitor of TNAP. The aim was to investigate whether lansoprazole increases plasma PPi levels in subjects with PXE. We conducted a 2 × 2 randomized, double-blind, placebo-controlled crossover trial in patients with PXE. Patients were allocated 30 mg/day of lansoprazole or a placebo in two sequences of 8 weeks. The primary outcome was the differences in plasma PPi levels between the placebo and lansoprazole phases. 29 patients were included in the study. There were eight drop-outs due to the pandemic lockdown after the first visit and one due to gastric intolerance, so twenty patients completed the trial. A generalized linear mixed model was used to evaluate the effect of lansoprazole. Overall, lansoprazole increased plasma PPi levels from 0.34 ± 0.10 µM to 0.41 ± 0.16 µM (p = 0.0302), with no statistically significant changes in TNAP activity. There were no important adverse events. 30 mg/day of lansoprazole was able to significantly increase plasma PPi in patients with PXE; despite this, the study should be replicated with a large number of participants in a multicenter trial, with a clinical end point as the primary outcome.
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Affiliation(s)
- Belén Murcia Casas
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Juan Luis Carrillo Linares
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - Isabel Baquero Aranda
- Ophtalmology Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - José Rioja Villodres
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, 29071 Málaga, Spain
| | | | | | | | - Ricardo Bosch
- Dermatology Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
| | - María García Fernández
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Department of Phisiology, Universidad de Málaga, 29016 Málaga, Spain
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, 29071 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
- Correspondence: ; Tel.: +34-952131615
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11
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Rizzo M, Colletti A, Penson PE, Katsiki N, Mikhailidis DP, Toth PP, Gouni-Berthold I, Mancini J, Marais D, Moriarty P, Ruscica M, Sahebkar A, Vinereanu D, Cicero AFG, Banach M, Al-Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Gouni-Berthold I, Bhaskar S, Bielecka-Dąbrowa A, Bjelakovic B, Bruckert E, Bytyçi I, Cafferata A, Ceska R, Cicero AF, Chlebus K, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Gouni-Berthold I, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, John Mancini G, David Marais A, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Mohammad Nabavi S, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Serban MC, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh HI, Zhisheng J, Zirlik A. Nutraceutical approaches to non-alcoholic fatty liver disease (NAFLD): A position paper from the International Lipid Expert Panel (ILEP). Pharmacol Res 2023; 189:106679. [PMID: 36764041 DOI: 10.1016/j.phrs.2023.106679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.
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Affiliation(s)
- Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Via del Vespro 141, 90127 Palermo, Italy.
| | - Alessandro Colletti
- Department of Science and Drug Technology, University of Turin, Turin, Italy
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Ioanna Gouni-Berthold
- Department of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
| | - John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Patrick Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dragos Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular disease risk research center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy; IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
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12
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Rioja J, Ariza MJ, Benítez-Toledo MJ, Espíldora-Hernández J, Coca-Prieto I, Arrobas-Velilla T, Camacho A, Olivecrona G, Sánchez-Chaparro MÁ, Valdivielso P. Role of lipoprotein lipase activity measurement in the diagnosis of familial chylomicronemia syndrome. J Clin Lipidol 2023; 17:272-280. [PMID: 36813655 DOI: 10.1016/j.jacl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Activity assays for lipoprotein lipase (LPL) are not standardised for use in clinical settings. OBJECTIVE This study sought to define and validate a cut-off points based on a ROC curve for the diagnosis of patients with familial chylomicronemia syndrome (FCS). We also evaluated the role of LPL activity in a comprehensive FCS diagnostic workflow. METHODS A derivation cohort (including an FCS group (n = 9), a multifactorial chylomicronemia syndrome (MCS) group (n = 11)), and an external validation cohort (including an FCS group (n = 5), a MCS group (n = 23) and a normo-triglyceridemic (NTG) group (n = 14)), were studied. FCS patients were previously diagnosed by the presence of biallelic pathogenic genetic variants in the LPL and GPIHBP1 genes. LPL activity was also measured. Clinical and anthropometric data were recorded, and serum lipids and lipoproteins were measured. Sensitivity, specificity and cut-offs for LPL activity were obtained from a ROC curve and externally validated. RESULTS All post-heparin plasma LPL activity in the FCS patients were below 25.1 mU/mL, that was cut-off with best performance. There was no overlap in the LPL activity distributions between the FCS and MCS groups, conversely to the FCS and NTG groups. CONCLUSION We conclude that, in addition to genetic testing, LPL activity in subjects with severe hypertriglyceridemia is a reliable criterium in the diagnosis of FCS when using a cut-off of 25.1 mU/mL (25% of the mean LPL activity in the validation MCS group). We do not recommend the NTG patient based cut-off values due to low sensitivity.
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Affiliation(s)
- José Rioja
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain (Drs Rioja, Ariza, Sánchez-Chaparro and Valdivielso)
| | - María José Ariza
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain (Drs Rioja, Ariza, Sánchez-Chaparro and Valdivielso).
| | - María José Benítez-Toledo
- Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain (Drs Benítez-Toledo, Espíldora-Hernández, Coca-Prieto, Sánchez-Chaparro and Valdivielso)
| | - Javier Espíldora-Hernández
- Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain (Drs Benítez-Toledo, Espíldora-Hernández, Coca-Prieto, Sánchez-Chaparro and Valdivielso)
| | - Inmaculada Coca-Prieto
- Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain (Drs Benítez-Toledo, Espíldora-Hernández, Coca-Prieto, Sánchez-Chaparro and Valdivielso)
| | | | - Ana Camacho
- Unidad de Riesgo Vascular. Hospital Infanta Elena, Huelva, Spain (Dr Camacho)
| | - Gunilla Olivecrona
- Department of Medical Biosciences/Physiological Chemistry, Umeå University, Umeå, Sweden (Dr Olivecrona)
| | - Miguel Ángel Sánchez-Chaparro
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain (Drs Rioja, Ariza, Sánchez-Chaparro and Valdivielso); Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain (Drs Benítez-Toledo, Espíldora-Hernández, Coca-Prieto, Sánchez-Chaparro and Valdivielso)
| | - Pedro Valdivielso
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain (Drs Rioja, Ariza, Sánchez-Chaparro and Valdivielso); Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain (Drs Benítez-Toledo, Espíldora-Hernández, Coca-Prieto, Sánchez-Chaparro and Valdivielso)
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13
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Ramírez-Torres JM, López-Téllez A, Ariza MJ, Rioja J, García-Casares N, Rodríguez EEG, García JAR, Chaparro MAS, Barbancho MA, Valdivielso P. Subclinical atherosclerosis burden in non-diabetic hypertensives treated in primary care center: the IMTABI study. BMC Prim Care 2023; 24:43. [PMID: 36759767 PMCID: PMC9912653 DOI: 10.1186/s12875-023-01997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Identifying patients at high risk of cardiovascular disease in primary prevention is a challenging task. This study aimed at detecting subclinical atherosclerosis burden in non-diabetic hypertensive patients in a primary care centre. METHODS Clinical, anthropometric and analytical data were collected from patients with hypertension who were free from clinical vascular disease and diabetes. The cardiovascular risk was assessed using the SCORE system. Subclinical atherosclerosis burden was assessed by carotid ultrasonography (intima-medial thickness [IMT] and plaque) and measurement of the ankle-brachial index (ABI). RESULTS Out of 140 patients, 59 (42%) have carotid plaque, 32 (23%) have IMT higher than 75% and 12 (9%) have an ABI < 0.9. Total atherosclerosis burden was present in 91 (65%) of the subjects. Consequently, 59 (42%) patients were re-classified into the very high-risk category. In multivariate analyses, smoking, creatinine levels and duration of hypertension were associated with atherosclerosis burden. In contrast, only smoking and age were associated with the presence of carotid plaque. Almost 90% of patients were treated with hypotensive drugs, half of them combined several drugs and 60% were well-controlled. Only 30% received statins in monotherapy and only less than 20% had an LDL cholesterol < 100 mg/dL. CONCLUSIONS In non-diabetic hypertensive patients managed at a primary care centre, 4 out of 10 had subclinical atherosclerosis burden and were re-classified into the very high- risk category. There was clear undertreatment with lipid-lowering drugs of most LDL cholesterol inappropriate levels, according to current clinical guidelines.
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Affiliation(s)
| | - Antonio López-Téllez
- grid.418355.eCentro de Salud Puerta Blanca, Servicio Andaluz de Salud, Málaga, Spain
| | - María J. Ariza
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - José Rioja
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Natalia García-Casares
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | | | | | - Miguel A. Sánchez Chaparro
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain ,grid.411062.00000 0000 9788 2492Servicio de Medicina Interna, Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | - Miguel A. Barbancho
- grid.10215.370000 0001 2298 7828Departamento de Fisiología Humana, Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain. .,Servicio de Medicina Interna, Hospital Universitario Virgen de La Victoria, Málaga, Spain.
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14
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Ruiz Molina Y, Aguilera Quitzke SA, Pabas Dotes AB, Tirado Reyes LM, Valdivielso P. Role of weight lost in breast cancer-related lymph. Rehabilitacion (Madr) 2022; 57:100763. [PMID: 36372588 DOI: 10.1016/j.rh.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. METHODS Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. RESULTS Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [-50 (-248 to 141) ml vs. 130 (-148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. CONCLUSIONS Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus - right from the start - on weight management or weight-loss in obese patients.
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Affiliation(s)
- Y Ruiz Molina
- Department of Physical Medicine and Rehabilitation, Hospital Regional Universitario, Malaga, Spain.
| | - S A Aguilera Quitzke
- Department of Physical Medicine and Rehabilitation, Hospital Regional Universitario, Malaga, Spain
| | - A B Pabas Dotes
- Department of Physical Medicine and Rehabilitation, Hospital Regional Universitario, Malaga, Spain
| | - L M Tirado Reyes
- Department of Physical Medicine and Rehabilitation, Hospital Regional Universitario, Malaga, Spain
| | - P Valdivielso
- Department of Medicine and Dermatology, University of Malaga and The Biomedical Research Institute of Malaga (IBIMA), Spain
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15
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Ariza MJ, Valdivielso P. Familial chylomicronemia syndrome in children: a diagnosis challenge. Transl Pediatr 2022; 11:1743-1747. [PMID: 36506766 PMCID: PMC9732601 DOI: 10.21037/tp-22-515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- María José Ariza
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Pedro Valdivielso
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain
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16
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Marco-Benedí V, Bea AM, Sánchez Hernández RM, Plana N, Valdivielso P, Civeira F. Dyslipidemia treatment strategies in primary and secondary prevention. Dyslipemia Registry of the Spanish Arteriosclerosis Society. Clin Investig Arterioscler 2022; 34:303-310. [PMID: 35654677 DOI: 10.1016/j.arteri.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Clinical studies show that patients with high cardiovascular risk are still far from reaching the therapeutic objectives, especially of the levels of LDL cholesterol. If the management of these patients in specialized units differs from other scenarios is known. PATIENTS AND METHODS 61 certified Lipid Units were selected in the Registry of Dyslipemias of the Spanish Arteriosclerosis Society for the collection of study data. The study included 3958 subjects >18 years of age who met the criteria for hypercholesterolemia (LDL cholesterol ≥160 mg/dL or non-HDL cholesterol ≥190 mg/dL) without familial hypercholesterolemia. A total 1,665 subjects were studied with a mean follow-up time of 4.2 years. RESULTS AND CONCLUSIONS A total of 42 subjects had a cardiovascular event since their inclusion in the Registry, which represents 0.6%. There were no differences in the treatment used at follow-up, but 50% of the patients did not reach the therapeutic goals at the visit end of follow-up. An increase in the potency of the lipid-lowering treatment was observed, including PCSK9 inhibitors use in 16.7% of subjects with recurrences.
