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Rey-Brandariz J, Guerra-Tort C, López-Medina DC, García G, Teijeiro A, Casal-Fernández R, Candal-Pedreira C, Varela-Lema L, Ruano-Ravina A, Pérez-Ríos M. Mortality attributable to secondhand smoke exposure in the autonomous communities of Spain. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00127-0. [PMID: 38609041 DOI: 10.1016/j.rec.2024.02.019] [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: 12/05/2023] [Accepted: 02/22/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION AND OBJECTIVES Exposure to secondhand smoke (SHS) causes cardiovascular disease, respiratory disease, and cancer. The aim of this study was to estimate the mortality attributed to SHS in people aged ≥ 35 years in Spain and its autonomous communities (AC) by sex from 2016 to 2021. METHODS Estimates of SHS-attributable mortality were calculated by applying the prevalence-dependent method where SHS exposure was derived from the adjustment of small-area models and based on the calculation of population-attributed fractions. Sex, age group, AC, and cause of death (ischemic heart disease and lung cancer) were included. The estimates of attributed mortality are presented with their 95% confidence interval (95%CI). Crude and age-standardized rates were estimated for each sex and AC. RESULTS From 2016 to 2021, SHS exposure caused 4,970 (95%CI, 4,787-5,387) deaths, representing 1.6% of total mortality for ischemic heart disease and lung cancer. The burden of attributed mortality differed widely among the AC, with Andalusia having the highest burden of attributed mortality (crude rate: 46.6 deaths per 100 000 population in men and 17.0/100 000 in women). In all the AC, the main cause of death in both sexes was ischemic heart disease. The highest burden of mortality was observed in nonsmokers. CONCLUSIONS The burden of SHS-attributable mortality was high and varied geographically. The results of this study should be considered to advance tobacco control legislation in Spain.
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Affiliation(s)
- Julia Rey-Brandariz
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carla Guerra-Tort
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Diana Carolina López-Medina
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Facultad de Medicina, Universidad Cooperativa de Colombia, Colombia; Fundación Carolina, Madrid, Spain. https://twitter.com/@JuliaReyB
| | - Guadalupe García
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. https://twitter.com/@guadagarcia23
| | - Ana Teijeiro
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. https://twitter.com/@cristinacandal
| | - Raquel Casal-Fernández
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Cristina Candal-Pedreira
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Leonor Varela-Lema
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Alberto Ruano-Ravina
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Mónica Pérez-Ríos
- Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
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Velázquez-Sotelo CE, Fernández-Gómez MJ, Cázares-Pérez A, Covarrubias-Gil A, Carranza-Rosales P, Carranza-Torres IE, Morán-Martínez J, Guzmán-Delgado NE. Frank's sign associated with the severity of ischemic heart disease in patients under 65 years old. Med Clin (Barc) 2023; 161:509-514. [PMID: 37517929 DOI: 10.1016/j.medcli.2023.07.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Frank's sign is the diagonal ear fold which has been associated with ischemic heart disease. The objective of this work was to evaluate the relationship of Frank's sign with severity of ischemic heart disease in adults ≤ 65 years old in the northeast of Mexico. PATIENTS AND METHODS A cross-sectional study was conducted in patients ≤ 65 years old who underwent coronary angiography consecutively over a period of 5 months in 2022. Severe coronary artery disease (CAD) was associated with Frank's sign and other common cardiovascular risks. To determine the association, bivariate and multivariate analysis was performed using logistic regression that included variables with a value of p<0.05. Statistical analysis was performed with SPSS version 22. RESULTS We included 311 patients ≤ 65 years, of whom 80% were men. The median age was 57 years (range 28-65). Frank's sign was positive in 62% of the population. The main clinical characteristics in patients with Frank's sign were type 2 diabetes mellitus (55%), p=0.003, dyslipidemia (53%), p=0.026 and smoking (68%), p=0.002. In the multivariate analysis, the independent variables associated with severe CAD were Frank's Sign OR 3.26; 95% CI (1.98-5.38), p≤0.001, male gender OR 2.28; 95% CI (1.20-4.35), p=0.012, and dyslipidemia OR 1.81; 95% CI (1.11-2.97), p=0.017. CONCLUSIONS There is an independent association between Frank's sign with the presence of severe CAD in patients ≤ 65 years old, which may be useful for screening and prevention.
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Affiliation(s)
- Claudia Elizabeth Velázquez-Sotelo
- Departamento de Cardiología de la Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Especialidad Médica de Posgrado, Universidad de Monterrey, San Pedro Garza, García, Nuevo León, Mexico
| | - María José Fernández-Gómez
- División de Investigación en Salud de la Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - Annet Cázares-Pérez
- Departamento de Cirugía Cardiotorácica de la Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Especialidad Médica de Posgrado, Universidad de Monterrey, San Pedro Garza, García, Nuevo León, Mexico
| | - Antonio Covarrubias-Gil
- Departamento de Cardiología de la Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - Pilar Carranza-Rosales
- Centro de Investigación Biomédica del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - Irma Edith Carranza-Torres
- Centro de Investigación Biomédica del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - Javier Morán-Martínez
- Facultad de Medicina, Universidad Autónoma de Coahuila, Unidad Torreón, Coahuila, Mexico
| | - Nancy Elena Guzmán-Delgado
- División de Investigación en Salud de la Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Especialidad Médica de Posgrado, Universidad de Monterrey, San Pedro Garza, García, Nuevo León, Mexico.
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Milà López M, Jiménez Heffernan A, Sánchez de Mora E, Fierro Alanis MP. Nuclear Cardiology in the COVID-19 pandemic. Rev Esp Med Nucl Imagen Mol 2023; 42:106-112. [PMID: 36681148 PMCID: PMC9847316 DOI: 10.1016/j.remnie.2023.01.002] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias…, during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease. The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocols.
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Affiliation(s)
- Marta Milà López
- Servicio de Medicina Nuclear IDI, Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain.
| | | | - Elena Sánchez de Mora
- Servicio de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
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Roldán-Gómez FJ, Soriano E, Rodríguez-Echevarría G, Lacy-Niebla MDC, López-Alvis F, González-Oscoy R, Rivera-Román LS, Rivera-Gutiérrez F, Arauz A. Impact of the Mexican education system and age on basic knowledge about ischemic heart disease in the pre-COVID-19 era. Arch Cardiol Mex 2023; 93:102-107. [PMID: 38537219 DOI: 10.24875/acm.22000238] [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: 10/12/2022] [Accepted: 12/05/2022] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVE To assess general population's knowledge about ischemic heart disease (IHD) and its relationship to years of schooling in Mexico. METHOD Analysis of surveys designed to measure knowledge about IHD applied in Mexico City. RESULTS 530 surveys were analyzed. 51.7% were women. The median age was 43 years (IQR: 15-92) and the median of schooling was 18 years (IQR: 15-18). 64.5% of respondents scored less than 50% of correct answers. A slight increase in the knowledge level and years of study (p < 0.001) and age (p = 0.101) was observed, but with low correlation indexes (r = 0.215 and r = 0.071, respectively). CONCLUSIONS Knowledge about IHD in general population is deficient and doesn't increase adequately neither with age nor academic studies. It is necessary to review our health education strategies.
