Patients at high risk of cerebrovascular disease: the REACH study.

Cerebrovascular disease is one of the leading causes of morbidity and mortality in developed countries. The identification of at-risk individuals is a high priority so that efficacious preventive measures can be implemented. Subjects with the highest risk of cerebrovascular diseases are those who already have had a stroke or a transient ischemic attack, and those with vascular disease in other territories, either in coronary or peripheral arteries. Other subjects at risk are those with cardiac disease, such as atrial fibrillation, those with hypertension, diabetes and smoking habit, as well as individuals with subclinical vascular disease. Although there is considerable evidence for the efficacy of preventive treatment in this population, the percentage of patients receiving optimum treatment is far from ideal. There is a need to implement strategies in the population directed towards increasing awareness of the need to establish healthy habits and adequate preventive pharmacological treatment that could reduce the incidence of this debilitating disease.

[Carotid intima-media thickness in heterozygous familial hypercholesterolemia: associated factors and changes following 1 year of treatment]. / Grosor de la íntima-media carotídea en la hipercolesterolemia familiar heterocigótica: factores asociados y variación al año de tratamiento.

BACKGROUND AND OBJECTIVE: To evaluate the factors associated with intima-media thickness (IMT) and carotid plaques in patients with familial hypercholesterolemia (FH) and to assess the evolution following 1 year of treatment. PATIENTS AND METHOD: Subjects (n=201) diagnosed as having probable or definite FH according to the MED-PED criteria had a clinical history, physical examination, blood chemistry and lipid profile determined. Ultrasound was used to measure the IMT in both common carotid arteries and to assess the presence of plaques. The measurements were repeated in 123 of the patients after 1 year of treatment. RESULTS: Mean age (standard deviation) was 47.8 (13.2) years; 46.3% were males; 11.4% had a clinical history of cardiovascular disease (CVD); 15.9% were hypertensive; 26.4% were smokers; mean plasma total cholesterol concentration was 362 (49)mg/dL; 66.2% had received previous treatment with statins. In the multivariate analysis, baseline IMT was directly associated with age and history of CVD and inversely related to the years of treatment with statins. The presence of carotid plaques was associated directly with the cholesterol-years index and inversely with years of treatment with statins. The mean LDL-cholesterol reduction at 1 year of treatment was 50%. Neither the IMT nor the percentage of patients with plaques changed significantly following 1 year of treatment. CONCLUSIONS: Intensive hypocholesterolemic treatment in our patients with probable or definite FH did not increase significantly either the carotid IMT or the prevalence of plaques.

Ischaemic related transitory left ventricular dysfunction in 201Tl gated SPECT.

AIM: To report our data concerning the changes in post-stress and at-rest left ventricular ejection fraction and ventricular volumes in patients with thallium gated SPECT. METHODS: Post-stress and at-rest thallium gated SPECT was performed in 629 consecutive patients; left ventricular ejection fraction (LVEF), left ventricular volumes and quantitative perfusion data were obtained. Transitory left ventricular dysfunction was diagnosed when post-stress LVEF did not increase at least 5% from LVEF at-rest. RESULTS: In all patients post-stress LVEF was 64%+/-17 while at-rest LVEF was 66%+/-15 (P=0.6). Post-stress end diastolic volume (EDV) was 142 ml+/-7, at-rest EDV was 141 ml+/-92 (P=0.57), post-stress end systolic volume (ESV) was 54 ml+/-51 and at-rest ESV was 56 ml+/-59 (P=0.38). Data from the perfusion study were used to divide patients into three groups: normal patients (group I), patients with total or partially reversible defects (group II) and patients with fixed defects (group III). In group I and group III patients LVEF at-rest was lower than post-exercise (LVEF 75%+/-11 vs 81%+/-10 (P<0.001) and 57%+/-16 vs 60%+/-18 (P=0.025)), respectively. Patients in group II had a higher at-rest LVEF than post-exercise (LVEF 66%+/-14 vs 64%+/-16 (P=0.003)). While the left ventriuclar volumes in group I and III patients decreased with exercise, group II patients had increased post-stress ESV. CONCLUSIONS: Post-stress and at-rest LVEF are similar when all patients are considered but significant differences appear when patients are divided according to the results of the perfusion study. Normal and fixed defect patients have increased post-exercise LVEF. Patients with reversible defects have decreased LVEF, which is largely due to an increased ESV. Transitory left ventricular dysfunction is related to the presence of reversibility and may benefit from revascularization.

[Dilated cardiomyopathy and autoimmunity: an overview of current knowledge and perspectives]. / Autoinmunidad y miocardiopatía dilatada: situación actual y perspectivas.

The diagnosis of idiopathic dilated cardiomyopathy is assigned to patients with left ventricular systolic dysfunction and dilatation in the absence of any other documented cause. Idiopathic dilated cardiomyopathy is presumed to have a multifactorial origin, possibly including autoimmune mechanisms. We reviewed the current state of knowledge of this topic, including a pathophysiological hypothesis postulating a relation between an autoimmune process and sympathetic over-stimulation and systolic dysfunction. The implications for therapy are considered in the light of experience with other autoimmune diseases. The results of immunosuppressant treatment and preliminary experiences with immunoadsorption are reviewed and their future perspectives are discussed.