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Affiliation(s)
- Victoria Marco-Benedí
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
| | - Ana M Bea
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Zaragoza, España
| | - Rosa M Sánchez Hernández
- Sección de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España; Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Núria Plana
- Unidad de Medicina Vascular y Metabolismo, Hospital Universitari Sant Joan, Reus, Instituto de Investigación Sanitaria Pere Virgili (IISPV), CIBERDEM, Universidad Rovira i Virgili, Tarragona, España
| | - Pedro Valdivielso
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Virgen de la Victoria, Departamento de Medicina y Dermatología, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, España
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España.
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17
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Cosín-Sales J, Campuzano Ruiz R, Díaz Díaz JL, Escobar Cervantes C, Fernández Olmo MR, Gómez-Doblas JJ, Mostaza JM, Pedro-Botet J, Plana Gil N, Valdivielso P. Dyslipidemia observatory: Treatment of hypercholesterolemia in Spain, context and levers for improvement in clinical practice. Clin Investig Arterioscler 2022; 34:253-260. [PMID: 35272866 DOI: 10.1016/j.arteri.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES The treatment of dyslipidemia exhibits wide variability in clinical practice and important limitations that make lipid-lowering goals more difficult to attain. Getting to know the management of these patients in clinical practice is key to understand the existing barriers and to define actions that contribute to achieving the therapeutic goals from the most recent Clinical Practice Guidelines. METHODS Observatory where the information gathered is based on routine clinical practice and the experience from the healthcare professionals involved in the treatment of dyslipidemia in Spain. The information is collected by health area through: (i) face-to-face meeting with three different medical specialties and (ii) quantitative information related to hypercholesterolemia patients' management (ad-hoc questionnaire). Information includes patients' profiles, assistance burden, guidelines and protocols used, goal attainment, limitations and opportunities in clinical practice. RESULTS 145 health areas are planned to be included, with the participation of up to 435 healthcare professionals from the 17 Autonomous Regions of Spain. Information collection will result in aggregated data from over four thousand patients. CONCLUSIONS This observatory aims to understand how hypercholesterolemia is being treated in routine clinical practice in Spain. Even though the preliminary results show important improvement areas in the treatment of dyslipidemias, mechanisms to drive a change towards health outcomes optimization are also identified.
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Affiliation(s)
- Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España
| | | | | | | | | | - Juan José Gómez-Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria-IBIMA CIBERCV, Málaga, España
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18
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Arrobas Velilla T, Brea Á, Valdivielso P. Implementation of a biochemical, clinical, and genetic screening programme for familial hypercholesterolemia in 26 centres in Spain: The ARIAN study. Front Genet 2022; 13:971651. [PMID: 36105085 PMCID: PMC9465084 DOI: 10.3389/fgene.2022.971651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Familial hypercholesterolemia (FH) is clearly underdiagnosed and undertreated. The aim of this present study is to assess the benefits of FH screening through a joint national program implemented between clinical laboratories and lipid units.Methods: All clinical laboratory tests from 1 January 2017 to 31 December 2018 were reviewed, and those with LDL cholesterol (LDL-C) levels >250 mg/dl were identified in subjects >18 years of age of both sexes. Once secondary causes had been ruled out, the treating physician was contacted and advised to refer the patient to an LU to perform the Dutch Lipid Clinic Network score and to request genetic testing if the score was ≥6 points. Next Generation Sequencing was used to analyse the promoter and coding DNA sequences of four genes associated with FH (LDLR, APOB, PCSK9, APOE) and two genes that have a clinical overlap with FH characteristics (LDLRAP1 and LIPA). A polygenic risk score based on 12 variants was also obtained.Results: Of the 3,827,513 patients analyzed in 26 centers, 6,765 had LDL-C levels >250 mg/dl. Having ruled out secondary causes and known cases of FH, 3,015 subjects were included, although only 1,205 treating physicians could be contacted. 635 patients were referred to an LU and genetic testing was requested for 153 of them. This resulted in a finding of sixty-seven pathogenic variants for FH, 66 in the LDLR gene and one in APOB. The polygenic risk score was found higher in those who had no pathogenic variant compared to those with a pathogenic variant.Conclusion: Despite its limitations, systematic collaboration between clinical laboratories and lipid units allows for the identification of large numbers of patients with a phenotypic or genetic diagnosis of FH, which will reduce their vascular risk. This activity should be part of the clinical routine.
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Affiliation(s)
- Teresa Arrobas Velilla
- Laboratorio de Nutrición y Riesgo Cardiovascular de Bioquímica Clínica, Unidad de Lípidos, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Ángel Brea
- Servicio de Medicina Interna, Unidad de Lípidos, Hospital de San Pedro, Logroño, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Unidad de Lípidos, Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
- *Correspondence: Pedro Valdivielso,
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19
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Mela V, Ruiz-Limón P, Balongo M, Motahari Rad H, Subiri-Verdugo A, Gonzalez-Jimenez A, Soler R, Ocaña L, el Azzouzi H, Tinahones FJ, Valdivielso P, Murri M. Mitochondrial Homeostasis in Obesity-related Hypertriglyceridemia. J Clin Endocrinol Metab 2022; 107:2203-2215. [PMID: 35608825 PMCID: PMC9282366 DOI: 10.1210/clinem/dgac332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 12/04/2022]
Abstract
CONTEXT The prevalence of obesity and hypertriglyceridemia is an alarming worldwide health issue. Mitochondria play a central role in these disorders as they control cell metabolism. OBJECTIVE The aim of the present study was to characterize mitochondrial homeostasis in subcutaneous and visceral adipose tissue (SAT and VAT) in grade III obese patients with and without hypertriglyceridemia. Moreover, this study presents the evaluation of mitochondrial fitness as a marker for hypertriglyceridemia improvement. PATIENTS Eight control and 12 hypertriglyceridemic (HTG) grade III obese subjects undergoing bariatric surgery were included. MAIN OUTCOME MEASURES Anthropometric and biochemical data were obtained before and 3 months after surgery. Mitochondrial homeostasis was evaluated by mitochondrial DNA (mtDNA), gene expression and protein abundance in SAT and VAT. RESULTS Mitophagy-related gene expression was increased in HTG SAT and VAT, while mitochondrial marker gene expression and mtDNA were decreased, indicating an altered mitochondrial homeostasis in HTG. Mitophagy protein abundance was increased in VAT of those subjects that did not improve their levels of triglycerides after bariatric surgery, whereas mitochondrial protein was decreased in the same tissue. Indeed, triglyceride levels positively correlated with mitophagy-related genes and negatively with mitochondrial content markers. Moreover, mitochondria content and mitophagy markers seem to be significant predictors of hypertriglyceridemia and hypertriglyceridemia remission. CONCLUSIONS Mitochondrial homeostasis of adipose tissue is altered in hypertriglyceridemic patients. At the protein level, mitochondria content and mitophagy are potential markers of hypertriglyceridemia remission in obese patients after bariatric surgery. These results may contribute to the implementation of a clinical approach for personalized medicine.
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Affiliation(s)
- Virginia Mela
- Correspondence: Virginia Mela, PhD, Endocrine Diseases Research Group, Biomedical Research Institute of Malaga (IBIMA), University Hospital of Malaga (Virgen de la Victoria), Malaga, Campus de Teatinos s/n 29010 Málaga, Spain.
| | | | - Manuel Balongo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010, Málaga, Spain
| | - Hanieh Motahari Rad
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010, Málaga, Spain
- Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, 14115-154, Tehran, Iran
| | - Alba Subiri-Verdugo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010, Málaga, Spain
| | | | - Rocio Soler
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Clínico Virgen de la Victoria, 29010, Málaga, Spain
| | - Luis Ocaña
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Clínico Virgen de la Victoria, 29010, Málaga, Spain
| | - Hamid el Azzouzi
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, 3436 HR, Netherlands
| | - Francisco J Tinahones
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010, Málaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 29010, Málaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University ofMalaga, 29010, Malaga, Spain
| | | | - Mora Murri
- Mora Murri, PhD, Endocrine Diseases Research Group, Biomedical Research Institute of Malaga (IBIMA), University Hospital of Malaga (Virgen de la Victoria), Malaga, Campus de Teatinos s/n 29010 Málaga, Spain.
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20
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Penson PE, Bruckert E, Marais D, Reiner Ž, Pirro M, Sahebkar A, Bajraktari G, Mirrakhimov E, Rizzo M, Mikhailidis DP, Sachinidis A, Gaita D, Latkovskis G, Mazidi M, Toth PP, Pella D, Alnouri F, Postadzhiyan A, Yeh HI, Mancini GBJ, von Haehling S, Banach M, Al‐Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Bhaskar S, Bytyçi I, Bjelakovic B, Bruckert E, Cafferata A, Ceska R, Cicero AF, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, Mancini GJ, Marais AD, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Nabavi SM, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Sattar N, Serban M, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh H, Zhisheng J, Zirlik A. Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP). J Cachexia Sarcopenia Muscle 2022; 13:1596-1622. [PMID: 35969116 PMCID: PMC9178378 DOI: 10.1002/jcsm.12960] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3-5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)-what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy.