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Affiliation(s)
- Francisco J. Roldán-Gómez
- Departamento de Consulta Externa, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Eduardo Soriano
- Dirección General, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | | | - Ma. del Carmen Lacy-Niebla
- Departamento de Consulta Externa, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Fernando López-Alvis
- Dirección General, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Rodrigo González-Oscoy
- Dirección General, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Luis S. Rivera-Román
- Departamento de Consulta Externa, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Frida Rivera-Gutiérrez
- Departamento de Consulta Externa, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Antonio Arauz
- Dirección General, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
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Aceña Á, Pello-Lázaro AM, Martínez-Milla J, González-Lorenzo Ó, Tarín N, Cristóbal C, Blanco-Colio LM, Martín-Ventura JL, Huelmos A, López-Castillo M, Alonso J, Gutiérrez-Landaluce C, López Bescós L, Alonso-Pulpón L, González-Parra E, Egido J, Mahíllo-Fernández I, Lorenzo Ó, González-Casaus ML, Tuñón J. Impact of renal function on the prognostic value of mineral metabolism in patients with chronic ischaemic heart disease patients with chronic ischaemic heart disease. Clin Investig Arterioscler 2022; 34:1-9. [PMID: 34876305 DOI: 10.1016/j.arteri.2021.09.003] [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: 06/18/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Parathormone (PTH) is a component of the Mineral Metabolism (MM) system that has been shown recently to add prognostic value in pts. with stable coronary artery disease (SCAD) and average renal function. However, the influence of renal function on the prognostic role of PTH in pts. with SCAD has not been shown yet. PURPOSE To assess the influence of estimated glomerular filtration rate (eGFR) on the prognostic role of PTH and other MM markers in pts. with SCAD. METHODS We analyzed the prognostic value of MM markers (PTH, klotho, phosphate, calcidiol [25-hydroxyvitamin D], and fibroblast growth factor-23 [FGF23]) in 964 pts. with SCAD and eGFR<60ml/min/1.73 m2 (LGFR) vs pts. with eGFR≥60ml/min/1.73 m2 (HGFR) included in five hospitals of Madrid. The main outcome was the combination of death with ischemic events (any acute coronary syndrome, ischemic stroke or transient ischemic attack). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). RESULTS Age was 60.0 (52.0-72.0) years, 76.2% of patients were men, and eGFR was 80.4 (65.3-93.1) ml/min/1,73 m2. Median follow-up was 5.39 (2.81-6.92) years. There were 790 pts. with HGFR and 174 with LGFR. In HGFR pts., predictors of ischemic events or death were plasma levels of calcidiol [HR=0.023 (0.94-0.99) p=0.023], FGF23 [HR=1.00 (1.00-1.003) p=0.036], non-HDL cholesterol [HR=1.01 (1.00-1.01) p=0.026] and high sensitivity troponin I [HR=5.12 (1.67-15.59) p=0.004], along with age [HR=1.03 (1.01-1.05) p=0.01], treatment with statins [HR=0.36 (0.19-0.68) p=0.002], nitrates [HR=1.13 (1.07-2.79) p=0.027], dihydropyridines [HR=1.71 (1.05-2.77) p=0.032], verapamil [HR=5.71 (1.35-24.1) p=0.018], and proton-pump inhibitors [HR=2.23 (1.36-3.68) p= 0.002]. In the LGFR subgroup, predictors of death or ischemic events were PTH plasma levels, [HR=1.01 (1.00-1.01) p=0.005], eGFR [HR=0.96 (0.94-0.99) p=0.004], age [HR=1.06 (1.02-1.10) p=0.003], caucasian race [HR=0.04 (0.004-0.380) p=0.005], and treatment with insulin [HR=2.6 (1.20-5.63) p=0.015]. CONCLUSIONS In pts. with SCAD, PTH is an independent predictor of poor outcomes only in those with eGFR<60ml/min/1.73 m2, while in pts. with eGFR≥60ml/min/1.73 m2 calcidiol and FGF23 become the only components of MM that may predict prognosis. Then, renal function influences the predictive power of MM markers in pts. with SCAD.
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Affiliation(s)
- Álvaro Aceña
- Departamento de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España; Universidad Autónoma de Madrid, Madrid, España
| | | | | | | | - Nieves Tarín
- Departamento de Cardiología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - Carmen Cristóbal
- Departamento de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España; Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Luis M Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERCV, Madrid, España
| | - José Luis Martín-Ventura
- Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERCV, Madrid, España
| | - Ana Huelmos
- Departamento de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Joaquín Alonso
- Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Departamento de Cardiología, Hospital de Getafe, Getafe, Madrid, España
| | | | | | - Luis Alonso-Pulpón
- Universidad Autónoma de Madrid, Madrid, España; Departamento de Cardiología, Hospital Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Emilio González-Parra
- Universidad Autónoma de Madrid, Madrid, España; Departamento de Nefrología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Jesús Egido
- Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; Departamento de Nefrología, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERDEM, Madrid, España
| | | | - Óscar Lorenzo
- Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERDEM, Madrid, España
| | | | - José Tuñón
- Departamento de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España; Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERCV, Madrid, España.
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Flores-Ríos X, Calviño-Santos RA, Estévez-Loureiro R, Peteiro-Vázquez J, Salgado-Fernández J, Rodríguez-Vilela A, Franco-Gutiérrez R, Bouzas-Mosquera A, Rodríguez-Fernández JÁ, Marzoa-Rivas R, González-Juanatey C, Aldama-López G, Piñón-Esteban P, Vázquez-González N, Muñiz-García J, Vázquez-Rodríguez JM. Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the STEACS with multivessel disease. Rev Esp Cardiol (Engl Ed) 2021; 74:1054-1061. [PMID: 33257214 DOI: 10.1016/j.rec.2020.09.028] [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: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial. METHODS We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography-guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N=306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system. RESULTS The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9±6236.8 € vs 14 038.7±4958.5 €; P <.001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5±4568.0 vs SelR 2653.9±5709.1; P=.697). Total cost was 22 081.3±7505.6 for the ComR arm and 16 692.6±7669.9 for the SelR group (P <.001). CONCLUSIONS In the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty. Study registred at ClinicalTrial.gov (Identifier: NCT01179126).
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Affiliation(s)
- Xacobe Flores-Ríos
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Ramón A Calviño-Santos
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rodrigo Estévez-Loureiro
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Jesús Peteiro-Vázquez
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jorge Salgado-Fernández
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alejandro Rodríguez-Vilela
- Servicio de Cardiología, Complexo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | | | - Alberto Bouzas-Mosquera
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Ángel Rodríguez-Fernández
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Raquel Marzoa-Rivas
- Servicio de Cardiología, Complexo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | | | - Guillermo Aldama-López
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Pablo Piñón-Esteban
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Nicolás Vázquez-González
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Javier Muñiz-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | - José Manuel Vázquez-Rodríguez
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Fernández-Bergés D, Buitrago Jiménez F, Palomo Cobos L, Lozano Mera L, González-Fernández MR, Rubini A, Ramírez Moreno JM, Robles Pérez-Monteoliva NR, Félix-Redondo FJ. [Incidence of ischemic heart disease in the HERMEX study and its association with classical cardiovascular risk factors]. Semergen 2021:S1138-3593(21)00271-9. [PMID: 34702607 DOI: 10.1016/j.semerg.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Knowledge about the incidence of coronary heart disease in our country is scarce and its sources are not comparable. Our aim was to determine the incidence of ischemic heart disease in a population cohort in a 7 years of follow-up, as well as the risk associated with the different classical cardiovascular risk factors. METHODS Cohort study with a population sample of 2833 subjects, selected by the simple random method in a population between 25 and 79, from the Don Benito - Villanueva de la Serena (Badajoz) health area, response rate was 80.5%. All episodes of angina pectoris, lethal and non-lethal myocardial infarction were collected in individuals with no previous history of cardiovascular disease. Cumulative incidences and incidence rates adjusted per 100,000 person-years by sex and overall were calculated. RESULTS From 2833 initial cohort participants, 103 were excluded due to a history of cardiovascular disease and 61 for losses, 2669 completed the follow-up (94.2%). The median follow-up was 6.9 years (IR 6.5-7.5), 56.4% women; 59 events were recorded. The overall incidence rate of ischemic heart disease was 327 cases/100,000 person-years, corresponding to 470 cases/100,000 for men and 211 cases/100,000 people-years for women. The classical cardiovascular risk factors that were associated with a higher risk of presenting events in the follow-up were dyslipidemia and arterial hypertension, in addition to male sex and age. CONCLUSIONS The incidence of ischemic heart disease in the urban-rural population of Extremadura is high. The classical cardiovascular risk factors most strongly associated with events were dyslipidemia, and arterial hypertension.
