Arterial Hypertension, Structural Damage of the Brain and Cognitive Test / Hipertensión arterial, daño estructural del cerebro y test cognitivos.

Introduction: The arterial hypertension cause brain vascular damage (white matter lesion) and the burden and progression determine their cognitive consequences. Therefore, arterial hypertension is considered the main modifiable vascular risk factor for cognitive impairment and dementia. Therefore, the aim of the current study was to evaluate the results of cognitive tests in a sample of hypertensive patients and to establish possible associations with structural brain lesions (atrophy, white matter lesions) identified by magnetic resonance imaging Methods: Were included 70 hypertensive patients from Heart-Brain study in Argentina with magnetic resonance imaging and cognitive test. Fazekas scale and the Global Cortical Atrophy were used to quantify the white matter lesions and the brain atrophy, respectively. The Mini-Mental Status Examination, Clock Drawing test and Mini-Boston Naming test were used to evaluate the cognitive status. Results: average age 69.7 ± 10.6 years, 55.7% female). Based on the linear regression analysis, Fazekas scale and cognitive tests were inversely associated. For each grade of increase in Fazekas scale, the clock drawing test (Coef -0.56, CI 95% -1.01 -0.10, p=0.01) and the Mini-mental Status Examination (Coef -0.7, CI 95% -1.27 -0.13, p=0.01) scores decreased. The subcortical atrophy was significantly associated with the clock drawing test (OR 3.29, CI 95% 1.25-8.63; p=0.016). Conclusion: The cognitive tests, particularly the clock drawing test could be used (in the clinical routine practice) as "subrrogate" of the brain structural hypertension-mediated damage.

Introducción: La hipertensión arterial causa daño vascular cerebral (lesiones de sustancia blanca) y su carga y progresión determinan las consecuencias cognitivas. Así, la hipertensión es considerada el principal factor de riesgo vascular modificable para desarrollar deterioro cognitivo y demencia. Por lo tanto el objetivo de la presente investigación fue evaluar el resultado de los test cognitivos en una muestra de pacientes hipertensos y establecer las posibles asociaciones con las lesiones estructurales del cerebro (atrofia, lesiones de sustancia blanca) identificadas mediante resonancia magnética. Métodos: Se incluyeron 70 pacientes hipertensos pertenecientes al estudio Corazón-Cerebro en Argentina a los que se les realizó resonancia magnética y evaluación cognitiva. Se utilizaron las escalas de Fazekas y la Global Cortico Atrophy para evaluar las lesiones de sustancia blanca y la atrofia cerebral, respectivamente y el Mini-mental test, el test del reloj y el test de denominación Mini-Boston para conocer el estatus cognitivo. Resultados: Edad promedio 69.7 ± 10.6 años, 55.7% mujeres. Basados en el análisis de regresión lineal, la escala de Fazekas se asoció en forma inversa con los test cognitivos. Por cada punto de aumento en la escala de Fazekas el puntaje del test del reloj descendió -0.56 (IC 95% -1.01 -0.10, p=0.01) y el Mini-mental test -0.7 (IC95% -1.27 -0.13, p=0.01). La atrofia subcortical se asoció en forma inversa solo con el test del reloj (OR 3.29, IC 95% 1.25-8.63; p=0.016). Conclusión: Los test cognitivos, en especial el test del reloj, podrían ser utilizados, en la práctica clínica asistencial, como un subrogado del daño estructural del cerebro mediado por la hipertensión arterial.

[Cognitive profile in hypertensive patients. Usefulness of the Clock Drawing Test]. / Perfiles cognitivos en pacientes hipertensos. Utilidad del test del reloj.

INTRODUCTION: Hypertension is the main cause of cognitive impairment and the executive dysfunction the most com- mon cognitive domain affected. The aims of this research have been to characterize the cognitive profiles (s) in hypertensive patients and to identify the most usefulness Test (s) in the routine clinical practice to identify them. METHODS: We assessed the cognitive status in 69 hypertensive patients who were administered a battery of cognitive Tests that included the MMSE, the Mini-Boston Naming Test, verbal fluency and the Clock drawing Test. RESULTS: The average of the sample was 72.2±10.1 years. The Clock-drawing Test and the Mini-Boston Naming Test differentiated 3 cognitive profiles: no cognitive impairment, minor cognitive disorder and major cognitive disorder. A strong association was observed between the semantic (0.87) and executive (0.75) components of the Clock-drawing Test with the Mini-Boston Naming Test (0.96). The analysis of clusters and switchings in the verbal fluency Test differentiated the severe forms of cognitive impairment. CONCLUSION: The results obtained confirm the value of the Clock-drawing Test to identify the different cognitive profiles in hypertensive patients, becoming a valid screening test to be used in routine clinical practice and a potential biomarker of cognitive dysfunction in hypertensive patients.