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Affiliation(s)
- Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Eric Bruckert
- Pitié-Salpetrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Matteo Pirro
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinic of Cardiology, University Clinical Centre of Kosova, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Internal Disease, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Erkin Mirrakhimov
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Diseases, Bishkek, Kyrgyzstan
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), London, UK
| | - Alexandros Sachinidis
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, Romania.,Clinica de Cardiologie, Institutul de Boli Cardiovasculare Timisoara, Timisoara, Romania
| | - Gustavs Latkovskis
- Pauls Stradins Clinical University Hospital, Riga, Latvia.,University of Latvia, Riga, Latvia
| | - Mohsen Mazidi
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Pella
- 2nd Department of Cardiology of the East Slovak Institute of Cardiovascular Disease and Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
| | - Fahad Alnouri
- Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre Riyadh, Riyadh, Saudi Arabia
| | - Arman Postadzhiyan
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - G B John Mancini
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Maciej Banach
- Polish Moother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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21
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Mena-Vázquez N, Redondo-Rodríguez R, Rioja J, Jimenez-Nuñez FG, Manrique-Arija S, Lisbona-Montañez JM, Cano-García L, Rojas-Gimenez M, Ureña I, Valdivielso P, Fernández-Nebro A. Postprandial Hyperlipidemia: Association with Inflammation and Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis. Biomedicines 2022; 10:133. [PMID: 35052812 PMCID: PMC8773280 DOI: 10.3390/biomedicines10010133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVE To describe postprandial lipidemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis and inflammatory activity. METHODS Observational study of 80 cases of RA and 80 sex- and age-matched controls. We excluded individuals with dyslipidemia. Postprandial hyperlipidemia (PPHL) was defined as postprandial triglycerides >220 mg/dL and/or postprandial ApoB48 levels >75th percentile (>p75). Plasma lipids, cholesterol, triglycerides, ApoB48, and total ApoB were evaluated at baseline and after a meal. Other variables analyzed included subclinical atherosclerosis (defined as presence of carotid atheromatous plaque), inflammatory activity (disease activity score (DAS28-ESR)), cytokines, apolipoproteins, and physical activity. A multivariate analysis was performed to identify factors associated with PPHL in patients with RA. RESULTS A total of 75 patients with RA and 67 healthy controls fulfilled the inclusion criteria. PPHL was more frequent in patients with RA than controls (No. (%), 29 (38.70) vs. 15 (22.40); p = 0.036), as was subclinical atherosclerosis (No. (%), 22 (30.10) vs. 10 (14.90); p = 0.032). PPHL in patients with RA was associated with subclinical atherosclerosis (OR (95% CI) 4.69 (1.09-12.11); p = 0.037), TNF-α (OR (95% CI) 2.00 (1.00-3.98); p = 0.048), high-sensitivity C-reactive protein (OR (95% CI) 1.10 (1.01-1.19); p = 0.027), and baseline triglycerides (OR (95% CI) 1.02 (1.00-1.04); p = 0.049). CONCLUSION PPHL was more frequent in patients with RA than in controls. PPHL in patients with RA was associated with inflammation and subclinical atherosclerosis.
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Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - José Rioja
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Francisco Gabriel Jimenez-Nuñez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Jose Manuel Lisbona-Montañez
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Marta Rojas-Gimenez
- UGC de Reumatología, Instituto Maimónides de Investigación Biomédica de Cordoba (IMIBIC), Hospital Universitario Reina Sofia, 14004 Cordoba, Spain;
| | - Inmaculada Ureña
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Pedro Valdivielso
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
- UGC de Medicina Interna, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
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22
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Alvarez Gonzalez C, Carrillo Linares JL, García Muñoz I, Escalona García A, Valdivielso P. IgG4-Related Disease Affecting Testicle and Myelodysplastic Syndrome: Just a Coincidence? Eur J Case Rep Intern Med 2021; 8:002981. [PMID: 35059333 PMCID: PMC8765686 DOI: 10.12890/2021_002981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is progressive immune-mediated fibrotic condition characterised by a tendency to form tumefactive lesions in different organs and by elevated IgG4 serum concentrations. Urological manifestations are rare and normally occur together with other systemic affections. Myelodysplastic syndromes (MDS) are hematopoietic stem cell neoplasms, with different subtypes based on the type of blood cells involved. MDS can be associated with other pathologies or medical treatments. We present an uncommon case of testicular manifestation associated with myelodysplastic syndrome here.
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Affiliation(s)
- Carla Alvarez Gonzalez
- Department of Internal Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Isabel García Muñoz
- Department of Pathological Anatomy, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Andrea Escalona García
- Department of Pathological Anatomy, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Pedro Valdivielso
- Department of Internal Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Faculty of medicine, University of Malaga, Malaga, Spain
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23
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Guijarro C, Civeira F, López-Miranda J, Masana L, Pedro-Botet J, Pintó X, Valdivielso P, Mostaza JM. Situation in 2020 of the requirements for the use of PCSK9 inhibitors in Spain: Results of a national survey. Clin Investig Arterioscler 2021; 34:10-18. [PMID: 34656373 DOI: 10.1016/j.arteri.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
AIMS During 2019 and 2020 a series of meetings over the country were carried out, with the aim of explaining the methodology and criteria for the ellaboration of the recommendations on the use of iPCSK9, published by the Spanish Society of Atherosclerosis (SEA in Spanish). At the end of the meetings, a survey was conducted among the participants, in order to describe the prescription requirements of these drugs in the Spanish regions. METHODOLOGY Butterfly Project was developed by a scientific Committee of experts in lipids. After the ellaboration of the materials for the project, a train the trainers program was carried out, imparted by 17 experts who were the Project coordinators. Later, 16 regional workshops were performed, with the attendance of 169 medical doctors involved in the management of hipercolesterolemia. The attendants responded the survey, where they were asked different questions on the use of iPCSK9 on their clinical practice. RESULTS A high heterogeneity among centers regarding the requirements and difficulties for iPCSK9 prescription was revealed. Twenty one per cent of responders indicated to have low difficulties to prescribe iPCSK9 in their hospitals, whereas 78% found moderate or high difficulties. The difficulties came from burocracy- administrative aspects (18%), restrictions in the indication (41%) and both (38%). In general, the obstacles did not depend on the hospital level, neither the speciality, or the presence of lipid units, although the existance of lipid units was associated with a higher number of patients treated with iPCSK9. The factors which were associated with higher difficulty in the prescription were: the presence of an approval committee in the hospitals, the frequency in the revision of the treatment by hospital pharmacy, the temporal cadence of the prescription, the profile of patients seen and the criteria followed by the specialists for the prescription. CONCLUSION The results show important diferences in the treatment with iPCSK9 in the context of clinical practice in Spain. The analysis of these results will permit to make proposals regarding future actions addressed to reach the equity in the access to iPCSK9 in Spain, with the main aim of maximizing their potential benefit according to the patients profile.
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Affiliation(s)
- Carlos Guijarro
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Fernando Civeira
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
| | - José López-Miranda
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBEROBN, Córdoba, España
| | - Luis Masana
- Servicio de Medicina Interna, Hospital Universitario de Reus, Universidad Rovira i Virgili, IISPV, CIBERBEM, Reus, Tarragona, España
| | - Juan Pedro-Botet
- Servicio de Medicina Interna, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge-Idibell, Universidad de Barcelona, CIBEROBN, L' Hospitalet de Llobregat, Barcelona, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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Lillo E, Gutierrez-Cardo A, Murcia-Casas B, Carrillo-Linares JL, Garcia-Argüello F, Chicharo de Freitas R, Baquero-Aranda I, Valdivielso P, García-Fernández M, Sánchez-Chaparro MÁ. Cutaneous and Vascular Deposits of 18F-NaF by PET/CT in the Follow-Up of Patients with Pseudoxanthoma Elasticum. J Clin Med 2021; 10:jcm10122588. [PMID: 34208205 PMCID: PMC8230828 DOI: 10.3390/jcm10122588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
Active microcalcification of elastic fibers is a hallmark of pseudoxanthoma elasticum and it can be measured with the assessment of deposition of 18F-NaF using a PET/CT scan at the skin and vascular levels. It is not known whether this deposition changes over time in absence of specific therapy. We repeated in two years a PET/CT scan using 18F-NaF as a radiopharmaceutical in patients with the disease and compared the deposition at skin and vessel. Furthermore, calcium score values at the vessel wall were also assessed. Main results indicate in the vessel walls that calcification progressed in each patient; by contrast, the active microcalcification, measured and target-to-background ratio showed reduced active deposition. By contrast, at skin levels (neck and axillae) the uptake of the pharmaceutical remains unchanged. In conclusion, because calcification in the arterial wall is not specific for pseudoxanthoma elasticum condition, the measurement of the deposition of 18F-NaF in the neck might be potentially used as a surrogate marker in future trials for the disease.
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Affiliation(s)
- Eugenia Lillo
- Molecular Imaging Unit, Centro de Investigaciones Médico Sanitarias (CIMES), Fundación General de la Universidad de Málaga, 29010 Málaga, Spain; (E.L.); (R.C.d.F.)
| | - Antonio Gutierrez-Cardo
- Nuclear Medicine Department, Regional Hospital, 29010 Malaga, Spain;
- Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (J.L.C.-L.); (F.G.-A.); (M.G.-F.); (M.Á.S.-C.)
| | - Belén Murcia-Casas
- Internal Medicine Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain;
| | - Juan Luis Carrillo-Linares
- Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (J.L.C.-L.); (F.G.-A.); (M.G.-F.); (M.Á.S.-C.)
- Internal Medicine Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain;
| | - Francisco Garcia-Argüello
- Molecular Imaging Unit, Centro de Investigaciones Médico Sanitarias (CIMES), Fundación General de la Universidad de Málaga, 29010 Málaga, Spain; (E.L.); (R.C.d.F.)
- Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (J.L.C.-L.); (F.G.-A.); (M.G.-F.); (M.Á.S.-C.)
| | - Reinaldo Chicharo de Freitas
- Molecular Imaging Unit, Centro de Investigaciones Médico Sanitarias (CIMES), Fundación General de la Universidad de Málaga, 29010 Málaga, Spain; (E.L.); (R.C.d.F.)
| | | | - Pedro Valdivielso
- Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (J.L.C.-L.); (F.G.-A.); (M.G.-F.); (M.Á.S.-C.)
- Internal Medicine Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain;
- Department of Medicine and Dermatology, University of Malaga, 29010 Malaga, Spain
- Correspondence: ; Tel.: +34-952131615; Fax: +34-952131511
| | - María García-Fernández
- Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (J.L.C.-L.); (F.G.-A.); (M.G.-F.); (M.Á.S.-C.)
- Department of Human Physiology, University of Malaga, 29010 Malaga, Spain
| | - Miguel Ángel Sánchez-Chaparro
- Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (J.L.C.-L.); (F.G.-A.); (M.G.-F.); (M.Á.S.-C.)
- Internal Medicine Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain;
- Department of Medicine and Dermatology, University of Malaga, 29010 Malaga, Spain
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Arrobas Velilla T, Brea Á, Valdivielso P. Implantation of a biochemical and genetic screening programme for family hypercholesterolaemia. Collaboration between the clinical laboratory and lipid units: Design of the ARIAN Project. Clin Investig Arterioscler 2021; 33:289-295. [PMID: 34090714 DOI: 10.1016/j.arteri.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVE Familial hypercholesterolaemia (FH) is the most common genetic disorder associated with premature coronary artery disease due to the presence of LDL-C cholesterol increased from birth. It is underdiagnosed and undertreated. The primary objective of the ARIAN project was to determine the number of patients diagnosed with FH after implementing a new screening procedure from the laboratory. MATERIAL AND METHODS This project was designed as a retrospective analysis by consulting the computer system. We selected from databases serum samples from patients ≥ 18 years with direct or calculated LDL-C>250mg/dL from 1 January 2017 to 31 December 2018. Once secondary causes had been ruled out, the requesting primary care physician was notified that their patient might have FH and to arrange a priority appointment in the lipid unit. All patients with a score of ≥ 6 points according to the Dutch Lipid Clinic Criteria were proposed for a genetic study RESULTS: By December 30th, 2020, 24 centres out of the initial 55 had submitted results. The number of patients analysed up to that point was 3,266,341, which represents 34% of the population served in those health areas (9,727,434). CONCLUSIONS The identification of new subjects with FH through this new strategy from the laboratory and their referral to lipid units should increase the number of patients treated in lipid units and initiate familial cascade screening.