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8
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Viscasillas M, Lamíquiz-Moneo I, Pérez-Ruiz MR, Garcia-Fenoll R, Jarauta E. Clinical characteristics of premature cardiovascular disease in our health area. Rev Clin Esp 2021; 222:348-353. [PMID: 34154974 DOI: 10.1016/j.rceng.2020.12.009] [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: 06/08/2020] [Accepted: 12/29/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease continues to be the main cause of mortality, but few data are available in the young population. The aim of our study was to know the incidence and clinical characteristics of premature cardiovascular disease in our health area. METHODS Cross-sectional study of patients admitted for acute episode of premature cardiovascular disease in a referral hospital during 2018. RESULTS We detected 367 subjects: 306 (83.4%) with atherosclerotic cardiovascular disease. Almost half (164, 44.7%) were diabetic, with primary hypercholesterolaemia or high cardiovascular risk, and 84 (22.9%) had a personal history of cardiovascular disease. Among those with elevated risk or history (n = 207) only 47 subjects had LDL cholesterol at therapeutic target. CONCLUSIONS Most of the subjects with premature cardiovascular disease in our study had higher cardiovascular risk than attributable to their age. Intensive diagnosis and treatment of cardiovascular risk factors may prevent cardiovascular disease in young adults.
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Affiliation(s)
- M Viscasillas
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - I Lamíquiz-Moneo
- Unidad Clínica y de Investigación en Lípidos y Arteriosclerosis, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERCV, Zaragoza, Spain
| | - M R Pérez-Ruiz
- Unidad Clínica y de Investigación en Lípidos y Arteriosclerosis, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERCV, Zaragoza, Spain
| | - R Garcia-Fenoll
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E Jarauta
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain; Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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9
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Hervella MI, Carratalá-Munuera C, Orozco-Beltrán D, López-Pineda A, Bertomeu-González V, Gil-Guillén VF, Pascual R, Quesada JA. Trends in premature mortality due to ischemic heart disease in Spain from 1998 to 2018. ACTA ACUST UNITED AC 2021; 74:838-45. [PMID: 33402321 DOI: 10.1016/j.rec.2020.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 09/15/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ischemic heart disease (IHD) is the leading cause of death and one of the leading causes of disability. The aim of this study was to analyze trends in premature mortality due to IHD in patients younger than 75 years in Spain from 1998 to 2018 by region. METHODS Observational study of temporal trends in premature mortality due to IHD in Spain by region and sex from 1998 to 2018. The study population included resident citizens aged between 0 and 74 years. The data sources were the continuous population register and the mortality registry of the National Institute of Statistics. We calculated age-adjusted mortality rates and their average annual percent change estimated by Poisson models. RESULTS During the study period, mortality rates due to IHD decreased, both in the country as a whole and by provinces (53% in men and 61% in women), with an average annual percent change of -3.92% and -5.07%, respectively. In the first year (1998), mortality was unequally distributed among provinces, with higher mortality in the south of Spain. CONCLUSIONS Premature mortality due to IHD significantly decreased in Spain during the study period in both sexes to roughly half of initial cases. This decrease was statistically significant in almost all regions. Interprovincial differences in mortality and their variation also decreased in recent years.
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10
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Barrios V, Cosín-Sales J, Bravo M, Escobar C, Gámez JM, Huelmos A, Ortiz Cortés C, Egocheaga I, García-Pinilla JM, Jiménez-Candil J, López-de-Sá E, Torres Llergo J, Obaya JC, Pallares-Carratalá V, Sanmartín M, Vidal-Pérez R, Cequier Á. Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2020:S1885-5857(20)30363-7. [PMID: 32921586 DOI: 10.1016/j.rec.2020.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care.
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Bonanad Lozano C, Díez-Villanueva P, Blas SG, Ayesta A, Ibars S, Ariza-Solé A, Ferreiro JL, Moreno R, Roldán I, Marín F, Carol Ruiz A, García Pardo H, Sanchís J, Cruz-González I, Anguita M, Cequier Á, Ruiz García J, Martínez-Sellés M. [Impact of antithrombotic treatment and geriatric syndromes in octogenarians with atrial fibrillation and ischaemic heart disease. Atrial Fibrillation and Ischemic Heart Disease in the Elderly]. Rev Esp Geriatr Gerontol 2020; 55:338-342. [PMID: 32718577 DOI: 10.1016/j.regg.2020.05.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHC) increases with age. They coexist in up to 20% of octogenarian patients, a situation that poses a therapeutic challenge. Trials that have addressed this scenario, which included a low percentage of octogenarians, showed that double therapy (single antiplatelet + anticoagulation) compared to triple therapy (double antiplatelet + anticoagulation) was associated with less bleeding events, especially with direct oral anticoagulants. These studies did not have sufficient power to detect differences in ischaemic events. On the other hand, prevalent characteristics in the elderly, such as geriatric syndromes, were not assessed in these studies, and are not usually evaluated in clinical practice. Accordingly, their prognostic impact remains unknown in this clinical context. METHODS Observational, prospective, and multicentre study that will include patients ≥ 80 years with AF and IHC in Spain. Baseline characteristics and geriatric syndromes will be assessed, as well as the choice of antithrombotic treatment. The primary endpoint is cardiovascular and overall mortality at one and three years follow-up. RESULTS This study will assess both characteristics and prognosis of octogenarian patients with AF and IHC in Spain, the factors involved in the choice of antithrombotic treatment, and the incidence of ischaemic and haemorrhagic events during the short- and long-term follow-up. CONCLUSION This study will contribute to improve the knowledge in terms of safety and efficacy of the different therapeutic options in older patients with AF and IHC, as well as their prognostic impact.
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Affiliation(s)
| | | | - Sergio García Blas
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, España
| | - Ana Ayesta
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, España
| | - Sonia Ibars
- Servicio de Cardiología, Hospital Universitario Mutua Terrasa, Barcelona, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge (IDIBELL, CIBER-CV), L'Hospitalet de Llobregat, Barcelona, España
| | - José Luis Ferreiro
- Servicio de Cardiología, Hospital Universitario de Bellvitge (IDIBELL, CIBER-CV), L'Hospitalet de Llobregat, Barcelona, España
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz (IdiPaz-CIBER-CV), Madrid, España
| | - Inmaculada Roldán
- Servicio de Cardiología, Hospital Universitario La Paz (IdiPaz-CIBER-CV), Madrid, España
| | - Francisco Marín
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca, CIBERCV), Murcia, España
| | - Antoni Carol Ruiz
- Servicio de Cardiología, Hospital Sant Joan Despí Moisès Broggi, Barcelona, España
| | - Héctor García Pardo
- Servicio de Cardiología, Hospital Universitario Río Hortega, Valladolid, España
| | - Juan Sanchís
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, España
| | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge (IDIBELL, CIBER-CV), L'Hospitalet de Llobregat, Barcelona, España
| | - Juan Ruiz García
- Servicio de Cardiología, Hospital Universitario Torrejón, Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España
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12
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Pérez-Barreda A, Román-Fernández I, Peix-González A, Rodríguez-Navarro ÁY, Alfonso-Montero ÓA, Naranjo-Domínguez A. Estudio de la deformación miocárdica longitudinal en pacientes con cardiopatía isquémica. Arch Cardiol Mex 2020:1-9. [PMID: 32179879] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases are the leading cause of death in Cuba and most of the developed countries. -Two-dimensional speckle tracking echocardiography (2D ST) is a recent technique in the evaluation of cardiac function. OBJECTIVES To determine the relationship between myocardial deformation measured by 2D ST and coronary circulation in patients with ischemic heart disease, in the CIMEQ, for 1 year. MATERIAL AND METHOD An analytical, cross-sectional study was carried out with 55 patients with an indication for coronary angiography who underwent 2D echocardiography and 2D ST study with longitudinal strain measurement (LSM). Two groups significant coronary disease (SCD = 32) and not significant (NSCD = 23) were created. SSPS was used to analyze the results. RESULTS The average age was higher in SCD (55.6 ± 9.3 vs. 61.8 ± 8.8, p = 0.014). Men with SCD (47.3%), hypertensive (SCD = 90.6% and NSCD = 65.2%, p = 0.02) and smokers (SCD = 59.4% and NSCD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease (75%) prevailed in SCD. The LMS was lower in SCD ([-20.0 ± 3.2 vs. -22.1 ± 3.6, p = 0.035]; AUC = 0.458). There were no differences in LSM according to the number of significantly diseased vessels. CONCLUSIONS The results found do not justify the use of 2D ST to discriminate SCD.