[Prevalence of anxiety and depression in patients with cardiovascular disease during the COVID-19 pandemic]. / Prevalencia de ansiedad y depresión en pacientes con enfermedad cardiovascular durante la pandemia COVID-19.

INTRODUCTION: The COVID-19 pandemic and the sanitary measures implemented had an impact on the mental health of the most vulnerable populations. AIMS: To know the prevalence of anxiety and depression in patients with cardiovascular disease and/or vascular risk factors after the end of quarantine and compare it with the prevalence during quarantine and before the COVID-19 pandemic. METHODS: An online questionnaire was sent 150 days after the quarantine ended. The Hospital Anxiety Depression (HAD) scale was used and clinical and demographic data were recorded. The results were compared with samples obtained during quarantine and the EPICA study conducted in 2016 before the COVID-19 pandemic. RESULTS: The samples included 1076, 3542 and 1035 patients respectively. The prevalence of anxiety fluctuated but did not change (20.8%, 13.5% and 21% respectively). Depression increased its prevalence (9.8%, 16.7% and 19.7% respectively). Depression was associated with coronary heart disease and risk behaviors (cigarette smoking and sedentary lifestyle). CONCLUSION: Depression doubled its prevalence during the COVID-19 pandemic in patients with cardiovascular disease and/or vascular risk factors. The effects of the pandemic appear to extend beyond the duration of the quarantine.

The depressor axis of the renin-angiotensin system and brain disorders: a translational approach.

All the components of the classic renin-angiotensin system (RAS) have been identified in the brain. Today, the RAS is considered to be composed mainly of two axes: the pressor axis, represented by angiotensin (Ang) II/angiotensin-converting enzyme/AT1 receptors, and the depressor and protective one, represented by Ang-(1-7)/ angiotensin-converting enzyme 2/Mas receptors. Although the RAS exerts a pivotal role on electrolyte homeostasis and blood pressure regulation, their components are also implicated in higher brain functions, including cognition, memory, anxiety and depression, and several neurological disorders. Overactivity of the pressor axis of the RAS has been implicated in stroke and several brain disorders, such as cognitive impairment, dementia, and Alzheimer or Parkinson's disease. The present review is focused on the role of the protective axis of the RAS in brain disorders beyond its effects on blood pressure regulation. Furthermore, the use of drugs targeting centrally RAS and its beneficial effects on brain disorders are also discussed.

Predicting cognitive function and dementia risk in patients with hypertension.

In spite of the fact that hypertension stand out as the main vascular risk factor for developing dementia, it is essential to acknowledge the presence of other risk factors, both vascular and non-vascular that contribute to increase this risk. This study stratified the dementia risk using CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) dementia risk score in a sample of 1279 hypertensive patients from the Heart-Brain Study in Argentina and to observed the association between the risk factors include in the CAIDE score and the current cognitive status. The average age of the sample was 60.2 ± 13.5 years (71% female) and the average years of education was 9.9 ± 5.1 years. To assess the current cognitive status, we used the Mini-mental test (MMSE), the clock drawing test (CDT) and Mini-Boston test. According to CAIDE score ( ≥9 points) the risk of dementia was 40.4% in the total sample and 28.1% in the middle-life hypertensive patients (between 47 to 53 years). An inverse association was observed between CAIDE score and the results of current cognitive tests (MMSE = R2 0.9128, p < 0.0001; CDT = R2 0.9215, p < 0.0001 y Mini-Boston= R2 0.829, p < 0.0001). The CAIDE score can predict the risk of dementia in hypertensive patients and its result was associated with the current cognitive status (result of cognitive tests).

Routine assessment of cognitive function in older patients with hypertension seen by primary care physicians: why and how-a decision-making support from the working group on 'hypertension and the brain' of the European Society of Hypertension and from the European Geriatric Medicine Society.