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Affiliation(s)
- Teresa Arrobas Velilla
- Laboratorio de Nutrición y Riesgo Cardiovascular de Bioquímica Clínica, Unidad de Lípidos, Hospital Universitario Virgen de la Macarena, Sevilla, España.
| | - Ángel Brea
- Servicio de Medicina Interna y Unidad de Lípidos, Hospital San Pedro, Logroño, La Rioja, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna y Unidad de Lípidos, Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, España
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26
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Pérez de Isla L, Valdivielso P. New treatments for dyslipidemia. Clin Investig Arterioscler 2021; 33 Suppl 1:1-2. [PMID: 33966806 DOI: 10.1016/j.arteri.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Leopoldo Pérez de Isla
- Servicio de Cardiología, Hospital Clínico San Carlos, IDISSC, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España.
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Manrique-Arija S, Mena-Vazquez N, Ureña I, Rioja J, Valdivielso P, Ginel-Mendoza L, Abad-Sánchez S, Jiménez-Núñez FG, Oliver-Martos B, Fernandez-Nebro A. Cumulative inflammatory burden and obesity as determinants of insulin resistance in patients with established rheumatoid arthritis: cross-sectional study. BMJ Open 2021; 11:e044749. [PMID: 33563625 PMCID: PMC7875272 DOI: 10.1136/bmjopen-2020-044749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To describe the prevalence of insulin resistance (IR) in patients with established rheumatoid arthritis (RA) and to analyse the contribution of cumulative inflammatory burden and other factors to its development. DESIGN Observational cross-sectional study. PARTICIPANTS Patients with RA and controls matched for age, sex and Body Mass Index. We excluded patients with diabetes. SETTINGS Patients from an RA inception cohort at Hospital Regional Universitario de Málaga, Spain, were recruited between September 2016 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES IR was evaluated using the homeostasis model assessment for IR and beta-cell function and the quantitative insulin sensitivity check index. Other variables included the cumulative 28-Joint Disease Activity Score (DAS28) with C reactive protein (CRP) body composition and cytokines. Two logistic regression models were constructed to identify factors associated with IR in patients with RA. RESULTS Eighty-nine patients with RA and 80 controls were included. The prevalence of IR was similar in both cases and controls. Inflammatory activity was controlled appropriately in patients during follow-up (mean DAS28 3.1 (0.8)). The presence of IR in patients with RA was associated with obesity (OR 6.01, 95% CI 1.9 to 8.7), higher cumulative DAS28-CRP values during follow-up (OR 2.8, 95% CI 1.3 to 6.0), and higher interleukin-1β levels (OR 1.6, 95% CI 1.1 to 2.4). The second model showed that the risk of IR increased by 10% for each kilogram of excess body fat. CONCLUSION In patients with well-controlled, established RA, IR is associated mainly with poorer control of inflammation from diagnosis and with obesity, specifically total fat mass.
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Affiliation(s)
- Sara Manrique-Arija
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Mena-Vazquez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Inmaculada Ureña
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - José Rioja
- Departamento de Medicina y Dermatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- UGC de Medicina Interna, Instituto de InvestigaciónBiomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Salomé Abad-Sánchez
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain
| | - Francisco G Jiménez-Núñez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Begoña Oliver-Martos
- UGC Neurociencias, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernandez-Nebro
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
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Valdivielso P, Jacinto M, Devernois G, Laplana J, García-Fernández M, Martin L. Role of patients associations in connective tissue calcifiying diseases: a position statement from EuroSoftCalc.Net group. Orphanet J Rare Dis 2021; 16:71. [PMID: 33557904 PMCID: PMC7869194 DOI: 10.1186/s13023-021-01703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Patients have been showing a growing interest in taking active participation in decision making, and having the opportunity to drive clinical investigation. This is more common for patients who have a rare disease than for those with more prevalent diseases. The EuroSoftCalc.Net COST Action, a group of clinicians and researchers involved in the dystrophic calcification process held a meeting in which three representatives of patients’ associations, coming from Portugal, France and Spain, discussed the role of patients and their associations, namely in the Action, and also the main concerns in their countries. The disparities in health care between European Union countries with regard to connective tissue calcifying diseases, and the existing conflicts of interest, were a matter of debate during the meeting. As a consequence of the presentations and the debate that followed, it became clear that, despite their countries, the main concerns of the patients are identical, namely a lack of specific therapy and follow-up clinical guidelines, delays in the diagnosis, difficulties in getting members to enrol to associations, and/or difficulties with doctors’ explanations for the diseases. The attendees also agreed that EuroSoftCalc.Net group should help to set up new associations where no Patient Associations presently exist, and, furthermore, should release diagnosis and follow-up guidelines, especially helpful in countries, and/or for diseases, where no multidisciplinary consultations are available.
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Affiliation(s)
- Pedro Valdivielso
- Departamento de Medicina y Dermatología, School of Medicine, Spain and Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Medicina, University of Málaga, Boulevard Luis Pasteur 32, 29071, Málaga, Spain.
| | - Marta Jacinto
- Associação Pseudoxantoma Elástico Portugal, Lisbon, Portugal
| | | | - Jorge Laplana
- Asociación Española de Afectados Por Pseudoxantoma Elástico, Malaga, Spain
| | - Maria García-Fernández
- Departamento de Medicina y Dermatología, School of Medicine, Spain and Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Medicina, University of Málaga, Boulevard Luis Pasteur 32, 29071, Málaga, Spain
| | - Ludovic Martin
- PXE Consultation Center, MAGEC Nord Reference Center for Rare Skin Diseases, Angers University Hospital, Angers, France
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Lofaro FD, Boraldi F, Garcia-Fernandez M, Estrella L, Valdivielso P, Quaglino D. Relationship Between Mitochondrial Structure and Bioenergetics in Pseudoxanthoma elasticum Dermal Fibroblasts. Front Cell Dev Biol 2020; 8:610266. [PMID: 33392199 PMCID: PMC7773789 DOI: 10.3389/fcell.2020.610266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a genetic disease considered as a paradigm of ectopic mineralization disorders, being characterized by multisystem clinical manifestations due to progressive calcification of skin, eyes, and the cardiovascular system, resembling an age-related phenotype. Although fibroblasts do not express the pathogenic ABCC6 gene, nevertheless these cells are still under investigation because they regulate connective tissue homeostasis, generating the “arena” where cells and extracellular matrix components can promote pathologic calcification and where activation of pro-osteogenic factors can be associated to pathways involving mitochondrial metabolism. The aim of the present study was to integrate structural and bioenergenetic features to deeply investigate mitochondria from control and from PXE fibroblasts cultured in standard conditions and to explore the role of mitochondria in the development of the PXE fibroblasts’ pathologic phenotype. Proteomic, biochemical, and morphological data provide new evidence that in basal culture conditions (1) the protein profile of PXE mitochondria reveals a number of differentially expressed proteins, suggesting changes in redox balance, oxidative phosphorylation, and calcium homeostasis in addition to modified structure and organization, (2) measure of oxygen consumption indicates that the PXE mitochondria have a low ability to cope with a sudden increased need for ATP via oxidative phosphorylation, (3) mitochondrial membranes are highly polarized in PXE fibroblasts, and this condition contributes to increased reactive oxygen species levels, (4) ultrastructural alterations in PXE mitochondria are associated with functional changes, and (5) PXE fibroblasts exhibit a more abundant, branched, and interconnected mitochondrial network compared to control cells, indicating that fusion prevail over fission events. In summary, the present study demonstrates that mitochondria are modified in PXE fibroblasts. Since mitochondria are key players in the development of the aging process, fibroblasts cultured from aged individuals or aged in vitro are more prone to calcify, and in PXE, calcified tissues remind features of premature aging syndromes; it can be hypothesized that mitochondria represent a common link contributing to the development of ectopic calcification in aging and in diseases. Therefore, ameliorating mitochondrial functions and cell metabolism could open new strategies to positively regulate a number of signaling pathways associated to pathologic calcification.
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Affiliation(s)
| | - Federica Boraldi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Garcia-Fernandez
- Department of Human Physiology, Biomedical Research Institute of Málaga, University of Malaga, Málaga, Spain
| | - Lara Estrella
- Department of Human Physiology, Biomedical Research Institute of Málaga, University of Malaga, Málaga, Spain
| | - Pedro Valdivielso
- Department of Medicine and Dermatology, Instituto de Investigación Biomédica de Málaga, University of Malaga, Málaga, Spain.,Internal Medicine Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | - Daniela Quaglino
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Rioja J, Ariza MJ, García-Casares N, Coca-Prieto I, Arrobas T, Muñiz-Grijalvo O, Mangas A, Ibarretxe D, Sánchez-Chaparro MÁ, Valdivielso P. Evaluation of the chylomicron-TG to VLDL-TG ratio for type I hyperlipoproteinemia diagnostic. Eur J Clin Invest 2020; 50:e13345. [PMID: 32649781 DOI: 10.1111/eci.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study is to confirm the diagnostic performance of the Chylomicron to very low-density lipoproteins triglycerides (CM/VLDL-TG) ratio, the triglycerides to cholesterol ratio (TG/TC) and a dichotomic rule including the tryglycerides to apolipoprotein B (TG/APOB) ratio for the presence of Type I hyperlipoproteinemia (HPLI) in patients with severe hypertriglyceridemia (sHTG) that were at high risk for familial chylomicronemia syndrome (FCS). METHODS Two cohorts (derivation and validation) of patients with sHTG were included in the study. Anthropometric, clinical, biochemical and genetic data were obtained. The CM/VLDL-TG, TG/TC and TG/APOB ratios were calculated. Finally, a diagnostic performance study was developed to establish sensitivity, specificity and cut-offs by a ROC curve analysis in the derivation cohort as well as agreement and predictive values in the validation cohort. RESULTS Patients with FCS in both cohorts showed an earlier presence in pancreatitis, greater number of acute pancreatitis episodes and lower BMI. FCS patients also showed higher ratios of CM/VLDL-TG, TG/TC and TG/APOB ratios, whereas their HDL-C, LDL-C and APOB levels were lower than in non-FCS patients. Sensitivity and agreement were low for both the TG/TC and TG/APOB ratios, although predictive values were good. The CM/VLDL-TG ratio showed greatest sensitivity, specificity, agreement and predictive values for cut-off of 3.8 and 4.5. CONCLUSIONS Our results suggest that in subjects at high risk of FCS a total serum TG/TC ratio or TG/APOB ratio are feasible to initially screen for HLPI; however, a CM/VLDL-TG ratio ≥4.5 is a better diagnostic criterion for HPLI.