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Affiliation(s)
- Aylen Pérez-Barreda
- Instituto Cubano de Cardiología y Cirugía Cardiovascular, Unidad de Imagen Cardiovascular. La Habana, Cuba
| | - Idalys Román-Fernández
- Centro de Investigaciones Médico Quirúrgicas, Unidad de Imagen Cardiovascular. La Habana, Cuba
| | - Amalia Peix-González
- Instituto Cubano de Cardiología y Cirugía Cardiovascular, Unidad de Imagen Cardiovascular. La Habana, Cuba
| | | | - Óscar A Alfonso-Montero
- Centro de Investigaciones Médico Quirúrgicas, Unidad de Imagen Cardiovascular. La Habana, Cuba
| | - Adrián Naranjo-Domínguez
- Instituto Cubano de Cardiología y Cirugía Cardiovascular, Unidad de Imagen Cardiovascular. La Habana, Cuba
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Ibarra-Torres A, Cabrera-Leal C, López-Medina G, Soto ME, Vallejo E, Rodríguez-Galván A, Álvarez-Contreras L. Giant aneurysm of the right coronary artery, report of a case and review of the literature. Arch Cardiol Mex 2020; 90:102-105. [PMID: 31967588 DOI: 10.24875/acme.m19000055] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus toward its management in adult patients. The options are medical, surgical, or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with a history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.
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Affiliation(s)
| | | | | | - María E Soto
- Cardiovascular Intensive Care, Centro Médico ABC, Mexico City, Mexico
| | - Enrique Vallejo
- Cardiovascular Imaging, Centro Médico ABC, Mexico City, Mexico
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14
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Escobar C, Anguita M, Arrarte V, Barrios V, Cequier Á, Cosín-Sales J, Egocheaga I, López de Sa E, Masana L, Pallarés V, Pérez de Isla L, Pintó X. Recommendations to improve lipid control. Consensus document of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2019; 73:161-167. [PMID: 31818706 DOI: 10.1016/j.rec.2019.08.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/08/2019] [Indexed: 12/29/2022]
Abstract
T***he current control of low-density lipoprotein cholesterol among patients with atherosclerotic cardiovascular disease is very low and this is associated with an increase of cardiovascular outcomes. In addition, the latter this happens, the risk will be greater. This is mainly due to an insufficient use of the lipid-lowering therapy currently available. In fact, with current treatments (statins, ezetimibe and PCSK9 inhibitors), the majority of patients in secondary prevention should achieve low-density lipoprotein cholesterol goals. For these reasons, in this manuscript promoted by the Spanish Society of Cardiology we propose three simple and feasible decision-making algorithms that include the majority of clinical scenarios among patients with ischemic heart disease, with the double aim of attaining therapeutic goals in the majority of patients as soon as possible; in secondary prevention the magnitude of the benefit is risk- and time-dependent.
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Affiliation(s)
- Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Vicente Arrarte
- Servicio de Cardiología, Hospital General Universitario, Alicante, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | | | | | - Luis Masana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Reus, Tarragona, Spain
| | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, Spain
| | | | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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15
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Brea A, Hernández-Mijares A, Millán J, Ascaso JF, Blasco M, Díaz A, Mantilla T, Pedro-Botet JC, Pintó X. Non-HDL cholesterol as a therapeutic goal. Clin Investig Arterioscler 2019; 31 Suppl 2:28-33. [PMID: 31806265 DOI: 10.1016/j.arteri.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/04/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 01/08/2023]
Abstract
Although cholesterol linked to low-density lipoproteins (c-LDL) is well established as a risk factor for cardiovascular disease, there is often a more complex dyslipidaemia pattern that contributes to the formation of atherosclerotic plaque. Non-HDL cholesterol (c-NO-HDL) is used to estimate the total amount of atherogenic lipoproteins in plasma, some of which are not usually determined in daily clinical practice. c-NO-HDL is easily calculated from the subtraction of total plasma cholesterol from the cholesterol content carried by high density lipoproteins. The c-NO-HDL has a predictive value superior to that of C-LDL to estimate the risk of major cardiovascular events in epidemiological studies. Genetic studies by analysis of the complete genome, together with those based on Mendelian randomisation, point to the aetiological character of c-NO-HDL on ischaemic heart disease (IHD). Intervention studies, and the meta-analyses derived from them, close the causal circle between c-NO-HDL and IHD, by demonstrating that any intervention that decreases the concentrations of the former reduces the incidence of arteriosclerotic heart disease. The European ESC/EAS 2016 guide for the management of dyslipidaemia considers c-NO-HDL as a therapeutic target with a Class IIa recommendation (should be performed) Level B (data from a single randomised clinical trial [RCT]) or from several non-RCTs), and sets its target at less than 100 or 130mg/dL for those patients with very high risk or high risk, respectively. These achievable c-NO-HDL values are easily calculated by adding 30mg/dL to the c-LDL targets.
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Affiliation(s)
- Angel Brea
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, La Rioja, España.
| | - Antonio Hernández-Mijares
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Servicio de Endocrinología, Hospital Universitario Dr. Peset, Universitat de Valencia, Valencia, España
| | - Jesús Millán
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
| | - Juan F Ascaso
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Servicio de Endocrinología, Hospital Clínico, Valencia, España
| | - Mariano Blasco
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Área Sanitaria de Delicias, Atención Primaria, Zaragoza, España
| | - Angel Díaz
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Centro de Salud de Bembibre, Bembibre, León, España
| | - Teresa Mantilla
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Centro de Salud de Prosperidad, Atención Primaria, Madrid, España
| | - Juan C Pedro-Botet
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Institut d'Investigació Biomèdica de Bellvitge (Idibell), Centre d'Investigació Biomèdica en Xarxa-Fisiopatologia de l'Obesitat i la Nutrició (CiberObn), L'Hospitalet de Llobregat, Barcelona, España
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Raposeiras Roubín S, Cordero A. The Two-way Relationship Between Cancer and Atherosclerosis. ACTA ACUST UNITED AC 2019; 72:487-494. [PMID: 31053376 DOI: 10.1016/j.rec.2018.12.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/14/2018] [Indexed: 01/10/2023]
Abstract
In the last few years, there has been growing interest in the relationship between cancer and cardiovascular disease. The increase in life expectancy in both diseases has led to their frequent coexistence in the same patient, which can lead to adverse drug reactions that increase patient risk. This is especially relevant in the case of atherosclerosis, which seems to share a common pathophysiological substrate with cancer. In this review, we analyze these common risk factors, and specifically analyze the relationship between different cancer treatments with the risk of coronary or cerebrovascular disease, as well as the current scientific evidence on the possible relationship between antiplatelet therapy and cancer risk. We also review the incidence and prognosis of cancer in patients with atherosclerosis and vice versa, based on the information reported in the most recently published studies in the field of cardio-oncology.
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Affiliation(s)
- Sergio Raposeiras Roubín
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain.
| | - Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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17
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Esteban-Fernández A, Bastarrika G, Castanon E, Coma-Canella I, Barba-Cosials J, Jiménez-Martín M, Alpendurada F, Gavira JJ, Azcárate-Agüero PM. Prognostic role of stress cardiac magnetic resonance in the elderly. ACTA ACUST UNITED AC 2019; 73:241-247. [PMID: 30930252 DOI: 10.1016/j.rec.2019.02.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly. METHODS We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models. RESULTS Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01). CONCLUSIONS Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.