: The guidelines on hypertension recently published by the European Societies of Hypertension and Cardiology, have acknowledged cognitive function (and its decline) as a hypertension-mediated organ damage. In fact, brain damage can be the only hypertension-mediated organ damage in more than 30% of hypertensive patients, evolving undetected for several years if not appropriately screened; as long as undetected it cannot provide either corrective measures, nor adequate risk stratification of the hypertensive patient.The medical community dealing with older hypertensive patients should have a simple and pragmatic approach to early identify and precisely treat these patients. Both hypertension and cognitive decline are undeniably growing pandemics in developed or epidemiologically transitioning societies. Furthermore, there is a clear-cut connection between exposure to the increased blood pressure and development of cognitive decline.Therefore, a group of experts in the field from the European Society of Hypertension and from the European Geriatric Medicine Society gathered together to answer practical clinical questions that often face the physician when dealing with their hypertensive patients in a routine clinical practice. They elaborated a decision-making approach to help standardize such clinical evaluation.

Hypertension and cognitive decline: impact on executive function.

Hypertension is a risk factor for mild cognitive deterioration and vascular dementia. Cognitive deterioration attributable to normal aging was distinguished from cognitive deterioration related to hypertension by means of neuropsychologic tests. Sixty hypertensive patients, aged 65-80 years, were compared with 30 normotensive individuals. Patients with a history of stroke and/or transient ischemic attacks, diabetes, atrial fibrillation, hypercholesterolemia, or bypass surgery, and those diagnosed with dementia, depression, or anxiety, were excluded. Neither gender differences, duration of hypertension (10.2+/-8.2 years), nor prescribed antihypertensive drug treatment had an influence on study results. Immediate recall was impaired in both groups. The hypertensive patients evinced impairment in all tests vs. the normotensive subjects. Mean deferred recall scores +/- SD were 5.68+/-2.6 vs. 7.13+/-2.4; p<0.01. Deficits in attention speed and executive function, as measured by nonperformance on the Trail Making Test Part B, were present in 46% of hypertensive patients vs. 13% of normotensive patients (p<0.005), with more errors made by the hypertensive patients (1.15+/-1.54 vs. 0.46+/-0.9; p<0.02). Scores on the Stroop Color and Word Test also revealed deficits in the hypertensive patients (24.7+/-7.6 vs. 32+/-10.7; p<0.005). Compared with the control group, the hypertensive participants revealed more deficits in skills involving delayed recall and prefrontal-region skills. The relevant neuropsychologic tests were sufficiently sensitive and proved easy to use in clinical practice.

[Syndrome X. A paradoxically anonymous identity]. / Síndrome X. Una identidad paradójicamente anónima.

Since the original description, the list of statistically related components, which make up the metabolic syndrome, is in continuous increase. Therefore, different medical groups and their consensus and reports still do not agree on the criteria for its definition and denomination. Although the syndrome is related with high risk of diabetes and cardiovascular disease, the trials have not demonstrated the relationship between hyperinsulinemia and cardiovascular diseases; in consequence it is difficult to conclude whether cardiovascular disease is a part of the syndrome or its consequence. Therefore, it is impossible to accept that the syndrome is synonymous of high risk for cardiovascular disease. These facts may be the reason why its identity hides behind an "X".

At the Heart of Brain Disorders - Preventing Cognitive Decline and Dementia.

Vascular risk factors are shared by heart and brain. Vascular brain injury (small vessel disease, stroke) alone or combined with neurodegenerative pathology (ß-amyloid depositions) brings about either cognitive decline and vascular dementia or Alzheimer's disease. Long-term exposure to vascular risk factors precedes the onset of neurocognitive diseases by one or two decades. Early detection and control of modifiable vascular risk factors seem to be the only current strategies to prevent cognitive impairment and dementia.

Association Between Hypertension, Menopause, and Cognition in Women.

The aim of this study was to investigate the cognitive state in women and its relation to menopause and hypertension (HTN). The authors included 1034 women aged 47.13±15.71 years. The prevalence of HTN was 47.1%, with 67.8% of patients treated and 48.6% controlled. Cognitive impairment was higher among hypertensive menopausal (mini-Boston Naming Test: 7.4±3.1 vs 8.5±2.4, P<.001; Clock-Drawing Test: 5.2±2 vs 5.6±1.6, P<.01). Using logistic regression adjusted by age and education level, statistical differences were found in the results from the mini-Boston Naming Test between menopausal hypertensive vs menopausal normotensive women (odds ratio, 1.48; 95% confidence interval, 1.06-2.07; P=.021), and no difference between nonmenopausal hypertensive vs menopausal normotensive women (odds ratio, 0.89; 95% confidence interval, 0.51-1.57; P=.697). The P interaction between both groups was significant (P=.038). The possibility of alteration in cortical functions in menopausal hypertensive woman showed a relative increment of 48% (P=.021). The association between HTN and menopause increases the possibility of compromising the semantic memory by 50%.