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Affiliation(s)
- José Rioja
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - María-José Ariza
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Natalia García-Casares
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | | | - Teresa Arrobas
- Clinical Chemistry Unit, Virgen Macarena Hospital, Sevilla, Spain
| | - Ovidio Muñiz-Grijalvo
- Internal Medicine Department, UCERV-UCAMI, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Alipio Mangas
- Internal Medicine Department, School of Medicine, Institute of Research and Innovation in Biomedical Sciences (INiBICA), University Hospital Puerta del Mar, University of Cadiz, Cádiz, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Spain
| | - Miguel Ángel Sánchez-Chaparro
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Pedro Valdivielso
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain
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31
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Calvo-Bonacho E, Catalina-Romero C, Fernández-Labandera C, Fernández-Meseguer A, González-Quintela A, Martínez-Muñoz P, Quevedo L, Valdivielso P, Sánchez-Chaparro MÁ. COVID-19 and Sick Leave: An Analysis of the Ibermutua Cohort of Over 1,651,305 Spanish Workers in the First Trimester of 2020. Front Public Health 2020; 8:580546. [PMID: 33194983 PMCID: PMC7604328 DOI: 10.3389/fpubh.2020.580546] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives: The worldwide SARS-COV2 pandemic has impacted the health of workers and companies. The aim is to quantify it according to sick leave. Methods: Using ICD-9 codes, we analyzed Ibermutua records of all sick leaves during the first trimester of 2020, compared to during the same months of 2017, 2018, and 2019. We stratified the analysis by causes, patient sex, activity sectors, and regional data. All sick leaves were adjusted by the number of Ibermutua-affiliated persons in each period. Results: In March 2020, there was an unprecedented (116%) increase in total sick leaves, mainly due to infectious and respiratory diseases. Men and women were equally affected. All activity sectors were impacted, with the highest increase (457%) observed among health-related workers, especially due to contagious disease. The incidences of sick leaves were heterogeneous among different regions. Cost-analysis of sick leaves during the first trimester of 2020 compared with in previous years showed 40.3% increment (mean 2,813 vs. 2,005 € per 100 affiliated workers). Conclusions: The SARS-COV2 pandemic is having a huge impact on workers' health, as shown by data regarding sick leaves in March 2020. This is associated with greater economic burden for companies, both due to the cost associated with sick leaves and the losses in productivity due to confinement.
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Affiliation(s)
- Eva Calvo-Bonacho
- Departamento de Proyectos Sanitarios, Ibermutua, Mutua Colaboradora con la Seguridad Social 274, Madrid, Spain
| | - Carlos Catalina-Romero
- Departamento de Proyectos Sanitarios, Ibermutua, Mutua Colaboradora con la Seguridad Social 274, Madrid, Spain
| | - Carlos Fernández-Labandera
- Departamento de Proyectos Sanitarios, Ibermutua, Mutua Colaboradora con la Seguridad Social 274, Madrid, Spain
| | - Ana Fernández-Meseguer
- Departamento de Proyectos Sanitarios, Ibermutua, Mutua Colaboradora con la Seguridad Social 274, Madrid, Spain
| | - Arturo González-Quintela
- Departamento de Medicina Interna, Hospital Universitario, Universidad de Santiago de Compostela, A Coruña, Spain
| | - Paloma Martínez-Muñoz
- Departamento de Proyectos Sanitarios, Ibermutua, Mutua Colaboradora con la Seguridad Social 274, Madrid, Spain
| | - Luis Quevedo
- Departamento de Proyectos Sanitarios, Ibermutua, Mutua Colaboradora con la Seguridad Social 274, Madrid, Spain
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Virgen de la Vic, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga and Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
| | - Miguel Ángel Sánchez-Chaparro
- Servicio de Medicina Interna, Hospital Virgen de la Vic, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga and Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain
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Climent E, Pérez-Calahorra S, Benaiges D, Pintó X, Suárez-Tembra M, Plana N, Sánchez-Hernández RM, Valdivielso P, Ascaso JF, Pedro-Botet J. Diferencias clínicas y genéticas de los pacientes con hipercolesterolemia familiar heterocigota con y sin diabetes mellitus tipo 2. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Espíldora-Hernández J, Díaz-Antonio T, Baena-Espinar J, Alonso-Calderón I, Rioja J, Alba-Conejo E, Valdivielso P, Sánchez-Chaparro MÁ. Subclinical Arteriosclerosis is Associated With Common Vascular Risk Factors in Long-Term Survivors of Testicular Cancer. J Clin Med 2020; 9:jcm9040971. [PMID: 32244483 PMCID: PMC7231146 DOI: 10.3390/jcm9040971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular disease risk is increased in survivors of testicular cancer because of exposure to treatment (chemotherapy and radiotherapy), as well as modification in lifestyle. Our aim was to assess the presence of subclinical arteriosclerosis in survivors of testicular cancer in comparison with a control group. This was a cross-sectional, observational, case–control study including 50 survivors of Germ Cell Tumor (GCT) (14 years of follow-up) and 53 age-matched controls with no cancer. We registered clinical data, cardiovascular risk factors, physical and Mediterranean questionnaires, intima-media thickness and plaque at carotid and femoral arteries by ultrasound, calcium score at the abdominal aorta, and liver steatosis by computed tomography, and applied analytical tests to quantify metabolic risk factors and inflammation markers. Patients showed a trend toward greater intima-media thickness (IMT) and plaques than controls, as well as a higher calcium score in the abdominal aorta. Remarkably, patients had higher waist circumference, insulin resistance (HOMA-IR), and liver steatosis, but lower physical activity and high-density lipoprotein (HDL) cholesterol than controls (all p < 0.05). In multivariate analyses, only common vascular risk factors were associated with subclinical arteriosclerosis. As a conclusion, in our study, a higher rate of subclinical arteriosclerosis in testicular cancer survivors was associated with classical metabolic risk factors and lifestyle, but not with exposure to chemotherapy.
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Affiliation(s)
| | | | - Javier Baena-Espinar
- Oncology Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.B.-E.); (E.A.-C.)
| | | | - José Rioja
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
| | - Emilio Alba-Conejo
- Oncology Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.B.-E.); (E.A.-C.)
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.E.-H.); (M.-Á.S.-C.)
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
- Correspondence: ; Tel.: +34-952131615
| | - Miguel-Ángel Sánchez-Chaparro
- Internal Medicine Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.E.-H.); (M.-Á.S.-C.)
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
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Fernández-Labandera C, Calvo-Bonacho E, Valdivielso P, Quevedo-Aguado L, Martínez-Munoz P, Catalina-Romero C, Ruilope LM, Sánchez-Chaparro MA. Prediction of fatal and non-fatal cardiovascular events in young and middle-aged healthy workers: The IberScore model. Eur J Prev Cardiol 2019; 28:177–186. [PMID: 33838039 DOI: 10.1177/2047487319894880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/18/2019] [Indexed: 11/15/2022]
Abstract
AIMS Our primary objective was to improve risk assessment for fatal and non-fatal cardiovascular events in a working population, mostly young and healthy. METHODS We conducted a prospective cohort study to derive a survival model to predict fatal and non-fatal 10-year cardiovascular risk. We recruited 992,523 workers, free of diagnosed cardiovascular disease at entry, over six years, from 2004-2009. We divided the sample into two independent cohorts: a derivation one (626,515 workers; from 2004-2006) and a temporal validation one (366,008 workers; over 2007-2009). Then, we followed both cohorts over 10 years and registered all fatal and non-fatal cardiovascular events. We built a new risk calculator using an estimation of cardiovascular biological age as a predictor and named it IberScore. There were remarkable differences between this new model and Systematic Coronary Risk Evaluation (SCORE) (in both the specification and the equation). RESULTS Over the 10-year follow-up, we found 3762 first cardiovascular events (6‰) in the derivation cohort. Most of them (80.3%) were non-fatal ischaemic events. If we had been able to use our model at the beginning of the study, we had classified in the 'high-risk' or 'very high-risk' groups 82% of those who suffered a cardiovascular event during the follow-up. All the post-estimation tests showed superior performance (true positive rate: 81.8% vs 11.8%), higher discrimination power and better clinical utility (standardised net benefit: 58% vs 13%) for IberScore when compared to SCORE. CONCLUSION Risk assessment of fatal and non-fatal cardiovascular events in young and healthy workers was improved when compared to the previously used model (SCORE). The latter was not reliable to predict cardiovascular risk in our sample. The new model showed superior clinical utility and provided four useful measures for risk assessment. We gained valuable insight into cardiovascular ageing and its predictors.
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Affiliation(s)
| | - Eva Calvo-Bonacho
- Ibermutuamur, Mutua Colaboradora con la Seguridad Social n° 274, Spain
| | - Pedro Valdivielso
- University Hospital 'Virgen de la Victoria', University of Malaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | | | | | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, University Hospital 12 de Octubre, Spain
| | - Miguel A Sánchez-Chaparro
- University Hospital 'Virgen de la Victoria', University of Malaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
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Sánchez-Tévar AM, García-Fernández M, Murcia-Casas B, Rioja-Villodres J, Carrillo JL, Camacho M, Van Gils M, Sánchez-Chaparro MA, Vanakker O, Valdivielso P. Plasma inorganic pyrophosphate and alkaline phosphatase in patients with pseudoxanthoma elasticum. Ann Transl Med 2019; 7:798. [PMID: 32042814 DOI: 10.21037/atm.2019.12.73] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Inorganic pyrophosphate (PPi) plays a major role inhibiting dystrophic calcification. The aim was to analyze levels of PPi in patients having pseudoxanthoma elasticum (PXE), and controls as well as the enzymes who regulate the PPi plasma concentration. Methods We collected fasting blood samples from PXE patients and age- and sex-matched controls in ethylenediamine tetraacetic acid (EDTA) and citrate-theophylline-adenosine-dipyridamole (CTAD) containing tubes. We measured PPi, ENPP1 mass and activity, alkaline phosphatase (AP) and tissue non-specific alkaline phosphatase (TNAP), CD73 and Human Platelet Factor-4 (CXCL4). Results PPi in EDTA and CTAD samples were lower in PXE subjects than in controls (1.11±0.26 vs. 1.43±0.41 µM/L and 0.35±0.15 vs. 0.61±0.18 µM/L respectively, P<0.05). TNAP and liver TNAP activities were also higher in PXE than in controls (80.3±27.0 vs. 63.3±16.4 UI/L and 25.6±14.9 vs. 12.9±9.2 UI/L respectively, P<0.05). ENPP1 mass and activity as well as CD73 were almost identical. There was a weak but significant inverse correlation between TNAP activity and PPi levels (Pearson correlation -0.379, P<0.05) in both groups. Conclusions High TNAP activity seems to contribute to low plasma levels of PPi in subjects with PXE, reinforcing the idea that pharmacological reduction of TNAP activity may help to reduce dystrophic calcification in PXE patients.