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Affiliation(s)
| | - Gorka Bastarrika
- Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Eduardo Castanon
- Departamento de Oncología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Isabel Coma-Canella
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Joaquín Barba-Cosials
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marta Jiménez-Martín
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Francisco Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Juan José Gavira
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Almagro P, Acosta E, Navarro A, Murillo MF, Valdivielso S, de la Sierra A. Study of arterial stiffness in patients with an acute coronary event and chronic obstructive pulmonary disease confirmed by spirometry. Rev Clin Esp 2019; 219:251-255. [PMID: 30660321 DOI: 10.1016/j.rce.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/25/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) worsens the prognosis for patients with an acute coronary event (ACE) treated with percutaneous coronary intervention. Objective To assess the effect of COPD on arterial stiffness in patients with an ACE. METHODS The study included patients with an ACE treated with percutaneous coronary intervention. At 1 month, postbronchodilation spirometry was performed, and arterial stiffness and markers of myocardial damage (troponin T and ProBNP) were measured. RESULTS We included 68 patients, 33% of whom had COPD (59% undiagnosed). The patients with COPD presented higher arterial stiffness values after adjusting for age and blood pressure readings. The troponin T and ProBNP levels were higher in the patients with COPD. CONCLUSIONS Arterial stiffness is greater in patients with an ACE if they have concomitant COPD. These findings can help explain the poorer prognosis of patients with both conditions.
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Affiliation(s)
- P Almagro
- Unidad de Pacientes Crónicos Complejos, Departamento de Medicina Interna, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, España; Departamento de Medicina Interna, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, España.
| | - E Acosta
- Departamento de Medicina Interna, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, España
| | - A Navarro
- Servicio de Neumología, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, España
| | - M F Murillo
- Departamento de Medicina Interna, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, España
| | - S Valdivielso
- Servicio de Cardiología, Hospital Universitario Mútua Terrassa, Universidad de Barcelona, Terrasa, Barcelona, España
| | - A de la Sierra
- Departamento de Medicina Interna, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, España
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Pérez Sorí Y, Herrera Moya VA, Puig Reyes I, Moreno-Martínez FL, Bermúdez Alemán R, Rodríguez Millares T, Fleites Medina A. Histology of atherosclerotic plaque from coronary arteries of deceased patients after coronary artery bypass graft surgery. Clin Investig Arterioscler 2018; 31:63-72. [PMID: 30262443 DOI: 10.1016/j.arteri.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Ischaemic heart disease is an important health problem. The characteristics of atherosclerotic plaques determine patient outcome. The aim of this study was to determine the histological grade of coronary atherosclerotic lesions in deceased patients after coronary artery bypass graft surgery, and to identify the complications of the severe plaques. METHOD A descriptive, cross-sectional, prospective study was carried out on 21 anatomical pieces of deceased patients over a period of 3 years. The epicardial coronary arteries were sectioned transversally every 1cm, and the odd numbered fragments and the regions of the anastomosis with the grafts were selected. They were embedded in paraffin, stained with haematoxylin-eosin, and the histological slides were studied using an Olympus BHM microscope. RESULTS An age over 50 years (85.7%), male gender (81.0%), and smoking (66.7%) predominated. Peri-operative infarction (38.1%) and cardiogenic shock (33.3%) were the main direct causes of death. The majority of the grafts were of venous origin (64.6%), and 149 lesions were detected, of which 116 (77.8%) were severe plaques, and 47.4% of them were located in the left anterior descending artery. The large majority (81.9%) of the lesions were located in the arterial segments proximal to the graft. A total of 255 histological complications were detected in the severe plaques, with 75.0% showing calcification. Hypertensive patients had more plaques with more complications, but no statistically significant association was found between these variables. CONCLUSIONS Severe plaques predominated, mostly located in the proximal segments of the coronary arteries, and the left anterior descending was the most affected artery. Calcification was the most observed complication in the severe plaques.
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Affiliation(s)
- Yanet Pérez Sorí
- Universidad de Ciencias Médicas de Villa Clara, Villa Clara, Cuba
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Galán I, Simón L, Boldo E, Ortiz C, Medrano MJ, Fernández-Cuenca R, Linares C, Pastor-Barriuso R. Impact of 2 Successive Smoking Bans on Hospital Admissions for Cardiovascular Diseases in Spain. Rev Esp Cardiol (Engl Ed) 2018; 71:726-734. [PMID: 29673904 DOI: 10.1016/j.rec.2017.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/08/2017] [Accepted: 10/10/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the impact of 2 smoking bans enacted in 2006 (partial ban) and 2011 (comprehensive ban) on hospitalizations for cardiovascular disease in the Spanish adult population. METHODS The study was performed in 14 provinces in Spain. Hospital admission records were collected for acute myocardial infarction (AMI), ischemic heart disease (IHD), and cerebrovascular disease (CVD) in patients aged ≥ 18 years from 2003 through 2012. We estimated immediate and 1-year effects with segmented-linear models. The coefficients for each province were combined using random-effects multivariate meta-analysis models. RESULTS Overall, changes in admission rates immediately following the implementation of the partial ban and 1 year later were -1.8% and +1.2% for AMI, +0.1 and +0.4% for IHD, and +1.0% and +2.8% for CVD (P>.05). After the comprehensive ban, immediate changes were -2.3% for AMI, -2.6% for IHD, and -0.8% for CVD (P>.05), only to return to precomprehensive ban values 1 year later. For patients aged ≥ 65 years of age, immediate changes associated with the comprehensive ban were -5.0%, -3.9%, and -2.3% for AMI, IHD, and CVD, respectively (P<.05). Again, the 1-year changes were not statistically significant. CONCLUSIONS In Spain, smoking bans failed to significantly reduce hospitalizations for AMI, IHD, or CVD among patients ≥ 18 years of age. In the population aged ≥ 65 years, hospital admissions due to these diseases showed significant decreases immediately after the implementation of the comprehensive ban, but these reductions disappeared at the 1-year evaluation.
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Affiliation(s)
- Iñaki Galán
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.
| | - Lorena Simón
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Boldo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto de Investigación Sanitaria Puerta del Hierro, Madrid, Spain
| | - Cristina Ortiz
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María José Medrano
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Fernández-Cuenca
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Linares
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Pastor-Barriuso
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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García-González I, López-Díaz RI, Canché-Pech JR, Solís-Cárdenas ADJ, Flores-Ocampo JA, Mendoza-Alcocer R, Herrera-Sánchez LF, Jiménez-Rico MA, Ceballos-López AA, López-Novelo ME. Epistasis analysis of metabolic genes polymorphisms associated with ischemic heart disease in Yucatan. Clin Investig Arterioscler 2018; 30:102-111. [PMID: 29395491 DOI: 10.1016/j.arteri.2017.11.002] [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: 09/22/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Epistasis is a type of genetic interaction that could explain much of the phenotypic variability of complex diseases. In this work, the effect of epistasis of metabolic genes and cardiovascular risk on the susceptibility to the development of ischemic heart disease in Yucatan was determined. METHODS Case-control study in 79 Yucatecan patients with ischemic heart disease and 101 healthy controls matched by age and origin with cases. The polymorphisms -108CT, Q192R, L55M (paraoxonase 1; PON1), C677T, A1298C (methylenetetrahydrofolate reductase; MTHFR), and the presence/absence of the glutathione S-transferase T1 (GSTT1) gene were genotyped. Epistasis analysis was performed using the multifactorial dimensional reduction method. The best risk prediction model was selected based on precision (%), statistical significance (P<0.05), and cross-validation consistency. RESULTS We found an independent association of the null genotype GSTT1*0/0 (OR=3.39, CI: 1.29-8.87, P=0.017) and the null allele (OR=1.86, CI: 1.19-2.91, P=0.007) with ischemic heart disease. The GSTT1*0 deletion and the 677TT genotype (MTHFR) were identified as being at a high cardiovascular risk, whereas the GSTT1*1 wild type genotype and the CC677 variant were at low risk. The gene-environment interaction identified the GSTT1 gene, C677T polymorphism (MTHFR), and hypertension as the factors that best explain ischemic heart disease in the study population. CONCLUSIONS The interaction of the MTHFR, GSTT1 and hypertension may constitute a predictive model of risk for early onset ischemic heart disease in the population of Yucatan.