Registro Nacional de Hipertensión Arterial. Características epidemiológicas de la hipertensión arterial en la Argentina. Estudio RENATA 2 / National Registry of Hypertension. Epidemiological Characteristics of Hypertension in Argentina. The RENATA 2 study

Introducción: La hipertensión arterial es el principal factor de riesgo para enfermedad y muerte cardiovascular. Su prevalencia va en aumento, lo cual hace necesario conocer los datos actualizados en la Argentina. Objetivo: Evaluar la prevalencia, el conocimiento, el tratamiento y el control de la hipertensión arterial en la Argentina. Material y métodos: Estudio de corte transversal que incluyó individuos ≥ 18 años de 25 ciudades argentinas. Los participantes fueron encuestados y se midió la presión arterial con presurómetros automáticos validados. Resultados: Se encuestaron 5.931 individuos, con una edad promedio de 43,5 ± 17,1 años. La prevalencia de hipertensión arterial fue del 36,3% (IC 95% 35,1-37,6), siendo mayor en varones (43,7% vs. 30,4%; p < 0,0001). La prevalencia aumentó con la edad en ambos sexos. El 38,8% de los hipertensos desconocían su enfermedad y el 5,7% la conocían pero no recibían tratamiento. El 55,5% estaban tratados y solo el 24,2% se encontraban controlados, observándose más control en las mujeres. El 73,4% de los hipertensos tratados recibían monoterapia y solo el 43,6% estaban controlados. Los pacientes adherentes al tratamiento tuvieron mejor control de la presión arterial que los no adherentes (46,9% vs. 40,1%; p = 0,01). Conclusiones: La prevalencia de hipertensión arterial en la Argentina es del 36,3%, en coincidencia con los reportes de la Organización Mundial de la Salud para la región. El 38,8% de los participantes desconocían su enfermedad. La mitad de los hipertensos recibían tratamiento farmacológico y solo la cuarta parte estaban controlados. Tres de cada cuatro pacientes tratados recibían monoterapia. El control de la presión arterial se relacionó con mejor adherencia al tratamiento.

Cognition and vascular risk factors: an epidemiological study.

We conducted an epidemiological approach to identify the negative impact of the vascular risk factors (such as hypertension, diabetes and hypercholesterolemia) over cognition. The interesting aspect of this study was that the survey was conducted in all age groups through a voluntary call (n = 1365; ≥18 years old, both sexes; age 49 ± 15 y, female 75.7%). Thus, we demonstrated that the use of a Minimum Cognitive Examination (MCE), a brief, simple, and easy managed neuropsychological evaluation, detected a greater number of people with cognitive decline surpassing to the Minimal Mental Statement Examination alone (14.5% of the participants showed MMSE ≤24, 34,6% showed dys-executive function, and 45,8% memory impairment. Out of the 4 studied RF, the only one that was not related to cognitive impairment was dyslipemia. Finally, we noted the importance of cognitive state early detection in all age groups, even in the youngest group. Acting in the middle of the life stages, we can prevent or delay the onset of a disease in adults, nowadays incurable: dementia.

Cognitive evolution in hypertensive patients: a six-year follow-up.

BACKGROUND: Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function. AIMS: 1) to report the cognitive evolution in a cohort of hypertensive patients, 2) to identify the affected domains, and 3) to correlate the results obtained with blood pressure measurements. MATERIALS AND METHODS: Observational 6-year follow-up cohort study including both males and females aged≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years). The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation. RESULTS: Sixty patients were followed for 76.4±2.8 months. The average age at baseline was 72.5±4.2 and 77.9±4.6 at 6 years (65% were women). Two patients were lost to follow up (3.3%) and 8 patients died (13.3%).The density incidence for dementia was 0.6% patients per year (pt/y) (n=3) and for depression was 1.6% pt/y (n=12). No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE) results (p=ns) during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements. CONCLUSION: 1) the incidence of dementia doubled to general population, 2) the initial memory impairment did not change during the evaluation period, 3) cognitive impairment worsened in the areas related to executive function (prefrontal cortex) regardless of the adequacy of anti-hypertensive treatment and blood pressure values.