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Affiliation(s)
- Ana María Sánchez-Tévar
- Lipid and Arteriosclerosis Laboratory, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Málaga, Málaga, Spain
| | - María García-Fernández
- Department of Physiology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | | | - José Rioja-Villodres
- Lipid and Arteriosclerosis Laboratory, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Málaga, Málaga, Spain.,Department of Medicine and Dermatology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | | | - Marta Camacho
- Obstetric and Gynecology Department, Hospital Virgen de la Victoria, Málaga, Spain
| | - Matthias Van Gils
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Miguel Angel Sánchez-Chaparro
- Lipid and Arteriosclerosis Laboratory, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Málaga, Málaga, Spain.,Internal Medicine Unit, Hospital Virgen de la Victoria, Málaga, Spain.,Department of Medicine and Dermatology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Olivier Vanakker
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Pedro Valdivielso
- Lipid and Arteriosclerosis Laboratory, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Málaga, Málaga, Spain.,Internal Medicine Unit, Hospital Virgen de la Victoria, Málaga, Spain.,Department of Medicine and Dermatology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
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Ariza MJ, Pérez-López C, Almagro F, Sánchez-Tévar AM, Muñiz-Grijalvo O, Álvarez-Sala Walter LA, Rioja J, Sánchez-Chaparro MÁ, Valdivielso P. Genetic variants in the LPL and GPIHBP1 genes, in patients with severe hypertriglyceridaemia, detected with high resolution melting analysis. Clin Chim Acta 2019; 500:163-171. [PMID: 31669931 DOI: 10.1016/j.cca.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Pathogenic variants in lipoprotein lipase (LPL) and glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) have been described in patients with severe hypertriglyceridaemia. We aimed to optimise high resolution melting (HRM) assays to detect the presence of functional variants in these genes. METHODS One hundred and sixteen patients with severe hypertriglyceridaemia were studied. HRM assays were optimised to scan exons and splice junctions in LPL and GPIHBP1. Sanger sequencing was the reference method. Next-generation-sequencing (NGS) was performed in five patients, including one with Familial Chylomicronemia syndrome (FCS). RESULTS We identified 15 different variants in LPL and 6 in GPIHBP1. The variants revealed with NGS were also detected with HRM, including a rare premature stop codon in LPL (p.Trp421*) and two LPL pathogenic variants in the patient with FCS (p.His80Arg + p.Gly215Glu). Having multiple functional variant alleles was associated with pancreatitis onset at younger ages and higher baseline triglycerides. CONCLUSIONS Our HRM assays detected the presence of functional gene variants that were confirmed with Sanger and NGS sequencing. The presence of multiple functional variant alleles was associated with differences in the clinical profile. Therefore, these assays represent a reliable, cost-effective tool that can be used to complement the NGS approach for gene scanning.
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Affiliation(s)
- María José Ariza
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain.
| | - Carmen Pérez-López
- Internal Medicine Unit, University Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - Fátima Almagro
- Lipids Unit, Internal Medicine, University Hospital Donostia, San Sebastian, Begiristain Doktorea Pasealekua, 107-115, 20014 Donostia, Gipuzkoa, Spain
| | - Ana María Sánchez-Tévar
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain
| | - Ovidio Muñiz-Grijalvo
- UCERV-UCAMI, Internal Medicine Department, University Hospital Virgen del Rocío, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
| | - Luis Antonio Álvarez-Sala Walter
- Lipids Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, IiSGM, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
| | - José Rioja
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain
| | - Miguel Ángel Sánchez-Chaparro
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain; Internal Medicine Unit, University Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - Pedro Valdivielso
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain; Internal Medicine Unit, University Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
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Ruilope LM, Calvo-Bonacho E, Quevedo-Aguado L, Catalina-Romero C, Valdivielso P, Sanchez-Chaparro MA, Fernandez-Labandera C. P3403Clinical utility of the integration of Life Simple 7 designed by the American Heart Association and the model for cardiovascular risk prediction IberScore. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Practice guidelines are agreed on the importance of lifestyle advice for cardiovascular risk reduction as well as cardiovascular risk prediction in planning preventive strategies.
Purpose
To assess the clinical usefulness of the application of the predictive model of cardiovascular risk (CVR) IberScore combined with the recommendations of “Life's Simple 7” (LS7) of the American Heart Association (AHA) in a working population.
Methods
IberScore model is a predictive function for fatal and non-fatal cardiovascular (CV) events derived from a cohort of 774,404 workers (70.4% of the target population) between 16–65 years (average of 35.7 (SD = 10.7)) without CV disease at admission, which was followed for a period of 10 years. Age, sex, total cholesterol, HDL, SBP, glycemia, obesity and a history of dyslipidemia, hypertension and diabetes were used as factors of CVR. Using this model, patients were classified into 4 risk levels. It was also assessed the ideal health status according to the recommendations of “Life's Simple 7” (which includes healthy diet, physical activity, smoking cessation, BMI <25 kg/m2, total cholesterol without treatment <200mg/dl, blood pressure without treatment <120/80 mmHg and basal glycemia <100 mg/dl). Finally, these classifications were compared with the appearance of CV events in a 10-year follow-up.
Results
The results showed a high sensitivity (given that the predictive capacity reached 82% of the cardiovascular events) by using the IberScore, a logistic flexible parametric model to predict 10-year cardiovascular risk. Likewise, the clinical usefulness of the “Life's Simple 7” recommendations could be verified in order to reduce the incidence of total CV events (fatal and non-fatal).
Conclusions
The integration of the predictive model IberScore with the preventive recommendations “Life's simple 7” of the AHA applied to the working population would allow a more efficient cardiovascular prevention.
Acknowledgement/Funding
This project received a research grant from the Carlos III Health Institute (Ministry of Science, Innovation and Universities, Spain). Ref. PI18/01809
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Affiliation(s)
- L M Ruilope
- University Hospital 12 de Octubre, Hypertensive Unit, Research Institute Imas12, Madrid, Spain
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Ramírez Torres JM, López Téllez A, Valdivielso P, Barbancho Fernández MÁ. Evaluation of the atherosclerotic burden in hypertensive patients with prediabetes. Clin Investig Arterioscler 2019; 31:160-165. [PMID: 30971375 DOI: 10.1016/j.arteri.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/24/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
AIM To assess the atherosclerotic burden in hypertensive patients with prediabetes without cardiovascular disease. PATIENTS AND METHODS We included patients with hypertension and prediabetes (fasting blood glucose: 100-125mg/dL and/or glycohemoglobin A1c: 5.7-6.4%), excluding those with established cardiovascular disease or those at very high risk. We recorded major vascular risk factors. Subclinical arteriosclerosis was measured by the ankle/brachial index (ABI) and carotid intima-medial thickness (IMT). Subclinical arteriosclerosis was mild if IMT was >75p adjusted by age and sex and/or ABI was 0.7-0.9 and was considered moderate-severe when there was plaque and/or ABI<0.7. RESULTS We included 53 patients, 63±7 years-old; women: 50,9% (95%CI: 36.8-64.9). Atherosclerotic burden was detected in 66.0% (95%CI: 51.7-78.5) of subjects. 24,5% (95%CI: 13.8-38.3) of patients had mild arteriosclerosis disease and 41.5% (95%CI: 28.1-55.9) had moderate-severe. This allowed us to re-stratified as very high vascular risk the 41.5% (95%CI: 28.1-55.9) of patients. 45.4% (95%CI: 16-74.8) of subjects with moderate initial risk were considered high or very high risk. In multivariate analyses, only smoking was associated with atherosclerotic burden (P=.07). CONCLUSIONS Two thirds of hypertensive patients with prediabetes had subclinical arteriosclerotic disease when they were evaluated by the ankle/brachial index and carotid ultrasonography. Approximately forty percent of patients were re-stratified as very high vascular risk. Nearly half of the prediabetic hypertensive patients initially classified as moderate risk were considered high or very high risk.
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Affiliation(s)
| | | | - Pedro Valdivielso
- Medicina Interna, Hospital Virgen de la Victoria, Departamento de Medicina y Dermatología, Universidad de Málaga, IBIMA, Málaga, España
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Masana L, Ibarretxe D, Rodríguez-Borjabad C, Plana N, Valdivielso P, Pedro-Botet J, Civeira F, López-Miranda J, Guijarro C, Mostaza J, Pintó X. Toward a new clinical classification of patients with familial hypercholesterolemia: One perspective from Spain. Atherosclerosis 2019; 287:89-92. [PMID: 31238171 DOI: 10.1016/j.atherosclerosis.2019.06.905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The introduction of singular therapies, such as proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), to lower high cholesterol levels requires better classification of patients eligible for intensive lipid lowering therapy. According to the European Medicines Administration, PCSK9i are recommended in primary prevention only in familial hypercholesterolemia (FH) patients. Therefore, an FH diagnosis is not simply an academic issue, because it has many clinical implications. The bases of a diagnosis of FH are not entirely clear. The availability of genetic testing, including large genome-wide association analyses and whole genome studies, has shown that some patients with a clinical diagnosis of definite FH have no mutations in the genes associated with the disease. This fact does not exclude the very high cardiovascular risk of these patients, and an early and intensive lipid lowering therapy is recommended in all FH patients. Because an FH diagnosis is a cornerstone for decisions about therapies, a precise definition of FH is urgently required. This is an expert consensus document from the Spanish Atherosclerosis Society. We propose the following classification: familial hypercholesterolemia syndrome integrated by (1) heterozygous familial hypercholesterolemia: patients with clinically definite FH and a functional mutation in one allele of the LDLR, ApoB:100, and PCSK9 genes; (2) homozygous familial hypercholesterolemia: mutations affect both alleles; (3) polygenic familial hypercholesterolemia: patients with clinically definite FH but no mutations associated with FH are found (to be distinguished from non-familial, multifactorial hypercholesterolemia); (4) familial hypercholesterolemia combined with hypertriglyceridemia: a subgroup of familial combined hyperlipidaemia patients fulfilling clinically definite FH with associated hypertriglyceridemia.