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Affiliation(s)
- Igrid García-González
- Departamento de Biología Molecular, Laboratorios Biomédicos de Mérida, Mérida, Yucatán, México.
| | - Roger Iván López-Díaz
- Departamento de Biología Molecular, Laboratorios Biomédicos de Mérida, Mérida, Yucatán, México
| | - José Reyes Canché-Pech
- Departamento de Biología Molecular, Laboratorios Biomédicos de Mérida, Mérida, Yucatán, México
| | | | | | | | | | | | | | - María E López-Novelo
- Departamento de Biología Molecular, Laboratorios Biomédicos de Mérida, Mérida, Yucatán, México
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Abstract
Ischemic heart disease continues to cause high morbidity and mortality. Its prevalence is expected to increase due to population aging, and its prevention is a major goal of health policies. The risk of developing ischemic heart disease is related to a complex interplay between genetic, environmental, and lifestyle factors. In the last decade, considerable progress has been made in knowledge of the genetic architecture of this disease. This narrative review provides an overview of current knowledge of the genetics of ischemic heart disease and of its translation to clinical practice: identification of new therapeutic targets, assessment of the causal relationship between biomarkers and disease, improved risk prediction, and identification of responders and nonresponders to specific drugs (pharmacogenomics).
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Affiliation(s)
- Roberto Elosua
- Grupo de Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
| | - Sergi Sayols-Baixeras
- Grupo de Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Departamento de Ciencias de la Salud y de la Vida, Universidad Pompeu Fabra, Barcelona, Spain
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Vehí C, Falces C, Sarlat MÀ, Gonzalo A, Andrea R, Sitges M. Nordic walking for cardiovascular prevention in patients with ischaemic heart disease or metabolic syndrome. Med Clin (Barc) 2016; 147:537-539. [PMID: 27871767 DOI: 10.1016/j.medcli.2016.09.041] [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: 05/12/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The incidence of atherosclerotic diseases has increased in Europe due in part to the population's sedentary lifestyle. Physical activity is useful for cardiovascular prevention. Nordic walking (NW) mobilizes a great number of muscular groups and is very popular in northern Europe. There is no data available on its impact in the healthcare system of the Mediterranean area. We propose the implementation of a NW program to promote physical activity and control cardiovascular risk factors (CVRF), as well as to improve quality of life and the adherence to medical treatment in patients with a chronic ischemic heart disease or metabolic syndrome. METHODS We selected patients with uncontrolled CVRFs. These patients performed 2 weekly sessions of NW over the course of one year. Baseline data extracted from the patients' medical history, quality of life questionnaires and on adherence to treatment was compared with the results obtained at the end of the program. RESULTS A reduction in the rate of CVRFs from 4.78 to 3 was observed, with an evident trend towards the improvement of the patients' quality of life and a better adherence to the treatment. CONCLUSIONS The implementation of a NW program is feasible in the public healthcare system and can aid in the management of CVRFs.
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Affiliation(s)
- Cristina Vehí
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - Carles Falces
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Miquel Àngel Sarlat
- Centre d'Atenció Primària Bordeta-Magòria, Institut Català de la Salut, Barcelona, España
| | - Ana Gonzalo
- Centre d'Atenció Primària La Marina, Institut Català de la Salut, Barcelona, España
| | - Rut Andrea
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Marta Sitges
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. [Chronic ischaemic heart disease in the elderly]. Rev Esp Geriatr Gerontol 2016; 51:170-179. [PMID: 27102136 DOI: 10.1016/j.regg.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/20/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
It is the aim of this manuscript to take into account the peculiarities and specific characteristics of elderly patients with chronic ischaemic heart disease from a multidisciplinary perspective, with the participation of the Spanish Society of Cardiology (sections of Geriatric Cardiology and Ischaemic Heart Disease/Acute Cardiovascular Care), the Spanish Society of Internal Medicine, the Spanish Society of Primary Care Physicians and the Spanish Society of Geriatrics and Gerontology. This consensus document shows that in order to adequately address these elderly patients a comprehensive assessment is needed, which includes comorbidity, frailty, functional status, polypharmacy and drug interactions. We conclude that in most patients medical treatment is the best option and that this treatment must take into account the above factors and the biological changes associated with aging.
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Affiliation(s)
- Manuel Martínez-Sellés
- Sociedad Española de Cardiología (SEC), Sección de Cardiología Geriátrica, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, España.
| | - Ricardo Gómez Huelgas
- Sociedad Española de Medicina Interna (SEMI), Departamento de Medicina Interna, Hospital Universitario Regional de Málaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Málaga, España
| | - Emad Abu-Assi
- Sociedad Española de Cardiología (SEC), Sección de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Alberto Calderón
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, España
| | - María Teresa Vidán
- Sociedad Española de Geriatría y Gerontología (SEGG), Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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González Romero PM, Cuevas Fernández FJ, Marcelino Rodríguez I, Rodríguez Pérez MDC, Cabrera de León A, Aguirre-Jaime A. [ETAP: A smoking scale for Primary Health Care]. Aten Primaria 2016; 48:288-94. [PMID: 26454625 PMCID: PMC6877883 DOI: 10.1016/j.aprim.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/20/2015] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To obtain a scale of tobacco exposure to address smoking cessation. DESIGN Follow-up of a cohort. Scale validation. SETTING Primary Care Research Unit. Tenerife. PARTICIPANTS A total of 6729 participants from the "CDC de Canarias" cohort. METHODS A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI). RESULTS The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors. CONCLUSION The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking.
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Affiliation(s)
| | | | - Itahisa Marcelino Rodríguez
- Unidad de Investigación Atención Primaria, Hospital Universitario NS de Candelaria, Sta. Cruz de Tenerife, España
| | | | - Antonio Cabrera de León
- Dirección del Servicio Canario de la Salud, Área de Medicina Preventiva de la Universidad de La Laguna, Sta. Cruz de Tenerife, España.
| | - Armando Aguirre-Jaime
- Unidad de Investigación Atención Primaria, Hospital Universitario NS de Candelaria, Sta. Cruz de Tenerife, España
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Gámez JM, Ripoll T, Barrios V, Anguita M, Pedreira M, Madariaga I. The clinical profile of women with stable ischaemic heart disease in Spain. More effort is needed in secondary prevention. SIRENA study. Rev Clin Esp 2015; 216:1-7. [PMID: 26548859 DOI: 10.1016/j.rce.2015.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/03/2015] [Revised: 08/26/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Cardiovascular diseases are the leading cause of death for women, especially ischaemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischaemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischaemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. PATIENTS AND METHODS A multicentre observational study was conducted with a sample of 631 women with stable ischaemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. RESULTS The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. CONCLUSIONS Women with stable ischaemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischaemic heart disease.