Sistema renina-angiotensina, deterioro cognitivo y demencia. Implicancias terapéuticas de su inhibición / Renin-angiotensin system, cognitive deterioration and dementia. therapeutic implications of their Inhibition

La acumulación de amiloide, la edad y la enfermedad vascular son los principales factores de riesgo para desarrollar una demencia. Existe un interjuego entre los factores genéticos y vasculares para desarrollar la enfermedad de Alzheimer de inicio tardío. La activación sostenida del sistema renina Angiotensina parece ocupar un papel destacado en la fisiopatología de las demencias incluyendo la enfermedad de Alzheimer. El tratamiento antihipertensivo con inhibidores de la enzima de conversión de Angiotensina tanto como el bloqueo de los receptores de la Angiotensina II, parecen superiores sobre otros fármacos en la prevención de las demencias

The age, aggregation of amyloid, and vascular disease are major risk factors for developing dementia. There is interplay between genetic and vascular factors to develop late-onset Alzheimer's disease. Sustained the renin angiotensin system activation seems to occupy an important role in the pathophysiology of dementia including Alzheimer's disease. Antihypertensive treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockade, seem superior over other drugs in the prevention of dementia

Características del síndrome metabólico en la consulta cardiológica. Grupo de estudio CARISMA. Caracterización y Análisis del Riesgo en Individuos con Síndrome Metabólico en la Argentina / Characteristic of the metabolic syndrome in cardiology consultation. CARISMA Study Group. Characterization and risk analysis in individuals with metabolic syndrome in Argentina

Antecedentes. El síndrome metabólico (SM) identifica sujetos con riesgo cardiometabólico incrementado. Su prevalencia en la población general varía de acuerdo con la definición utilizada, encontrándose cercana al 23% aplicando los criterios del Adult Treatment Panel-III (ATP III).Objetivos. 1) Determinar la prevalencia del síndrome metabólico según las distintas definiciones en la población que consulta al cardiólogo, 2) determinar la prevalencia de los componentes del síndrome metabólico en la población estudiada, 3) establecer la correlación entre el diagnóstico clínico de síndrome metabólico percibido por el médico cardiólogo vs la presencia de los criterios diagnósticos de síndrome metabólico según el ATP-III y la International Diabetes Federation (IDF) y 4) establecer la concordancia entre el riesgo cardiovascular “percibido” vs score de Framingham.Material y métodos. Se incluyeron en forma prospectiva pacientes de ambos sexos mayores de 21 años que consultaran por primera vez al especialista en cardiología perteneciente a las distintas sociedades federadas

Resultados. Sobre una muestra de 339 participantes, con un 49,3% de mujeres y una edad promedio de 58,3±1,0 años, la prevalencia de SM según ATP-III fue 48,9% y 60,1% según IDF. La prevalencia observada de los criterios diagnósticos de síndrome metabólico fue: 93,3% de hipertensión arterial (presión arterial sistólica/presión arterial diastólica: 147,5±19,4/ 88,9±14,1 mm Hg), 72,8% de perímetro de la cintura elevado (113,7±8,5 cm), 80,1% de hipertrigliceridemia (236,7±19,1 mg/dL), 86,7% de colesterol-HDL (C-HDL) bajo (37,0±1,4 mg/dL) y 38,5% de hiperglucemia (102±37,5 mg/dL). Se observó una concordancia moderada entre el diagnóstico de SM según juicio clínico vs. ATP-III (índice kappa 0,53), en tanto que la observada entre el juicio clínico y la definición de SM por IDF fue buena (índice kappa 0,74). La concordancia entre la “percepción” clínica del riesgo cardiovascular vs el score de Framingham fue nula (índice kappa 0,033).Conclusiones. 1) La prevalencia del SM en la población que consulta al cardiólogo duplica a la reportada en la población general (48,9% según ATP-III y 60,1% según IDF). La tríada más frecuente de sus componentes fue la conformada por hipertensión, C-HDL bajo e hipertrigliceridemia, 2) hubo buena concordancia entre el diagnóstico clínico de SM y los criterios de IDF. El riesgo cardiovascular “percibido” no se correlacionó con el score Framingham