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Affiliation(s)
- Luis Masana
- Unitat de Medicina Vascular i Metabolisme. Hospital Universitari Sant Joan. Universitat Rovira i Virgili. IISPV, CIBERDEM. Reus, Spain.
| | - Daiana Ibarretxe
- Unitat de Medicina Vascular i Metabolisme. Hospital Universitari Sant Joan. Universitat Rovira i Virgili. IISPV, CIBERDEM. Reus, Spain
| | - Cèlia Rodríguez-Borjabad
- Unitat de Medicina Vascular i Metabolisme. Hospital Universitari Sant Joan. Universitat Rovira i Virgili. IISPV, CIBERDEM. Reus, Spain
| | - Núria Plana
- Unitat de Medicina Vascular i Metabolisme. Hospital Universitari Sant Joan. Universitat Rovira i Virgili. IISPV, CIBERDEM. Reus, Spain
| | - Pedro Valdivielso
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, CIMES, University of Málaga, Virgen de la Victoria University Hospital, IBIMA, Málaga, Spain
| | - Juan Pedro-Botet
- Unitat de Lípids i Risc Vascular. Hospital del Mar. Departament de Medicina. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Civeira
- Unidad de Lípidos, Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Jose López-Miranda
- Lipid and Atherosclerosis Unit, Department of Internal Medicine / IMIBIC/Reina Sofia University Hospital/University of Cordoba, CIBEROBN, Spain
| | - Carlos Guijarro
- Internal Medicine Unit, University Hospital Alcorcon Foundation, Rey Juan Carlos University, Madrid, Spain
| | - Jose Mostaza
- Internal Medicine Service, Hospital Carlos III, Madrid, Spain
| | - Xavier Pintó
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Villena García AC, Cardo AG, Hidalgo CM, Palomo L, Lillo E, Espíldora J, Trigo JM, Chaparro MÁS, Valdivielso P. 18FDG PET/CT & arterial inflammation: predicting cardiovascular events in lung cancer. QJM 2019; 112:401-407. [PMID: 30715503 DOI: 10.1093/qjmed/hcz036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 18F-FDG PET/CT predicts cardiovascular disease. To analyze the predictive value of cardiovascular events from inflammation and arterial calcification in patients who underwent an 18F-FDG PET/CT for lung cancer. METHODS A retrospective study of 274 patients with primary lung neoplasia. We determined: (i) TBR (target-to-background ratio), and (ii) the calcium score, at eight common arterial segments. We took as arteriosclerosis, a TBR ≥1.6 and ≥15 Calcium Score sum. We registered cardiovascular risk factors, comorbidities, histology, stage, treatment, status at the last clinical review, cause of death and cardiovascular event during the follow-up. RESULTS The territory presenting the greatest uptake of 18F-FDG, was the thoracic aorta with an average of 1.77 (± 0.27 TBR) in the aortic arch, while the greatest degree of calcification was obtained in the abdominal aorta (52% with a Calcium Score ≥ 3). 24% of the patients presented a sum Calcium Score ≥15, and 17% a TBR ≥1.6. Patients with high TBR, (17%), had not a higher frequency of cardiovascular comorbidities beforehand, nor did they in the follow-up. However, those with a sum Calcium Score ≥15 (24%), were older, had more cardiovascular risk factors and ischemic events during follow-up. The calcium score, but not the TBR, predicted the emergence of a cardiovascular event (HR 4.9 IC95% 2.1-9.1, P < 0.05). CONCLUSION In our cohort, a high Calcium Score was an independent predictor for developing cardiovascular events.
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Affiliation(s)
- A C Villena García
- Nuclear Medicine, Molecular imaging department, Centro de Investigaciones Médico Sanitarias (CIMES)
| | - A Gutierrez Cardo
- Nuclear Medicine, Molecular imaging department, Centro de Investigaciones Médico Sanitarias (CIMES)
| | - C M Hidalgo
- Department of Medicine and Dermatology, University of Malaga, Málaga, Spain
| | - L Palomo
- Department of Medicine and Dermatology, University of Malaga, Málaga, Spain
| | - E Lillo
- Nuclear Medicine, Molecular imaging department, Centro de Investigaciones Médico Sanitarias (CIMES)
| | | | - J Manuel Trigo
- Oncology, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - M Á Sánchez Chaparro
- Internal Medicine, Hospital Clínico Universitario Virgen de la Victoria, Department of Medicine and Dermatology, Insituto de Investigaciones Biomédicas de Málaga (IBIMA), University of Malaga, Málaga, Spain
| | - P Valdivielso
- Internal Medicine, Hospital Clínico Universitario Virgen de la Victoria, Department of Medicine and Dermatology, Insituto de Investigaciones Biomédicas de Málaga (IBIMA), University of Malaga, Málaga, Spain
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41
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Ascaso JF, Civeira F, Guijarro C, López Miranda J, Masana L, Mostaza JM, Pedro-Botet J, Pintó X, Valdivielso P. Indications of PCSK9 inhibitors in clinical practice. Recommendations of the Spanish Sociey of Arteriosclerosis (SEA), 2019. Clin Investig Arterioscler 2019; 31:128-139. [PMID: 31130361 DOI: 10.1016/j.arteri.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Abstract
A group of experts convened by the Spanish Society of Arteriosclerosis (SEA) has been in charge of updating the SEA document on the indications of PCSK9 inhibitors (PCSK9i) in clinical practice that was published in 2016. This update is justified by the fact that the data from clinical trials carried out on a large scale with PCSK9i have shown that in addition to their high potency to lower atherogenic cholesterol, they reduce the risk of atherosclerotic cardiovascular disease, both in patients with stable disease, and with recent disease, and with a high degree of security. This update provides the recommendations and level of evidence for the prescription of iPCSK9 in patients with homozygous and heterozygous familial hypercholesterolemia, with atherosclerotic cardiovascular disease, and in primary prevention in patients with very high cardiovascular risk. These recommendations have been established taking into account the concentration of LDL-C, the clinical situation of the patient, the additional risk factors and the cost-effectiveness of their use.
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Affiliation(s)
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Guijarro
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - José López Miranda
- Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBEROBN, Córdoba, España
| | - Luis Masana
- Hospital Universitario de Reus, Universidad Rovira y Virgili, IISPV, CIBERDEM, Reus, Tarragona, España
| | | | - Juan Pedro-Botet
- Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Hospital Universitario de Bellvitge-Idibell, Universidad de Barcelona, CIBEROBN, Hospitalet de Llobregat, Barcelona, España.
| | - Pedro Valdivielso
- Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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42
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Catalina-Romero C, Sanchez Chaparro MA, Valdivielso P, Quevedo-Aguado L, Brotons C, Ruilope LM, Calvo-Bonacho E. Estimating the impact of obesity and metabolic phenotype on sickness absence. Results from the ICARIA study. Nutr Metab Cardiovasc Dis 2019; 29:383-389. [PMID: 30803866 DOI: 10.1016/j.numecd.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/05/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS To assess the impact of obesity and being overweight on sickness absence (SA) as a function of healthy/unhealthy metabolic phenotype. METHODS AND RESULTS A total of 173 120 healthy workers who underwent a routine check-up, consisting of a structured interview, anthropometric measurements and blood pressure and fasting blood analysis, were included as the study sample (67.1% males; 49.2% manual workers; mean age 40.6 ± 21.9 years). Workers were classified according to their body mass index (BMI) and metabolic phenotype. A metabolically unhealthy phenotype was defined as the presence of three or more of the following criteria: glycaemia ≥110 mg/dL or previously diagnosed type I/II diabetes or treatment for diabetes; triglycerides ≥150 mg/dL or lipid-lowering therapy; HDL <40/50 mg/dL M/F; blood pressure ≥130/85 mmHg or previously diagnosed hypertension or antihypertensive therapy; waist circumference >102/88 cm M/F. A one-year follow-up was conducted to evaluate the incidence of work-related and non-work-related SA (WRSA/NWRSA). The association of BMI with SA was tested using Poisson regression (standard error correction), segmenting on the basis of metabolic phenotype. The overall percentages of workers who were overweight, obese and/or had a metabolically unhealthy phenotype were 37.7%, 16.3% and 8.8%, respectively. BMI was associated with increased incidence of NWRSA in both phenotypes. It was also associated with WRSA in subjects with a BMI in the range of 35-39.99 kg/m2 and in metabolically healthy individuals. WRSA was lower in subjects with a BMI ≥40 kg/m2 and among metabolically unhealthy individuals. CONCLUSION Obesity is associated with health problems that have a significant impact on SA.
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Affiliation(s)
- C Catalina-Romero
- Ibermutuamur (Mutua colaboradora con la Seguridad Social 274), Madrid, Spain.
| | - M A Sanchez Chaparro
- Department of Internal Medicine, University Hospital "Virgen de la Victoria", and University of Malaga, Malaga, Spain
| | - P Valdivielso
- Department of Internal Medicine, University Hospital "Virgen de la Victoria", and University of Malaga, Malaga, Spain
| | - L Quevedo-Aguado
- Ibermutuamur (Mutua colaboradora con la Seguridad Social 274), Madrid, Spain
| | - C Brotons
- Research Unit, Sardenya Primary Health Care Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - L M Ruilope
- Research Institute Hospital 12 de Octubre, Madrid, Spain
| | - E Calvo-Bonacho
- Ibermutuamur (Mutua colaboradora con la Seguridad Social 274), Madrid, Spain
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43
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Omarjee L, Fortrat JO, Larralde A, Pabic EL, Kauffenstein G, Laot M, Navasiolava N, Mention PJ, Carrillo Linares JL, Valdivielso P, Vanakker OM, Mahé G, Martin L, Lefthériotis G. Internal Carotid Artery Hypoplasia: A New Clinical Feature in Pseudoxanthoma Elasticum. J Stroke 2019; 21:108-111. [PMID: 30732446 PMCID: PMC6372903 DOI: 10.5853/jos.2018.02705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/01/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Loukman Omarjee
- Vascular Medicine Department, INSERM CIC1414, Rennes, France.,PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | | | - Antoine Larralde
- Radiology and Medical Imaging Department, Rennes University Hospital, Rennes, France
| | - Estelle Le Pabic
- Department of Biostatistics and Methodology, Rennes University Hospital, Rennes, France
| | - Gilles Kauffenstein
- PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | - Maxence Laot
- Radiology and Medical Imaging Department, Rennes University Hospital, Rennes, France
| | - Nastassia Navasiolava
- PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | | | - Juan Luis Carrillo Linares
- Internal Medicine Unit, Hospital Virgen de la Victoria and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Virgen de la Victoria and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain
| | | | - Guillaume Mahé
- Vascular Medicine Department, INSERM CIC1414, Rennes, France
| | - Ludovic Martin
- PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | - Georges Lefthériotis
- PXE Reference Center, University Hospital of Angers, Angers, France.,Department of Physiology and Vascular Investigations, University Hospital, Nice, France
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44
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Bäck M, Aranyi T, Cancela ML, Carracedo M, Conceição N, Leftheriotis G, Macrae V, Martin L, Nitschke Y, Pasch A, Quaglino D, Rutsch F, Shanahan C, Sorribas V, Szeri F, Valdivielso P, Vanakker O, Kempf H. Endogenous Calcification Inhibitors in the Prevention of Vascular Calcification: A Consensus Statement From the COST Action EuroSoftCalcNet. Front Cardiovasc Med 2019; 5:196. [PMID: 30713844 PMCID: PMC6345677 DOI: 10.3389/fcvm.2018.00196] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/19/2018] [Indexed: 01/29/2023] Open
Abstract
The physicochemical deposition of calcium-phosphate in the arterial wall is prevented by calcification inhibitors. Studies in cohorts of patients with rare genetic diseases have shed light on the consequences of loss-of-function mutations for different calcification inhibitors, and genetic targeting of these pathways in mice have generated a clearer picture on the mechanisms involved. For example, generalized arterial calcification of infancy (GACI) is caused by mutations in the enzyme ecto-nucleotide pyrophosphatase/phosphodiesterase-1 (eNPP1), preventing the hydrolysis of ATP into pyrophosphate (PPi). The importance of PPi for inhibiting arterial calcification has been reinforced by the protective effects of PPi in various mouse models displaying ectopic calcifications. Besides PPi, Matrix Gla Protein (MGP) has been shown to be another potent calcification inhibitor as Keutel patients carrying a mutation in the encoding gene or Mgp-deficient mice develop spontaneous calcification of the arterial media. Whereas PPi and MGP represent locally produced calcification inhibitors, also systemic factors contribute to protection against arterial calcification. One such example is Fetuin-A, which is mainly produced in the liver and which forms calciprotein particles (CPPs), inhibiting growth of calcium-phosphate crystals in the blood and thereby preventing their soft tissue deposition. Other calcification inhibitors with potential importance for arterial calcification include osteoprotegerin, osteopontin, and klotho. The aim of the present review is to outline the latest insights into how different calcification inhibitors prevent arterial calcification both under physiological conditions and in the case of disturbed calcium-phosphate balance, and to provide a consensus statement on their potential therapeutic role for arterial calcification.