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Affiliation(s)
- J M Gámez
- Servicio de Cardiología, Hospital Son Llàtzer, Palma de Mallorca, España; Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, España; CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III, Madrid, España.
| | - T Ripoll
- Servicio de Cardiología, Hospital Son Llàtzer, Palma de Mallorca, España; Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, España; CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III, Madrid, España
| | - V Barrios
- Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, España
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, España
| | - M Pedreira
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - I Madariaga
- Servicio de Cardiología, Hospital Virgen del Camino, Pamplona, España
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Rodríguez Masi M, Martín Lores I, Bustos García de Castro A, Cabeza Martínez B, Maroto Castellanos L, Gómez de Diego J, Ferreirós Domínguez J. [Preoperative and follow-up cardiac magnetic resonance imaging of candidates for surgical ventricular restoration]. Radiologia 2015; 58:38-45. [PMID: 25907257 DOI: 10.1016/j.rx.2015.01.009] [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: 06/04/2014] [Revised: 01/02/2015] [Accepted: 01/06/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess pre and post-operative cardiac MRI (CMR) findings in patients with left endoventriculoplasty repair for ventricular aneurysm due to ischemic heart disease. MATERIAL AND METHODS Data were retrospectively gathered on 21 patients with diagnosis of ventricular aneurysm secondary to ischemic heart disease undergoing left endoventriculoplasty repair between January 2007 and March 2013. Pre and post-operative CMR was performed in 12 patients. The following data were evaluated in pre-operative and post-operative CMR studies: quantitative analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volume index, presence of valvular disease and intracardiac thrombi. The time between surgery and post-operative CRM studies was 3-24 months. RESULTS Significant differences were found in the pre and post-operative LVEF, LVEDV and LVESV data. EF showed a median increase of 10% (IQR 2-15) (p=0.003). The LVEDV showed a median decrease of 38 ml/m(2) (IQR 18-52) (p=0.006) and the LVESV showed a median decrease of 45 ml/m(2) (IQR:12-60) (p=0.008). Post-operative ventricular volume reduction was significantly higher in those patients with preoperative LVESV >110 ml/m(2) (59 ml/m(2) and 12 ml/m(2), p=0.006). CONCLUSION In patients with ischemic heart disease that are candidates for left endoventriculoplasty, CMR is a reliable non-invasive and reproducible technique for the evaluation of the scar before the surgery and the ventricular volumes and its evolution after endoventricular surgical repair.
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Affiliation(s)
- M Rodríguez Masi
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, España.
| | - I Martín Lores
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, España
| | | | - B Cabeza Martínez
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, España
| | | | - J Gómez de Diego
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, España
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Alonso JJ, Muñiz J, Gómez-Doblas JJ, Rodríguez-Roca G, Lobos JM, Permanyer-Miralda G, Anguita M, Chorro FJ, Roig E. Prevalence of Stable Angina in Spain. Results of the OFRECE Study. ACTA ACUST UNITED AC 2015; 68:691-9. [PMID: 25697076 DOI: 10.1016/j.rec.2014.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/14/2014] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective of the OFRECE study was to estimate the prevalence of stable angina in Spain. This prevalence is currently unknown, due to a lack of recent studies and to changes in the epidemiology and treatment of ischemic heart disease. METHODS This cross-sectional study involved a representative sample of the Spanish population aged 40 years or older, obtained via 2-stage random sampling: in the first stage, primary care physicians were randomly selected from each Spanish province, whereas in the second stage 20 people were selected from the population assigned to each physician. The prevalence was weighted by age, sex, and geographical area. Participants were classified as having angina if they met the "definite angina" criteria of the Rose questionnaire and as having confirmed angina if the angina was confirmed by a cardiologist or if they had a history of acute ischemic heart disease or revascularization. RESULTS Of the 11 831 people invited to participate, 8378 (71%) were analyzed (mean age, 59.2 years). The weighted prevalence of definite angina (Rose) was 2.6% (95% confidence interval, 2.1%-3.1%) and was higher in women (2.9%) than in men (2.2%), whereas that of confirmed angina was 1.4% (95% confidence interval, 1.0%-1.8%), without differences between men (1.5%) and women (1.3%). The prevalence of definite angina (Rose) increased with age (0.7% in patients aged 40 to 49 years and 7.1% in those aged 70 years or older), history of cardiovascular disease, and cardiovascular risk factors, except smoking. CONCLUSIONS The prevalence of definite angina (Rose) in the Spanish population aged 40 years or older was 2.6%, whereas that of confirmed angina was 1.4%. Both prevalences increased with age, cardiovascular risk factors, and cardiovascular history.
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Affiliation(s)
- Joaquín J Alonso
- Servicio de Cardiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - Javier Muñiz
- Instituto de Ciencias de la Salud, Universidad de A Coruña, INIBIC, A Coruña, Spain
| | - Juan José Gómez-Doblas
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | | | - Eulàlia Roig
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Dayan V, Ricca R. [Cardiac rehabilitation after coronary artery bypass surgery]. Arch Cardiol Mex 2014; 84:286-92. [PMID: 25240582 DOI: 10.1016/j.acmx.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/12/2013] [Revised: 01/29/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022] Open
Abstract
Ischemic heart disease is the leading cause of death worldwide with an increase in the incidence in younger populations. Today revascularization strategies are capable of alleviating acute ischemia and/or chronic ischemia. These can be performed percutaneously or through surgery. Even if we improve myocardial perfusion by these methods, the main determinant in maintaining patency of coronary arteries and bypass is a correctly instituted secondary prevention. This is the main focus of cardiac rehabilitation proposals. Although much has been published about the role of cardiac rehabilitation after percutaneous revascularization, there is little work able to synthesize the current state of cardiac rehabilitation in patients undergoing coronary artery bypass surgery. The aim of this paper is to review the effect of rehabilitation in the return to work, survival, functional capacity, depression and anxiety, as well as compare centralized vs. home rehabilitation in this patient population.
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Affiliation(s)
- Victor Dayan
- Cátedra de Cirugía Cardiaca, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
| | - Roberto Ricca
- Cátedra de Cardiología, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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García González JM. Contributions of cardiovascular mortality to Spanish life expectancy from 1980 to 2009. ACTA ACUST UNITED AC 2014; 66:848-53. [PMID: 24773991 DOI: 10.1016/j.rec.2013.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/03/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES This article describes the contribution of the decrease in cardiovascular mortality to the increase in life expectancy at birth in Spain from 1980 to 2009. We explain the demographic factors underlying the decrease in mortality from cardiovascular diseases at older ages and the effect of this decrease on lifespan. METHODS The contribution of these decreases to Spanish life expectancy at birth was calculated using decomposition methods for life expectancy. We calculated standardized mortality rates by sex and 3 causes of death (cerebrovascular disease, ischemic heart disease, and other heart disease) for 3 age groups: 65 to 79 years, 80 to 89 years, and ≥ 90 years. RESULTS From 1980 to 2009, life expectancy at birth in Spain increased by more than 6 years for both sexes. The contribution of the decrease in cardiovascular mortality to the total increase in life expectancy at birth was 63% among women and 53% among men. Among the ≥ 65-year-old age group, this contribution was 93% among women and 87% among men. CONCLUSIONS The decrease in cardiovascular mortality, mainly at older ages, has been the main contributor to increased Spanish life expectancy at birth during the last 3 decades.
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Tello-Montoliu A, Jover E, Valdés M. [New antiplatelet drugs in coronary artery disease]. Med Clin (Barc) 2014; 143:508-14. [PMID: 24480290 DOI: 10.1016/j.medcli.2013.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
The dual antiplatelet therapy with acetylsalicylic acid and clopidogrel has been the mainstay of both acute and chronic phase coronary artery disease, reducing importantly the risk of adverse events. Despite a correct compliance, a non-negligible rate of adverse events still happens. New compounds, with improved properties, are now clinically available (such as prasugrel or ticagrelor) or under advanced development. The aim of the present review is the description of these new compounds, particularly prasugrel and ticagrelor.