Nutrición enteral por sonda nasoentérica. Una alternativa posible en pacientes con demencia avanzada / Enteral nutrition by nasoenteric tube. A possible alternative in patients with advanced dementia

No existe hasta el momento evidencia médica sólida que justifique el apoyo nutricional para pacientes con demencia avanzada y trastornos deglutorios, lo cual convierte tal decisión en un aspecto controvertido. La indecisión familiar y las opiniones médicas encontradas se funden con principios éticos, morales y religiosos. La escasa incidencia de complicaciones con el uso de sondas nasoentéricas por tiempo prolongado es una alternativa posible, poco invasiva, segura y eficaz, que hace que este método sea superior al implante de una sonda por gastrostomía percutánea. Su simple remoción permite retomar con facilidad la alimentación por vía oral y disminuir los altos costos que conlleva la atención médica de estos pacientes.

Up to now, there is not solid medical evidence that justifies nutritional support in patients who suffer from advanced dementia with swallowing disorders. As a matter of fact, such a determination is controversial. Opposite medical opinions plis ethic, moral and religious principles, emphasize the great difficulties that the patient's relatives have to face when asked to decide on this issue. The use of nose-enteric catheter for a long time is a better alternative in comparison with implanting a percutaneous gastrostomy catheter, because it is less invasive, more secure, more effective and has a low incidence of complications. Lastly, it is easily removed to restore oral feeding as well as ir helps to reduce medical attetion costs.

Prevalencia de los factores de riesgo en la población del Hospital Español: una aproximación al riesgo cardiovascular absoluto / Prevalence of coronary risk factors in the Hospital Español population. Assessment of the overall cardiovascular risk

Objetivo: Identificar la prevalencia de los factores de riesgo vascular y evaluar el riesgo cardiovascular absoluto en la población del Hospital Español. Participantes y métodos: Estudio observacional de corte horizontal. Se relevaron 264 personas de ambos sexos mayor igual 18 años. Se confeccionó un cuestionario con preguntas cerradas y anónimo. Se midió la presión arterial en condiciones basales según normas del JNC VI. Se valoraron, como datos antropométricos, peso corporal, talla e índice de masa corporal. La circunferencia de la cintura fue índice de obesidad abdominal. La colesterolemia y la glucemia se dosaron en sangre capilar con un reflectómetro de lectura inmediata. Se tuvo en cuenta el tiempo de ayuno. Resultados: La edad promedio fue 59,3 ± 15,5. El 70,1 por ciento eran mujeres. El 66,6 por ciento refirieron antecedentes cardiovasculares y/o factores de riesgo entre sus familiares directos. La prevalencia de HTA fue del 39,9 por ciento ± 5,8 por ciento. El 32,9 ± 5,6 por ciento presentaron colesterol elevado y sólo el 31,2 por ciento -de las dislipemias- recibían tratamiento con estatinas. La diabetes estuvo presente en el 7,6 ± 3,19 por ciento. El 37,8 por ciento presentaban sobrepeso (IMC 27,5 ± 1,4 kg. m²­-¹) y el 28,7 por ciento eran obesos (IMC 33,5 por ciento ± 3,2 kg. m²-¹). Treinta y ocho hombres y 90 mujeres presentaron un perímetro de cintura anormal. Del total, el 20,4 por ciento eran fumadores y el 46,9 por ciento eran sedentarios. Conclusión: La alta prevalencia de FR en la población examinada representa un riesgo absoluto para eventos cardiovasculares futuros muy elevado, en especial en la población masculina. El control de los FR es insuficiente de acuerdo con las recomendaciones vigentes. Es necesario implementar políticas de prevención más estrictas en la atención primaria.

Síndrome de precondicionamiento cardíaco / Syndrome of heart preconditioning

El precondicionamiento cardíaco es incluído actualmente entre los nuevos síndromes isquémicos y considerado un importante mecanismo endógeno que protege al corazón del daño isquémico prolongado. Por otro lado, se incrementa la mortalidad cardiovascular de pacientes diabéticos tratados con hipoglucemiantes orales, por lo que se hace necesario conocer las drogas que bloquean esta forma endógena de protección para alcanzar finalmente el modelado molecular de nuevos fármacos y el precondicionamiento farmacológico