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Affiliation(s)
- Magnus Bäck
- Translational Cardiology, Center for Molecular Medicine, Karolinska University Hospital Stockholmt, Stockholm, Sweden
| | - Tamas Aranyi
- Research Center for Natural Sciences, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary
| | - M Leonor Cancela
- Department of Biomedical Sciences and Medicine, Algarve Biomedical Centre, Centre of Marine Sciences/CCMAR, University of Algarve, Faro, Portugal
| | - Miguel Carracedo
- Translational Cardiology, Center for Molecular Medicine, Karolinska University Hospital Stockholmt, Stockholm, Sweden
| | - Natércia Conceição
- Department of Biomedical Sciences and Medicine, Algarve Biomedical Centre, Centre of Marine Sciences/CCMAR, University of Algarve, Faro, Portugal
| | - Georges Leftheriotis
- LP2M, University of Nice-Sophia Antipolis and Vascular Physiology and Medicine, University Hospital of Nice, Nice, France
| | - Vicky Macrae
- The Roslin Institute and Royal School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Ludovic Martin
- PXE Reference Center, Angers University Hospital, Angers, France
| | - Yvonne Nitschke
- Department of General Pediatrics, Münster University Children's Hospital, Münster, Germany
| | | | - Daniela Quaglino
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Frank Rutsch
- Department of General Pediatrics, Münster University Children's Hospital, Münster, Germany
| | - Catherine Shanahan
- British Heart Foundation Centre of Research Excellence, James Black Centre, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Victor Sorribas
- Laboratory of Molecular Toxicology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
| | - Flora Szeri
- Research Center for Natural Sciences, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pedro Valdivielso
- Internal Medicine, Instituto de Investigación Biomédica (IBIMA), Virgen de la Victoria University Hospital, Universidad de Málaga, Málaga, Spain
| | - Olivier Vanakker
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Hervé Kempf
- UMR 7365 CNRS-Université de Lorraine, IMoPA, Vandoeuvre-lès-Nancy, France
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45
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Gutiérrez-Cardo A, Pérez Duarte A, García-Argüello S, López Lorenzo B, Lillo García M, Valdivielso P. Assessment of 68Ga-PSMA-11 PET positivity predictive factors in prostate cancer. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Sánchez-Chaparro MÁ, Pérez-Martínez P, Ibarretxe D, Suárez-Tembra M, Valdivielso P. Criteria for referring patients to Spanish Atherosclerosis Society lipid units. Clin Investig Arterioscler 2019; 31:26-30. [PMID: 30257791 DOI: 10.1016/j.arteri.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
Abstract
The Spanish Arteriosclerosis Society has accredited more than 70 lipid units across the country. The main criteria for patients to be referred to these units are presented. These are not only grouped by the type of dyslipidaemia or the lipid levels, but also on certain clinical characteristics suggesting primary hyperlipidaemia, a complex diagnosis, or difficult management due to inefficacy, or side effects.
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Affiliation(s)
- Miguel Ángel Sánchez-Chaparro
- Unidad de Lípidos, Departamento de Medicina y Dermatología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | - Pablo Pérez-Martínez
- Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, España
| | - Diana Ibarretxe
- Unidad de Metabolismo y Medicina Vascular, Unidad de Investigación en Lípidos y Arteriosclerosis, Hospital Universitario Sant Joan, Universidad Rovira i Virgili, Reus, Tarragona, España; Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | | | - Pedro Valdivielso
- Unidad de Lípidos, Departamento de Medicina y Dermatología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España.
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47
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Jiménez Villodres M, García Gutiérrez G, García Frías P, Rioja Villodres J, Martín Velázquez M, Sánchez Chaparro MÁ, Pérez López C, Valdivielso P. Fractional excretion of phosphorus and vascular calcification in stage 3 chronic kidney disease. J Investig Med 2018; 67:674-680. [DOI: 10.1136/jim-2018-000852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2018] [Indexed: 12/16/2022]
Abstract
The role of renal excretion of Pi in relation to vascular calcification (VC) in patients in the early stages of chronic kidney disease (CKD) is controversial. Thus, we determine the relation between fractional excretion of phosphorus (FEP) and VC, measured using two methods in a cross-sectional study of patients with stage 3 CKD. We recorded demographic data, anthropometry, comorbidities and active treatment. We measured 24-hour urine FEP and, in serum, measured fibroblast growth factor 23 (FGF23), α-Klotho, intact parathyroid hormone (iPTH), calcium and phosphorus. VC was measured by lateral abdominal radiography (Kauppila index (KI)) and CT of the abdominal aorta (measured in Agatston units). In 57% of subjects, abnormal VC was present when measured using CT, and in only 17% using lateral abdominal radiography. Factors associated with VC using CT were age, cardiovascular risk factors, vascular comorbidity, microalbuminuria and levels of FGF23, phosphorus and calcium x phosphorus product (CaxP); although only age (OR 1.25, 95% CI 1.11 to 1.41), smoking (OR 21.2, CI 4.4 to 100) and CaxP (OR 1.21, CI 1.06 to 1.37) maintained the association in a multivariate analysis. By contrast, only age (OR 1.35, 95% CI 1.07 to 1.74), CaxP (OR 1.14, CI 1.13 to 1.92) and FEP (OR 1.07,95% CI 1004 to 1.14) were associated with abnormal VC in the lateral abdominal radiography. In conclusion, in patients with stage 3 CKD, the detection of VC by abdominal CT is more sensitive than conventional X-rays. Moreover, CaxP is associated with cardiovascular risk factors and vascular comorbidity; quantification of FEPi in these patients provides additional clinical information in advanced VC detected by KI.
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48
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Ariza MJ, Rioja J, Ibarretxe D, Camacho A, Díaz-Díaz JL, Mangas A, Carbayo-Herencia JA, Ruiz-Ocaña P, Lamíquiz-Moneo I, Mosquera D, Sáenz P, Masana L, Muñiz-Grijalvo O, Pérez-Calahorra S, Valdivielso P, Suárez Tembra M, Iglesias GP, Carbayo Herencia J, Guerrero Buitrago C, Vila L, Morales Coca C, Llargués Rocabruna E, Perea Castillo V, Pedro-Botet J, Climent E, Mauri Pont M, Pinto X, Ortega Martínez de la Victoria E, Amor J, Zambón Rados D, Blanco Vaca F, Ramiro Lozano J, Fuentes Jiménez F, Soler I, Ferrer C, Zamora Cervantes A, Vila Belmonte A, Novoa Mogollón F, Sanchez-Hernández R, Expósito Montesdeoca A, Romero Jiménez M, González García M, Bueno Díez M, Brea Hernando A, Lahoz C, Mostaza Prieto J, Millán Núñez-Cortés J, Reinares García L, Blanco Echevarría A, Ariza Corbo MJ, Rioja Villodres J, Sánchez-Chaparro M, Jansen Chaparro S, Sáenz Aranzubía P, Martorell Mateu E, Almagro Múgica F, Muñiz Grijalvo O, Masana Martín L, Plana Gil N, Ibarretxe Gerediaga D, Rodríguez Borjabad C, Zabala López S, Hernández Mijares A, Ascaso Gimilio J, Pérez García L, Civeira Murillo F, Pérez-Calahorra S, Lamiquiz-Moneo I, Mateo Gallego R, Marco Benedí V, Ferrando Vela J. Molecular basis of the familial chylomicronemia syndrome in patients from the National Dyslipidemia Registry of the Spanish Atherosclerosis Society. J Clin Lipidol 2018; 12:1482-1492.e3. [DOI: 10.1016/j.jacl.2018.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/09/2018] [Accepted: 07/24/2018] [Indexed: 01/16/2023]
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49
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Pérez-Jiménez F, Pascual V, Meco JF, Pérez Martínez P, Delgado Lista J, Domenech M, Estruch R, León-Acuña A, López-Miranda J, Sánchez-Ramos A, Soler I Ferrer C, Soler-Rivas C, Solá Alberich RM, Valdivielso P, Ros E. Document of recommendations of the SEA 2018. Lifestyle in cardiovascular prevention. Clin Investig Arterioscler 2018; 30:280-310. [PMID: 30236615 DOI: 10.1016/j.arteri.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 02/05/2023]
Abstract
Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases.
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Affiliation(s)
- Francisco Pérez-Jiménez
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España.
| | - Vicente Pascual
- Centro de Salud Palleter, Universidad CEU-Cardenal Herrera, Castellón, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - José Félix Meco
- Medicina Interna, Advance Medical, Barcelona, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - Pablo Pérez Martínez
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - Javier Delgado Lista
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - Monica Domenech
- Grupo de Riesgo Cardiovascular, Nutrición y Envejecimiento del Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Servicio de Medicina Interna, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Departamento de Medicina Interna, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, España
| | - Ana León-Acuña
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - José López-Miranda
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), UGC de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - Andrea Sánchez-Ramos
- Unidad de Lípidos, Instituto de Investigación Biomédica de Málaga (IBIMA), UGC de Medicina Interna, Hospital Virgen de la Victoria, Málaga, España
| | - Cristina Soler I Ferrer
- Unidad de Lípidos y Arteriosclerosis, Medicina Interna, Hospital de Santa Caterina, Salt, Girona, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - Cristina Soler-Rivas
- Departamento de Producción y Caracterización de Nuevos Alimentos. CIAL -Instituto de Investigación en Ciencias de la Alimentación (UAM +CSIC), Universidad Autónoma de Madrid, Madrid, España
| | - Rosa Maria Solá Alberich
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Hospital Universitario Sant Joan, EURECAT-Technological Center of Nutrition and Health (CTNS), Facultad de Medicina y Ciencias de la Salud, Universidad Rovira i Virgili, Reus, Tarragona, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España
| | - Pedro Valdivielso
- Unidad de Lípidos, Instituto de Investigación Biomédica de Málaga (IBIMA), UGC de Medicina Interna, Hospital Virgen de la Victoria, Málaga, España
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Departamento de Medicina Interna, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, España; Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España; Grupo de Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA), España.
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Ruilope LM, Catalina-Romero C, Sanchez-Chaparro MA, Valdivielso P, Quevedo-Aguado L, Moral I, Brotons C, Calvo-Bonacho E. P5414Dietary habits and sick leave. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L M Ruilope
- University Hospital 12 de Octubre, Hypertension Unit, Madrid, Spain
| | | | | | | | | | - I Moral
- Sardenya Primary Health Care Centre-Biomedical Research Institute Sant Pau, Research Unit, Barcelona, Spain
| | - C Brotons
- Sardenya Primary Health Care Centre-Biomedical Research Institute Sant Pau, Research Unit, Barcelona, Spain
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