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Affiliation(s)
- Antonio Tello-Montoliu
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, Murcia, España.
| | - Eva Jover
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, Murcia, España
| | - Mariano Valdés
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, Murcia, España
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Brotons C, Cuende JI, Fernández Pardo J, Plana N, Moral I. [Ischaemic heart disease]. Clin Investig Arterioscler 2013; 25:203-210. [PMID: 24238749 DOI: 10.1016/j.arteri.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 06/02/2023]
Abstract
In the year 2011, cardiovascular diseases were responsible of 31.2% of total deaths in Spain. The absolute number of cases of acute coronary syndrome in this year will be approximately 115,752 cases (95%CI: 114,822-116,687). The prevalence of stable angina in the population aged 25-74 years is 2.6% in men and 3.5% in women. Cardiovascular diseases were in the year 2011 the first cause of hospitalizations representing 14.1% of the total hospitalizations. Diagnose of ischaemic heart disease and acute myocardial infarction were responsible of 110,950 and 50,064 hospitalizations, respectively. In the year 2003, the hospitalization rate was 314 while in the year 2011 was 237 per 100,000, a reduction of 24.4%. The average cost of hospitalization due to ischaemic heart disease in 1997 was 3,093.7euros while in the year 2011 was 7,028.71euros. Cardiovascular mortality rates have decreased from 2007 to 2011, showing a relative reduction of 7% in women and 8% in men. With regard to myocardial infarction, it was observed a relative reduction of 17% in men and 20% in women. According to EUROASPIREIII survey done in 8,966 patients with ischaemic heart disease in Europe, 17% of patients were still smokers, 35% were obese, 56% has uncontrolled blood pressure, 51% has raised blood cholesterol and 25% were diabetics. With regard to drugs utilisation, 91% were treated with antiplatelets agents, 80% with beta blockers, 71% with ACE inhibitors/ARBs.
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Affiliation(s)
- Carlos Brotons
- Unidad de Investigación, Equip d'Atenció Primària Sardenya, Unidad Docente ACEBA, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España.
| | - José I Cuende
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial de Palencia, Palencia, España
| | - Jacinto Fernández Pardo
- Unidad de Hipertensión y Lípidos, Hospital General Universitario Reina Sofía, Murcia, España
| | - Nuria Plana
- Unitat de Investigació Clínica (UIC), Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Reus, Tarragona, España
| | - Irene Moral
- Unidad de Investigación, Equip d'Atenció Primària Sardenya, Unidad Docente ACEBA, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España
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Delgado C, Vázquez M, Oca R, Vilar M, Trinidad C, Sanmartin M. Myocardial ischemia evaluation with dual-source computed tomography: comparison with magnetic resonance imaging. ACTA ACUST UNITED AC 2013; 66:864-70. [PMID: 24773993 DOI: 10.1016/j.rec.2013.05.026] [Citation(s) in RCA: 9] [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: 01/31/2013] [Accepted: 05/31/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVES Computed tomography does not accurately determine which coronary lesions lead to myocardial ischemia and consequently further tests are required to evaluate ischemia induction. The aim of this study was to compare diagnostic accuracy between dual-energy computed tomography and magnetic resonance imaging in the assessment of myocardial perfusion and viability in patients suspected of coronary artery disease. METHODS A prospective study was performed in 56 consecutive patients (39 men [69.6%]; mean age [standard deviation], 63 [10]; range, 23-81). Computed tomography was performed with the following protocol: 1, adenosine stress perfusion; 2, coronary angiography; and 3, delayed enhancement. Magnetic resonance imaging for the evaluation of stress perfusion and delayed enhancement was performed within 30 days. Two observers in consensus analyzed the perfusion and delayed enhancement images. RESULTS We studied 952 myocardial segments and 168 vascular territories. In a per-segment analysis, the sensitivity, specificity, and positive and negative predictive values of computed tomography compared with magnetic resonance were 76%, 99%, 89%, and 98% for perfusion defects, and 64%, 99%, 82%, and 99% for delayed enhancement, respectively. In a per-vascular territory analysis, the same measures were 78%, 97%, 86%, and 95% for perfusion defects, and 72%, 99%, 93%, and 97% for delayed enhancement, respectively. The mean radiation dose was 8.2 (2) mSv. CONCLUSIONS Dual-source computed tomography may allow accurate and concomitant evaluation of perfusion defects and myocardial viability and analysis of coronary anatomy.
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Affiliation(s)
- Carlos Delgado
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain.
| | - María Vázquez
- Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Roque Oca
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Manuel Vilar
- Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Carmen Trinidad
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain
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Romero-Farina G, Candell-Riera J, Aguadé-Bruix S, Cuberas-Borrós G, Pizzi MN, Santos A, de León G, García-Dorado D. [Variables that influence the indication of a second myocardial perfusion gated-SPECT after a normal stress-rest gated SPECT]. Rev Esp Med Nucl Imagen Mol 2014; 33:72-8. [PMID: 23938191 DOI: 10.1016/j.remn.2013.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/19/2013] [Accepted: 06/30/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to investigate predictor variables at the moment of normal stress-rest myocardial perfusion gated SPECT for indication of a second gated SPECT. MATERIAL AND METHODS A prospective, single center cohort study was conducted. We evaluated 2326 consecutive patients (age 63.6 ± 13 years, 57.3% females) without perfusion defects and with normal left ventricular ejection fraction on a myocardial perfusion gated SPECT. Clinical and stress test variables were studied to predict indication of a second gated SPECT and presence of reversible perfusion defects in the second gated SPECT. RESULTS During a mean follow-up of 3.6 ± 2 years a second gated SPECT was performed in 286 patients (12.3%). Independent predictor variables of a second gated SPECT were presence of three or more cardiovascular risk factors (χ(2): 5.510; HR: 1.4; p=0.019), previous acute myocardial infarction (χ(2): 3.867; HR: 1.4; p=0.049), previous coronary revascularization (χ(2): 41.081; HR: 2.5; p<0.001), and a positive stress test (χ(2): 8.713; HR: 1.5; p=0.003). Observation of perfusion defects in the 280 patients in whom a second stress-rest gated SPECT was performed was more likely in male patients (χ(2): 4.322; HR: 1.9; p=0.038) who had a first pure pharmacological gated-SPECT (χ(2): 7.182; HR: 2.6; p=0.007). CONCLUSIONS In patients with a first normal myocardial perfusion gated SPECT, various clinical factors and variables derived from the stress test affect the indication of a second gated SPECT and the presence of ischemia in the latter.
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Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA, Recio-Rodríguez JI, Mora-Simón S, Pérez-Arechaederra D, Agudo-Conde C, Escribano-Hernández A, Patino-Alonso MC. [Prevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study]. Aten Primaria 2013; 45:349-57. [PMID: 23528294 PMCID: PMC6985525 DOI: 10.1016/j.aprim.2013.01.012] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of cardiovascular diseases, cardiovascular risk factors, and the psychosocial characteristics associated with them in an urban population aged 65 years and older. DESIGN Descriptive cross-sectional study of the population. SETTING City of Salamanca (Spain). PARTICIPANTS A total of 480 participants aged 65 and older were selected using a stratified randomized sampling method. A health questionnaire was completed in the participants' homes. MAIN MEASUREMENTS Weight, height, waist circumference, arterial pressure, blood glucose and cholesterol, were measured, and the standardized prevalence for a European population was estimated. RESULTS A total of 327 participants were interviewed (68.10% of those selected), mean age of participants was 76 (SD: 7.33). Of the total, 64.5% were women and 20.2% (15.8-24.5) had some cardiovascular disease. In males, the most prevalent cardiovascular disease was ischemic heart disease (12.1% [6.1-18]), while in females it was heart failure (10.4% [6.3-14.6]). Hypertension was the most frequent cardiovascular risk factor for males (63.8% [53.2-70.9]) and females (69.7%.[63.5-75.9]), followed by diabetes in males (36.2% [27.5-45]), and sedentary lifestyle in females (36.0% [29.5-42.5]). Those with cardiovascular diseases were more dependent and had a worse prognosis (Charlson's Comorbility Index). CONCLUSIONS Ischemic heart disease is the most prevalent heart disease in males, while heart failure is the most prevalent disease for females. Almost 80% of the population aged 65 and older did not suffer any of the three cardiovascular diseases that are the main causes of mortality in this group of age. Participants who had a CVD were more dependent for activities of daily living.
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